Surgery Room Research Articles

Features of hemodynamics in elderly patients with coronary heart disease using a combination of propofol, ketamine and fentanyl for induction anesthesia

The aim – to analyze hemodynamic changes in elderly patients with coronary heart disease during coronary artery bypass grafting surgery without cardiopulmonary bypass at the stage of induction into anesthesia using propofol, ketamine and fentanyl.Materials and methods. The results of the examination of 20 patients with coronary artery disease over 60 years of age who underwent coronary artery bypass grafting without the use of artificial circulation are presented. The effect of anesthesia on hemodynamics was assessed by mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), and systemic vascular resistance index (SVRI). The following drugs were used for induction: Propofol 1.5 mg/kg, Ketamine 0.5 mg/kg, Fentanyl 2.0 μg/kg, Pipecuronium bromide 0.1 mg/kg. Anesthesia maintenance: Propofol 4 mg/kg/hour, Fentanyl 2.0 μg/kg/hour.Results and discussion. At the time of admission to the surgery room, hemodynamic parameters reflected that the general condition of patients was stable. After the administration of the combination of drugs for induction propofol + fentanyl + ketamine in the dosage according to the study design, it was found that MAP decreased by 18.71 % (p<0,0001), heart rate decreased by 4.72 % (p = 0,2199), CI decreased by 14.37 % (p = 0,0035), and SVRI decreased by 3.93 % (p = 0,41). After insertion of the intubation tube, it was determined that MAP was 92.34±7.26 % of the baseline values (p = 0,0001), heart rate was 100.81±9.77 % of the baseline data (p = 0,848), CI was determined at 110.38±12.37 % of baseline value (p = 0,0769), and SVRI was 83.57±10.7 % of the baseline, respectively. In 25 minutes after successful tracheal intubation, the parameters were re-registered again: MAP = 86.47±6.07 % of the baseline (p < 0,0001); heart rate = 100.08±5.03 % of the baseline value (p = 0,9711); CI = 108.29±9.95 % of baseline data (p = 0,1248); SVRI = 77.86±9.83 % of the baseline (p = 0,0001).Conclusions. Since hypotension is a frequent side effect of traditional drugs for induction of anesthesia, such as propofol and fentanyl, the addition of ketamine to this combination helps to stabilize hemodynamic parameters and prevents undesirable hemodynamic fluctuations.

The lived experiences of operating room nurses from the surgery on COVID-19 patients: a phenomenological study

BackgroundDuring the COVID-19 pandemic, some patients who were transported to the operating room for emergency surgery had COVID-19; operating room nurses should be in direct contact with these patients in a small and closed space of the operating room. This can lead to unpleasant experiences for these people. Accordingly, this study was conducted to understand the experience of operating room nurses during the surgery of COVID-19 patients.MethodsThis qualitative study is a descriptive phenomenological study. Sampling was done purposefully and participants were selected based on the inclusion and exclusion criteria. The data of this study was obtained through semi-structured interviews with 12 participants and analyzed using the Colaizzi method.ResultsFour main themes and 13 sub-themes were presented in this study: (1) feeling heroic (being a savior, self-sacrificing). (2) Exacerbating burnout (emotional exhaustion, feeling of incompetence, physical overtiredness). (3) Psychiatric crisis (destructive anxiety, horror of death, worrying about being a carrier, drastic feeling of pity). (4) Feeling the need for support (need for professional support, need for emotional support, need for social support).ConclusionThe results of this study show that operating room nurses experienced conflicting feelings during surgery on patients with COVID-19. So the feeling of being a hero was a heartwarming experience, but the aggravation of job burnout and mental crisis was unpleasant for them. Also, these people have experienced the need to be supported in various aspects.

Does the introduction of streamlight decrease refractive surgery operating time?

