Surgical Assistance Research Articles

First human surgery using a surgical assistance robotics device for laparoscopic cholecystectomies

BackgroundOver the past 20 years, surgeons involved in soft tissue minimally invasive surgery have experienced the pros and cons of both conventional and tele-robotic laparoscopic approaches. The Maestro System, developed by Moon Surgical (Paris, France) aims to overcome the challenges inherent to both approaches thanks to a new concept that augments the surgeon’s performance at the bedside during a laparoscopic procedure.MethodsThe current study aims to present the first human experience with laparoscopic cholecystectomy with the Maestro system on 10 patients.ResultsAll ten procedures were completed successfully. No significant complications related to the use of the Maestro system werenoted.ConclusionOur preliminary observations appear to support the benefits of the Maestro system in non-emergent laparoscopic cholecystectomies. It goes without saying that further research is necessary to demonstrate the safety of this approach in other procedures.

A Novel Evaluation Method for SLAM-Based 3D Reconstruction of Lumen Panoramas.

Laparoscopy is employed in conventional minimally invasive surgery to inspect internal cavities by viewing two-dimensional images on a monitor. This method has a limited field of view and provides insufficient information for surgeons, increasing surgical complexity. Utilizing simultaneous localization and mapping (SLAM) technology to reconstruct laparoscopic scenes can offer more comprehensive and intuitive visual feedback. Moreover, the precision of the reconstructed models is a crucial factor for further applications of surgical assistance systems. However, challenges such as data scarcity and scale uncertainty hinder effective assessment of the accuracy of endoscopic monocular SLAM reconstructions. Therefore, this paper proposes a technique that incorporates existing knowledge from calibration objects to supplement metric information and resolve scale ambiguity issues, and it quantifies the endoscopic reconstruction accuracy based on local alignment metrics. The experimental results demonstrate that the reconstructed models restore realistic scales and enable error analysis for laparoscopic SLAM reconstruction systems. This suggests that for the evaluation of monocular SLAM three-dimensional (3D) reconstruction accuracy in minimally invasive surgery scenarios, our proposed scheme for recovering scale factors is viable, and our evaluation outcomes can serve as criteria for measuring reconstruction precision.

Is Total Knee Arthroplasty Surgical Performance Enhanced Using Augmented Reality? A Single-Center Study on 76 Consecutive Patients

BackgroundAugmented reality (AR) is a powerful multipurpose tool. With a dedicated visor, AR allows the visualization of a series of information and/or images superimposed on the user’s field of vision. For this reason, it was recently introduced as a surgical assistant tool. This single-center study aimed to evaluate the intraoperative outcomes of total knee arthroplasties performed with AR assistance in terms of time required and the difference between preplanned and achieved implant positioning (in terms of tibial cut varus and slope angles). MethodsA total of 76 consecutive patients was selected. Preplanning was performed according to the AR protocol, and the target varus and slope angles were defined to instruct the device, which subsequently guided the tibial cuts intraoperatively. Surgeries were performed starting from the tibial cut, and the time required to perform the calibration, registration, and fixation of the resection block was recorded. The varus and slope angles achieved were recorded to compare with the preplanned ones to determine the means and SDs of the differences. ResultsThe mean usage time of the AR tool was 5 ± 1 minutes. Results showed a mean difference of 0.59 ± 0.55° for varus angles and 0.70 ± 0.75° for the slope. For varus angles, the differences were <1° for 96% of the cases. Concerning the slope, 89% of the cases were <1°. ConclusionThe results showed excellent accuracy of the surgical cuts and a limited increase in surgery duration. Therefore, these outcomes highlighted the potential of this new technology as a valid option for surgical assistance.

Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces.

