Simulated Surgical Environment Research Articles

Dural Closure Training With Prototyped Model.

The hermetic closure of the dura mater is a critical step in neurosurgical training, often undervalued but crucial to preventing serious complications such as cerebrospinal fluid (CSF) leaks leading to meningitis and death. Inadequate closure, often due to insufficient training, can result in challenging complications, including prolonged hospitalization and reoperation. To address the deficiencies in dural closure training, this study aims to describe a 3D prototype for simulating post-craniotomy dura mater suturing. The objective is to reduce the incidence of CSF leaks and improve the training of neurosurgery residents. The study involves the creation of a 3D prototype based on magnetic resonance imaging and computed tomography scans. The additive manufacturing of structures is performed using ABS filament, and a silicone rubber membrane is used to simulate the meningeal dura mater. Neurosurgery residents undergo training using this model, and the effectiveness is evaluated. The study is conducted at the Institute of Neurology of Curitiba (Hospital INC), focusing on neurosurgery residents from the first to fifth year of residency. Seven residents participate in the study, with varying levels of experience in dural closure procedures. The training involves a simulated surgical environment using the 3D prototype. After training, residents show improvements in confidence and theoretical knowledge related to dural closure. Binary questions indicate a strong desire for more practical training on dural closure, with 85.7% believing in the essential role of 3D molds in their neurosurgery training. The study highlights the importance of adequate training for dural closure to prevent serious complications in neurosurgery. The use of 3D simulation models, despite some limitations, proves to be an effective educational strategy. The emerging technology of bioprinting holds promise for further enhancing simulation materials, bringing medical education closer to realistic tissue replication.

Toward Intraoperative Visual Intelligence: Real-Time Surgical Instrument Segmentation for Enhanced Surgical Monitoring.

Open surgery relies heavily on the surgeon's visual acuity and spatial awareness to track instruments within a dynamic and often cluttered surgical field. This system utilizes a head-mounted depth camera to monitor surgical scenes, providing both image data and depth information. The video captured from this camera is scaled down, compressed using MPEG, and transmitted to a high-performance workstation via the RTSP (Real-Time Streaming Protocol), a reliable protocol designed for real-time media transmission. To segment surgical instruments, we utilize the enhanced U-Net with GridMask (EUGNet) for its proven effectiveness in surgical tool segmentation. For rigorous validation, the system's performance reliability and accuracy are evaluated using prerecorded RGB-D surgical videos. This work demonstrates the potential of this system to improve situational awareness, surgical efficiency, and generate data-driven insights within the operating room. In a simulated surgical environment, the system achieves a high accuracy of 85.5% in identifying and segmenting surgical instruments. Furthermore, the wireless video transmission proves reliable with a latency of 200 ms, suitable for real-time processing. These findings represent a promising step towards the development of assistive technologies with the potential to significantly enhance surgical practice.

Use of adhesive cranial bone flap fixation without hardware to improve mechanical strength, resist cerebrospinal fluid leakage, and maintain anatomical alignment: a laboratory study.

