Robotic Assisted RouxenY Gastric Bypass

Robotic Gastric Bypass Set

The procedure that benefits most from robotic assistance in the field of bariatric surgery is the gastric bypass. Our group currently uses the system to perform a robotic-assisted, hand-sewn gastrojejunostomy for completion of the laparoscopic Roux-en-Y gastric bypass procedure. The operative room is set up as shown in (Fig. 9.1). The first part of the opera tion is performed laparoscopically a small pouch and a 120-cm limb are created. After this, the robot is put in place and a running...

Bariatric Surgery

The field of bariatric surgery benefited greatly from the introduction of minimally invasive techniques. Robotic-assisted surgery represents a small but growing subset of minimally invasive surgical applications that enables surgeons to perform bariatric procedures with minimal alteration of their current laparoscopic or open technique. A survey of surgeons in 2003 showed that only 11 surgeons in the United States were currently using a robotic surgical system for bariatric surgery 4 . The...

Robotic Assisted Adjustable Gastric Banding

Robotic-assisted adjustable gastric banding is also performed at select institutions. Three of 11 surveyed robotic-assisted bariatric surgeons in the United States were using the da Vinci System in 2003 4 . At the University of Illinois at Chicago, we began randomizing patients to robotic or laparoscopic adjustable gastric banding placement in 2001. We found similar outcomes in length of hospital stay and weight loss, although the operative time was significantly longer in the robotic group 4 ....

Contents

1 Overview of Emerging Technologies 3 2 Economics of New Surgical Technologies 7 2.1 Technology A De nition of Terms 7 of Medical Technology 7 of Health Care to Health Care Cost 8 3 The Scientific, Social, and Ethical Implications of Disruptive Technologies 11 3.1 Introduction 3.2 Intelligent Computers and Robots 13 3.3 Human Cloning 3.4 Genetic Engineering 13 3.5 Longevity 3.6 Human-Machine Communication 14 3.7 Arti cial Organs and Prostheses 14 3.8 Suspended Animation 15 3.9 Summary 4 The...

Endoluminal Surgery of Rectum and Colon

The first endoscopic procedure for the rectal cavity was designed in 1980 14 and has been in clinical application for more than 22 years. Figure 12.14 demonstrates the principle of the procedure 15 Stereoscopic optic gives optimal view, gas dilatation allows good exposition of the rectal cavity, and the curved instruments allow a better access in typical positions of the tumor, so that optimal surgical performance is given. This image with the three instruments also demonstrates the problem of...

Info

Computer-based simulation has been used for decades in aviation and other professional fields. However, the last 15 years have seen numerous attempts to introduce computer-based simulation into clinical medicine. Surgery, and specifically minimally invasive surgery (MIS), has led the way in the development and application of this technology in clinical practice. Recently, use of computer-based simulation for training has expanded into the multidisciplinary fields of catheter-based, image-guided...

Future Prospects

The field of tissue engineering has reached a critical junction. The fundamental principles of tissue engineering are based on cell transplantation, which has been studied for more than 60 years. The concept of tissue engineering is appealing and easily understood by clinicians, scientists, investors, and the general public. During the 1990s, tissue engineering received highly favorable media attention. Tissue engineering was hailed as one of the greatest scientific achievements of the...

Robotic Technology in Laparoscopic Living Donor Nephrectomy

From its introduction in Boston in 1954 by Murray, living-donor nephrectomy performed in an open fashion has proven over the years to be a safe and effective procedure. In the following four decades, thousand of patients affected by end-stage renal failure have been successfully treated with living-donor kidney transplantation. The data generated have confirmed the safety of a healthy donor to donate one kidney in terms of physical performances and quality of life 6, 7 . Although safe and...

Actions

The Virtual Reality Turing Test, Objective Structured Clinical Exam (OSCE), Objective Structured Assessment of Technical Skills (OSATS), McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS), and Minimally Invasive Surgical Training - Virtual Reality (MIST-VR) are examples of evaluation modalities based on these parameters. In this regard, it is of utmost importance the work of the aforementioned Work Group for Evaluation and Implementation...

Surgical Education and Certification

The paradigm shift in surgical education is from time-based training (e.g., 5 years of surgical residency, and then graduate with a subjective agreement by experts of the surgeon's basic training) to the new objective, criterion-, or proficiency-based training. The earlier model of mentoring (supplemented by knowledge acquisition and testing lectures followed by written tests) resulted in a subjective assessment of performance, especially of technical procedural skills. The 1980s and 1990s saw...

Bone

The treatment of bone defects remains a critical challenge in orthopedic surgery. Currently, bone grafts are used to treat defects caused by trauma, pathological degeneration, or congenital deformities. Bone grafting has become a common procedure in orthopedic surgery, and it is estimated that over 500,000 grafting procedures are performed each year in the United States 64 . Allografts are widely available and provide the defect site with structural stability. However, their use is limited by...

Implantable MST Devices

Human Blood Pressure Implanting

Telemetric implants are among the most important applications of MST in medicine. MST components implanted into the human body include sensors of various types that measure specific health parameters, such as blood glucose 18 or blood pressure or flow 1, 4, 30 . The signals are then transferred via telemetric coils to readout device outside of the body. A good example for existing products in this field is cardiac pacemakers or defibrillators that are equipped with miniaturized telemetry units...

Subject Index

ACCME, see Accreditation Council for Continuing Medical Education Accreditation Council for Continuing Medical Education (ACCME) 23 achalasia 78 adaptive workflow engine 60 adrenalectomy - robotic-assisted 80 Akamai platform 24 albumin synthesis 143 alerting system 68 allogeneic graft 140 anesthesia 7 anesthesiology 38 angiogenesis 146 antisepsis 7 antitelomerase 14 apligraf 136 artificial graft 140 artificial organ 14, 156, 158 artificial prosthesis 133 automated monitoring 59, 64, see also...

