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1.
Junmo An Andrew G. Webb Dipan J. Shah Karen Chin Nikolaos V. Tsekos 《The international journal of medical robotics + computer assisted surgery : MRCAS》2018,14(1)
Background
A method for the identification of semi‐active fiducial magnetic resonance (MR) markers is presented based on selectively optically tuning and detuning them.Methods
Four inductively coupled solenoid coils with photoresistors were connected to light sources. A microcontroller timed the optical tuning/detuning of coils and image collection. The markers were tested on an MR manipulator linking the microcontroller to the manipulator control to visibly select the marker subset according to the actuated joint.Results
In closed‐loop control, the average and maximum were 0.76° ± 0.41° and 1.18° errors for a rotational joint, and 0.87 mm ± 0.26 mm and 1.13 mm for the prismatic joint.Conclusions
This technique is suitable for MR‐compatible actuated devices that use semi‐active MR‐compatible markers. 相似文献2.
Julia Torabi Juan P. Rocca Krystina Choinski Katherine Lorenzen Camille Yongue Michelle L. Lubetzsky Melvon E. Herbert Attasit Chokechanachaisakul Maria Ajaimy Layla Kamal Enver Akalin Milan Kinkhabwala Jay A. Graham 《Clinical transplantation》2018,32(1)
Background
We analyze our outcomes utilizing imported allografts as a strategy to shorten wait list time for pancreas transplantation.Methods
This is an observational retrospective cohort of 26 recipients who received either a locally procured (n = 16) or an imported pancreas graft (n = 10) at our center between January 2014 and May 2017. Wait list times of this cohort were compared to UNOS Region 9 (New York State and Western Vermont). Hospital financial data were also reviewed to analyze the cost‐effectiveness of this strategy.Results
Imported pancreas grafts had significantly increased cold ischemia times (CIT) and peak lipase (PL) levels compared to locally procured grafts (CIT 827 vs 497 minutes; P = .001, PL 563 vs 157 u/L; P = .023, respectively). There were no differences in graft or patient survival. The median wait time was significantly lower for simultaneous kidney‐pancreas transplants at our center (518 days, n = 21) compared to Region 9 (1001 days, n = 65) P = .038. Despite financial concerns, the cost of transport for imported grafts was offset by lower standard acquisition costs.Conclusions
Imported pancreas grafts may be a cost‐effective strategy to increase organ utilization and shorten wait times in regions with longer waiting times. 相似文献3.
Juan D. San Juan Abie H. Mendelsohn 《The international journal of medical robotics + computer assisted surgery : MRCAS》2023,19(4):e2510
Background
Transoral robotic surgery (TORS) using the Single-Port system (SPS) relies on electrocautery, limiting its applications in the upper aerodigestive tract. We evaluated the feasibility of a CO2 delivery system for the SPS.Methods
Otolaryngology residents performed a cutting exercise using a handheld CO2 laser and participated in a cadaveric oropharyngeal dissection using the SPS with monopolar cautery (SP + EC) and CO2 laser (SP + CO2). Residents completed the System Usability Scale (SUS) questionnaire to evaluate these techniques.Results
The same laser fiber was used for all combined dissections. The handheld CO2 laser, SP + EC, and SP + CO2 demonstrated similar SUS scores. On individual domain scores, SP + CO2 received less favorable ratings compared to the handheld CO2 laser for complexity, integration, and cumbersome experience (p < 0.05). On subgroup stratification, less TORS experience was associated with worse SUS scores.Conclusion
SP-guided CO2 laser delivery is a viable alternative to electrocautery in robotic surgery, and should be considered when performing TORS. 相似文献4.
Antonio Gangemi Paolo Bernante Matteo Rottoli Federica Pasquali Gilberto Poggioli 《The international journal of medical robotics + computer assisted surgery : MRCAS》2023,19(4):e2544
Introduction
As robotic surgery increases its reach, novel platforms are being released. We present the first 17 consecutive cases of alimentary tract surgery performed with the HugoTM RAS (Medtronic).Methods
patients were selected to undergo surgery from February through April 2023. Exclusion criteria were age <16 years, BMI>60, ASA IV.Results
17 patients underwent ileocaecal resection for Chrons disease (2 M and 1 F) and pseudo-obstruction of the terminal ileum (1 M), cholecystectomy (3 M and 5 F), subtotal gastrectomy with D2 lymphadenectomy (1 F), sleeve gastrectomy (1 F), hiatal hernia repair with Nissen fundoplication (1 M), right hemicolectomy (1 M) and sigmoidectomy (1 M). No conversion to an open approach or any arm collisions requiring corrective actions were reported.Conclusions
Our preliminary experience with the HugoTM RAS point to safety and feasibility for a rather wide spectrum of surgical procedures of the alimentary tract. 相似文献5.
