2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH POSTER ABSTRACTS
and ambient atmosphere provides several cost benefits like
valve less simple trocars, suction aspiration without loss of
work space, simplified hand instruments. It obviates deleterious
effects of CO2 by maintaining a work space at ambient
pressure, temperature and humidity. If feasible in clinical practice
this device could help spread the benefits of MAS to all
people in all places.
TP011
THE USE OF ACCELEROMETER DATA TO TRACK AND QUAN-
TIFY LEARNING DURING TRAINING ON VIRTUAL LAPARO-
SCOPIC SKILL MODULES, Michael J Dancisak PhD, James
Korndorffer MD,Michelle J Pinette BS, Department of Exercise
and Sport Sciences, 2Department of Surgery, 3Department of
Biomedical Engineering, Tulane University, New Orleans, LA
Objective of the Technology
Accelerometer data have been successfully utilized to track
and quantify reaching and grasping movements in infants and
adult populations. Previous studies have used temporal measures
such as time to peak acceleration and time to peak deceleration.
Those measures represent single point data on a discrete
reaching task. The present study examined the efficacy
of acceleration data for determining skill levels of performers
during several sessions on a virtual laparoscopic training
device. It was hypothesized that the number of acceleration
reversals (e.g., acceleration/deceleration) could be obtained
from a single tri-axial accelerometer during virtual laparoscopic
training sessions.
Technology and Method
The present study used a Biopac MP100 system with a triaxial
accelerometer to assess acceleration reversals during a standardized
laparoscopic training module. Acceleration reversals
were defined as persistent 0-point crossings. Three levels of
participants were assessed to determine if expert and novice
performers could be determined from the number of reversal
done by each performer. Novice performers were non-medical
students from a private university. Intermediate performers
were individuals trained on the virtual training modules but
not practicing surgeons, and expert performers were practicing
surgeons familiar with both the training modules and highly
accomplished in their field. In the current study, the number
of specific tasks as determined by the training module was
held constant and time varied.
Results
Results from the acceleration reversals indicate that the number
of reversals inversely correlates with skill level. Lower
numbers of acceleration reversals were recorded for the higher
skill level performers. The results from this study are consistent
with reversal data seen in novice and expert reaching tasks.
Conclusions/Future Directions
The results from the present study indicate that the use of
acceleration reversal data may provide a metric to assess skill
level in individuals training on virtual skills modules. The
reversal data may also provide feedback for current practitioners
when developing skills on new equipment. The use of
acceleration reversals may also provide information about
practice schedules for medical students and others learning
new surgical skills.
TP012
GASLESS HAND ASSISTED LAPAROSCOPY., Daniel T Farkas
MD, Scott Laker MD,Vincent Iannace MD,Annette Wasielewski
RN,Patrick F Leahy MD,Garth H Ballantyne MD, Hackensack
University Medical Center
Objective: The objective of this technology is to provide surgeons
the ability to perform hand assisted laparoscopy, without
the need for a carbon dioxide pneumoperitoneum.
Description: A new hand access device (Freedom) was
designed by Galileo Corporation (Dublin, Ireland). This device
is essentially a sleeve, with multiple balloons around the outside
of it. The device is inserted into the abdomen, and the
balloons insufflated through a single tube. This has the effect
of lifting the abdominal wall, and provides room within the
abdominal cavity to work, without the need for a pneumoperitoneum.
Preliminary Results: Using a ?proof of concept? design, we
performed a hand assisted laparoscopic left hemicolectomy in
a cadaver. With the use of the Freedom device, and no pneumoperitoneum,
we were able to obtain excellent intra-abdominal
views. We were able to mobilize the left colon and splenic
flexure, as well as dissect out the rectosigmoid. The pelvic
views were equally good using this hand access device.
Conclusion: The Freedom hand access device allows the use
of gasless hand assisted laparoscopy. Carbon dioxide pneumoperitoneum
is not necessary when using this device, and
this can eliminate some of the adverse effects and complications
associated with laparoscopy.
TP013
COMPUTER MEDIATED, PER-ORAL CIRCULAR STAPLER (EEA
TYPE) FOR CREATION OF THE GASTRO-JEJUNOSTOMY DUR-
ING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS Alex
Nagle MD, Eric Hungness MD, Jay B Prystowsky MD,
Nathaniel J Soper MD, Northwestern Univeristy, Feinberg
School of Medicine, Department of Surgery, Chicago, IL
Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is technically
challenging and has a long learning curve. Morbidity and mortality
are often associated with complications related to the
gastro-jejunostomy (GJ), particularly early in the learning
curve. Although stapling devices have simplified performance
of the GJ, complications have not been eliminated. An FDAapproved
computer mediated stapler (SurgASSIST; Power
Medical Interventions, USA) has been introduced. This technology
eliminates potential stapling errors and provides a precise,
reproducible staple line by digitally establishing a staple
height determined by the tissue thickness. SurgASSIST consists
of a computer console, remote control, flexible shaft, and
circular stapler. To facilitate passage through the esophagus,
the length of the stapler has been shortened and a soft, conical
shaped introducer tip has been added to the distal end. A
hydrophilic coated sheath covers the stapler to provide a
smooth trans-oral passage. Once passed through the esophagus,
the introducer tip is unlocked and the sheath is retracted
to expose the stapler head. A flexible wire trocar, centrally
located within the stapler then penetrates the gastric wall. This
long, thin trocar creates a small gastric defect compared to
other EEA devices and allows easy and quick connection to the
anvil. The anvil and stapler are then united and a computer
mediated, circular 21-mm GJ is created.
This technology has been evaluated in a human cadaver
model. Trans-oral passage of the stapler was performed with
no difficulties and several inherent advantages were confirmed.
A trans-oral approach simplified performance of the
GJ and provided a consistent, reliable anastomosis in a timely
fashion. Based on this preliminary experience, we believe this
device will shorten the learning curve associated with LRYGB
and potentially decrease morbidity and mortality. Further
prospective clinical evaluation will be conducted to validate
these claims.
TP014
IMAGE OVERLAY FOR CT-GUIDED HEPATIC NEEDLE INSER-
TIONS — CADAVER STUDIES, Michelle L deOliveira MD,
Anton Deguet MS,Gregory Fischer MS,Emese Balogh
MS,Laura M Fayad MD,S. James Zinreich MD,Gabor Fichtinger
PhD, Johns Hopkins University
OBJECTIVE: We present a two-dimensional image overlay
device to assist hepatic needle placement on CT scanners.
MATERIALS AND METHODS: The image overlay system consists
of a flat display and a semitransparent mirror mounted
on the gantry. When the physician looks at the patient through
the mirror, the CT image appears to be floating inside the
body with correct size and position, as if the physician had
http://www.sages.org/
SAGES 2005
243