The aim of the study was to analyze the time-savings associated with introduction of Streamlight™ (Alcon Laboratories, Fort Worth, TX, USA) transepithelial photorefractive keratectomy (PRK) in surface corneal ablations. All refractive surgeries were performed using the Alcon WaveLight® EX500 at the ArtLife Clinic, Gdańsk, Poland. The study included patients treated for refractive errors with transepithelial PRK between April 2019 and October 2021, who were matched with patients treated with alcohol-assisted PRK during the same period. Only results for the left eye were analyzed. One-hundred-five patients underwent transepithelial PRK (age 33.42 ± 8.67years) and were matched with 105 patients that underwent alcohol-assisted PRK (age 33.05 ± 10.16years; p = 0.11). The mean preoperative spherical equivalent refraction was - 2.04 ± 2.28 D, and - 1.9 ± 1.71 D for the transepithelial and alcohol-assisted PRK group, respectively (p = 0.20). The total surgery time was non-significantly shorter in transepithelial PRK (349.46 ± 47.83s) than in alcohol-assisted PRK (354.93 ± 137.63s; p = 0.7); however, the variance of surgical time was significantly lower in transepithelial PRK (p<0.001). The laser treatment duration was greater in transepithelial PRK (41.78 ± 17.2s) than in alcohol-assisted PRK (8.48 ± 6.12s; p < 0.001), and so was the number of breaks during the laser treatment (0.95 ± 0.63 vs. 0.53 ± 0.88, respectively; p < 0.001). The introduction of transepithelial PRK did not bring significant time-associated savings into the refractive surgery suite.

The Relationship of The Nurse's Handover Process With Implementation of Patient Safety Targets in The Surgery Room and Icu

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Every year, millions of patients suffer injuries or die because of unsafe and Not Good-quality health care. Many medical practices and healthcare-related risks have emerged as major challenges to patient safety and contribute significantly to the burden of harm from unsafe care. The aim of this research is to determine the relationship between the nurse handover process and the implementation of patient safety targets in the surgical ward and ICU of the &lt;/em&gt;&lt;em&gt;Royal Prim&lt;/em&gt;&lt;em&gt;e&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;Hospital &lt;/em&gt;&lt;em&gt;Medan&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;2022. This research is a type of quantitative research with a pre-experimental design method type one group pretest-posttest (single group initial test-final test), with a population of all nurses working in the surgical ward (26 nurses) and ICU (26 nurses). 25 nurses) &lt;/em&gt;&lt;em&gt;Royal Prim&lt;/em&gt;&lt;em&gt;e&lt;/em&gt;&lt;em&gt; &lt;/em&gt;&lt;em&gt;Hospital &lt;/em&gt;&lt;em&gt;Medan&lt;/em&gt;&lt;em&gt;, totaling 51 people. Research sample collection techniques are primary data, secondary data and tertiary data. The instrument used is a questionnaire. Research data analysis is univariate analysis and bivariate analysis. The results of the research showed that there was a significant increase in the implementation of the nurse handover process before the treatment was 24.75 and it increased after the treatment to 39.22. Shows that there was a significant increase in the implementation of patient safety targets before treatment, amounting to 27.65 and an increase after treatment to 43.39. And showing a p value (0.005) &amp;lt; 0.05, it shows that there is a significant relationship between the handover process and the implementation of patient safety targets at the RSU. Royal Prima Medan in 2022&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;br /&gt;&lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;strong&gt;&lt;em&gt;Keyword : Handover, Hospital, Patient Safety&lt;/em&gt;&lt;/strong&gt;

Direct superior sagittal sinus puncture via a surgical burr hole for curative embolization of the complex transverse-sigmoid sinus dural arteriovenous fistula: How I do it.

Transvenous embolization of high-grade dural arteriovenous fistulas (dAVFs) is challenging particularly when the direct sinus access is favorable due to the complex venous anatomy which prohibits endovascular access via the transfemoral approach. The procedure was conducted in the hybrid operating suite, where a burr hole was performed, followed by direct catheterization of the superior sagittal sinus. Coil embolization was then executed to achieve complete obliteration of the fistula. The direct puncture of the superior sagittal sinus is a safe and effective method for treating complex dAVFs. This approach grants access to the fistula channel which facilitates curative embolization.