To describe changes in the comprehensiveness of services delivered by family physicians across service settings and service areas in 4 Canadian provinces, to identify which settings and areas have changed the most, and to compare the magnitude of changes by physician characteristics. Descriptive analysis of province-wide, population-based billing data linked to population and physician registries. British Columbia, Manitoba, Ontario, and Nova Scotia. Family physicians registered to practise in the 1999-2000 and 2017-2018 fiscal years. Comprehensiveness was measured across 7 service settings (home care, long-term care, emergency departments, hospitals, obstetric care, surgical assistance, anesthesiology) and in 7 service areas consistent with office-based practice (prenatal and postnatal care, Papanicolaou testing, mental health, substance use, cancer care, minor surgery, palliative home visits). The proportion of physicians with activity in each setting and area are reported and the average number of service settings and areas by physician characteristics is described (years in practice, sex, urban or rural practice setting, and location of medical degree training). Declines in comprehensiveness were observed across all provinces studied. Declines were greater for comprehensiveness of settings than for areas consistent with office-based practice. Changes were observed across all physician characteristics. On average across provinces, declines in the number of service settings and service areas were highest among physicians in practice 20 years or longer, male physicians, and physicians practising in urban areas. Declining comprehensiveness was observed across all physician characteristics, pointing to changes in the practice and policy contexts in which all family physicians work.

Surgery tips for the soon-to-be and new practitioner

Surgical procedures conducted on livestock in field settings car­ry their own set of unique challenges related to environmental factors, variable quality of facilities available to the veterinar­ian, untrained surgical assistants in the form of owners or farm workers (or no available help at all), and access to surgical in­struments, anesthetics and emergency drugs limited to what is carried on the veterinarian’s practice vehicle or clinic. Adher­ing to the basic principles of surgery specifically applied to the veterinarian performing surgery in the field can help decrease the incidence of surgical site infections, improve patient out­comes, and avoid failure of the surgical intervention.

The prevalence of contact dermatitis among surgical assistants, anaesthesia assistants and anaesthesiologists working at the Amsterdam University Medical Centre.

Professions requiring frequent and/or long lasting wet-work are at high risk for contact dermatitis (CD). CD may lead to loss of work productivity, sick leave and reduced quality of work. The 1-year prevalence of healthcare workers varies between 12% and 65%. However, the prevalence of CD among surgical assistants, anaesthesia assistants and anaesthesiologists is unknown. (1) To establish the point-prevalence and 1-year prevalence among surgical assistants, anaesthesia assistants and anaesthesiologists and (2) to determine the impact of CD on work and daily activities. A single-centre cross-sectional prevalence study was conducted among surgical assistants, anaesthesia assistants and anaesthesiologists. Data were obtained from the Amsterdam University Medical Centre between the 1 June 2022 and 20 July 2022. For data collection, a questionnaire was used, derived from the Dutch Association for Occupational Medicine (NVAB). Participants with an atopic predisposition or symptoms of CD were invited to the contact dermatitis consultation hour (CDCH). A total of 269 employees were included. The total point prevalence of CD was 7.8%; 95% CI: 4.9-11.7, the total 1-year prevalence was 28.3%; 95% CI: 23.0-34.0. The point-prevalence among surgical assistants, anaesthesia assistants and anaesthesiologists was 14%, 4% and 2%, respectively. The 1-year prevalence was 49%, 19% and 3%, respectively. Two employees reported changed work-tasks because of symptoms, no sick days were reported. The majority of the visitors of the CDCH indicated an impact on work productivity and daily activities because of CD; however, the extent to which varied widely. This study established that CD is a relevant occupational health disease among surgical assistants, anaesthesia assistants and anaesthesiologists.

Effects of Corrective Exercises on Work-Related Musculoskeletal Disorders and Quality of Life in Surgical Residents: A Pilot, Quasi-Experimental Study

Work-related musculoskeletal disorders (WMSDs) are one of the most important reasons for absenteeism, high costs of health care and human injuries; the latter are very common in medical staff. The present study was designed to evaluate the effects of corrective exercises on quality of life and work-related musculoskeletal disorders in surgical residents. In a quasi-experimental study with a one-group pretest-posttest design, we assessed the eligibility of 135 surgical assistants. All recruited participants performed corrective exercises and were followed for 12 months. The primary outcome of the study was any change in the surgical residents' work-related musculoskeletal disorders, which was assessed using the Nordic Musculoskeletal Questionnaire(NMQ) and the Numerical Pain Rating Scale (NPRS) prior to, and 3, 6, and 12 months after intervention. The secondary outcome was any change in the surgical residents' quality of life (QOL) score, which was assessed at baseline, 6 and 12 months after the intervention using the World Health Organization Quality of Life - BREF (WHOQOL-BREF) questionnaire. One hundred eligible surgical residents were enrolled, of whom 67 (67%) completed the study. At baseline the majority of the participants were female and >30 years of age. Fifty-five percent of them used analgesic drugs. The use of analgesic drugs per week fell by 14.7% from baseline to 12 months; the change was statistically significant (p = 0.042). The effect of corrective exercises on the intensity of pain in the shoulder (p = 0.002), hand/wrist (p = 0.001), upper back (p = 0.03), lower back (p = 0.02) and knee (p = 0.01) was significant. Corrective exercises also led to a significant rise in the quality-of-life score (p < 0.019). This study demonstrated the effectiveness of corrective exercises in reducing work-related musculoskeletal disorders and improving quality of life among surgical residents.

