This study takes an initial step towards understanding the learning process of flexible endoscopic surgery. Bimanual coordination learning curves were contrasted between three different surgical paradigms. We hypothesized that use of an open or laparoscopic paradigm would result in better performance and a shorter learning process (reaching a learning plateau earlier) than an endoscopic paradigm. Our model required seven subjects to perform identical bimanual coordination tasks with three different tools (a dual-channel endoscope with graspers, laparoscopic Maryland graspers, and straight hemostats for open surgery). The task required subjects to coordinate two instruments in order to perform a series of standardized maneuvers. Performance was measured by movement speed and accuracy. The learning process was broken down into three distinct phases: the practice phase, the short-term retention phase, and the long-term retention phase. The learning curves of four surgical novices for 33 tasks with each device were compared with the performance of three surgeons. Overall performance speed was significantly faster using open or laparoscopic tools than endoscopy for all groups (open 13 Â+- 1 s; lap 28 Â+- 3 s; endo 202 Â+- 82 s; P < 0.001). The difference between open and laparoscopy was not significant (P = 0.149). There was no significant difference (P = 0.434) in accuracy (number of ring drops) between any of the devices. Novices performed significantly slower than the expert in the endoscopy task (P = 0.010). Their performance improved with practice (P = 0.005) but they failed to reach the level of the expert after the practice phase (novices: 202.3 Â+- 23.4 s versus expert: 89.0 Â+- 34 s, P = 0.009). Bimanual coordination tasks have shortest performance time and are easiest to learn using an open surgery paradigm. Performance times and the learning process take longer for the laparoscopic paradigm and significantly longer for the endoscopic paradigm.
Natural orifice transluminal endoscopic surgery (NOTES), a recent development in the field of minimally invasive surgery, provides theoretical advantages over open and laparoscopic surgery. Challenges with the use of NOTES for colon resections include the need to extract a large specimen and perf...
Abdominal procedures have been performed for a long time through the anterior abdominal wall. Since the first reports in the 1980s, laparoscopy has become the standard for cholecystectomy, with many advantages over open procedures. Now a natural-orifice approach to the peritoneal cavity may furth...
Uterine cancer is the most common gynecologic cancer in women in the United States with an estimated number of 40,100 women diagnosed in 2008, the great majority of which belongs to endometrial classification. The traditional approach to treatment of endometrial cancer has been primarily surgery ...
Laparoscopic bile duct exploration (LBDE) is well established although the results via choledochotomy are relatively poorly documented. This report evaluates the results achieved by a single surgeon operating in one institution on an unselected group of patients using modern instrumentation. Over...
Cerebral patterns of activity elicited by dual-task performance throughout the learning of a complex bimanual coordination pattern were addressed. Subjects (N=12) were trained on the coordination pattern and scanned using fMRI at early (PRE) and late (POST) learning stages. During scanning, the c...
Transoral stapled diverticulo-esophagostomy (TSDE) has gained increased popularity in surgical treatment of Zenker diverticulum (ZD). One of the advantages of this approach is early rehabilitation with significant decrease in patient morbidity and time to resumption of oral intake as compared wit...
Currently, advanced minimal-access surgery cannot be realized without the application of modern stapling devices. The introduction of stapling devices with a flexible shaft and computer-assisted steering abilities was followed by the technical basis to provide just these features. This study aime...
submitted by charlesdowney 1 year and 3 months ago
We evaluated robotically assisted laparoscopic adrenalectomy (RLA) in a prospective study of 100 consecutive patients (60 women and 40 men) undergoing unilateral adrenalectomy at the University Hospital. The median age was 59 (24–82) years and BMI 27.6 (17.1–40.9) kg/m2. Preoperative diagnose...
Esophageal cancer surgery is traditionally performed by a number of open surgical approaches. Open approaches require thoracotomy and laparotomy. Developments in instrumentation and optics have allowed the use of minimally invasive approaches to esophageal cancer, which had been traditionally man...
The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data. A PubMed search for all articles describing human NOTES cases was performed. All articles pr...
