Contents

Part I Introduction

1 Overview of Emerging Technologies 3

2 Economics of New Surgical Technologies ... 7

2.2 A Brief History of Medical Technology 7

2.3 The Economic Burden of Health Care 8

2.4 A Technological Solution to Health Care Cost 8

3 The Scientific, Social, and Ethical Implications of Disruptive Technologies ... 11

3.1 Introduction 11

3.2 Intelligent Computers and Robots ... 13

3.3 Human Cloning 13

3.4 Genetic Engineering 13

3.5 Longevity 14

3.6 Human-Machine Communication .. 14

3.7 Arti^cial Organs and Prostheses 14

3.8 Suspended Animation 15

3.9 Summary 15

Part II Education and Training

4 The World Virtual University and the Internet: http://www.websurg.com 19

4.1 Surgical Operative Techniques 21

4.2 Video Footage 21

4.3 The Voices and Opinions of the Experts 22

4.4 New Improvements for Access to Surgical Education 22

4.5 Other Educational Services 22

5 Virtual Reality: Objective Assessment, Education, and Training 27

5.1 Simulation Development:

Lessons Learned 28

5.2 Simulation Training: Evidence-Based Adoption? 28

5.3 Metrics for Objective Assessment 29

5.4 Education and Training 30

5.5 Simulation Fidelity:

Are Graphics Enough? 31

5.6 Simulation as Part of the Curriculum 31

5.7 Training to Pro^ciency on a VR Simulator 32

5.8 Conclusion 32

6 Organizing Surgical Simulation Centers in Response to Disruptive Technologies ... 35

6.1 Making the Case for Simulation for Medical Education 35

6.2 Simulation and Simulators for Medical Education:

Past, Present, and Future 36

6.2.1 Bench Models 37

6.2.2 Laparoscopic Skills 37

6.2.3 Gastrointestinal Endoscopy 38

6.2.4 Endonasal Surgery 38

6.2.5 Urology 38

6.2.6 Bronchoscopy 38

6.2.7 Anesthesiology 38

6.2.8 Case Study: The National Capital

Area Medical Simulation Center 39

6.3 Conclusion 44

7 Ideal VR systems: Is There a ‚ÄěHoly Grail"

in Simulation System Land? 47

7.1 Curriculum 50

8 The Medical Informatics Challenge in Surgery 57

8.1 The Perioperative Environment 57

8.1.1 Why Adapt Solutions from Other Industries? 58

8.2 Radical Improvement in Quality of Patient Care is Possible 58

8.3 Toward a Solution:

Adaptive Process Control 59

8.4 Context-Aware WorkSow as Autopilot 60

8.5 Stealth Mode:

Automated Data Collection 60

8.6 A RECIPE for Incremental Systems Evolution and Process Improvement 61

8.7 Applying the RECIPE

to Perioperative Systems Design 63

8.8 Perioperative Systems Acceleration

Tool in the Preoperative Period 63

8.9 PSPAT in the Intraoperative Period .. 65

8.10 PSPAT in the Postoperative Period ... 65

8.11 PSPAT at the University of

Maryland Medical Center 65

8.12 PSPAT Components 66

8.12.1 A Workflow Engine 66

8.12.2 Adapters to Gather Information from any Human or Machine Source 67

8.12.3 MER: Virtual Information Repository for the Worklow Engine Access 67

8.12.4 A Rules Engine to Provide Intelligent Agent Support for the Worklow Engine 67

8.12.5 An Alerting System to Ensure

Timely Completion of Clinical Events 68

8.12.6 A Reporting System to Access Outcomes Data in Real Time 68

8.12.7 A Logistics Subsystem to Manage Inventory 69

8.12.8 Web-Based Telemedicine View 69

8.13 Research Directions 69

8.14 Web Services 69

8.15 Conclusion 70

Part III Robotics and Novel Surgical Approaches

9 Robotics in General Surgery:

Today and Tomorrow 75

9.1 Introduction 75

9.2 Cholecystectomy 75