Vein Harvesting Techniques in Coronary Artery Bypass Grafting: A Prospective Comparative Observational Study

Despite well-established recommendations for endoscopic vein harvesting (EVH) internationally, open vein harvesting (OVH) is still the main harvesting technique for the great saphenous vein in coronary artery bypass graft (CABG) surgery in Australia. At the Alfred Hospital, EVH is currently being performed by perioperative nurse surgical assistants (PNSA) on patients who are high risk for postoperative leg wound complications. This study aimed to compare and evaluate postoperative leg wound complications of both EVH and OVH at the Alfred Hospital.

ALGORITHM FOR TREATMENT OF COMPLICATED DIABETIC FOOT SYNDROME

Summary. Diabetes mellitus (DM) is the most common endocrine pathology, which ranks third in the general structure of morbidity after cardiovascular and oncopathology. DM is recognized by the WHO as an epidemic of non-infectious origin, which allows us to talk about the globalization of the problem.&#x0D; We monitored 2,024 patients with complicated SDS who were treated in the purulent-septic center with diabetic foot beds, Municipal Hospital No. 3, Zaporizhzhia, during the period 2008-2022. In the article, we present the classification and algorithm for the treatment of complicated SDS developed by us, which, in our opinion, will contribute to the progress of specialized medical care for purulent-inflammatory processes of the diabetic foot.&#x0D; The difficulty of creating and adopting a single surgical classification of complicated SDS is caused, first of all, by the combination of several pathogenetic mechanisms of the development of the pathology. Modern disease classifications should be: clear and accessible; clearly classify diseases according to the degree of severity; facilitate clinical decision-making; take into account modern diagnostic and treatment methods; increase the economic efficiency of medical care;&#x0D; contribute to the simplification of statistical processing.&#x0D; The distribution of patients thanks to the proposed classification creates conditions for statistical processing and registration of forms of complicated SDS, as well as the volume of surgical assistance. Allows to determine surgical tactics depending on the specific complication of SDS. The use of a controlled approach to ABT allowed to reduce the number of cases associated with antibacterial resistance from 23% to 11%. Optimization of the complex treatment of patients with complicated SDS made it possible to increase the number of patients with preserved supporting function of the lower limb from 21.9 to 36.5% (χ2=11.2; P&lt;0.05), reduce the number of «high» amputations from 24 .5 to 15.1% (χ2=4.8; Р&lt;0.05). The distribution of patients according to the proposed classification substantiates the actual terms of arrival at the hospital, taking into account all stages of treatment. A comprehensive approach, priority areas of treatment and a mandatory sequence of actions allow to improve the final results of treatment, reduce mortality from 25.8 to 5.3% (χ2=3.92; P&lt;0.05).

The Significant Burden of Iatrogenic Vascular Injury on the Vascular Surgery Workforce at an Academic Medical Center

The treatment of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other inpatient services. Vascular surgeons are called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and at the bedside. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to January 8, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, were retrospectively collected from February 1 to October 13 and prospectively collected for the remainder of the study period. Analyses were performed with R version 2022.02.03. There were 63 patients with consultations related to iatrogenic vascular injury. Of these, 29 (46%) were female and the mean age was 59 ± 18 years. The most common consulting services were cardiology (32%), cardiothoracic surgery (27%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (38%), limb ischemia (32%), and treatment for pseudoaneurysm (27%). Of the consults, 25% were intraoperative, 19% related to ECMO cannulation, and 19% related to ventricular assist devices including left ventricular assist devices and intra-aortic balloon pumps. The majority of consult requests occurred during evening and night hours (5 pm to 7 am) (60%) (Figure). Emergent intervention was required in 75% of cases and consisted of: primary open surgical repair of arterial injury (50%), endovascular intervention (15%), and open thromboembolectomy (13%). Overall, in-hospital mortality for the patient cohort was 18% and the reintervention rate was 21%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. Vascular surgery plays an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. These consults and complications require immediate bedside or intraoperative consultation and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to vascular surgeons.

