SATA-LRS: A modular and novel steerable hand-held laparoscopic instrument platform for low-resource settings☆.

BACKGROUND: Hospitals in low resource settings (LRS) can benefit from modern laparoscopic methodologies. However, cleaning, maintenance and costs requirements play a stronger role while training and technology are less available. Steerable laparoscopic instruments have additional requirements in these settings and need extra identified adaptations in their design. METHOD: Several modular detachability and tip steerability features were applied to the SATA-LRS instrument platform designed specifically for LRS. Ten subjects participated a dis- and reassembly experiment to validate the modularity, and in a steering experiment using a custom made set-up to validate steering. RESULTS: A new steerable SATA-LRS instrument was developed with the ability to exchange end-effectors through a disassembly of the shafts. Experiments showed an average 34 and 90 s for complete dis- and reassembly, respectively. Participants were able to handle the instrument independently after a single demonstration and 4 rounds of repetitions. Precise tip-target alignment in the box set-up showed a very short learning-curve of 6 repetitions. CONCLUSION: A novel instrument platform with articulating and rotating end-effector was designed for LRS. Within a minute the SATA-LRS can be disassembled to component level for inspection, cleaning, maintenance and repair, and can be autonomously reassembled by novices after a minimal training. The modular buildup is expected to reduce purchasing and repair costs. The instrument has been shown intuitive by use without extensive training.

Low-level laser therapy in ankle sprains: a randomized clinical trial.

OBJECTIVE: To test the efficacy of low-level laser therapy on lateral ankle sprains as an addition to a standardized treatment regimen, a trial was conducted in which high-dose laser (5J/cm2), low-dose laser (0.5J/cm2), and placebo laser therapy (0J/cm2) at skin level were compared. DESIGN: Randomized, double-blind, controlled clinical trial with a follow-up of 1 year. Patients, therapists, assessors, and analysts were blinded to the assigned treatment. SETTING: An ambulatory care setting. PATIENTS: After informed consent and verification of exclusion criteria, 217 patients with acute lateral ankle sprains were randomized to three groups from September 1, 1993, through December 31, 1995. INTERVENTIONS: Twelve treatments of 904nm laser therapy in 4 weeks as an adjunct to a standardized treatment regimen of 4 weeks of brace therapy combined with standardized home exercises and advice. The laser therapy device used was a 904nm Ga-As laser, with 25-watt peak power and 5,000 or 500Hz frequency, a pulse duration of 200nsec, and an irradiated area of 1cm2. PRIMARY OUTCOME MEASURES: Pain and function as reported by the patient. RESULTS: Intention-to-treat analysis of the short-term results showed no statistically significant difference on the primary outcome measure, pain (p = .41), although the placebo group showed slightly less pain. Function was significantly better in the placebo group at 10 days (p = .01) and 14 days (p = .03) after randomization. The placebo group also performed significantly better on days of sick leave (p = .02) and at some points for hindrance in activities in daily life and pressure pain, as well as subjective recovery (p = .05). Intention-to-treat analysis showed that total days of absenteeism from work and sports were remarkably lower in the placebo group than in the laser groups, ranging from 3.7 to 5.3 and 6 to 8 days, respectively. The total number of relapses at 1 year in the low-dose laser group (n = 22) was significantly higher (p = .04) than in the other two groups (high laser, n = 13; placebo, n = 13). Subgroup analysis to correct for possible confounders did not alter these findings. CONCLUSIONS: Neither high- nor low-dose laser therapy is effective in the treatment of lateral ankle sprains.

The prognosis of ankle sprains.

We developed a new diagnostic tool for predicting the severity of ankle sprains just after injury. Since hard data obtained by diagnostic imaging techniques are still imperfect, we decided to use data from individual medical history and signs and symptoms that are part of the admission routine. During a three month-period data were collected on thirty-five patients with lateral ankle sprains who visited the first aid department of the University Hospital of Maastricht. Assessments took place at admission and at two and four weeks after injury. Assessors were the first-aid physician, a physiotherapist and the patient. Dependent variables were healed ankle in two and four weeks. Predicting variables were the data obtained at admission by the physician, the physiotherapist and the patient. The ability to predict outcome after two and four weeks was determined in a bivariate analysis, followed by logistic modelling. Accurate prediction of recovery time at admission appeared to be possible. Best two weeks predictor was the modified function score, an accuracy of 97% was achieved. Four weeks prediction was most accurate when function score was used together with the report mark from the doctor and the palpation score (accuracy of 81%).