Chapters authored
Ergonomics in Laparoscopic Surgery By Francisco M. Sánchez-Margallo and Juan A. Sánchez-Margallo
Despite the many advantages for patients, laparoscopic surgery entails certain ergonomic inconveniences for surgeons, which may result in decreasing the surgeons’ performance and musculoskeletal disorders. In this chapter, the current status of ergonomics in laparoscopy, laparoendoscopic single‐site surgery (LESS), and robot‐assisted surgery will be reviewed. Ergonomic guidelines for laparoscopic surgical practice and methods for ergonomic assessment in surgery will be described. Results will be based on the scientific literature and our experience. Results showed that the surgeon's posture during laparoscopic surgery is mainly affected by the static body postures, the height of the operating table, the design of the surgical instruments, the position of the main screen, and the use of foot pedals. Ergonomics during the laparoscopic surgical practice is related to the level of experience. Better ergonomic conditions entail an improvement in task performance. Laparoscopic instruments with axial handle lead to a more ergonomic posture for the wrist compared to a ring handle. LESS is physically more demanding than conventional and hybrid approaches, requiring greater level of muscular activity in the back and arm muscles, but better wrist position compared with traditional laparoscopy. Physical and cognitive ergonomics with robotic assistance were significantly less challenging when compared to conventional laparoscopic surgery.
Part of the book: Laparoscopic Surgery
Laparoscopic Pancreas Surgery: Image Guidance Solutions By Juan A. Sánchez-Margallo, Thomas Langø, Erlend F. Hofstad,
Ronald Mårvik and Francisco M. Sánchez-Margallo
Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause of cancer-related deaths. Surgery is the only viable treatment, but irradical resection rates are still high. Laparoscopic pancreatic surgery has some technical limitations for surgeons and tumor identification may be challenging. Image-guided techniques provide intraoperative margin assessment and visualization methods, which may be advantageous in guiding the surgeon to achieve curative resections and therefore improve the surgical outcomes. In this chapter, current available laparoscopic surgical approaches and image-guided techniques for pancreatic surgery are reviewed. Surgical outcomes of pancreaticoduodenectomy and distal pancreatectomy performed by laparoscopy, laparoendoscopic single-site surgery (LESS), and robotic surgery are included and analyzed. Besides, image-guided techniques such as intraoperative near-infrared fluorescence imaging and surgical navigation are presented as emerging techniques. Results show that minimally invasive procedures reported a reduction of blood loss, reduced length of hospital stay, and positive resection margins, as well as an improvement in spleen-preserving rates, when compared to open surgery. Studies reported that fluorescence-guided pancreatic surgery might be beneficial in cases where the pancreatic anatomy is difficult to identify. The first approach of a surgical navigation system for guidance during pancreatic resection procedures is presented, combining preoperative images (CT and MRI) with intraoperative laparoscopic ultrasound imaging.
Part of the book: Laparoscopic Surgery
Handheld Devices for Laparoscopic Surgery By Francisco M. Sánchez-Margallo, Juan A. Sánchez-Margallo and Amir
Szold
Despite the well-known benefits of minimally invasive surgery (MIS) to the patients, this surgical technique implies some technical challenges for surgeons. These technical limitations are increased with the introduction of laparoendoscopic single-site (LESS) surgery. In order to overcome some of these technical difficulties, new handheld devices have been developed, providing improved functionalities along with precision-driven and articulating instrument tips. In this chapter, we will review the current status of handheld devices for laparoscopy and LESS surgery. Devices that provide additional and innovative functionalities in comparison with conventional surgical instruments will be considered. Results will be based on studies published in the scientific literature and our experience. These surgical devices will be organized into two main groups, mechanical devices and robotic-driven devices. In general, these instruments intend to simulate the dexterity of movements of a human wrist. Mechanical devices are cheaper and easier to develop, so most of the available handheld instruments fall into this category. The majority of the robotic-driven devices are needle holders with an articulating tip, controlled by an interface implemented on the instrument handle. In general, these handheld devices claim to offer an enhancement of dexterity, precision, and ergonomics.
Part of the book: New Horizons in Laparoscopic Surgery
Advanced Ergonomics in Laparoscopic Surgery By Kostas Gianikellis, Andreas Skiadopoulos, Rafael Gutiérrez Horrillo, Miguel Rodal, Juan Alberto Sánchez-Margallo and Francisco M. Sánchez-Margallo
Applied ergonomics is very important in minimally invasive surgery (MIS), especially with the introduction of robotized techniques that have changed the surgeons’ work conditions. However, the main aim remains the engineering to enable the compatibility of fulfillment of surgeons’ tasks in a physical, logical, and organizational environment with security, comfort, and efficiency. Ergonomics contribution is oriented both to design and redesign utilized material and to work organization. Epidemiological studies have shown the appearance of musculoskeletal pathologies in surgeons performing MIS; therefore, it is relevant to identify the intensity, frequency, and duration of risk factors (posture, repeatability, level of effort, touch pressure, and vibration if relevant) associated with this profession. A further relevant consequence of the effort applied during MIS is local muscle fatigue (LMF), an important factor to consider in musculoskeletal pathologies. The aim of this chapter is to present different methodological approaches by employing most advanced technologies to define the most appropriate posture that surgeons should adopt during MIS to decrease LMF apparition risk level and at the same time to increase capacity to variate the posture without reducing the precision task performance.
Part of the book: Recent Advances in Laparoscopic Surgery
Wearable Technology for Assessment and Surgical Assistance in Minimally Invasive Surgery By Juan A. Sánchez-Margallo, José Castillo Rabazo, Carlos Plaza de Miguel, Peter Gloor, David Durán Rey, Manuel Ramón González-Portillo, Isabel López Agudelo and Francisco M. Sánchez-Margallo
Wearable technology is an emerging field that has the potential to revolutionize healthcare. Advances in sensors, augmented reality devices, the internet of things, and artificial intelligence offer clinically relevant and promising functionalities in the field of surgery. Apart from its well-known benefits for the patient, minimally invasive surgery (MIS) is a technically demanding surgical discipline for the surgeon. In this regard, wearable technology has been used in various fields of application in MIS such as the assessment of the surgeon’s ergonomic conditions, interaction with the patient or the quality of surgical performance, as well as in providing tools for surgical planning and assistance during surgery. The aim of this chapter is to provide an overview based on the scientific literature and our experience regarding the use of wearable technology in MIS, both in experimental and clinical settings.
Part of the book: Advances in Minimally Invasive Surgery
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