Titanium plates and screws (TPS) are the current standard of care for fixation of cranial bone flaps. These materials have been used for decades but have known potential complications, including flap migration, bone resorption/incomplete osseous union, hardware protrusion, cosmetic deformity, wound infection/dehiscence, and cerebrospinal fluid (CSF) leakage. This study evaluated the efficacy of a novel mineral-organic bone adhesive (Tetranite) for cranial bone flap fixation. Craniotomy bone flaps created in human cadaveric skulls were tested under quasistatic and impact loading in the following conditions: 1) uncut skull; 2) bone flaps fixated with TPS alone; and 3) bone flaps fixated with bone adhesive alone. All fixative surgical procedures were performed by a group of 16 neurosurgeons in a simulated surgical environment. The position of adhesive-fixated cranial bone flaps was measured using computed tomography and compared with their original native location. The resistance of adhesive-fixated cranial bone flaps to simulated CSF leakage was also evaluated. Because there was a gap around the circumference of the TPS-fixated specimens that was visible to the naked eye, pressurized CSF leak testing was not attempted on them. Adhesive-fixated bone flaps showed significantly stiffer and stronger quasistatic responses than TPS-fixated specimens. The strength and stiffness of the adhesive-fixated specimens were not significantly different from those of the uncut native skulls. Total and plastic deflections under 6-J impact were significantly less for adhesive-fixed bone flaps than TPS. There were no significant differences in any subthreshold impact metrics between the adhesive-fixed and native specimens at both 6-J and 12-J impact levels, with 1 exception. Plastic deflection at 6-J impact was significantly less in adhesive-fixated bone flaps than in native specimens. The energy to failure of the adhesive-fixated specimens was not significantly different from that of the native specimens. Time since fixation (20 minutes vs 10 days) did not significantly affect the impact failure properties of the adhesive-fixated specimens. Of the 16 adhesive-fixated craniotomy specimens tested, 14 did not leak at pressures as high as 40 mm Hg. The neurosurgeons in this study had no prior exposure or experience with the bone adhesive. Despite this, improved resistance to CSF egress, superior mechanical properties, and better cosmetic outcomes were demonstrated with bone adhesive compared with TPS.

Exploring the Performance of Geometry-Based Markerless Registration in a Simulated Surgical Environment: A Comparative Study of Registration Algorithms in Medical Augmented Reality.

Augmented Reality (AR) has been utilized in multiple applications in the medical field, such as augmenting Computed Tomography (CT) images onto the patient's body during surgery. However, one of the challenges in its utilization is to register the pre-operative CT images to the patient's body accurately. The current registration process requires prior attachment of tracking markers, and their localization within the body and CT images. This process can be cumbersome, error-prone, and dependent on the surgeon's experience. Moreover, there are cases where medical instruments, drapes, or the body may occlude the markers. In light of these limitations, markerless registration algorithms have the potential to aid the registration process in the clinical setting. While those algorithms have been successfully used in other sectors, such as multimedia, they have not yet been thoroughly investigated in a clinical setting, especially in surgery, where there are more challenging cases with different positions of the patients in the image and the surgical environment. In this paper, we benchmarked and evaluated the performance of 6 state-of-the-art markerless registration algorithms from the multimedia sector by registering a CT image onto the whole-body phantom dataset acquired from a simulated surgical environment. We also analyzed the suitability of these algorithms for use in the surgical setting and discussed their potential for the advancement of AR-assisted surgery.Clinical Relevance-Our study provides insight into the potential of AR-assisted surgery and helps practitioners in choosing the most suitable registration algorithm for their needs to improve patient outcomes, reduce the risk of surgical errors and shorten the time of preoperative planning.

Mixed-reality visualization in shoulder arthroplasty: is it better than traditional preoperative planning software?

Preoperative traditional software planning (TSP) is a method used to assist surgeons with implant selection and glenoid guide-pin insertion in shoulder arthroplasty. Mixed-Reality (MR) is a new technology that uses digital holograms of the preoperative plan and guide-pin trajectory projected into the operative field. The purpose of this study was to compare TSP to MR in a simulated surgical environment involving insertion of guide-pins into models of severely deformed glenoids. Eight surgeons inserted guide-pins into eight randomized three-dimensional-printed severely eroded glenoid models in a simulated surgical environment using either TSP or MR. In total, 128 glenoid models were used and statistically compared. The outcomes compared between techniques included procedural time, difference in guide-pin start point, difference in version and inclination, and surgeon confidence via a confidence rating scale. When comparing traditional preoperative software planning to MR visualization as techniques to assist surgeons in glenoid guide pin insertion, there were no statistically significant differences in terms of mean procedure time (P=0.634), glenoid start-point (TSP = 2.2 ± 0.2 mm , MR = 2.1 ± 0.1 mm; P=0.760), guide-pin orientation (P=0.586), or confidence rating score (P=0.850). The results demonstrate that there were no significant differences between traditional preoperative software planning and MR visualization for guide-pin placement into models of eroded glenoids. A perceived benefit of MR is the real-time intraoperative visibility of the surgical plan and the patient’s anatomy; however, this did not translate into decreased procedural time or improved guide-pin position. Level of evidence: Basic Science Study; Biomechanics.