Modern tactics of follow-up care and treatment of patients with congenital maxillofacial defects combined with other comorbid conditions

Relevance. Questions of methodology and organization of specialized treatment of patients with congenital maxillofacial defects do not lose their relevance and retain the interest of researchers and practitioners. This article covers the accumulated experience of centralized medical examination of patients with congenital maxillofacial defects combined with other comorbid conditions in the comparative evolutionary aspect of advancing the organizational structure and follow-up care regulation.Purpose. To improve the rehabilitation process efficiency in patients with congenital maxillofacial defects complicated by other comorbid conditions by advancing the tactics of organizational and therapeutic measures.Material and methods. The study conducted an analytical and quantitative-qualitative analysis of medical documentation of the comprehensive care organizational and rehabilitation process for 2475 patients with congenital cleft face and palate for 24 years (1998-2022) in the specialized Bonum Center (Yekaterinburg). Of 2475 medical records of patients with congenital cleft face and/or palate, 823 cases (33.25%) had comorbid conditions.Results. The analysis of the results of a complex, specialized practice of multifunctional treatment of patients with congenital maxillofacial defects of complex systemic origin shows ways to improve and optimize the functionality of the rehabilitation process.Conclusions. The presented practice of improving the system for organizing follow-up care and specialized treatment of patients with maxillofacial defects complicated by other comorbid conditions allowed for the successful health restorative process completion in 55.04% of cases, including surgical assistance within the recommended rehabilitation period. The presented experience, as a concept, can serve as a guide for practitioners of specialized medicine concerning the development of a system of rehabilitation processes for patients with congenital maxillofacial defects of a complex somatic status.

Impact of training level of the first surgical assistant on quality metrics for hysterectomy: A retrospective review

Evaluate impact of first-assist level of training on surgical quality outcomes for hysterectomies performed by general gynaecologists.

Telepresence for surgical assistance and training using eXtended reality during and after pandemic periods

Existing challenges in surgical education (See one, do one, teach one) as well as the COVID-19 pandemic make it necessary to develop new ways for surgical training. Therefore, this work describes the implementation of a scalable remote solution called "TeleSTAR" using immersive, interactive and augmented reality elements which enhances surgical training in the operating room. The system uses a full digital surgical microscope in the context of Ear-Nose-Throat surgery. The microscope is equipped with a modular software augmented reality interface consisting an interactive annotation mode to mark anatomical landmarks using a touch device, an experimental intraoperative image-based stereo-spectral algorithm unit to measure anatomical details and highlight tissue characteristics. The new educational tool was evaluated and tested during the broadcast of three live XR-based three-dimensional cochlear implant surgeries. The system was able to scale to five different remote locations in parallel with low latency and offering a separate two-dimensional YouTube stream with a higher latency. In total more than 150 persons were trained including healthcare professionals, biomedical engineers and medical students.

The introduction of a Surgical Care Practitioner training programme to an acute National Health Service trust and an exploration of the interrelationships between Surgical Care Practitioners, their trainers and surgical trainees.

This study aimed to explore the impact of the introduction of a Surgical Care Practitioner programme on junior surgical training within an acute National Health Service trust. A qualitative methodology of semi-structured interviews was used to gather information from eight Surgical Care Practitioners, eight surgical trainees and eight consultant grade trainers. The authors found an overall positive and mutually beneficial outcome of the training programme, with surgical trainees unanimous that the presence of the Surgical Care Practitioners freed them up for more time to be spent in theatre, as well as acting as highly experienced surgical assistants when the trainees were operating on their own. This study found significant mutual benefits to surgical trainees and Surgical Care Practitioners, as well as smoother running of the wards, theatres and the clinical firms through the addition of a highly skilled and versatile Surgical Care Practitioner workforce.

Significance of surgical first assistant expertise for surgical site infection prevention: Propensity score matching analysis.