A Framework for Improving Patient Satisfaction by Reducing the Length of Stay in The Operation Suite Using the Combined DEMATEL-ANP Model

Operating room (OR) planning has gradually become an important element of Hospital administration in recent years. The OR performance plays a significant role in enhancing the quality of the care provided to the patients and reducing patients' length of stay (LOS), which is the function of the OR performance, decreasing costs. Following a survey of the existing research and conducted interviews with clinical and non-clinical OR staff, there are several factors influencing patients’ length of stay (LOS) in the OR and, consequently, the costs of the OR. In this work, first, we implemented the DEMATEL to define the relationship between OR factors, next, employed ANP to identify the most influential factors on the LOS in the OR. The results show the most influential factors are operative time, operative setup, patient waiting time, anesthesia, and patient preparation. Running two rooms concurrently and minimizing turnover time (TOT) reduce patients' LOS by 10% and 5.6%, respectively, and improve the patients' and clinical personnel's satisfaction. Reducing the LOS not only leads to reduced OR costs but also helps increase the number of operations and, thereby, hospitals' revenue.

OVERVIEW OF EARLY MOBILIZATION IN PATIENTS POST OPERATION FOR FEMUR FRACTURE AT NGUDI WALOYO WLINGI HOSPITAL

A fracture is a break in the continuity of a bone. The injury recovery process may not go perfectly if the patient cannot move after surgery. Of course, this condition will affect the length of time the patient is considered in the emergency clinic. The recovery that medical staff should be able to carry out in patients with post-operative femur fractures is to complete the initial assembly. Early mobilization is an effort to pursue freedom as quickly as possible by directing the victim to follow physiological capabilities. The motivation behind this study was to determine the impact of early preparation practices on postoperative femoral fracture patients. This research was conducted in the Surgery Room at Ngudi Waloyo Wlingi Regional Hospital. The technique used is a quantitative illustrative examination strategy with an overview type. The population was 5 respondents with post-operative femur fractures treated in the work room, who were examined using an all out examination procedure. Information is obtained through perception. Considering the side effects of the review, it was shown that most of the 60% of respondents with post-operative femur fractures were dependent on others. It stands to reason that there is an impact of movement practices in post-operative femur fracture patients that would encourage a longer stay in the emergency clinic. Patients who are recovering from surgery need to start mobilizing as soon as possible to ensure smooth blood flow, speed wound healing, and minimize hospitalization.words : Early mobilization, post-operative femur fracture, dependency

EARLY MOBILIZATION IN PATIENTS POST OPERATION FOR FEMUR FRACTURE AT NGUDI WALUYA WLINGI HOSPITAL

A fracture is a break in the continuity of a bone. The injury recovery process may not go perfectly if the patient cannot move after surgery. Of course, this condition will affect the length of time the patient is considered in the emergency clinic. The recovery that medical staff should be able to carry out in patients with post-operative femur fractures is to complete the initial assembly. Early mobilization is an effort to pursue freedom as quickly as possible by directing the victim to follow physiological capabilities. The motivation behind this study was to determine the impact of early preparation practices on postoperative femoral fracture patients. This research was conducted in the Surgery Room at Ngudi Waluyo Wlingi Regional Hospital. The technique used is a quantitative illustrative examination strategy with an overview type. The population was 5 respondents with post-operative femur fractures treated in the work room, who were examined using an all out examination procedure. Information is obtained through perception. Considering the side effects of the review, it was shown that most of the 60% of respondents with post-operative femur fractures were dependent on others. It stands to reason that there is an impact of movement practices in post-operative femur fracture patients that would encourage a longer stay in the emergency clinic. Patients who are recovering from surgery need to start mobilizing as soon as possible to ensure smooth blood flow, speed wound healing, and minimize hospitalization..

Design of a model for improving emergency room performance using a colored Petri net

Emergency rooms are one of the most complex and vital areas of healthcare institutions, which have presented overcrowding, long waiting, and length of stay times, affecting the timeliness, responsiveness, and quality of service. This research aimed to design a detailed patient flow model to improve emergency room performance using the hierarchical timed colored Petri nets. Then, the model was simulated to evaluate scenarios considering tactical decisions such as physician staff planning, operational decisions such as adjusting work schedules, and strategic decisions such as increasing observation beds. The best scenario would reduce the average waiting times for triage II patients by 17.30 % and 47.57 %, and triage III by 33.49 % and 43.49 % for medical consultation in the office or the minor surgery room, respectively. In addition, the waiting time in observation and the rate of patients left without being seen by a physician would be reduced by 92.45 % and 74.67 %, respectively. These results improve the quality and timeliness of the service and avoid putting the patient's health and life at risk. The designed model included more attributes for patients concerning the place of medical care in the emergency room, the number of visits to the physician, and the physician who will care for the patient. Moreover, the simulation model includes observation beds as a limited resource blocking new patient admission. Finally, this model is a tool to support emergency room managers in making short, medium, and long-term decisions to address problems such as overcrowding, long waiting and length of stay times, and high rates of patients left without being seen by a physician

