Surgical Technology International
32nd Edition
Contains 45 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
368 pages
May 2018 - ISSN:1090-3941
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both electronic and print versions
Virtual Reality Simulator Systems in Robotic Surgical Training
Alberto Mangano, MD, Robotic Surgery Research Specialist, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, Federico Gheza, MD, Robotic Surgery Research Specialist, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, Pier Cristoforo Giulianotti, MD, FACS, Vice Head, Department of Surgery, Head, Division of General, Minimally Invasive and Robotic Surgery, Professor of Surgery, Distinguished Lloyd M. Nyhus Chair in Surgery, University of Illinois at Chicago, Chicago, IL
967
The number of robotic surgical procedures has been increasing worldwide. It is important to maximize the cost-effectiveness of robotic surgical training and safely reduce the time needed for trainees to reach proficiency. The use of preliminary lab training in robotic skills is a good strategy for the rapid acquisition of further, standardized robotic skills. Such training can be done either by using a simulator or by exercises in a dry or wet lab. While the use of an actual robotic surgical system for training may be problematic (high cost, lack of availability), virtual reality (VR) simulators can overcome many of these obstacles. However, there is still a lack of standardization. Although VR training systems have improved, they cannot yet replace experience in a wet lab. In particular, simulated scenarios are not yet close enough to a real operative experience. Indeed, there is a difference between technical skills (i.e., mechanical ability to perform a simulated task) and surgical competence (i.e., ability to perform a real surgical operation). Thus, while a VR simulator can replace a dry lab, it cannot yet replace training in a wet lab or operative training in actual patients. However, in the near future, it is expected that VR surgical simulators will be able to provide total reality simulation and replace training in a wet lab. More research is needed to produce more wide-ranging, trans-specialty robotic curricula.
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Closing the Gap: Novel Abdominal Wound Closure Techniques
James Dana Kondrup, MD,
Assistant Clinical Professor,
Department of Obstetrics/Gynecology,
Our Lady of Lourdes, Memorial Hospital,
Binghamton, New York, Alaina M. Qayyum
Medical Student 4th Year,
Lake Erie College of Osteopathic Medicine,
Erie, Pennsylvania
983
Traditionally, surgical procedures within the realm of both general and gynecological surgery employ the use of staples and interrupted sutures that run continuously with knot tying or subcuticular sutures to ensure closure of large wound incisions, subcuticular incisions, and fascial repair. However, these methods may not always be cosmetically favorable and, thus, result in an unpleasant outcome for the patient, adding to their surgery-related stress. It is, therefore, imperative that surgeons and gynecologists are aware of alternative methods of wound closure that are not only cosmetically favorable, but also ensure rapid wound recovery and infection control. Two such products available include DERMABOND™ PRINEO™ Skin Closure System (Ethicon Inc., Somerville New Jersey) and STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device (Ethicon Inc., Somerville New Jersey). The DERMABOND™ PRINEO™ Skin Closure System is a topical mesh and skin adhesive that creates a strong polymeric bond across wound edges. This permits natural healing to occur, but with a synthetic flexible microbial barrier providing in vitro protection against organisms. The STRATAFIX™ Symmetric PDS™ Plus, on the other hand, is a knotless tissue control device that permits soft tissue approximation in appropriate situations where such absorbable sutures are permitted. This can be used for large fascial closure as well as on the skin. The purpose of this article is to review and share our experience with two alternative methods of wound closure (one for fascia and one for skin) with a review of their composition and benefits and to illustrate their common applications in gynecologic or general surgery when laparotomy is necessary.
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A Prospective Clinical and Instrumental Study on the Effects of a Transcutaneous Cosmeceutical Gel that is Claimed to Produce CO2
Gustavo H Leibaschoff, MD, Gynecologist, President of International Consulting in Aesthetic Medicine (ICAM), President of the International Union of Lipoplasty, Dallas, TX, Luis Coll, MD, Dermatologist, Director of the Center of Research in Video Capillaroscopy, Buenos Aires, Argentina, Wendy E. Roberts, MD, FAAD, Generational and Cosmetic Dermatology, Rancho Mirage, CA
976
Carboxytherapy is the therapeutic use of carbon dioxide (CO2) in its gaseous state. Since 1933, carboxytherapy has referred to either the subcutaneous injection of CO2 or percutaneous application in a warm bath. The present clinical study was performed to determine if there were any changes in the dermis after the application of a transcutaneous gel, which is claimed to produce CO2, and, if so, how these changes compared to those with CO2 injection. Ten patients received transcutaneous treatment with the gel on one side of the face and the other side without any product was used as a control. We used videocapillaroscopy with an optic probe (VCSO) to evaluate the changes in the microcirculation of the skin. VCSO was performed for the treated right and untreated left ear lobes in each patient. VCSO was performed before treatment was started (VCSO1) and after 7 days of treatment (VCSO2).A comparison of VCSO1 to VCSO2 showed an increase in the microcirculation, an increase in vertical and horizontal capillaries, and a reduction in the area of ischemia. These results are similar to those observed in other studies with CO2 injection. In conclusion, use of this transcutaneous CO2 gel produced changes in the dermis similar to those observed with subcutaneous injection of CO2.
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Microbial Load of Trocars: Potential Source of Contamination and Surgical Site Infection
Vanessa Aparecida Vilas-Boas, PhD, MSN, RN, Infection Control Nurse, Women's Health Hospital "Prof Dr José Aristodemo Pinotti" (CAISM), University of Campinas (UNICAMP), Campinas/SP - Brazil, Carlos Emílio Levy, PhD, MD, Professor, Clinical Pathology Department, School of Medical Sciences, University of Campinas (UNICAMP), Campinas/SP – Brazil, Maria Isabel Pedreira de Freitas, PhD, RN, Associate Professor, School of Nursing, University of Campinas (UNICAMP), Campinas/SP – Brazil, Kevin Woo, PhD, RN, Associate Professor, Queen’s University, Kingston, ON, Canada
986
Surgical site infection (SSI) is a common complication that is associated with delayed recovery, prolonged length of hospital stay, exorbitant cost, and mortality. The present prospective longitudinal study aimed to evaluate the relationships between the microbial load of trocars used in laparoscopic gynecological surgery, microbiota in surgical sites, and SSI. The final sample consisted of 24 patients, including 68 swab samples and 48 trocars. Microorganisms were recovered in 100.0% of the swabs collected from the umbilicus and vaginal fornix and in 58.3% (14/24) of the swabs collected from skin at the left McBurney’s point. Most of the samples collected from trocars (87.5%) did not exhibit bacterial growth, suggesting proper disinfection. In addition, antisepsis was effective for decolonization of the skin to create an aseptic surgical field.
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