Friday, June 17, 20224:00 PM - 5:00 PM MSPP01 Presentation Time: 4:00 PM: A Feasibility Study on Utilizing Cadaveric Models at a Network of Brachytherapy Research and Training Centers to Encourage Development and Widespread Use of Novel Robotic Bladder Cancer Brachytherapy Techniques

<h3>Purpose</h3> This feasibility study outlines a proof-of-concept model – the Houston Methodist Institute for Technology, Innovation & Education (MITIE) – for the use of cadaveric models at research centers to encourage development and training of novel robotic brachytherapy techniques, thereby expediting the incorporation of brachytherapy into the standard of care for muscle-invasive bladder cancer (MIBC). <h3>Materials and Methods</h3> Catheter insertion sites were marked on a male cadaver, and the da Vinci Surgical System(R) (Intuitive Surgical, Inc., Sunnyvale, CA) was docked. A modified catheter-needle system was assembled since pre-assembled bladder-specific catheter-needle systems are not compatible with all brachytherapy afterloaders. Closed-end catheters were inserted into 17-gauge curved needles. The first catheter was placed into the right lateral hypogastric abdominal wall, through the bladder dome wall, and out the opposing side. A single plane implant was completed with 1 cm spacing with the two other catheters (Figure 1a). Catheters were secured with nylon retaining buttons (Figure 1b). A CT simulation scan confirmed placement and a plan was developed for simulated brachytherapy delivery (Figure 1c). <h3>Results</h3> Cadaveric models enable physicians to develop new brachytherapy procedures in a controlled and simulated surgical environment without affecting operative time. Physicians can gain familiarity with the procedure and practice alterations to surgical equipment, including the catheter-needle system, which may prevent complications peri- and postoperatively. The proof-of-concept trial in MITIE shows how research and training centers can serve as incubators for the development of brachytherapy techniques. With a network of these centers, experts across the country can collaborate to test new techniques on cadaveric models and accelerate developments in bladder brachytherapy. This network would provide training opportunities for physicians, especially residents, which can familiarize physicians with brachytherapy techniques, promoting their use and providing clinical data to support these techniques as a new standard of care. Currently, institutes like MITIE are limited in number, necessitating travel and coordination of attending and resident physicians' schedules. Although an expanded network of these institutes would alleviate this issue, these training centers are associated with high operating costs, including the acquisition costs and high turnover rate required of cadaveric training models. Therefore, cost may impede scalability and must be considered alongside the benefits of establishing a widespread network of research and training programs for brachytherapy. <h3>Conclusions</h3> Robotic brachytherapy is a rarely utilized, minimally invasive treatment modality for MIBC. Innovation-focused facilities with cadaveric models can provide simulated surgical environments for the research, development, and training of robotic brachytherapy techniques and applicators, accelerating the acceptance of brachytherapy as the standard of care for MIBC.

270 The Innate Aptitude's Effect on the Surgical Task Performance

Abstract Aim Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Method A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3-null hypothesis, and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusions Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

EP-19 The innate aptitude's effect on the surgical task performance

Abstract Aims Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Methods A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3 null hypothesis and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet, a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusion Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

Power-assisted Pedicle Screw Technique Protects Against Risk of Surgeon Overuse Injury: A Comparative Electromyography Study of the Neck and Upper Extremity Muscle Groups in a Simulated Surgical Environment.