P399 Impact of Body Mass Index on Clinical Outcomes in Intestinal Behçet’s disease

Abstract Background The impact of underweight and obesity on clinical outcomes for intestinal Behçet’s disease (BD) is unknown. We aimed to identify the association between body mass index (BMI) and clinical outcomes in patients with intestinal BD. Methods We categorized 760 patients with intestinal BD according to the BMI at diagnosis into four groups (underweight, normal, overweight, obese) at Severance Hospital, Seoul, Korea between 1997 and 2021.We performed a Cox proportional hazard analysis to investigate the predictive capability of BMI for clinical outcomes such as biologics use, surgery, hospitalization and emergency room visit. Results Of the 760 patients, 130 patients were classified into underweight group (BMI&amp;lt;18.5), 384 patients into normal group (BMI 18.5~22.9), 152 patients into overweight group (BMI 23~24.9), and 94 patients into obese group (BMI≥25). Patients with a higher BMI group showed significantly lower cumulative rates of biologics use (p trend = 0.001), surgery (p trend = 0.008), hospitalization (p trend = 0.002), and emergency room visits (p trend = 0.003) than those with a lower BMI group. In a multivariate analysis, normal BMI group (HR: 0.667, 95% CI 0.483-0.992, p =0.014), overweight group (HR: 0.589, 95% CI 0.394-0.879,p=0.010), and obese group (HR: 0.515, 95% CI 0.321-0.828, p=0.006) were negatively associated with future hospitalization compared to underweight group. Overweight group (HR: 0.490, 95% CI 0.241-0.996, p =0.049) and obese group (HR: 0.312, 95% CI 0.116-0.840,p =0.021) were negatively associated with future biologics use compared to the underweight group. Normal BMI group (HR: 0.706, 95% CI 0.484- 1.029, p=0.070) and obese group (HR : 0.556, 95% CI 0.303-1.020,p=0.058) were negatively associated with future surgery compared to the underweight group. Normal BMI group (HR: 0.711, 95% CI 0.513-0.985, p=0.041) and obese group (HR: 0.602, 95% CI 0.376-0.963, p=0.034) were negatively associated with future emergency room visit compared to the underweight group. Conclusion Underweight could affect poor outcomes in intestinal Behçet’s disease. Physicians should pay attention to the patients with underweight and make an effort to improve nutritional status.

Grammar-based evolutionary approach for automated workflow composition with domain-specific operators and ensemble diversity

The process of extracting valuable and novel insights from raw data involves a series of complex steps. In the realm of Automated Machine Learning (AutoML), a significant research focus is on automating aspects of this process, specifically tasks like selecting algorithms and optimising their hyper-parameters. A particularly challenging task in AutoML is automatic workflow composition (AWC). AWC aims to identify the most effective sequence of data preprocessing and machine learning algorithms, coupled with their best hyper-parameters, for a specific dataset. However, existing AWC methods are limited in how many and in what ways they can combine algorithms within a workflow.Addressing this gap, this paper introduces EvoFlow, a grammar-based evolutionary approach for AWC. EvoFlow enhances the flexibility in designing workflow structures, empowering practitioners to select algorithms that best fit their specific requirements. EvoFlow stands out by integrating two innovative features. First, it employs a suite of genetic operators, designed specifically for AWC, to optimise both the structure of workflows and their hyper-parameters. Second, it implements a novel updating mechanism that enriches the variety of predictions made by different workflows. Promoting this diversity helps prevent the algorithm from overfitting. With this aim, EvoFlow builds an ensemble whose workflows differ in their misclassified instances.To evaluate EvoFlow’s effectiveness, we carried out empirical validation using a set of classification benchmarks. We begin with an ablation study to demonstrate the enhanced performance attributable to EvoFlow’s unique components. Then, we compare EvoFlow with other AWC approaches, encompassing both evolutionary and non-evolutionary techniques. Our findings show that EvoFlow’s specialised genetic operators and updating mechanism substantially outperform current leading methods in predictive performance. Additionally, EvoFlow is capable of discovering workflow structures that other approaches in the literature have not considered.

