Surgical endoscopy
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Rising health and financial costs associated with iatrogenic errors have drawn increasing attention to the dexterity of surgeons. With the advent of new technologies, such as robotic surgical systems and medical simulators, researchers now have the tools to analyze surgical motion with the goal of differentiating the level of technical skill in surgeons. ⋯ In this paper, we provide a clinical motivation for the importance of surgical skill evaluation. We review the current methods of tracking surgical motion and the available data-collection systems. We also survey current methods of surgical skill evaluation and show that most approaches fall into one of three methods: (1) structured human grading; (2) descriptive statistics; or (3) statistical language models of surgical motion. We discuss the need for an encompassing approach to model human skill through statistical models to allow for objective skill evaluation.
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The acquisition of technical skills using surgical simulators is an area of active research and rapidly evolving technology. The LapSim is a virtual reality simulator that currently allows practice of basic laparoscopic skills and some procedures. To date, no reviews have been published with reference to a single virtual reality simulator. ⋯ Although the LapSim currently does not have any proven significant advantages over video trainers in terms of basic skills instruction and although the results of validation studies are variable, the potential for such technology to have a huge impact on surgical training is apparent. Work to determine standardized learning curves and proficiency criteria for different levels of trainees is incomplete. Moreover, defining which performance parameters measured by the LapSim accurately determine laparoscopic skill is complex. Further technological advances will undoubtedly improve the efficacy of the LapSim, and the results of large multicenter trials are anticipated.
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Comparative Study
Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis: a technical skill and intermediate-term report in 62 cases.
This study aimed to present the authors' technique and the intermediate-term outcome for laparoscopic choledochal cyst excision with Roux-en-Y hepatoenterostomy. ⋯ Laparoscopic choledochal cyst excision, hepaticojejunostomy, and extracorporeal Roux-en-Y anastomosis can be safely and quickly performed for children, with satisfactory intermediate-term results. Extracorporeal Roux-en-Y anastomosis could shorten the operative time.
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Comparative Study
Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients.
Laparoscopic total mesorectal excision for low rectal cancer is not considered a gold standard treatment due to the high conversion rate and the long operation time. ⋯ Laparoscopic total mesorectal excision for low rectal cancer is safe and effective, allowing surgical and oncologic outcomes similar to those reported for open surgery.
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Comparative Study
Clinical experience with a multifunctional, flexible surgery system for endolumenal, single-port, and NOTES procedures.
Single-port and incisionless surgical approaches hold the promise of fewer complications, reduced pain, faster recovery, and improved cosmesis compared with traditional open or laparoscopic approaches. The ability to select an access approach (i.e., endolumenal, single-port, transvaginal, or transgastric) with one platform may be important to optimization of individual patient results. The authors report their results using these four separate surgical approaches tailored to three different therapeutic procedures, all with the use of a single flexible platform, the Incisionless Operating Platform (IOP). ⋯ Availability of a multifunctional, flexible surgery platform provides a choice of a single-port or incisionless surgical approach with the potential to reduce complications, pain, and recovery time while improving cosmesis.