Cadaveric. The aim of this study was to quantify the amplitude and duration of surgeons' muscle exertion from pedicle cannulation to screw placement using both manual and power-assisted tools in a simulated surgical environment using surface electromyography (EMG). A survey of Scoliosis Research Society members reported rates of neck pain, rotator cuff disease, lateral epicondylitis, and cervical radiculopathy at 3 ×, 5 ×, 10 ×, and 100 × greater than the general population. The use of power-assisted tools in spine surgery to facilitate pedicle cannulation through screw placement during open posterior fixation surgery may reduce torque on the upper limb and risk of overuse injury. Pedicle preparation and screw placement was performed from T4-L5 in four cadavers by two board-certified spine surgeons using both manual and power-assisted techniques. EMG recorded muscle activity from the flexor carpi radialis, extensor carpi radialis, biceps, triceps, deltoid, upper trapezius, and neck extensors. Muscle activity was reported as a percentage of the maximum voluntary exertion of each muscle group (%MVE) and muscle exertion was linked to low- (0-20% MVE), moderate- (20%-45% MVE), high- (45%-70% MVE) and highest- (70%-100% MVE) risk of overuse injury based on literature. Use of power-assisted tools for pedicle cannulation through screw placement maintains average muscle exertion at low risk for overuse injury for every muscle group. Conversely with manual technique, the extensor carpi radialis, biceps, upper trapezius and neck extensors operate at levels of exertion that risk overuse injury for 50% to 92% of procedure time. Powerassisted tools reduce average muscle exertion of the biceps, triceps, and deltoid by upwards of 80%. Power-assisted technique protects against risk of overuse injury. Elevated muscle exertion of the extensor carpi radialis, biceps, upper trapezius, and neck extensors during manual technique directly correlate with surgeons' self-reported diagnoses of lateral epicondylitis, rotator cuff disease, and cervical myelopathy.Level of Evidence: N/A.

An Analysis of the Effectiveness of High-level Disinfection for Surgical Instruments Used by Department of Defense Austere Surgical Teams

The purpose of this investigation was to evaluate the efficacy of currently employed commercial disinfectants in a simulated austere surgical environment similarly faced by ground surgical teams in forward deployed positions. Severe contamination of traumatic combat wounds along with limitations of operations in austere environments may result in available disinfectants providing inadequate surgical instrument decontamination. The study consisted of nine experimental groups and two control groups evaluating hemostatic forceps found in kits of ground surgical teams. Hemostats were contaminated in a manner replicating the use in austere wartime surgery, cleaned by manual debridement and soaked in a disinfectant. Initially, instruments were debrided in one of three initial liquids (potable water, sterile water, or potable water with Envirocleanse A) and subsequently treated with one of three terminal disinfectants (Cidex OPA, CaviCide, or Neutral Disinfectant Cleaner). Treated hemostats were placed in sterile wire-closure bags for various storage times and tested for viable bacteria measured by colony-forming units. Our findings indicated that mechanical debridement in water, independent of Envirocleanse A, followed by soaking in any of the three terminal disinfectants achieved a marked reduction in recovered bacteria from hemostats regardless of storage length. Of the three disinfectants tested, Cidex OPA appeared to be the most robust in terms of decontamination, followed by CaviCide and Neutral Disinfectant Cleaner. This study supports the conclusion that all evaluated disinfectants are capable of rapidly producing instruments with minimal bacterial contaminants when standard sterilization is unavailable. Therefore, when lifesaving surgical intervention must be performed in a deployed environment, austere surgical teams can confidently utilize either product with minimal risk of infection. However, of the disinfectants, Cidex OPA appears to be most effective in reducing bacterial contamination for both rapid and slow turnover of instrument usage, and thus, the disinfectants are recommended for application when sterilization is not available.

P15. Power-assisted pedicle screw placement decreases screw wobble

P15. Power-assisted pedicle screw placement decreases screw wobble

Cerebrospinal Fluid Leak Repair Simulation Model: Face, Content, and Construct Validation.