Combined treatment of a giant palpebral keratoacanthoma

Aims/Purpose: To highlight the relevance of a therapeutic approach adapted to the clinical characteristics of the eyelid lesion found at the time of surgery to ensure an optimal functional and aesthetic result.Methods: Clinical case assessed, intervened and followed up at our centre.Results: A 76‐year‐old woman consulted for a nodular umbilicated lesion of recent appearance on the outer third of the upper eyelid of the left eye (UELE) measuring 0.5 cm in greatest diameter and 0.5 cm in elevation. The patient was placed on the waiting list for surgical excision and subsequent pathological examination (PE) of the lesion to confirm the initial clinical suspicion of keratoacanthoma (KA). One month later, the patient went to the operating room for surgery. During this time the lesion increased its initial size by more than 4 times, had a large necrotic centre, active borders and generated an evident left mechanical ptosis. As an alternative to the complete excisional surgery initially proposed, we offered the injection of neoadjuvant intralesional chemotherapy (CT) with the aim of reducing the size of the lesion to obtain a better functional and aesthetic result. The patient accepted this therapeutic alternative. KA was treated with weekly intralesional injections of 1 mL of methotrexate (MTX) 12.5 mg/mL. In our case, 3 injections were necessary to achieve a 78% reduction in the diameter of the lesion to allow reconstruction of the UELE with grafting of the contralateral upper eyelid. One week after the third injection of MTX, reconstruction of the UELE was performed after excisional surgery with wide margins for PE. One week later, the PE result ruled out malignancy and the graft had a pink appearance with complete vascular permeability, so the sutures were removed. Two weeks after reconstruction, the functional and aesthetic results were satisfactory.Conclusions: Therefore, in our experience, we recommend the above combined treatment for giant palpebral KA and stress the relevance of a therapeutic approach adapted to the clinical characteristics of the palpebral lesion at the time of surgery to ensure an optimal functional and aesthetic outcome.

A programmable and automated optical electrowetting-on-dielectric (oEWOD) driven platform for massively parallel and sequential processing of single cell assay operations.

Recently, there has been an increasing emphasis on single cell profiling for high-throughput screening workflows in drug discovery and life sciences research. However, the biology underpinning these screens is often complex and is insufficiently addressed by singleplex assay screens. Traditional single cell screening technologies have created powerful sets of 'omic data that allow users to bioinformatically infer biological function, but have as of yet not empowered direct functional analysis at the level of each individual cell. Consequently, screening campaigns often require multiple secondary screens leading to laborious, time-consuming and expensive workflows in which attrition points may not be queried until late in the process. We describe a platform that harnesses droplet microfluidics and optical electrowetting-on-dielectric (oEWOD) to perform highly-controlled sequential and multiplexed single cell assays in massively parallelised workflows to enable complex cell profiling during screening. Soluble reagents or objects, such as cells or assay beads, are encapsulated into droplets of media in fluorous oil and are actively filtered based on size and optical features ensuring only desirable droplets (e.g. single cell droplets) are retained for analysis, thereby overcoming the Poisson probability distribution. Droplets are stored in an array on a temperature-controlled chip and the history of individual droplets is logged from the point of filter until completion of the workflow. On chip, droplets are subject to an automated and flexible suite of operations including the merging of sample droplets and the fluorescent acquisition of assay readouts to enable complex sequential assay workflows. To demonstrate the broad utility of the platform, we present examples of single-cell functional workflows for various applications such as antibody discovery, infectious disease, and cell and gene therapy.

Project Spotlight: Precast concrete panels bring aesthetic appeal to Chicago surgery center

The University of Illinois Health Specialty Care Building, a new out¬patient surgery center in the heart of Chicago’s Medical District, includes two levels of same-day surgery suites, three levels of specialty clinics, and a ground floor with check-in, pharmacy, and imaging services. Precast concrete panel manufacturer International Concrete Products (ICP) from Germantown, Wis., was brought in very early in the process to work with the design team to find solutions for the facility.

