Search results for: Laparoscopic cholecystectomy

Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

Abstract:

Bile spillage occurs frequently during laparoscopic cholecystectomy, yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visit, with subsequent readmission and additional procedures. Thus, this study sought to examine whether bile spillage is indeed associated with increased risk of postoperative wound infections after laparoscopic cholecystectomy. We hypothesize that patients who experience bile spillage (BS) during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per Center for disease control and prevention (CDC) defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and absent in the rest i.e., 92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in non-bile spillage cases SSI was found in 8 cases (8.7%). However, it was statistically not significant (p value > 0.05). 11 (92%) cases were superficial SSI and one was organ-space infection. No mortality or 30-day readmission was found in our study period. Spillage of gallbladder content does not lead to an increase in SSIs. However, as the rate of SSI is still higher, surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage, thorough peritoneal irrigation with normal saline should be done.

Keywords: Biliary spillage, organ space infection, Laparoscopic cholecystectomy, surgical site infection.

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Authors: Ege Can Onal, Enver Ersen, Meltem Elitas

Abstract:

Laparoscopy is a surgical operation, well known as keyhole surgery. The operation is performed through small holes, hence, scars of a patient become much smaller, patients can recover in a short time and the hospital stay becomes shorter in comparison to an open surgery. Several tools are used at laparoscopic operations; among them, the laparoscope has a crucial role. It provides the vision during the operation, which will be the main focus in here. Since the operation area is very small, motion of the surgical tools might be limited in laparoscopic operations compared to traditional surgeries. To overcome this limitation, most of the laparoscopic tools have become more precise, dexterous, multi-functional or automated. Here, we present a robotic-assisted laparoscope that is controlled with pedals directly by a surgeon. Thus, the movement of the laparoscope might be controlled better, so there will not be a need to calibrate the camera during the operation. The need for an assistant that controls the movement of the laparoscope will be eliminated. The duration of the laparoscopic operation might be shorter since the surgeon will directly operate the camera.

Keywords: Laparoscope, laparoscopy, low-cost, minimally invasive surgery, robotic-assisted surgery.

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Authors: Ramon Sancibrian, Carlos Redondo-Figuero, Maria C. Gutierrez-Diez, Esther G. Sarabia, Maria A. Benito-Gonzalez, Jose C. Manuel-Palazuelos

Abstract:

In this paper, the design and evaluation of a handle for laparoscopic surgery is presented. The design of the handle is based on ergonomic principles and tries to avoid awkward postures for surgeons. The handle combines the so-called power-grip and accurate-grip in order to provide strength and accuracy in the performance of surgery. The handle is tested using both objective and subjective approaches. The objective approach uses motion capture techniques to obtain the angles of forearm, arm, wrist and hand. The muscular effort is obtained with electromyography electrodes. On the other hand, a subjective survey has been carried out using questionnaires. Results confirm that the handle is preferred by the majority of the surgeons.

Keywords: Laparoscopic Surgery, Ergonomics, Mechanical Design, Biomechanics.

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Authors: Fernando Pérez, Humberto Sossa, Rigoberto Martínez, Daniel Lorias, Arturo Minor

Abstract:

This paper presents a system for tracking the movement of laparoscopic instruments which is based on an orthogonal system of webcams and video image processing. The movements are captured with two webcams placed orthogonally inside of the physical trainer. On the image, the instruments were detected by using color markers placed on the distal tip of each instrument. The 3D position of the tip of the instrument within the work space was obtained by linear triangulation method. Preliminary results showed linearity and repeatability in the motion tracking with a resolution of 0.616 mm in each axis; the accuracy of the system showed a 3D instrument positioning error of 1.009 ± 0.101 mm. This tool is a portable and low-cost alternative to traditional tracking devices and a trustable method for the objective evaluation of the surgeon’s surgical skills.

Keywords: Laparoscopic Surgery, Orthogonal Vision, Tracking Instruments, Triangulation.

