The feasibility of disposable video-bronchoscopes, Ambu aScope3, for exploration of the common bile duct and extraction of stones.

Introduction: The aim of this study was to assess and evaluate the feasibility of using the Ambu aScope3 (aScope) for common bile duct (CBD) explorations, stone detection and extraction, as well as to assess feasibility of its use through the laparoscopic ports in a low-volume centre. Methods: This is a dual centre prospective study, conducted between February 2015 and August 2019, of patients undergoing laparoscopic cholecystectomy and common bile duct exploration. Ethical approval was obtained from the North West - Greater Manchester South Research Ethics Committee. All patients were counselled on the use of the aScope in clinic, prior to surgery. The Primary endpoints were the ability of the aScope to identify CBD stones, perform a cholangiogram through the available channel, retrieve the stones using a Dormia basket and to visualise second generation biliary radicles satisfactorily. The secondary endpoint was the use of the aScope, via a laparoscopic port without a gas leak. The data collected included patient demographics, need for a CBD exploration, intraoperative confirmation of CBD stones and their safe extraction using an aScope. Results: A total of nine patients were recruited. The aScope provided satisfactory views in eight of nine patients and enabled the safe extraction of CBD stones in six of nine cases. One patient had a bile leak, and another had a transected CBD prior to the use of the aScope. Conclusion: We found that the aScope is a safe, feasible alternative to a choledochoscope, and in a low-volume centre, it provides a financially viable option.

The introduction of an emergency safety protocol coupled with simulation training in robotic surgery, has enabled a more cohesive and efficient response to emergencies.

With the increasing popularity of robotic surgery, arise a unique set of challenges. In-order to minimise the risk and optimise patient safety, teams need to anticipate these, plan and train to improve familiarity with the nuances of robotic surgery. Human factors and simulation training (ST) are now an integral part of surgery and we have extended these principles to our robotic practice. From our experience with emergencies and a thorough debrief, we have realised the importance of an emergency safety protocol (ESP) for the undocking of the robot, and how training with the correct systems in place optimises our non-technical skills and improves our efficiency. This protocol is used across all robotic specialties allowing for clear communication, situational awareness and role clarity, thereby reducing errors in a high-pressured environment. We aim to share our protocol, highlight the importance of ST and show that coupling of the ESP with ST, including addressing a disrupted power supply and how to avoid the resulting loss of image capture, is where our paper contributes to the current literature. There is a paucity in the literature regarding emergency undocking, and also techniques for avoiding power interruptions, for which we utilise the Uninterruptible Power Supply (UPS) system. By sharing experiences and systems used, we create an opportunity that will result in a culture of shared learning in the robotic community, thereby encouraging other robotic teams to review their protocols and training practices and adapt as necessary.