Rashmitha Dachepally Alvaro Donaire Garcia Wei Liu Christine Flechler William J. Hanna 《Paediatric anaesthesia》2023,33(6):460-465
Background
Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions.Aim
The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access.Methods
This single-center retrospective cohort study included children 0–18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018–06/01/2021.Results
One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR = 2.20, 95% CI [1.45–3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28–3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18–0.85] p = .017).Conclusion
In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions. 相似文献6.
Qiangqiang Liu Ziyu Mao Junjie Wang Changquan Wang Wenze Chen Wenzhen Chen Xiaolai Ye Chencheng Zhang Yong Lu Jiwen Xu 《The international journal of medical robotics + computer assisted surgery : MRCAS》2023,19(2):e2479
Background
We aimed to evaluate the accuracy and safety of a novel self-tapping bone fiducial as a registration technique for stereoelectroencephalography (SEEG) implantation.Methods
Each patient was installed with five bone fiducial markers. All procedures were performed using the same Sinovation robot system. The accuracy was determined by calculating the target point error (TPE) and the entry point error (EPE) of electrodes.Results
Fourteen patients underwent SEEG implantation surgery; and the average installation time of the markers per patient was 86.1 s. In the operating theatre, the average registration time was 206.6 s, and the average registration error was 0.18 mm. The average TPE of 174 electrodes was 1.98 mm and the average EPE was 0.88 mm.Conclusion
Our study provided a bone fiducial marker installation and registration technique that was convenient and fast, highly accurate in registration, and highly tolerated by patients. 相似文献7.
A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis
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Thomas Ind Alex Laios Matthew Hacking Marielle Nobbenhuis 《The international journal of medical robotics + computer assisted surgery : MRCAS》2017,13(4)
8.
Navid Ahmadi MD MPhil Nima Ahmadi MBBS MS FRACS Praveen Ravindran MBBS FRACS Tae Jun Kim BMed GDipSurgSkills FRACS Christopher M. Byrne MBBS FRACS Christopher J. Young MBBS FRACS 《ANZ journal of surgery》2023,93(9):2161-2165
Background
Diverticular disease of the colon occurs commonly in developed countries. Immunosuppressed patients are thought to be more at risk of developing acute diverticulitis, worse disease, and higher complications secondary to therapy. This study aimed to assess outcomes for immunosuppressed patients with acute diverticulitis.Method
A retrospective single-centre review was conducted of all patients presenting with acute diverticulitis at a major tertiary Australian hospital from 2006 to 2018.Result
A total of 751 patients, comprising of 46 immunosuppressed patients, were included. Immunosuppressed patients were found to be older (62.25 versus 55.96, p = 0.016), have more comorbidities (median Charlson Index 3 versus 1, P < 0.001), and undergo more operative management (13.3% versus 5.1%, P = 0.020). Immunosuppressed patients with paracolic/pelvic abscesses (Modified Hinchey 1b/2) were more likely to undergo surgery (56% versus 24%, P = 0.046), while in patients with uncomplicated diverticulitis, there was no difference in immunosuppressed patients undergoing surgery (6.1% versus 5.1% P = 0.815). Immunosuppressed patients were more likely to have Grade III-IV Clavien-Dindo complication (P < 0.001).Conclusion
Immunosuppressed patients with uncomplicated diverticulitis can be treated safely with non-operative management. Immunosuppressed patients were more likely to have operative management for Hinchey 1b/II and more likely to have grade III/IV complications. 相似文献9.
A randomized trial of automated intermittent ropivacaine administration vs. continuous infusion in an interscalene catheter
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J. Oxlund A. H. Clausen S. Venø M. D. Nielsen M. Pall T. Strøm P. Toft 《Acta anaesthesiologica Scandinavica》2018,62(1):85-93
Background
Ultrasound‐guided interscalene nerve block with ropivacaine as local anesthetic agent given as boluses or continuous infusion is the preferred pain management after major shoulder surgery. The use of automated intermittent boluses has been shown to be superior to continuous infusion in sciatic and epidural nerve block. Hypothesis: Automated intermittent boluses reduce pain after major shoulder surgery.Methods
Seventy patients aged 18–75 years, scheduled for major shoulder surgery under general anesthesia with interscalene nerve block were included in this randomized controlled trial. Patients were allocated to either automated intermittent boluses with 16 mg ropivacaine every 2 h combined with patient‐controlled administration or to a conventional regimen of continuous infusion of 8 mg/h (4 ml/h) of ropivacaine combined with patient controlled administration (2 ml, lockout time 30 min). Pain (Visual Analog Scale, VAS) was assessed every 8 h postoperatively.Results
Fifty‐seven patients completed the study, 29 in the continuous infusion group and 28 in the automated intermittent bolus group. Shoulder arthroplasty was performed in 49 (86%) of the cases. There were no significant differences in VAS score from 8 to 48 h post‐operatively. No significant difference in opioid usage was observed. The automated intermittent bolus group reported significantly less force on coughing and more hoarseness. A significantly lower volume of ropivacaine was used in the automated intermittent bolus group.Conclusion
Automated intermittent boluses did not reduce pain or rescue opioid consumption compared with continuous infusion of ropivacaine. The automated intermittent bolus group had significantly less force on coughing and more hoarseness. 相似文献10.
