Name: emergency undocking in robotic surgery: a simulation curriculum
Uploaded: 2018-05-20T14:00:00.000+00:00
Duration: 6 min 48 s
Description: Watch this Scientific Journal Video about Emergency Undocking in Robotic Surgery: A Simulation Curriculum at JoVE.com

作者希望感谢医学模拟技术员杰瑞德设计的改良躯干, 和总结健康, 阿克伦校区手术室人员。这个项目没有外部资金。

irb 确定, 根据联邦定义的 45 CFR 46.101 类的豁免审查类别, 该项目免受 IRB 审查。
1. 收集和准备材料
<ol><li>为培训课程收集材料, 包括配备2训练臂的机器人系统 (参见材料表)、3套管针和腹腔镜。</li>
	<li>在空心训练躯干, 创造至少3个单独切口与手术刀放置腹腔镜仪器套管针。确保切口与机器人手术中发现的相同,即,在脐上方, 每一个右侧和左下象限大到足以容纳套管针。</li>
	<li>要模拟容器和随后的血管损伤, 请使用橡皮管创建容器。油管从水封胸腔排水功能良好。<ol>
<li>为腔静脉和降主动脉切开单独的管。</li>
		<li>用 Y 形连接器连接两个较短的片段, 分别复制右侧和左侧髂静脉, 两个较短的部分将共髂动脉复制到腔静脉和主动脉。</li>
		<li>在髂总动脉的远端建立一个凹槽, 允许模拟血液在血管损伤的情况下逃逸。</li>
		<li>将血管放在躯干后壁上, 用胶水固定。通过躯干的头侧部分向血管伸出通道, 以允许注入红色的食物有色液体。</li>
		<li>颜色作为必要的现实主义与油基红色和蓝色的动脉和静脉漆分别。涂有保护性的透明搪瓷喷雾剂, 经久耐用。</li>
	</ol>
</li>
	<li>获得1升的四液袋。注射红色食物着色, 直到液体有与血液一致的颜色。把这个包钩到以前组装的容器上。</li>
	<li>将躯干与手术室窗帘一起用于腹腔镜手术或开腹。确保悬垂覆盖整个或表格。</li>
	<li>有嵌入式标准化人员 (ESPs) 或同盟军, 以完成紧急脱位协议中规定的角色 (图 2)。至少需要4人。或者, 也可以使用人员来执行其实际角色。</li>
</ol>2. 手术室的设置
<ol><li>安置训练躯干, 完成与容器和 iv 管材, 并且连接它到 IV 液体袋子在或桌。将桌子放在陡峭的向健位置, 然后使用或窗帘。</li>
	<li>通过先前的切口将腹腔镜套管针进入训练躯干。将机器人病人侧推车移动到床边, 并将机器人手臂连接到套管针。一旦连接, 对接机器人训练仪器和相机的躯干使用套管针。</li>
	<li>将 ESPs 或工作人员置于所需的角色中, 如图 2所述。让外科医生控制台并准备好让外科医生控制机器人仪器。</li>
</ol>3. 模拟和汇报
<ol><li>让外科医生进入手术室并在外科医生的控制台上就位。指示外科医生调整位置设置, 但不能控制的仪器, 直到完成的方向的情况下。</li>
	<li>向外科医生介绍 ESPs 或工作人员。阅读图 3中显示的一个事例词根。然后, 指示外科医生在案件的完成后控制器械。</li>
	<li>麻醉电除尘器通过压力袋或手动泵送液袋, 一旦完成后, 由容器开始出血。IV 管应该是敞开的, 允许有轻快的流血。让外科医生5分钟完成紧急脱位。</li>
	<li>之后 (或5分钟后), 继续进行情景和程序的汇报和教诲部分。在报告中强调了在图 2中列出的人员角色的关键点, 包括仪表臂和病人侧推车的关键设备, 以及闭环通信的使用。</li>
	<li>重新定位 ESPs 或工作人员, 并运行第二个案例, 以加强在汇报过程中所讲授的课程。在这情况下, 重申在第二个案件中遗漏的任何问题。</li>
</ol>