Surgical site infection (SSI) is one of the most common postoperative complications in patients undergoing major operations, such as spinal fusion surgery, and a major contributor to patient morbidity and mortality. SSI is considered the most preventable type of infection; however, the risk of SSI is multifactorial. This study aimed to determine the extent to which the expertise of the surgical first assistant (SFA) affected SSI rates. We retrospectively reviewed 528 patients at a single institution who underwent lumbar spine fusion surgery via the posterior approach performed by a single surgeon between January 2012 and May 2020. The SFAs participating in the surgeries were classified into 2 groups: a certified neurosurgery specialist and relatively less experienced neurosurgery resident trainees. To reduce potential selection bias and confounding factors, propensity score matching was performed between the 2 groups. In 170 of the 528 lumbar spine fusion surgeries, the SFA was a certified neurosurgery specialist. In the other 358 surgeries, the SFA was a resident trainee. Seventeen patients met the SSI criteria. The SSI rate was significantly different between the 2 groups (0.6% (1 patient) and 4.5% (16 patients) in the certified specialist and resident trainee groups, respectively; P = .02). After propensity score matching, 170 paired patients were selected. After adjusting for confounding factors, SFAs that were certified neurosurgery specialists were associated with a lower likelihood of SSI (adjusted OR 0.09; 95% CI, 0.01 to 0.79; P = .029) than SFAs that were neurosurgery residents. A higher level of SFA expertise was significantly associated with a lower overall SSI rate in lumbar spine fusion surgeries. It is difficult to predict the incidence of SSI; however, this finding suggests the importance of SFA expertise in preventing SSI.

Sonification as a reliable alternative to conventional visual surgical navigation

Despite the undeniable advantages of image-guided surgical assistance systems in terms of accuracy, such systems have not yet fully met surgeons’ needs or expectations regarding usability, time efficiency, and their integration into the surgical workflow. On the other hand, perceptual studies have shown that presenting independent but causally correlated information via multimodal feedback involving different sensory modalities can improve task performance. This article investigates an alternative method for computer-assisted surgical navigation, introduces a novel four-DOF sonification methodology for navigated pedicle screw placement, and discusses advanced solutions based on multisensory feedback. The proposed method comprises a novel four-DOF sonification solution for alignment tasks in four degrees of freedom based on frequency modulation synthesis. We compared the resulting accuracy and execution time of the proposed sonification method with visual navigation, which is currently considered the state of the art. We conducted a phantom study in which 17 surgeons executed the pedicle screw placement task in the lumbar spine, guided by either the proposed sonification-based or the traditional visual navigation method. The results demonstrated that the proposed method is as accurate as the state of the art while decreasing the surgeon’s need to focus on visual navigation displays instead of the natural focus on surgical tools and targeted anatomy during task execution.

Surgical Assistant-friendly Breast Reconstruction Using a Head-mounted Wireless Camera with an Integrated LED Light as an Educational Tool