A rare case report: compartment syndrome after brachiocephalic arteriovenous fistula formation in a hemodialysis patient

Introduction: Acute compartment syndrome is a condition in which increased pressure in the tight fascia space reduces capillary perfusion below the level required for tissue viability. Very few cases of acute compartment syndrome associated with dialysis have been reported. It can lead to severe damage to the tissues of the arm. Case Illustration: A 47-year-old woman with end-stage renal failure presented to the emergency room with swelling and pain in the right upper extremity and has lasted for a day. Three days before admission, the patient underwent right brachiocephalic arteriovenous (AV) fistula surgery. Physical Examination showed a blackish bruise at the fossa cubiti, radial and ulnar artery were not palpable, but there is trill at AV fistula. Decreased motoric strength, reduced hand sensation and decreased capillary return in fingers. Oxygen blood saturation of the right fingers could not be read. Diagnosis of acute compartment syndrome was made. The patient was immediately taken to the operating room for decompression surgery. Emergency compartment fasciotomy was performed. After fasciotomy, necrotomy was performed. Furthermore, brachiocephalic AV fistula was ligated. Postoperative evaluation obtained good radial and ulnar artery. Six months after the surgery, the wound was fully healed and no sign of neuromuscular or vascular deficit. Conclusion: Compartment syndrome is a possible complication after AV fistula formation that can have disastrous consequences. However, it can be effectively treated if detected and treated early. Prognosis of compartment syndrome after fasciotomy depends on how quickly the condition is diagnosed and treated.

Impact of age at diagnosis on long-term prognosis in patients with intestinal Behçet's disease.

Although age at disease onset is considered to be a significant factor in the prognosis of Crohn's disease, little is known about its influence on the long-term prognosis of those with intestinal Behçet's disease (BD). This study aimed to evaluate the long-term clinical outcomes of patients with intestinal BD according to age of disease onset. Patients diagnosed with intestinal BD at <18, 18-60, and >60years of age were classified into early-onset, adult-onset, and late-onset groups, respectively. The influence of disease onset time on clinical prognosis, including specific medical requirements, BD-related intestinal surgery, hospitalization, and emergency room visits, was compared using the log-rank test in a large cohort of patients with intestinal BD. Among 780 patients, 21 (2.7%), 672 (86.2%), and 87 (11.1%) comprised the early-onset, adult-onset, and late-onset groups, respectively. Patients in the early-onset group were more likely to require immunosuppressants than those in the adult-onset group (P=0.048). Nine (42.9%), 158 (23.5%), and 18 (20.7%) patients in the early-onset, adult-onset, and late-onset groups, respectively, underwent intestinal resection. The early-onset group exhibited a higher risk for intestinal resection than the late-onset (P=0.043) and adult-onset (P=0.030) groups. The late-onset group exhibited a higher risk for BD-related hospitalization than the adult-onset group (P=0.023). Age at diagnosis affected the clinical course of intestinal BD, including intestinal surgery, hospitalization, and specific medical requirements. Different treatment strategies should be established according to age at diagnosis.

First Assistant In Bariatric Surgery: A Comparison Between Laparoscopic And Robotic Approaches: A 4-Year Analysis of the MBSAQIP Database (2016-2019).

The first assistant (FA) plays an important role in the operating room for bariatric surgery. The aim of this study was to examine the relationship between the type of FA and operative time (OT) and postoperative outcomes comparing robotic and laparoscopic approaches in bariatric surgery. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data for 2016-2019 was queried. Log-normal regression was performed to evaluate the association of FAs and OT variations within and between groups. We used logistic regression to examine the relationship between the type of FA and 30-day outcomes across all procedures and approaches. A total of 691,789 patients who underwent robotic (R), and laparoscopic (L) sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RYGB), and duodenal switch (DS) were included. The percentage variation of OT was higher in the laparoscopic group (L-SG: 8.18%, L-RYGB: 9.88%, and L-DS: 15.00%) compared to the robotic group (R-SG: 2.43%, R-RYGB: 5.76%, and R-DS: 0.80%). There was not a significant difference in 30-day outcomes between laparoscopic and robotic approaches for the same procedures. The FA was associated with a decreased variability in OT in the robotic cohort compared to the laparoscopic group with no significant difference in complication rates. These results suggest that the robotic approach may decrease the need for skilled FAs in bariatric procedures.