Vicente Lorenzo-Zúñiga Jaume Boix Vicente Moreno-de-Vega Napoleón D. de-la-Ossa Gemma Òdena Ramon Bartolí 《The Journal of surgical research》2014
Background
The aim of the present study was to develop a rat model of colonic microperforation secondary to thermal injury for future studies to assess new treatments.Methods
Twenty-four male Sprague–Dawley rats were used in this study. Hot biopsy forceps were used for all treatments. All lesions were created in proximal left colon using the soft coagulation setting. The power setting tested was 40 W, and the durations of monopolar soft coagulation application evaluated were 2, 3, and 4 s.Results
In the acute phase, 48 h after thermal injury, durations of cautery of 2 and 3 s resulted in transmural necrosis, whereas with 4 s microperforation was obtained. In the late phase, 7 d after the damage, only duration of cautery of 4 s showed deep cautery effects, with signs of peritonitis.Conclusions
We determined optimal power settings and duration of therapy in a rat model for producing electrocautery that involves transmural necrosis with microperforation. 相似文献11.
Introduction and hypothesis
The aim of this study was to assess complications and short-term results (3 months and 1 year) from a single-incision mid-urethral tape for stress urinary incontinence. 相似文献12.
A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals
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C. Lazzeri G. Cianchi T. Mauri A. Pesenti M. Bonizzoli S. Batacchi M. Chiostri F. Socci A. Peris 《Acta anaesthesiologica Scandinavica》2018,62(1):38-48
Background
Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start.Methods
Sixty‐nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed.Results
All patients were transported on ECMO (distance, median 77, range 4–456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m2, RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC‐ROC: 0.85, 95% CI: 0.76–0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 ± 8.6, whereas non‐survivors showed a mean value of 20.1 ± 7.4 (P < 0.001).Conclusions
Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation. 相似文献13.
Peter S. Finamore Karolynn T. Echols Krystal Hunter Howard B. Goldstein Adam S. Holzberg Babak Vakili 《International urogynecology journal》2010,21(3):285-291
Introduction and hypothesis
Our objective was to establish the overall graft erosion rate in a synthetic graft-augmented repair 3 months postoperatively. 相似文献14.
Sarah Friedman Katherine S. Sandhu Cuiling Wang Magdy S. Mikhail Erika Banks 《International urogynecology journal》2010,21(6):673-678
Introduction and hypothesis
We aimed to identify factors contributing to successful pessary use for over 1 year. 相似文献15.
16.
17.
Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi‐port laparoscopy
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M. Carvello E. J. de Groof A. de Buck van Overstraeten M. Sacchi A. M. Wolthuis C. J. Buskens A. D'Hoore W. A. Bemelman A. Spinelli 《Colorectal disease》2018,20(1):53-58
Aim
Single port (SP) ileocaecal resection (ICR) is an established technique but there are no large studies comparing SP and multi‐port (MP) laparoscopic surgery in Crohn's disease (CD). The aim of this study was to compare postoperative pain scores and analgesia requirements after SP and MP laparoscopic ICR for CD.Method
This was a retrospective study of patients undergoing SP or MP ICR for CD in three tertiary referral centres from February 1999 to October 2014. Baseline characteristics (age, sex, body mass index and indication for surgery) were compared. Primary end‐points were postoperative pain scores, analgesia requirements and short‐term postoperative outcomes.Results
SP ICR (n = 101) and MP ICR (n = 156) patients were included in the study. Visual analogue scale scores were significantly lower after SP ICR on postoperative day 1 (P = 0.016) and day 2 (P = 0.04). Analgesia requirements were significantly reduced on postoperative day 2 in the SP group compared with the MP group (P = 0.007). Duration of surgery, conversion to open surgery and stoma rates were comparable between the two groups. Surgery was more complex in terms of additional procedures when MP was adopted (P = 0.001). There were no differences in postoperative complication rates, postoperative food intake, length of stay and readmissions.Conclusion
These data suggest that in comparison to standard laparoscopic surgery SP ICR might be less painful and patients might require less opioid analgesia. 相似文献18.
Study design
Report of case series 相似文献19.
Robert E. Gutman Catherine S. Bradley Wen Ye Alayne D. Markland William E. Whitehead Mary P. Fitzgerald 《International urogynecology journal》2010,21(4):461-466
Introduction and hypothesis
Our objective was to evaluate bowel symptoms after colpocleisis. 相似文献20.
Jonas Leo Goran Filipovic Julia Krementsova Rickard Norblad Mattias Söderholm Erik Nilsson 《BMC surgery》2006,6(1):5-6