<ol>
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R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiac+resuscitation+in+the+operating+room:+reflections+on+how+we+can+do+better.">Cardiac resuscitation in the operating room: reflections on how we can do better.</a> Can J Anaesth. 59 (6), 522-526 (2012).</li><li>Shaligram, A., Meyer, A., Simorov, A., Pallati, P., Oleynikov, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survey+of+minimally+invasive+general+surgery+fellows+training+in+robotic+surgery.">Survey of minimally invasive general surgery fellows training in robotic surgery.</a> J Robot Surg. 7 (2), 131-136 (2013).</li><li>Acero, N. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Managing+a+surgical+exsanguination+emergency+in+the+operating+room+through+simulation:+an+interdisciplinary+approach.">Managing a surgical exsanguination emergency in the operating room through simulation: an interdisciplinary approach.</a> J Surg Educ. 69 (6), 759-765 (2012).</li><li>Hoffman, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+of+robotic+radical+hysterectomy+using+the+porcine+model.">Simulation of robotic radical hysterectomy using the porcine model.</a> J Robot Surg. 6 (3), 237-239 (2012).</li><li>Goonewardene, S. S., Cahill, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+surgery,+skills+and+simulation:+a+technical+sport.">Robotic surgery, skills and simulation: a technical sport.</a> J Robot Surg. 10 (1), 85-86 (2016).</li><li>Meier, M., Horton, K., John, H. D. a. V. i. n. c. i. &. #. 1. 6. 9. ;. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Skills+Simulator&#8482;:+is+an+early+selection+of+talented+console+surgeons+possible.">Skills Simulator&#8482;: is an early selection of talented console surgeons possible.</a> J Robot Surg. 10 (4), 289-296 (2016).</li><li>Gaba, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+future+vision+of+simulation+in+health+care.">The future vision of simulation in health care.</a> Qual Saf Health Care. 13, i2-i10 (2004).</li><li>Salas, E., Wilson, K. A., Burke, C. S., Priest, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+simulation-based+training+to+improve+patient+safety:+what+does+it+take?.">Using simulation-based training to improve patient safety: what does it take?.</a> Jt Comm J Qual Patient Saf. 31 (7), 363-371 (2005).</li><li>McGaghie, W. C., Siddall, V. J., Mazmanian, P. E., Myers, J., Committee, A. C. o. C. P. H. a. S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lessons+for+continuing+medical+education+from+simulation+research+in+undergraduate+and+graduate+medical+education:+effectiveness+of+continuing+medical+education:+American+College+of+Chest+Physicians+Evidence-Based+Educational+Guidelines.">Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.</a> Chest. 135 (3 Suppl), 62S-68S (2009).</li><li>Paige, J. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-fidelity,+simulation-based,+interdisciplinary+operating+room+team+training+at+the+point+of+care.">High-fidelity, simulation-based, interdisciplinary operating room team training at the point of care.</a> Surgery. 145 (2), 138-146 (2009).</li><li>Moitra, V. K., Gabrielli, A., Maccioli, G. A., O'Connor, M. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anesthesia+advanced+circulatory+life+support.">Anesthesia advanced circulatory life support.</a> Can J Anaesth. 59 (6), 586-603 (2012).</li><li>Ziewacz, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Crisis+checklists+for+the+operating+room:+development+and+pilot+testing.">Crisis checklists for the operating room: development and pilot testing.</a> J Am Coll Surg. 213 (2), 212-217 (2011).</li><li>O'Sullivan, O. E., O'Sullivan, S., Hewitt, M., O'Reilly, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Da+Vinci+robot+emergency+undocking+protocol.">Da Vinci robot emergency undocking protocol.</a> J Robot Surg. 10 (3), 251-253 (2016).</li><li>Arriaga, A. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation-based+trial+of+surgical-crisis+checklists.">Simulation-based trial of surgical-crisis checklists.</a> N Engl J Med. 368 (3), 246-253 (2013).</li></ol>

