2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH POSTER ABSTRACTS
Conclusions/Future Directions: A mechanical device has been
developed that retains the desirable attributes of an endoscope,
but incorporates features that overcome its inherent
limitations. The ShapeLock Cobra is flexible like an endoscope,
but can be locked to facilitate force transmission at the desired
target in the desired plane. Future directions include using a
CCD chip and LED light source for visualization. Using a CCD,
wires can be routed through the dead space between the circular
instrument lumens, thereby freeing space within the
lumen for operating instruments. The Cobra is expected to
facilitate advanced endoluminal procedures such as extended
mucosal resection, full-thickness resection of gastric and
colonic lesions, and gastric remodeling. Moreover, the Cobra
may become an enabling technology in transluminal interventions
to perform organ resection, anastomosis, bypass or
other surgical indications within the peritoneal cavity.
TP018
CLINICAL, RESEARCH AND EDUCATIONAL APPLICATIONS
FOR AUTOSTEREOSCOPIC DISPLAY AND PRINTING IN MINI-
MALLY INVASIVE SURGERY, Michael J Mastrangelo, Jr. MD,
Andrew H Joel, St. Charles Medical Center, Bend, OR and
Volugraphics, Inc., Atlanta, GA
Objective of the technology or device: A new technique is
available that produces affordable, high-resolution, photographic-quality
micro-lenticular transparencies and prints.
Autostereoscopic printing of volumetric data and animated
hardcopies (VolugramsTM) of cine, video and animation are
applicable to clinical, research and educational content.
Description of the technology: The Stereoscope was developed
in 1838 and first applied to radiographic tomograms in
1895. The ability to visualize and communicate volumetric
medical data in stereo is becoming more important as the
three-dimensional (3D) information produced by CT, MRI, PET
and 4D ultrasound grows exponentially in complexity.
Advancing technologies allow for routine stereo viewing and
printing of the data. Previous display options have included
active and passive stereo projection and display systems that
require specialized polarized or shuttered glasses that control
which image is seen by each eye. Autostereoscopic displays
accomplish stereoscopic visualization without the use of glasses
and instead use a lenticular lens system or a raster masking
technique to achieve the same effect. The result is a visual
sense of depth perception in the projected or printed image
similar to what we naturally see with our binocular vision.
Preliminary Results: Stereoscopic display technologies have
been successfully used for clinical, research and educational
applications including preoperative planning and surgical simulation.
Autostereoscopic hardcopies of volumetric medical
data are currently being utilized in scientific
presentations/posters.
Conclusions/Future direction: The micro-lenticular system is a
method for producing prints and transparencies of animations,
3D data and stereopairs that provides stereoscopic cues without
the use of glasses or special viewing devices. This technique
is applicable to volumetric medical imaging and holds
promise for minimally invasive surgical planning, research,
education and scientific presentation.
TP019
PROCEDURAL ALGORITHM FOR LCBDE USING MULTI-CHAN-
NEL INSTRUMENT GUIDE, Donald E Wenner MD, James H
Rosser, Jr. MD,Paul R Whitwam MD,David M Turner MD,
Eastern New Mexico Medical Center
Introduction: Laparoscopic Common Bile Duct Exploration
(LCBDE) methods have evolved rapidly since the introduction
of laparoscopic cholecystectomy. No unified approach or standardized
LCBDE procedure has developed. Additional hurdles
include damage to expensive fragile equipment and the organization
of a complex operating room environment. These challenges
have slowed the successful introduction of LCBDE into
general surgical practice.
Objective: The Multi-channel Instrument Guide (MIG) was
designed to protect the choledochoscope from damage when
guiding the choledochoscope into either the cystic duct or
common bile duct (CBD). The MIG enhances control of the
choledochoscope and lends itself to a systematic procedural
algorithm and a standardization of the ?tool kit? required for
LCBDE.
Description and use of the MIG: The MIG is a J shaped three
lumen guide tool. The largest lumen is 3.4mm diameter to
accommodate a 2.8 mm flexible choledochoscope. The two
smaller lumens are 1.9mm diameter. The flexible guide is
pulled into an introducer sheath and straightened for insertion
through a standard 10 mm laparoscopic port placed in the epigastric
location. The surgeon guides the flexible choledochoscope
into the cystic duct or into the CBD. The standardized
?tool kit? needed for LCBDE includes the MIG, a flexible choledochoscope,
balloon catheter, irrigation catheter, nitinol stone
basket, and lithotripter or Holmium laser fiber. A video system
that can accommodate two video inputs with picture in a picture
feature is also needed. A procedural algorithm is followed
based on patient anatomy, stone size and stone location. The
algorithm progresses from simple to complex in a logical
sequence.
Results: A total of 54 LCBDE cases were completed using the
MIG. A 96% rate of bile duct clearance was achieved. Damage
to the flexible choledochoscope was reduced ten fold. The procedural
algorithm was validated in cases with various stone
sizes, numbers, and locations. Lithotripsy was effectively
employed in cases with impacted or large stones.
Conclusion: The MIG has achieved the goal of improved introduction,
control, and protection of the choledochoscope. A
standardized approach guided by a procedural algorithm has
been achieved. For the future, this new approach to LCBDE
needs to be validated in a teaching institution with general
surgical residents so that LCBDE may be successfully integrated
into general surgical practice.
TP020
DEVELOPMENT OF A PROTOTYPE ARTICULATING LAPARO-
SCOPIC GRASPER., Dmitry Oleynikov MD, Tim Judkins
MS,Katherine Done MS,Susan Hallbeck PhD, University of
Nebraska
A prototype articulating laparoscopic grasper tool which
includes an articulating end effector, an ergonomic handle,
and an intuitive hand/tool interface (Figure 1) has been developed.
This study investigated the evaluation of the prototype
tool by surgeons and comparison with existing tools.
A questionnaire was developed to ask surgeons about problems
they experience associated with use of conventional
tools and then query their opinions of the prototype tool.
Eighteen laparoscopic surgeons volunteered to complete the
questionnaire.
Generalized results were obtained through use of a Wilcoxon
Signed Rank Test utilizing ranking with zeros for each hypothesis
test. The level of significance for all statistical tests was
0.05.
Tests on problems such as hand/wrist pain, shoulder pain, finger
tingling/numbness, etc. produced significant results for the
number of surgeons experiencing each of the queried problems.
A significant number of surgeons (p=0.045) identified the
prototype handle as either comfortable or extremely comfortable.
A significant number of surgeons (p=0.015) preferred the
prototype tool over conventional tools, based on general
impression.
Articulation of the tip has been successfully designed in the
prototype and 90% of the respondents believed the articulation
to be a useful addition to laparoscopic graspers. The new
shape of the handle is considered comfortable by a significant
number of respondents. Most respondents believe the new
design will relieve at least one problem currently experienced
during surgery. Fifteen of the 18 surgeons queried said they
would try a commercially available version of the prototype
tool.
http://www.sages.org/
SAGES 2005
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