Surgical Technique

The donor nephrectomy is performed under general anesthesia, with the patient placed in the right decubitus position with pressure points padded. The operating table is flexed to maximize the exposure of the left kidney during the procedure. A 7-cm midline incision is performed immediately below the umbilicus, taken down through the fascia and into the abdominal cavity. A LAP DISC hand port is inserted, and pneumoperitoneum is achieved with 14 mmHg CO2 insufflation. Under direct visualization,...

Intestine

Digestive diseases affect more than 60 million Americans each year and account for more than 100 million in direct and indirect medical costs. Most digestive diseases are very complex and have subtle symptoms. In many cases, the cause s remain s unknown. Resection of the small intestine may be required, which can lead to a state of malnutrition and malabsorption if the functional gut mass is reduced below the minimum amount required for digestion and absorption to satisfy the nutrient and fluid...

Perioperative Systems Acceleration Tool in the Preoperative Period

Perioperative Process

In the preoperative period the Perioperative Systems Acceleration Tool PSPAT needs to orchestrate and monitor the following activities Incoming patient medications and allergies Fig. 8.3 Perioperative process timeline 30 Fig. 8.3 Perioperative process timeline 30 Confirm operating room readiness Assure supplies and equipment availability Capture data on incoming medical record, capture vitals, inputs outputs I Os , preoperative medications, tests, and scans Monitor patient entry into operating...

MST in Endoscopy

Fig. 11.10 The E2 self-propelling endoscope is a pneumatically controlled inchworm that moves through the colon by a sequential adhering to the bowel wall and elongating shortening the midsection. a Inchworm with imaging head and propelling body. b High flexibility The field of endoscopy is an interesting area for the application of MST, since high-functional integration and miniaturization, the two main characteristics of MST, are an important advantage in this field. Besides microfiberoptics...

Esophageal Leiomyoma

Esophageal Leiomyoma

Leiomyoma is the most common benign mesenchymal esophageal tumor, representing up to 80 of benign esophageal tumors. Anatomically these neoplasms are localized to the middle and lower thirds of the esophagus, in most cases as a single lesion 13 . The most common symptoms include dysphagia and atypical chest pain. Surgical intervention is indicated not only for pain but also in asymptomatic patients in order to prevent the excessive growth that can complicate patient well-being and future...

Conclusion

The introduction of the robotic system in the field of minimally invasive surgery has produced an authentic revolution. Robotic surgery remains still in its infancy, and the limits of its expansion are unpredictable. Nevertheless, the robotic approach has already proved to be safe and feasible in the most complex procedures in general surgery. Currently, clear advantages of robotic technology are proven in surgical procedures where very precise movements in small areas and a good vision of the...

Donor Nephrectomy

Operating Room Setting

Living kidney donation represents an important source for patients with end-stage renal disease ESRD , and has emerged as an appealing alternative to cadaveric donation. Furthermore, within the last decade, lapa-roscopic donor nephrectomy has replaced the conventional open approach, and has gained surgeon and patients acceptance. The first laparoscopic living donor nephrectomy was attempted to alleviate the shortage of kidneys for transplantation and to reduce the hospitalization and...

Endoluminal Surgery

Initial endoscopic approaches to Barrett's esophagus have dealt with accurate diagnosis and staging of this condition. Early attempts at endoscopic ablation of Barrett's mucosa involved use of pinpoint thermal therapy and coagulation devices such as lasers, argon plasma coagulation, and bipolar probes. More recently pho-todynamic therapy has been utilized to destroy larger areas of abnormal mucosa. Attempts at endoscopic mucosal resection of larger areas of Barrett's mucosa have been...

The Endofreeze System

This system is designed to perform solo surgery. It is a very simple construction, which allows one to hold the camera or to hold retracting instruments. The position of camera or instruments can be changed against a cer tain friction with only one hand, and it stays automatically in the new position. Figure 12.11 shows the ball trocar. The system itself was developed by T bingen Scientific, and production and marketing is performed by Aesculap 12 . The ball trocar has always to be inserted...

Web Services

Some of the current interfaces in health care, particularly financial interfaces, are still batch oriented. The majority of clinical system interfaces are point-to-point, using HL7 version 2-formatted messages. These are difficult to implement and maintain because the HL7 version 2 standard specifies format, but not the semantics of the data put into formatted areas. As a result, every interface in unique and it is sometimes impossible to overcome semantic differences in the meaning of data...

Stealth Mode Automated Data Collection

A stealth mode of data collection is needed to introduce new technology without disrupting current manual processes. By stealth mode, we mean automated collection of data that is normally observed, yet irregularly captured because of lack of time and tedious manual data entry procedures. It is essential data for managing operations that is irregularly registered in a high-stress environment, leading to erroneous perceptions that generate to suboptimal organizational response. RFID technology...

Echtgenoot Lps Stassen

Clinical outcome of patients treated Fig. 7.3 Cuschieri's model of proficiency Fig. 7.3 Cuschieri's model of proficiency when reliable simulation will elevate a surgeon's skill, increasing the patients' safety. Simulation and attitudinal evaluation, at a lower level, could be used as well for medical schools students' selection, using the same productivity criteria applied to simpler tasks for novices. Finally, another field of application for the satisfactory VR simulator of the future is the...

W BSurg Global report

Fig. 4.4 WebSurg's report connections hits, visitors, videos Fig. 4.4 WebSurg's report connections hits, visitors, videos Validation of knowledge is more and more under the supervision of governments with their own requirements of nationally approved CME for physicians in order to maintain medical licensure. In the United States, the accreditation of CME activities is provided by the Accreditation Council for Continuing Medical Education ACCME 7 . Today the Internet represents one of the...