作者没有什么可透露的。

将这一课程纳入培训需要遵守上文概述的《议定书》。确保通过手训练紧急脱位的技术方面, 以及界定或人员的作用, 对成功的培训至关重要。所有三次培训前模拟、汇报和培训后模拟都可能需要, 以确保学习者获得最大的利益。
应该努力创造尽可能现实的学习环境。虽然使用就地环境不是强制性的, 但鼓励在实际或环境中确定任何后勤障碍或潜在安全威胁, 以阻止紧急脱位的完成。另一个重要的细节是在训练场景中使用的容器。选择一个持久和现实的材料是必不可少的, 因为学习者可以尝试任何数量的技术, 以获得止血取决于他们的技能水平。理想的容器设计应该能够经受反复的模拟。
实施这一课程的一个主要限制是缺乏教员或工作人员进行模拟或汇报培训。本课程的目标之一是清楚地编排材料所需的内容, 并设置以确保成功的模拟。提供或进行培训可能是一个限制, 但在紧急脱位的情况下, 在实际的临床环境中查明意外的障碍的重要性是非常宝贵的。骨盆模型的资源也可能是一些限制。虽然对模型的修改是为了重复使用而设计的, 但有些机构可能没有培训模式。在这项研究中, 有许多可负担得起的替代品。
这一培训课程的意义在于, 它是一个单一的工具, 不仅用来教授紧急脱位的程序技能, 还可以为整个 interprofessional 团队建立角色。现场环境为模拟增加了现实主义水平, 实践训练为巩固程序知识提供了一个行之有效的工具。
本课程可用于将来的应用, 包括修改, 以便与在机器人手术中涉及灾难性事件的其他案例场景一起使用。虽然这个课程的重点是妇产科机器人外科医生, 它可以扩展到使用与泌尿外科和普通外科机器人外科医生。改良后的躯干可用于任何腹腔镜手术的教学或急救, 而不仅仅是机器人手术。

这项培训的目的是提高机器人外科医生的信心, 知识和熟练程度的执行紧急脱位的机器人系统, 并提高外科医生的能力, 带领 interprofessional 团队通过有效的在紧急脱位时明确划定的角色的沟通。尽管手术室里有大量的人员和设备, 但缺乏管理这些危机的经验1,2。目前在线课程工作的培训要求和短时间的监考案例让许多外科医生觉得他们的训练不足3。不管这些不充分的感觉, 以前的研究已经证实, 外科医生在他们的职业生涯中至少会遇到1或紧急情况4。改进这些不足感的策略包括增加模拟训练的使用5。仿真训练与外科教育6是密不可分的。先前的研究已经确定, 基于仿真的团队培训是帮助学习者克服外科教育中认知和行为差距的宝贵工具, 并且作为一种工具, 可以让学员在与其他团队成员的会话中有能力演示知识和沟通技巧的基线, 同时改进模拟练习和任务汇报后的性能4,7,8,9, 10,11。
为了改进机器人危机管理, 已开发了各种模拟器培训方案1,12,13。尽管已经有许多研究团队培训的影响, 但对于复杂或方案4的研究分析培训缺乏。在复杂或紧急情况下, 核对清单和通过有效的沟通明确划定的作用是至关重要的。在机器人外科手术中, 缺乏可用的文献概述协议或培训此过程14。模拟已证明有效的验证检查表中使用的手术室危机, 以改善外科护理15。在这里, 我们提出了一个培训课程, 让机器人外科医生开发必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。本课程的实施在现场环境中进行三次以上, 如图 1所示, 可用于为认证提供培训、演示技能, 并且在任何医院都能轻松重现, 并具有机器人系统。

<table><tbody><tr><td>ZOE Gynecologic Simulator</td><td>Gaumard</td><td>S504.100</td><td>Incisions placed above umbilicus and in right and left lower quadrants large enough to pass trochars through. Vessels as detailed below. Tubing used to make aorta spliting into common iliacs as well as inferior vena cava.&amp;nbsp;</td></tr><tr><td>da Vinci Si Robotic System</td><td>Intuitive Surgical</td><td></td><td></td></tr><tr><td>Tubing from Atrium Water Seal Chest Drain</td><td>Atrium</td><td></td><td>Suction tubing removed an colored</td></tr><tr><td>Chest Tube Y-connector&amp;nbsp;</td><td>Sorin Group</td><td>050525-000</td><td>Connected to suction tubing for split from descending aorta to right and left iliac vessels</td></tr><tr><td>Reeve&#039;s Oil Colour Paint Set</td><td>Reeves</td><td></td><td>Coloring for venous and arterial vessel (Red and Blue)</td></tr><tr><td>Rust-oleum Clear Coat Enamel Spray</td><td>Rust-oleum</td><td></td><td>Coating for protection of vessels coloring</td></tr></tbody></table>