In breast reconstruction by a latissimus dorsi (LD) flap, a skin paddle is designed transversely so that the scar overlaps the bra line. Therefore, especially when dissecting the caudal end of the latissimus dorsi muscle, the assistants must always pull hooks blindly because they do it from the patient’s caudal side (Fig. 1). A similar situation occurs when a tissue expander or a silicone breast implant is inserted under the pectoralis major muscle through a lateral thoracic incision because it is done from the contralateral side. These situations make it difficult for the surgeon to simultaneously share the surgical field with the assistants. As a result, the assistants just pull hooks to expand the surgical field without being motivated to understand the details of the surgery. To resolve this, breast reconstruction was performed for six Japanese women, with the surgeon wearing a head-mounted wireless camera with an integrated LED light, FM-105 (Faspro Systems Co., Ltd., Taipei, Taiwan) (Fig. 1); two were reconstructed by LD, three by tissue expander, and one by silicone breast implant. The camera cost approximately $3650, and there were no other costs because we already had a laptop computer and an HDMI cable. The surgical field was projected to external large screen monitors in the operating room, as previously reported.1 The camera actually weighed about 315 g, and it could be used without any physical discomfort for 2 hours, which is enough time to complete elevating the LD or inserting the implant. In addition, the focus was automatically adjusted, and the brightness of the LED light could be manually adjusted in three steps, according to the darkness of the surgical field. Although the camera does not have a zoom function, the image is easily visible by projecting it onto a large screen. The surgical view could be shared simultaneously with the assistants and observers via the monitor in all cases, and the image is shown. (See Video [online], which displays a scene of dissecting the caudal side of the LD muscle and the results of a questionnaire survey following a scene of dissecting the caudal side of the LD muscle.) A questionnaire survey using a five-point scale (1 = unacceptable; 5 = excellent) was conducted among six assistants who participated in the surgery to assess the quality of the actual image and the educational usefulness of the head-mounted camera. All of them answered that it was a useful educational tool for breast reconstruction.Fig. 1.: The LD flap is elevated while the surgeon wears a head-mounted wireless camera with an integrated LED light, FM-105. The surgical assistant can assist from the caudal side while watching the surgical field via the screen in real time during the operation. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1","caption":"displays a scene of dissecting the caudal side of the LD muscle and the results of a questionnaire survey following a scene of dissecting the caudal side of the LD muscle.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_lkskropp"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Recently, how to teach surgical techniques to junior doctors is becoming a focus of attention in plastic and reconstructive surgery. The use of AR technology2,3 and model surgery4 has resulted in remarkable progress, and these technologies have contributed greatly to providing images of the details of the operation for young surgeons before surgery. During the operation, by teaching techniques while sharing the operative field that the surgical assistant cannot see directly, they can be involved in surgery as not only workers, but also as trainees or learners. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

MP68-20 RELIABLE INSTRUMENT COUNTER (RIC) FOR UROLOGIC PROCEDURES

You have accessJournal of UrologyCME1 Apr 2023MP68-20 RELIABLE INSTRUMENT COUNTER (RIC) FOR UROLOGIC PROCEDURES Catherine Nguyen, Michael Fink, Cayman Myers, Kayla Dunch, Daniel Aguilar, Jack Gibbs, Shelby McCoy, Hannah Bachtel, Chester Koh, and Charles Peak Catherine NguyenCatherine Nguyen More articles by this author , Michael FinkMichael Fink More articles by this author , Cayman MyersCayman Myers More articles by this author , Kayla DunchKayla Dunch More articles by this author , Daniel AguilarDaniel Aguilar More articles by this author , Jack GibbsJack Gibbs More articles by this author , Shelby McCoyShelby McCoy More articles by this author , Hannah BachtelHannah Bachtel More articles by this author , Chester KohChester Koh More articles by this author , and Charles PeakCharles Peak More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retained sponges and surgical instruments with urologic procedures can have significant consequences on patient outcomes such as increased morbidity, long term disabilities, as well as medicolegal ramifications. The traditional method of ensuring accurate counts for sponges and surgical instruments is manual counting by surgical assistants (i.e. nurses and surgical technicians). However, this method is time-consuming and prone to systemic and human errors which can lead to unidentified retention of instruments. Current technologies for sponge and instrument tracking are limited by cost and accuracy issues. In collaboration with the engineering teams at local engineering schools, we sought to develop an automated surgical instrument counter to increase the accuracy of surgical equipment counts. METHODS: We developed a prototype for the Reliable Instrument Counter (RIC) which performs continuous and automatic counting of surgical instruments using RFID technology. The device consists of a hard polymer tabletop for RFID transparency with three RFID antennas and one multichannel RFID reader. RFID tags were placed on each surgical instrument (7.8mm x 6.8mm x 2.7mm) that were compatible with all methods of instrument sterilization Figure 1). Java-based software was used to automate the count of surgical instruments with a user-friendly interface. Benchtop testing was performed to identify the number of tags needed per instrument and the accuracy of the RIC to count the instruments. RESULTS: The prototype table was developed with the surface divided into zones. The accuracy of detecting tagged instruments averaged 99.03% readability across all zones with only three small areas on the edges of the table that had less than 100% accuracy. Further modifications will involve adjust the mounted location of the RFID reader for improved accuracy. CONCLUSIONS: The RIC can accurately track surgical instruments in real time for urologic procedures, thereby reducing overall OR time and risk of miscounts which translates into reducing overall cost and increasing the safety of patients undergoing urologic surgeries. Source of Funding: FDA grant #1p50FD006428 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e961 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Nguyen More articles by this author Michael Fink More articles by this author Cayman Myers More articles by this author Kayla Dunch More articles by this author Daniel Aguilar More articles by this author Jack Gibbs More articles by this author Shelby McCoy More articles by this author Hannah Bachtel More articles by this author Chester Koh More articles by this author Charles Peak More articles by this author Expand All Advertisement PDF downloadLoading ...