Cerebrospinal fluid leak (CSFL) repair simulation models are scarce; however, these models are valuable tools for skull base reconstruction surgery training. This study aims to assess the face, content, and construct validity of a CSFL repair simulation model. Eight novices (residents- PGY3) and eight experts have performed skull base reconstruction in multiple sites in twelve human cadaveric heads in simulated surgical environment. The experts completed a post-study 21-item questionnaire to assess the face and content validity. The performances of the participants were recorded and scored by two independent investigators who were blinded to the participant's level. Global Rating Scale of Operative Performance (GRSOP) and a Specific Skull Base Reconstruction Checklist (SBRC) were used to score the performances. The responses from the expert group for the 21-item questionnaire were high for all items (4.13-4.88 out of 5). The internal consistency reliability of the questionnaire and the intraclass correlation, which was derived by Cronbach's Alpha, were 0.913 and 0.941 respectively. Differences in construct validity between the two groups were statistically significant for both the GRSOP and SBRS (P-value < 0.001). We demonstrated the face, content, and construct validity of the CSFL repair simulation model, which facilitates the acquisition of technical skills necessary for skull base reconstruction surgery. The model includes realistic features that make it useful in educational courses.

The effect of three-dimensional visualisation on performance in endoscopic sinussurgery: A clinical training study using surgical navigation for movement analysis in a randomised crossover design.

ObjectivesEndoscopic imaging techniques and endoscopic endonasal surgery (EES) expertise have evolved rapidly. Only few studies have assessed the effect of three‐dimensional (3D) endoscopy on endoscopic sinus surgery (ESS). The present study aimed to objectively and subjectively assess the additional value of 3D high‐definition (HD) endoscopy in ESS.DesignA randomized crossover study of endoscopic surgery performance, using five ESS tasks of varying complexity, performed on Thiel embalmed human specimens.SettingSimulated surgical environment.ParticipantsThirty participants, inexperienced in ESS.Main outcome measuresPerformance was assessed using video imaging, surgical navigation and questionnaires. Main outcome measures were as follows: efficiency (defined by time to task completion), distance covered inside the nose, average velocity towards target, accuracy (measured by error rate), and subjective assessment of endoscope characteristics.ResultsDuring ESS tasks, both efficiency and accuracy did not differ significantly between 2D HD and 3D HD endoscopy. Subjectively, imaging characteristics of the 3D HD endoscope were rated significantly better.ConclusionsESS performance of inexperienced participants was not significantly improved by the use of 3D HD endoscopy during ESS tasks, although imaging characteristics of the 3D HD endoscope were rated significantly better. Surgical field characteristics and surgical techniques are likely to influence any additional value of 3D HD endoscopy.

A Surgical Palpation Probe With 6-Axis Force/Torque Sensing Capability for Minimally Invasive Surgery

A novel surgical palpation probe installing a miniature 6-axis force/torque (F/T) sensor is presented for robot-assisted minimally invasive surgery. The 6-axis F/T sensor is developed by using the capacitive transduction principle and a novel capacitance sensing method. The sensor consists of only three parts, namely a sensing printed circuit board, a deformable part, and a base part. The simple configuration leads to simpler manufacturing and assembly processes in conjunction with high durability and low weight. In this study, a surgical instrument installed with a surgical palpation probe is implemented. The 6-axis F/T sensing capability of the probe has been experimentally validated by comparing it with a reference 6-axis F/T sensor. Finally, a vivo tissue palpation task is performed in a simulated surgical environment with an animal organ and a relatively hard simulated cancer buried under the surface of the organ.

Surgical Space Suits Increase Particle and Microbiological Emission Rates in a Simulated Surgical Environment

BackgroundThe role of space suits in the prevention of orthopedic prosthetic joint infection remains unclear. Recent evidence suggests that space suits may in fact contribute to increased infection rates, with bioaerosol emissions from space suits identified as a potential cause. This study aimed to compare the particle and microbiological emission rates (PER and MER) of space suits and standard surgical clothing. MethodsA comparison of emission rates between space suits and standard surgical clothing was performed in a simulated surgical environment during 5 separate experiments. Particle counts were analyzed with 2 separate particle counters capable of detecting particles between 0.1 and 20 μm. An Andersen impactor was used to sample bacteria, with culture counts performed at 24 and 48 hours. ResultsFour experiments consistently showed statistically significant increases in both PER and MER when space suits are used compared with standard surgical clothing. One experiment showed inconsistent results, with a trend toward increases in both PER and MER when space suits are used compared with standard surgical clothing. ConclusionSpace suits cause increased PER and MER compared with standard surgical clothing. This finding provides mechanistic evidence to support the increased prosthetic joint infection rates observed in clinical studies.