emergency undocking in robotic surgery: a simulation curriculum

以下是一个训练平台, 让机器人外科医生开发出必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。在对外科医生的传统机器人训练中, 对机器人系统进行初步的入门培训时提供了一个简短的基于 web 的执行紧急脱位的概述。在这一过程中, 没有为手术室 (或) 人员划定跨学科角色的培训。这里所提供的培训使用形成性模拟和汇报, 接着是一个讲座。对于模拟, 一个改良的妇科模拟器被覆盖在一个陡峭的向健位置与大多数妇科腹腔镜手术一致。训练躯干是修改使用的油管挂钩的红食品彩色 IV 流体压力袋, 用于模拟灾难性的船只受伤的需求。定位在整个手术室设置是一个 interprofessional 团队组成的嵌入式标准化人员 (ESPs), 以履行职能的循环护士, 擦洗护士, 麻醉师和床边协助外科医生。机器人外科医生被提出的情况下, 有必要紧急脱位, 并给予控制的机器人仪器。该方案在成功完成紧急移除后终止, 或在五分钟内由于该案件的突发性质。在模拟过程中, 将向您提供关于紧急脱位、必要设备、故障排除技术和手术室人员角色培训步骤的简报。学习者被介绍了一个简短的演讲 reemphasizing 的材料提出的报告为他们自己的自学。这项培训的结果是, 更多的时间进入病人, 改善知识, 信心和完成关键行动, 并可以复制在大多数机构。所有的机器人外科医生都应该能够在这个关键的干预中表现出能力。课程的限制是为培训目的进入现场环境的能力。