Intraoperative gaze guidance with mixed reality.

Efficient communication and collaboration are essential in the operating room for successful and safe surgery. While many technologies are improving various aspects of surgery, communication between attending surgeons, residents, and surgical teams is still limited to verbal interactions that are prone to misunderstandings. Novel modes of communication can increase speed and accuracy, and transform operating rooms. A mixed reality (MR) based gaze sharing application on Microsoft HoloLens 2 headset that can help expert surgeons indicate specific regions, communicate with decreased verbal effort, and guide novices throughout an operation is presented. The utility of the application is tested with a user study of endoscopic kidney stone localization completed by urology experts and novice surgeons. Improvement is observed in the NASA task load index surveys (up to 25.23%), in the success rate of the task (6.98% increase in localized stone percentage), and in gaze analyses (up to 31.99%). The proposed application shows promise in both operating room applications and surgical trainingtasks.

Use of 5G technology for oncological surgery streaming

This paper discusses the benefits of surgery streaming and tele-mentoring, as well as the use of 5G technology in surgical procedures. The paper describes the advantages of using wireless 5G broadband as a low-latency and large-bandwidth capacity connection, which can solve problems with cables and large equipment in the surgery room. The Chilean oncology clinic Fundación Arturo López Pérez coordinated an international project with Japanese companies NTT Data and Allm Inc. to implement a proof of concept using 5G technology for the transmission of an oncological surgery. This project consisted of the installation of a local 5G network, its configuration and testing, and the realization of the first broadcast of a robotic partial nephrectomy in Latin America using the 5G broadband. The paper provides details on the hardware infrastructure and components used in the project

Electrocardiographic deep learning for predicting post-procedural mortality: a model development and validation study

Preoperative risk assessments used in clinical practice are insufficient in their ability to identify risk for postoperative mortality. Deep-learning analysis of electrocardiography can identify hidden risk markers that can help to prognosticate postoperative mortality. We aimed to develop a prognostic model that accurately predicts postoperative mortality in patients undergoing medical procedures and who had received preoperative electrocardiographic diagnostic testing. In a derivation cohort of preoperative patients with available electrocardiograms (ECGs) from Cedars-Sinai Medical Center (Los Angeles, CA, USA) between Jan 1, 2015 and Dec 31, 2019, a deep-learning algorithm was developed to leverage waveform signals to discriminate postoperative mortality. We randomly split patients (8:1:1) into subsets for training, internal validation, and final algorithm test analyses. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values in the hold-out test dataset and in two external hospital cohorts and compared with the established Revised Cardiac Risk Index (RCRI) score. The primary outcome was post-procedural mortality across three health-care systems. 45 969 patients had a complete ECG waveform image available for at least one 12-lead ECG performed within the 30 days before the procedure date (59 975 inpatient procedures and 112 794 ECGs): 36 839 patients in the training dataset, 4549 in the internal validation dataset, and 4581 in the internal test dataset. In the held-out internal test cohort, the algorithm discriminates mortality with an AUC value of 0·83 (95% CI 0·79-0·87), surpassing the discrimination of the RCRI score with an AUC of 0·67 (0·61-0·72). The algorithm similarly discriminated risk for mortality in two independent US health-care systems, with AUCs of 0·79 (0·75-0·83) and 0·75 (0·74-0·76), respectively. Patients determined to be high risk by the deep-learning model had an unadjusted odds ratio (OR) of 8·83 (5·57-13·20) for postoperative mortality compared with an unadjusted OR of 2·08 (0·77-3·50) for postoperative mortality for RCRI scores of more than 2. The deep-learning algorithm performed similarly for patients undergoing cardiac surgery (AUC 0·85 [0·77-0·92]), non-cardiac surgery (AUC 0·83 [0·79-0·88]), and catheterisation or endoscopy suite procedures (AUC 0·76 [0·72-0·81]). A deep-learning algorithm interpreting preoperative ECGs can improve discrimination of postoperative mortality. The deep-learning algorithm worked equally well for risk stratification of cardiac surgeries, non-cardiac surgeries, and catheterisation laboratory procedures, and was validated in three independent health-care systems. This algorithm can provide additional information to clinicians making the decision to perform medical procedures and stratify the risk of future complications. National Heart, Lung, and Blood Institute.