3-D Tracking for Augmented Reality Using Combined Region and Dense Cues in Endoscopic Surgery.

An augmented reality (AR) technique has recently gained its popularity in minimally invasive surgery. Tracking is a crucial step to achieve precise AR. Besides optical tracking in traditional medical AR, visual tracking attracts a lot of attention due to its generality. Moreover, when the target organ's 3-D model can be obtained from preoperative images and under the model rigidity assumption, tracking is then converted into a problem of computing the six-degree-of-freedom pose of the 3-D model. In this paper, we introduce a robust tracking algorithm in our endoscopic AR system, where we combine the benefits of both region and dense cues in a unified framework. Each kind of cues alone may not be adequate for tracking in endoscopic surgery. However, they have complementary characteristics, with region cues being more robust to motion blur and fast motion, and dense cues being more accurate when motion is not large. We also propose an appearance model adaption method and an occlusion processing method to effectively handle occlusions. Experiments on both synthetic dataset and simulated surgical environment show the effectiveness and robustness of our proposed method. This work presents a novel tracking strategy in medical AR applications.

Instrument State Recognition and Tracking for Effective Control of Robotized Laparoscopic Systems

Surgical robots are an important component for delivering advanced paradigm shifting technology such as image guided surgery and navigation. However, for robotic systems to be readily adopted into the operating room they must be easy and convenient to control and facilitate a smooth surgical workflow. In minimally invasive surgery, the laparoscope may be held by a robot but controlling and moving the laparoscope remains challenging. It is disruptive to the workflow for the surgeon to put down the tools to move the robot in particular for solo surgery approaches. This paper proposes a novel approach for naturally controlling the robot mounted laparoscope’s position by detecting a surgical grasping tool and recognizing if its state is open or close. This approach does not require markers or fiducials and uses a machine learning framework for tool and state recognition which exploits naturally occurring visual cues. Furthermore a virtual user interface on the laparoscopic image is proposed that uses the surgical tool as a pointing device to overcome common problems in depth perception. Instrument detection and state recognition are evaluated on in-vivo and ex-vivo porcine datasets. To demonstrate the practical surgical application and real time performance the system is validated in a simulated surgical environment.

The effect of forced air warming devices compared to other active warming devices on surgical site contamination: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to synthesize the best available evidence comparing forced air warming devices to other active warming devices to determine whether or not there is an increased risk of surgical site contamination by microbial emissions during the perioperative period. Specifically the review question is: Do forced air warming devices compared to other active warming devices have an increased risk of surgical site contamination during the perioperative period? INCLUSION CRITERIA Types of participants This review will consider studies that include subjects (patients, volunteers, mannequins) of all ages that were warmed perioperatively in any type of surgery or simulated surgical environment. Types of intervention(s) This review will consider studies that compare only forced air warming devices to other active warming technologies such as a radiant warming blanket. Types of outcomes This review will consider studies that include the following outcome measures: particle counts or neutrally buoyant bubble counts, measured by: a laser particle count device or time-lapse photography.

A Laparoscopic Grasping Tool with Force Sensing Capability

This paper presents a laparoscopic grasping tool for minimally invasive surgery with the capability of multiaxis force sensing. The tool is able to sense three-axis Cartesian manipulation force and a single-axis grasping force. The forces are measured by a wrist force sensor located at the distal end of the tool, and two torque sensors at the tool base, respectively. We propose an innovative design of a miniature force sensor achieving structural simplicity and potential cost effectiveness. A prototype is manufactured and experiments are conducted in a simulated surgical environment by using an open platform for surgical robot research, called Raven-II.

Multifunctional Laparoscopic Trocar With Built-in Fascial Closure and Stabilization

Multifunctional Laparoscopic Trocar With Built-in Fascial Closure and Stabilization