通过将此课程纳入图 1和图 2中概述的脱位协议, 在机器人辅助手术训练过程中, 我们的研究显示了信心、知识和关键的全面改善。由外科医生执行的操作, 如图 3所示。在参加课程之前, 所有参加者都收集了关于知识和信心的基线测量。20题多选考试和6项李克特置信度范围从非常不舒服到非常舒适提供了这个基线。在我们的培训课程实施后, 机器人外科医生知识的基线水平显著提高 (p = 0.001;魏氏的中值变化的秩测试等于 0), 我们的结果也表明, 在我们的课程完成后, 当面临紧急脱位时, 外科医生的信心增加 (p = 0.003) (表 1,图 4).这可能表明, 利用机器人在训练过程中的模拟, 可以有利于机器人外科医生通过提高信心和熟悉的紧急协议。在脱位时间 (p < 0.001) 中也有一个改进, 并增加了7种可能的测量操作 (p = 0.002) (表 2,图 4) 中执行的关键操作。这可能意味着机器人外科医生能够更快地认识到紧急脱位的需要, 并有机会模拟整个紧急脱位过程, 同时带领团队在原位环境中立即课程完成后, 内容专家的反馈。必须在培训人员执行本议定书方面保持一致, 以确保外科医生之间的一致性, 并在现实生活中最大限度地发挥效用。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/57286/57286fig1.jpg"> 图 1: 培训前模拟、汇报和教学内容的课程大纲以及培训后模拟.<a href="/files/ftp_upload/57286/57286fig1large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/57286/57286fig2.jpg"> 图 2: 紧急脱位角色.<a href="/files/ftp_upload/57286/57286fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/57286/57286fig3.jpg"> 图 3: 事例词根读取以启动模拟.<a href="/files/ftp_upload/57286/Case_Stems.pdf">请单击此处下载此文件.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/57286/57286fig4.jpg"> 图 4: 统计显著结果的摘要图 (中四分位范围)。<a href="/files/ftp_upload/57286/57286fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td></td>
			<td>学习队列</td>
		</tr>
<tr>
<td>变量/统计</td>
			<td>(n = 21)</td>
		</tr>
<tr>
<td>基线知识评分 (20)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>10.0 (1.82)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>10 (8.5-11.5)</td>
		</tr>
<tr>
<td>范围</td>
			<td>7-13</td>
		</tr>
<tr>
<td>后基线知识分数 (20)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>12.4 (1.29)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>13 (12-13)</td>
		</tr>
<tr>
<td>范围</td>
			<td>9-14</td>
		</tr>
<tr>
<td>知识分数的变化</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>2.4 (2.20)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>3 (1-4.5)</td>
		</tr>
<tr>
<td>范围</td>
			<td>-2-5</td>
		</tr>
<tr>
<td>P</td>
			<td>0.001</td>
		</tr>
<tr>
<td>基线总置信度 (最大 75)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>38.5 (12.43)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>40 (33-48)</td>
		</tr>
<tr>
<td>范围</td>
			<td>15-62</td>
		</tr>
<tr>
<td>后基线总置信度 (75)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>58.9 (13.65)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>61.5 (53.75-69.25)</td>
		</tr>
<tr>
<td>范围</td>
			<td>25-74</td>
		</tr>
<tr>
<td>完全信任的变化</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>20.1 (19.93)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>18 (6-30.5)</td>
		</tr>
<tr>
<td>范围</td>
			<td>-15-58</td>
		</tr>
<tr>
<td>P</td>
			<td>0.003</td>
		</tr>
</tbody></table>表 1: 基线/后模拟知识和参与者的完全信任.p从魏氏有符号秩测试中中值变化等于0。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td></td>
			<td>学习队列</td>
		</tr>
<tr>
<td>变量/统计</td>
			<td>(n = 21)</td>
		</tr>
<tr>
<td>基线脱位时间 (秒)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>146.1 (40.01)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>139 (116.5-169)</td>
		</tr>
<tr>
<td>范围</td>
			<td>88-254</td>
		</tr>
<tr>
<td>后基线脱位时间 (秒)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>89.6 (18.20)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>89 (76-104.5)</td>
		</tr>
<tr>
<td>范围</td>
			<td>59-120</td>
		</tr>
<tr>
<td>脱位时间的变化 (秒)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>-56.5 (41.95)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>-50 (-81.5-23.5)</td>
		</tr>
<tr>
<td>范围</td>
			<td>-151--2</td>
		</tr>
<tr>
<td>P</td>
			<td>< 0.001</td>
		</tr>
<tr>
<td colspan="2">执行的基线关键操作 (出 7)</td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>4.3 (1.06)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>4 (3-5)</td>
		</tr>
<tr>
<td>范围</td>
			<td>3-6</td>
		</tr>
<tr>
<td>执行的基线后关键操作 (出 7)</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>5.3 (0.78)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>5 (5-6)</td>
		</tr>
<tr>
<td>范围</td>
			<td>3-6</td>
		</tr>
<tr>
<td>执行的关键操作的更改</td>
			<td></td>
		</tr>
<tr>
<td>平均值 (SD)</td>
			<td>1.0 (1.05)</td>
		</tr>
<tr>
<td>中位数 (IQR)</td>
			<td>1 (0-2)</td>
		</tr>
<tr>
<td>范围</td>
			<td>-1-3</td>
		</tr>
<tr>
<td>P</td>
			<td>0.002</td>
		</tr>
</tbody></table>表 2: 基线/后模拟脱位时间和完成关键操作.p从魏氏有符号秩测试中中值变化等于0。

Watch this Scientific Journal Video about Emergency Undocking in Robotic Surgery: A Simulation Curriculum at JoVE.com

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

机器人手术中的紧急脱位: 一个模拟课程

这一训练平台的目的是让机器人外科医生开发必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。培训包括利用技术和设备来执行紧急脱位, 以及为这种情况划分角色。

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

emergency-undocking-in-robotic-surgery-a-simulation-curriculum

Nanyang Technological University

Research

JoVE Journal

Medicine

9.1K 次观看.  Summa Health. 这一训练平台的目的是让机器人外科医生开发必要的技能, 以领导一个 interprofessional 团队在紧急脱位的机器人系统。培训包括利用技术和设备来执行紧急脱位, 以及为这种情况划分角色。

视频: Emergency Undocking in Robotic Surgery: A Simulation Curriculum

Robotic Pancreatoduodenectomy for Pancreatic Head Cancer: a Case Report of a Standardized Technique

Robotic pancreatoduodenectomy (RPD) for pancreatic cancer is a challenging procedure. Aberrant vasculature may increase the technical difficulty. Several studies have described the safety of RPD in case of a replaced or aberrant right hepatic artery, but detailed video descriptions of the approach are lacking. This case report describes a step-&#173;by-&#173;step technical video in case of a replaced right hepatic artery. A 58-year-old woman presented with an incidental finding of a 1.7 cm pancreatic head mass. RPD was performed using the da Vinci Xi system and involves a robotic-assisted pancreatico- and hepatico-jejunostomy and open gastro-jejunostomy at the specimen extraction site. The operation time was 410 min with 220 mL of blood loss. The patient had an uncomplicated postoperative course and was discharged after 5 days. Pathology revealed a pancreatic head cancer. RPD is a feasible and safe procedure in case of a replaced hepatic artery when performed in selected patients in high-volume centers by experienced surgeons.

