RESUMO
Advanced techniques in laparoscopic surgery have led to an increased need for appropriate training in instrument handling and dissection. Recent developments in computer video technology have facilitated critical analysis of surgical technique. Video deconstruction of oesophageal hiatal dissection during six laparoscopic fundoplication procedures was undertaken. The procedures were performed by surgeons with a wide range of surgical experience, and the investigators analysing performance were blinded to their level of training. Sequential five-second video segments were analysed in detail by 3 investigators. A taxonomy list was developed to describe individual types of movement. The number and time per movement was assessed and a degree of efficiency was assigned. An efficient movement was defined as one that advances the dissection towards a recognised goal. The total oesophageal dissection time varied from 10 minutes (min) to 25 min (mean 16 min). The mean number of actions performed was 173 (range 120-272). A mean of 7 min was spent separating tissues (range 5-13), with 6 min spent grasping and positioning tissue (range 3-8). The amount of time spent in inefficient movement varied from 3 to 14 min (mean 7 min). The greatest variation between operators was seen in the efficiency of tissue separation when using dissecting instruments. Inexperienced operators spent a lot more time performing additional movements such as scope cleaning, observation and instrument exchange. This technique of video deconstruction can identify key areas for improvement. This could be used for trainee assessment and to provide constructive feedback. Future development in this area could enhance training in advanced laparoscopic techniques.
RESUMO
A slow-growing mycobacterium was isolated from a cervical lymph node of an adolescent male. This isolate produced small, smooth, scotochromogenic colonies after 6 weeks of incubation at 25 degrees C and 30 degrees C (but not at 37 degrees C or 43 degrees C). The results of 16S-rRNA gene sequencing and high-performance liquid chromatography suggest that this isolate belongs to a hitherto unrecognised pathogenic species.
Assuntos
Infecções por Mycobacterium/microbiologia , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Tuberculose dos Linfonodos/microbiologia , Adolescente , Técnicas de Tipagem Bacteriana , Cromatografia Líquida de Alta Pressão , Humanos , Linfonodos/microbiologia , Masculino , Dados de Sequência Molecular , Mycobacterium/crescimento & desenvolvimento , Filogenia , RNA Ribossômico 16S/genética , Análise de Sequência de DNARESUMO
Ergonomic analysis of the tasks of endosurgery helps in the design of instruments and tasks, and in decreasing the mismatch between human capacities and technology. It requires the study of the constraints of working through narrow fixed ports and an understanding of how the processes of gripping and dividing tissue are determined by its mechanical properties. This formal approach may offer more than trial-and-error evolution and haphazard solutions to problems by quicker general answers, with shorter learning curves, greater productivity and fewer errors, and decreased operator frustration. The first and ultimate benefit is for patients undergoing endosurgery.
Assuntos
Endoscopia , Ergonomia , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Operatórios , Desenho de Equipamento , HumanosRESUMO
The durability and function of reusable and disposable laparoscopic instruments are compared, and the relative advantages and disadvantages of each are illustrated. Familiarity with the relevant issues described should allow surgeons to make informed choices on the most suitable instruments for their specific situation.
Assuntos
Equipamentos Descartáveis , Laparoscópios , Custos e Análise de Custo , Equipamentos Descartáveis/economia , Falha de Equipamento , Reutilização de Equipamento/economia , Reutilização de Equipamento/legislação & jurisprudência , Segurança de Equipamentos , Humanos , Responsabilidade Legal , Eliminação de Resíduos de Serviços de SaúdeRESUMO
Over a 10 year period, four patients with paraduodenal hernia were encountered. Two had small hernias that were incidental findings at the time of surgery for an unrelated abdominal condition; these were managed by suture closure of the neck of the sac. The other two patients presented with intestinal obstruction and are discussed here with a review of the literature.
Assuntos
Duodenopatias/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Hérnia/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-IdadeAssuntos
Constipação Intestinal/terapia , Abdome , Feminino , Humanos , Massagem , Pessoa de Meia-IdadeAssuntos
Transfusão de Sangue , Emergências , Adolescente , Adulto , Doadores de Sangue , Feminino , Hemorragia/terapia , Humanos , Masculino , Ferimentos e Lesões/complicaçõesRESUMO
Microsurgery presents special problems of visual information and fine manipulation, including tremor control. These problems can be studied usefully through ergonomics, the science of man at work, already used widely in industry. This paper presents factors affecting visual feedback, normal hand tremor, and instrument design, and refers to the process of skill acquisition and the care of surgical instruments.