Radiation dose to staff from medical X-ray scatter in the orthopaedic theatre

PurposeGiven the growing demand for intraoperative imaging, there is increased concern for radiation dose for orthopaedic surgical staff. This study sought to determine the distribution of scatter radiation from fluoroscopic imaging in the orthopaedic surgical environment, with particular emphasis on the positions of personnel and the type of orthopaedic surgery performed.MethodsA radiation survey detector was deployed at various angles and distances around an anthropomorphic phantom. The scatter dose rate in microsieverts per hour (µSv/h) was recorded using consistent exposure parameters for five common surgical procedures. A C-arm unit produced radiation for the hip arthroscopy, hip replacement and knee simulations, whilst a mini C-arm unit produced fluoroscopy for the foot and hand simulations.ResultsReadings were tabulated, and coloured heatmaps were generated from scatter measurements for each of the five procedures. Positions corresponding to the typical location of the surgical staff (surgeon, surgical assistant, anaesthetist, instrument (scrub) nurse, circulation (scout) nurse and anaesthetic nurse) were superimposed on heatmaps. The surgeon’s proximity to the radiation source meant this position experienced the greatest amount of radiation in all five surgical procedures. Mini C-arm doses were considered low in all procedures for positions, with and without lead protection.ConclusionThis investigation demonstrated the distribution of scattered radiation dose experienced at different positions within the orthopaedic surgical theatre. It reinforces the importance of staff increasing their distance from the primary beam where possible, reducing exposure time and increasing shielding with lead protection.

Real-time monitoring of middle ear prosthesis coupling

IntroductionIn reconstructive middle ear surgery, acoustic quality has received a high level of attention in recent years. Careful intraoperative selection and positioning of passive middle ear prostheses during tympanoplasty with ossiculoplasty is essential to ensure satisfactory sound transmission and postoperative hearing outcome. The reconstruction quality of the ossicular chain (OC) can be evaluated intraoperatively using a surgical assistance system which is based on a real-time monitoring system (RTM system) that acquires the transmission (middle ear transfer function (METF)) with electromagnetic excitation of the OC. In this experimental study, the METF with electromagnetic excitation of the (reconstructed) OC was compared to usual acoustic excitation and the benefit of the RTM system was investigated for the implantation of partial (PORP) and total (TORP) prostheses. MethodsLaser Doppler vibrometry (LDV) was used to measure the middle ear transfer function (METF) in 18 human temporal bones (TB). The RTM system uses electromagnetic excitation of the OC with a magnet placed on the umbo. Comparatively, measurements with the usual acoustical excitation, using an earphone in the external auditory canal, were performed. The measurements began with the intact OC, followed by real-time monitoring guided OC reconstruction with PORP and TORP. In addition, during the simulation of an intraoperative setting, the influence of the influence of opening (tympanomeatal flap lifted and pushed anteriorly) and closing (tympanomeatal flap folded back) the tympanic membrane on the measurements with the RTM system was determined. ResultsElectromagnetic and acoustic excitation of the intact and the reconstructed OC provided comparable METF. The application of the RTM system significantly improved the quality of the OC reconstruction. The METF increased by up to 10 dB over the entire frequency range during implantation of the PORP with positioning control by the RTM system. When using the TORP, the METF could be improved by up to 15 dB. The opening of the tympanomeatal flap did not affect the measurements with the RTM system at the reconstructed OC. ConclusionIn this TB study, we demonstrated that the quality of OC reconstruction (improved METF as a benchmark for improved transmission) could be significantly increased by means of a RTM system. Intraoperative studies should now be conducted to investigate to which quantitative extent the intraoperative reconstruction quality can be improved and whether or not this improvement also manifests in an increased (long-term) hearing outcome. This will enable conclusions to be drawn about the contribution of the intraoperative reconstruction quality to the (long-term) hearing outcome in the context of the conglomerate of various factors influencing the postoperative hearing outcome.