Robotic pancreatoduodenctomy (RPD) has been highly standardized in recent years and may be used in selected patients with pancreatic head cancer, including those with a replaced right hepatic artery. This case report describes a standardized and reproducible technique for RPD, which includes the approach of the Dutch LAELAPS-3 training program to an aberrant vasculature.

胰腺头癌机器人胰十二指肠切除术:标准化技术的病例报告

Robotic pancreatoduodenectomy (RPD) for pancreatic cancer is a challenging procedure. Aberrant vasculature may increase the technical difficulty. Several ...

科研

癌症研究

A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. Transiliac-transsacral screws provide a longer lever arm to withstand the perpendicular vertical shear forces. However, the screw channel is so long that a minor discrepancy can lead to iatrogenic neurovascular injuries. The development of medical robots has improved the precision of surgery. The present protocol describes how to use a new teleoperated robotic system to execute transiliac-transacral screw fixation. The Robot was operated remotely to position the entry point and adjust the orientation of the sleeve. The screw positions were evaluated using postoperative computed tomography (CT). All the screws were safely implanted, as confirmed using intraoperative fluoroscopy. Postoperative CT confirmed that all the screws were in the cancellous bone. This system combines the doctor's initiative with the Robot's stability. The remote control of this procedure is possible. Robot-assisted surgery has a higher position-retention capacity compared with conventional methods. In contrast to active robotic systems, surgeons have full control over the operation. The robot system is fully compatible with operating room systems and does not require additional equipment.

Teleoperated robotic system-assisted percutaneous transiliac-transsacral screw fixation is a feasible technique. Screw channels can be implemented with high accuracy owing to the excellent freedom of movement and stability of the robotic arms.

一种远程操作机器人系统辅助经皮经髂骶螺钉固定技术

Transiliac-transsacral screw fixation is challenging in clinical practice as the screws need to break through six layers of cortical bone. ...

工程学

Simulator Training for Endovascular Neurosurgery

Simulation-based training has become common practice across medical specialties, especially for learning complex skills performed in high-risk environments. In the field of endovascular neurosurgery, the demand for consequence- and risk-free learning environments led to the development of simulation devices valuable for medical trainees. The goal of this protocol is to provide instructive guidelines for the use of an endovascular neurosurgery simulator in an academic setting. The simulator provides trainees with the opportunity to receive realistic feedback on their knowledge of anatomy, as well as haptic feedback indicative of their success in handling the catheter-based systems without negative consequences. The utility of this specific protocol in relation to other neuroendovascular training modalities is also discussed.

Simulation of complex, high-risk procedures is critical to the education of medical trainees. A protocol for simulator-based endovascular neurosurgery training in a controlled academic environment is described. The protocol includes stepwise guidelines for trainees of varying levels, with a discussion of the advantages and limitations of this model.

血管内神经外科模拟器培训

Simulation-based training has become common practice across medical specialties, especially for learning complex skills performed in high-risk ...

神经科学

Technical Detail for Robot Assisted Pancreaticoduodenectomy

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic platform, including three-dimensional vision, wristed instruments, and improved ergonomics, allow the surgeon to recapitulate the principles of open pancreatoduodenectomy allowing safe oncologic dissection, hemostasis, and meticulous reconstruction. Over the course of the past decade, significant strides have been achieved in outlining the safety, feasibility, and learning curve of the robotic Whipple. When performed by high volume pancreatic surgeons experienced in RPD, recent comparative effectiveness studies show potential advantages compared to the open technique, including reductions in hospital stay and morbidity. National data also show reductions in conversion rates compared to its laparoscopic counterpart. Although long-term oncologic data are still needed, short-term oncologic surrogates of margin resection and lymph node harvest suggest no compromise in oncologic outcomes. As pancreatic surgeons increasingly integrate robotics into their practice, proficiency-based training and credentialing will be necessary for the safe application and dissemination of RPD. Here, we provide the detailed steps of a robotic pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.&#160;

The following manuscript details a stepwise approach to the robot-assisted pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.