9.3 Bariatric Surgery 75

9.3.1 Robotic-Assisted

Roux-en-Y Gastric Bypass 76

9.3.2 Robotic-Assisted

Adjustable Gastric Banding 77

9.3.3 Robotic-Assisted Biliary Pancreatic Diversion with Duodenal Switch 77

9.4 Esophageal Surgery 78

9.4.1 Heller Myotomy 78

9.4.2 Resection of Epiphrenic Diverticulum 79

9.4.3 Total Esophagectomy 79

9.4.4 Esophageal Leiomyoma 79

9.5 Pancreatic Surgery 80

9.6 Gastric Surgery 80

9.7 Colorectal Surgery 80

9.8 Adrenalectomy 80

9.9 Donor Nephrectomy 81

9.10 Conclusion 82

10 Evolving Endoluminal Therapies 85

10.1 Endoluminal Surgery 85

10.2 Transvisceral Surgery 86

Part IV Innovations in Surgical Instruments

11 Microtechnology in Surgical Devices 89

11.1 Introduction 89

11.2 MST in Medical Devices:

Challenges and Opportunities 89

11.3 Areas of MST Applications in Medical Devices 90

11.3.1 Extracorporeal

MST-Enhanced Devices 92

11.3.2 Intracorporeal

MST-Enhanced Devices 92

11.3.3 Implantable MST Devices 93

11.3.4 MST in Endoscopy 95

11.4 Discussion 96

12 Innovative Instruments in Endoscopic Surgery 99

12.1 Introduction 99

12.2 Innovative Instruments for Laparoscopic Surgery 99

12.2.1 Curved Instruments 99

12.2.2 Instruments with All Degrees of Freedom for Suturing:

the Radius Surgical System 101

12.2.3 The Endofreeze System 102

12.2.4 Combination Instruments for Endoscopic Surgery 103

12.3 Endoluminal Surgery of Rectum and Colon 103

12.4 Full-Thickness Resection Device, the Concept of a New Device for Removal of Polyps from the Rectum and Descending Colon 105

12.5 Conclusion 106

13 New Hemostatic Dissecting Forceps with a Metal Membrane Heating Element 107

13.1 Introduction 107

13.2 Materials and Methods 107

13.3 Results 109

13.4 Discussion 110

Acknowledgment 112

14 Radiofrequency and Hepatic Tumors 113

14.1 Introduction 113

14.2 Conclusions 119

15 Technological Innovations in Kidney and Liver Living-Donor-Related Transplantation 123

15.1 Introduction 123

15.2 Robotic Technology in Laparoscopic Living-Donor Nephrectomy 123

15.3 Surgical Technique 125

15.4 Liver Transplantation 126

15.4.1 Technological Innovations in

Transplant Surgery: from "Crash Clamp Technique" to Modern Instruments of "Intelligent" Dissection, Hemostasis 126

15.5 Transection Systems 127

15.5.1 Ultrasonic Dissector 127

15.5.2 Water-Jet Dissector 127

15.6 Hemostasis Systems 127

15.6.1 Staplers 127

15.6.2 Floating Ball 127

15.7 Simultaneous Hemostasis and Transection 128

15.7.1 Thermal Methods 128

15.7.2 Harmonic Scalpel 128

15.7.3 Laparoscopic Donor Hepatectomy for Living-Related Transplantation 128

Part V Bioengineering

16 Tissue Engineering 133

16.1 Introduction 133

16.2 Overview 135

16.2.2 Cartilage 136

16.2.4 Intestine 139

16.2.5 Cardiovascular Tissue 140

16.2.6 Liver 143

16.3 Future Prospects 144

16.4 Relevance for the Practicing Surgeon 146

Part VI Beyond the Future

17 Adapting to Future Technologies 155

17.1 Introduction 155

17.2 The Scientific Method 155

17.3 Interdisciplinary Medicine 156

17.4 Multiaccess Surgery 156

17.5 Information Technologies 157

17.6 Surgical Education and Certilcation 157

17.7 Surgical Simulation 158

17.8 Artificial Organs and Transplantation 158

17.9 Surgical Systems and Robotics 159

17.10 Unconventional Surgery 159

17.11 Conclusion 160

Subject Index

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