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Authors: Reza Yousefian, Michael A. Kia, Mehrdad Hosseini Zadeh

Abstract:

The blood ducts must be occluded to avoid loss of blood from vessels in laparoscopic surgeries. This paper presents a locking mechanism to be used in a ligation laparoscopic procedure (LigLAP I), as an alternative solution for a stapling procedure. Currently, stapling devices are being used to occlude vessels. Using these devices may result in some problems, including injury of bile duct, taking up a great deal of space behind the vessel, and bile leak. In this new procedure, a two-layer suture occludes a vessel. A locking mechanism is also required to hold the suture. Since there is a limited space at the device tip, a Shape Memory Alloy (SMA) actuator is used in this mechanism. Suitability for cleanroom applications, small size, and silent performance are among the advantages of SMA actuators in biomedical applications. An experimental study is conducted to examine the function of the locking mechanism. To set up the experiment, a prototype of a locking mechanism is built using nitinol, which is a nickel-titanium shape memory alloy. The locking mechanism successfully locks a polymer suture for all runs of the experiment. In addition, the effects of various surface materials on the applied pulling forces are studied. Various materials are mounted at the mechanism tip to compare the maximum pulling forces applied to the suture for each material. The results show that the various surface materials on the device tip provide large differences in the applied pulling forces.

Keywords: Laparoscopic surgery, ligation process, locking mechanism, Shape Memory Alloy (SMA) actuator.

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Authors: K. K. Saju, A. R. Reghuraj

Abstract:

High reflectance of surgical instruments under bright light hinders the visual clarity during laparoscopic surgical procedures leading to loss of precision and device control and creates strain and undesired difficulties to surgeons. Majority of the surgical instruments are made of surgical grade steel. Instruments with a non reflective surface can enhance the visual clarity during precision surgeries. A conversion coating of black oxide has been successfully developed 410 grade surgical stainless steel .The characteristics of the developed coating suggests the application of this technique for developing 410 grade surgical instruments with minimal reflectance.

Keywords: Conversion coatings, 410 stainless steel, black oxide, reflectance.

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Authors: M. Ramezanifard, J. Dargahi, S. Najarian, N. Narayanan

Abstract:

One of the major disadvantages of the minimally invasive surgery (MIS) is the lack of tactile feedback to the surgeon. In order to identify and avoid any damage to the grasped complex tissue by endoscopic graspers, it is important to measure the local softness of tissue during MIS. One way to display the measured softness to the surgeon is a graphical method. In this paper, a new tactile sensor has been reported. The tactile sensor consists of an array of four softness sensors, which are integrated into the jaws of a modified commercial endoscopic grasper. Each individual softness sensor consists of two piezoelectric polymer Polyvinylidene Fluoride (PVDF) films, which are positioned below a rigid and a compliant cylinder. The compliant cylinder is fabricated using a micro molding technique. The combination of output voltages from PVDF films is used to determine the softness of the grasped object. The theoretical analysis of the sensor is also presented. A method has been developed with the aim of reproducing the tactile softness to the surgeon by using a graphical method. In this approach, the proposed system, including the interfacing and the data acquisition card, receives signals from the array of softness sensors. After the signals are processed, the tactile information is displayed by means of a color coding method. It is shown that the degrees of softness of the grasped objects/tissues can be visually differentiated and displayed on a monitor.

Keywords: Minimally invasive surgery, Robotic surgery, Sensor, Softness, Tactile.

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Authors: Elnaz Afshari, Siamak Najarian, Naser Simforoosh, Siamak Hajizadeh Farkoush

Abstract:

Minimally invasive surgery (MIS) is now being widely used as a preferred choice for various types of operations. The need to detect various tactile properties, justifies the key role of tactile sensing that is currently missing in MIS. In this regard, Laparoscopy is one of the methods of minimally invasive surgery that can be used in kidney stone removal surgeries. At this moment, determination of the exact location of stone during laparoscopy is one of the limitations of this method that no scientific solution has been found for so far. Artificial tactile sensing is a new method for obtaining the characteristics of a hard object embedded in a soft tissue. Artificial palpation is an important application of artificial tactile sensing that can be used in different types of surgeries. In this study, a new method for determining the exact location of stone during laparoscopy is presented. In the present study, the effects of stone existence on the surface of kidney were investigated using conceptual 3D model of kidney containing a simulated stone. Having imitated palpation and modeled it conceptually, indications of stone existence that appear on the surface of kidney were determined. A number of different cases were created and solved by the software and using stress distribution contours and stress graphs, it is illustrated that the created stress patterns on the surface of kidney show not only the existence of stone inside, but also its exact location. So three-dimensional analysis leads to a novel method of predicting the exact location of stone and can be directly applied to the incorporation of tactile sensing in artificial palpation, helping surgeons in non-invasive procedures.

Keywords: Kidney Stone, Laparoscopic Surgery, Artificial Tactile Sensing, Finite Element Method.

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