机器人辅助胰腺切除术的技术细节

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

医学

Robotized Testing of Camera Positions to Determine Ideal Configuration for Stereo 3D Visualization of Open-Heart Surgery

Stereo 3D video from surgical procedures can be highly valuable for medical education and improve clinical communication. But access to the operating room and the surgical field is restricted. It is a sterile environment, and the physical space is crowded with surgical staff and technical equipment. In this setting, unobscured capture and realistic reproduction of the surgical procedures are difficult. This paper presents a method for rapid and reliable data collection of stereoscopic 3D videos at different camera baseline distances and distances of convergence. To collect test data with minimum interference during surgery, with high precision and repeatability, the cameras were attached to each hand of a dual-arm robot. The robot was ceiling-mounted in the operating room. It was programmed to perform a timed sequence of synchronized camera movements stepping through a range of test positions with baseline distance between 50-240 mm at incremental steps of 10 mm, and at two convergence distances of 1100 mm and 1400 mm. Surgery was paused to allow 40 consecutive 5-s video samples. A total of 10 surgical scenarios were recorded.

The human depth perception of 3D stereo videos depends on the camera separation, point of convergence, distance to, and familiarity of the object. This paper presents a robotized method for rapid and reliable test data collection during live open-heart surgery to determine the ideal camera configuration.

相机位置的机器人化测试，以确定心脏直视手术立体3D可视化的理想配置

Stereo 3D video from surgical procedures can be highly valuable for medical education and improve clinical communication. But access to the operating room ...

Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy

Central pancreatectomy is a parenchyma-sparing alternative to distal pancreatectomy in patients with a benign or low-grade malignant tumor in the body of the pancreas. The aim of central pancreatectomy is to prevent postoperative life-long endocrine and exocrine insufficiency. The downside of central pancreatectomy is the high rate of postoperative pancreatic fistula, which is the main reason that many surgeons do not routinely use central pancreatectomy in eligible patients. Most studies report open or laparoscopic central pancreatectomy with a pancreatico-gastrostomy anastomosis in adults. This is the first description of a standardized approach to robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy reconstruction in an adolescent (16-year-old boy) with a pseudopapillary tumor in the body of the pancreas. The operation time was 248 min with 20 mL of blood loss. The postoperative course was uneventful except for the short-term medical treatment for a grade B pancreatic fistula. Robotic central pancreatectomy can be safely applied in selected patients in experienced centers.

Robotic central pancreatectomy may be used in selected patients in experienced centers. This protocol presents all steps and the feasibility of a robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy in a 16-year-old adolescent patient.

机器人中央胰腺切除术与鲁恩-Y胰腺切除术

Central pancreatectomy is a parenchyma-sparing alternative to distal pancreatectomy in patients with a benign or low-grade malignant tumor in the body of ...

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. Surgery is the cornerstone treatment for patients with BC. While total BC excision and Roux-Y hepaticojejunostomy is the treatment method of the choice in patients with extrahepatic BC (i.e., Todani I-IV), patients with intrahepatic BC (i.e., Todani V) benefit the most from a surgical liver resection. In recent years, minimally invasive liver surgery (MILS) including robotic MILS has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. Robotic major MILS is still considered technically demanding and a detailed description of the technical approach during robotic major MILS has only been limitedly discussed in the literature. The current article describes the main steps for a robotic left hepatectomy in a patient with a large BC Todani Type V. The patient is in French position with 5 trocars placed (4 robotic, 1 laparoscopic assistant). After mobilizing the left hemiliver, the left and right hepatic artery are dissected carefully followed by a cholecystectomy. Intraoperative ultrasound is performed to confirm localization and margins of the BC. The Left hepatic artery and left portal vein are isolated, clipped, and divided. Indocyanine green (ICG) fluorescence imaging is used regularly during the entire procedure to visualize and confirm biliary tract anatomy and the BC. Parenchymal transection is performed with robotic cautery hook for the superficial part and robotic cautery spatula, bipolar cautery, and vessel sealer for the deeper parenchyma. The postoperative course was uncomplicated. A robotic left hepatectomy is technically demanding, yet a feasible and safe procedure. ICG-fluorescence imaging aids in delineating the BC and bile duct anatomy. Further, comparative studies are needed to confirm clinical benefits of robotic MILS for benign and malignant indications.

Robotic liver surgery has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. However, robotic left hepatectomy is still technically demanding. We describe our surgical technique of a robotic left hepatectomy using indocyanine green fluorescence imaging for a large biliary cyst.

使用吲哚菁绿荧光成像进行机器人左肝切除术治疗肝内复合胆囊肿

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. ...

Retzius-Sparing Robot-Assisted Radical Prostatectomy

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The technique is described step-by-step and further illustrated by a video to enhance reproducibility. Early oncological and functional results were evaluated. In total, 77 patients were included with a median follow-up of 11 months (range: 3-21 months). Fifty-one percent of patients had local high-risk or locally advanced prostate cancer. There were no intra-operative complications, and all high-grade complications (2.6%) were related to pelvic lymph node dissection performed concomitant with RS-RARP. Median operation time was 160 min (range: 122-265 min) and median hospital stay was 3 (range: 3-8) days. A positive surgical margin was reported in 42.9%. One-year biochemical recurrence-free survival was 90.1%. After 6 months, all patients were socially continent and after 1 year, 94.3% were fully continent. Of sexually active patients who underwent at least unilateral nerve-sparing, 43.3% were able to have sexual intercourse. This series underlines the surgical safety of performing RS-RARP by a standardized technique and confirms the beneficial effect on the early return of continence. The patient needs to be informed about the risk of a positive surgical margin.

Robot-assisted Retzius-sparing radical prostatectomy is a technique that enables to preserve urinary continence or facilitates recovery of urinary continence in the majority of patients. Patients must be informed about the risk of a positive surgical margin.

保留 retzius 机器人辅助根治性前列腺切除术

The technique of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and initial experience with it at a single center are provided. The ...

Robotic Cochlear Implantation for Direct Cochlear Access

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of the clinical workflow for robotic cochlear implantation using a robotic system specifically developed for a minimally invasive, direct cochlear access. The clinical workflow involves experts from various disciplines and requires training to ensure a smooth and safe procedure. The protocol briefly summarizes the history of robotic cochlear implantation. The clinical sequence is explained in detail, beginning with the assessment of patient eligibility and covering surgical preparation, preoperative planning with the special planning software, drilling of the middle ear access, intraoperative imaging to confirm the trajectory, milling of the inner ear access, insertion of the electrode array, and implant management. The steps that require special attention are discussed. As an example, the postoperative outcome of robotic cochlear implantation in a patient with advanced otosclerosis is presented. Finally, the procedure is discussed in the context of the authors' experience.

Robotic cochlear implantation is a procedure for minimally invasive inner ear access. Compared to conventional surgery, robotic cochlear implantation involves additional steps that need to be carried out in the operating room. In this article we give a description of the procedure and highlight the important aspects of robotic cochlear implantation.

用于直接访问人工耳蜗的机器人人工耳蜗植入

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of ...

Robotic D3 Partial Duodenal Resection with Primary Side-to-Side Anastomosis

Duodenal stenosis is a condition that can be related to several diseases, being either intrinsic, such as neoplasm and inflammatory stenosis, or extrinsic, such as pancreatic pseudocyst, superior mesenteric artery syndrome, and foreign bodies. Current treatments range from endoscopic approaches, such as endoscopic resection and stent placement, to surgical approaches, including duodenal resection, pancreaticoduodenectomy, and gastrointestinal bypass. Minimally invasive robot-assisted surgery is gaining importance due to its potential to decrease surgical stress, intraoperative blood loss, and postoperative pain, while its instruments and 3D-vision facilitate fine dissection and intra-abdominal suturing, all leading to a reduced time to functional recovery and shorter hospital stay. We present a case of a 75-year-old female who underwent robotic D3 partial duodenal resection with primary side-to-side duodeno-jejunal anastomosis for a 5 cm adenoma with focal high-grade dysplasia.

This protocol presents a case of a robotic partial duodenal resection with primary side-to-side duodeno-jejunal reconstruction in a patient with a 5 cm duodenal stenosis. This is done at the third duodenal segment (D3) after an endoscopic mucosal resection (EMR) for a duodenal polyp.