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Now, we are going to talk about surgery - specifically keyhole surgery. Now, this is something that can be quicker than normal surgery, it can cause less trauma and it can reduce recovery times. This kind of surgery can be carried out by remote-controlled robots, it’s just not that widely available. We’ve been to see a new type of robot surgeon that could change that.
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Dr Joseph Abdelmalak
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Dubai, UAE: Now the only institute in Asia providing training in the da Vinci method to surgeons and gynecologists. The World Laparoscopy Hospital in Dubai is now offering a hands-on training course on the da Vinci robotic surgery process. The four-day program is offered on a monthly basis and awards a FICRS certificate to students upon completion. Surgeons and gynecologists learn the da Vinci surgical system using state-of-the-art robotic technology which includes advanced three-dimensional HD visualization and up to 25x magnification inside the patient’s body.
The new system also offers surgeons an ergonomically designed console, a patient-side cart, and wrist instruments which are able to bend and rotate at a greater capacity than the human hand. The course’s professor, Dr. R. K. Mishra, focuses on teaching students through applied education, leading them through hands-on activities. He hopes to prepare doctors to quickly incorporate new surgical techniques in their own practices once they finish the class. After completing the program, student Dr. Labubah of Ruwi commented, “I really enjoyed [the] hands on session and gained lots of practical insight…The tips of laparoscopic surgery that Prof. Mishra gave me is something I can start with immediately in my gynecological laparoscopic practices.” The WLH Training Institute is eager to attract students from the global community who want to learn new skills in the world’s largest integrated healthcare free zone.
World Laparoscopy Training Institute, Dubai
With nearly 160 clinical partners in Dubai Healthcare City alone, the region is becoming increasingly more alluring to medical professionals looking to expand their skill sets and even open new operations in the UAE. Foreign visitors enjoy the immersion in Dubai’s cultural traditions, unique architecture, and exotic city life. WLH is currently accepting surgeon and gynecologist students from the USA, Europe, Gulf countries, Africa, and Australia. To find more information on the courses offered at WLH and to enroll, visit laparoscopyhospital.com or email [email protected]-
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Dr Joseph Abdelmalak
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Investigation could reopen into surgical instrument cleaning | | dailyprogress.c... (dailyprogress.com)Investigation could reopen into surgical instrument cleaning
http://www.dailyprogress.com/investigation-could-reopen-into-surgical-instrument-cleaning/article_38067b11-413f-5766-8e45-af32d7ec2627.htmlDETROIT (AP) — Michigan regulators could reopen an investigation of how the Detroit Medical Center ensures that surgical instruments are clean and sterile after another dirty tool was found.-
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Dr Joseph Abdelmalak
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A new study comparing robotic and open prostatectomy shows no difference in urinary or sexual function following surgery.
Researchers at Griffith University (Gold Coast, Australia), Royal Brisbane and Women's Hospital (RBWH; Australia), and other institutions conducted a study involving 326 patients whom were randomly assigned by a computer to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. One surgeon experienced in robotic prostatectomy performed all of the robotic-assisted procedures, and another surgeon with a history of 1,500 open prostatectomies performed all of the open procedures.
In all, 278 patients completed six weeks of follow-up, and 252 remained in follow-up for 12 weeks. The primary outcomes were urinary and sexual function assessed at 6 and 12 weeks, and again after 24 months of follow-up. The results showed no difference in urinary or sexual function; positive surgical margins and pain also did not differ between treatment groups. Robotic prostatectomy was associated with less blood loss, shorter operative duration, and a longer length of stay. The study was published on July 26, 2016, in The Lancet.
“In brief, both approaches have shown good early results, with minimally invasive benefits seen in the robot-assisted laparoscopic prostatectomy group,” concluded senior author Frank Gardiner, MD, of RBWH, and colleagues. “Urinary and sexual function are expected to continue to improve with time and, as such, significant differences in functional outcome between these surgical approaches might not become apparent until longer follow-up.”
“Trials that show equivalence for an innovation are sometimes interpreted as supporting a return to existing practice, including rediverting the training of a generation of surgeons who might have followed the innovation's evolution,” wrote Ara Darzi, MD, and Erik Mayer, MD, of Imperial College London (United Kingdom), in an accompanying editorial. "Equivalence and noninferiority should also be seen as positive, showing the innovation has preserved the intended and well established purpose of surgical intervention, such as good oncological outcomes balanced against acceptable functional side-effects.”
Radical prostatectomy uses a surgeon-controlled robot, mainly the Intuitive Surgical (Sunnyvale, CA, USA) da Vinci minimally invasive surgery system. Advantages include improved cosmetic result, less blood loss, briefer and less intense post-operative convalescence, and reduced hospitalization costs. It is also the basis of a nerve-sparing procedure called the Veil of Aphrodite, developed to minimize the erectile dysfunction common in men after undergoing traditional radical prostatectomy.-
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Dr Joseph Abdelmalak
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Background
The number of cases of laparoscopic surgery has been increasing. Lymph node dissection has been standardized, and the enlarged view provided by laparoscopes allows for the procedure to carried out successfully entirely within the abdominal cavity, but many cases of reconstruction using the Billroth-I method are performed under direct vision through a small incision. In this study, by placing an anchor thread on a suture line on the lesser curvature of the stomach, we simplified the procedure for hand-sewn anastomosis and safely performed gastroduodenal anastomosis at low cost to obtain good results.
Method
From January 2009 to August 2010, we performed hand-sewn gastroduodenal anastomosis in 18 cases. After performing lymph node dissection, the duodenum and the stomach were divided using an automatic suture device. Anchor sutures were placed on the suture line of the lesser curvature. First, the seromuscular layer of the stomach and the seromuscular layer of the duodenum were sutured by performing interrupted suturing using an extracorporeal knot-tying method. With the stomach and the duodenum in a fixed state, the anastomosis area was opened. The thread of the anchor suture was pulled toward the abdominal wall, and then all layers of the stomach and the duodenum at the posterior wall were continuously sutured. Similarly, for the anterior wall, all layers were continuously sutured from the lesser curvature toward the greater curvature.
Results
We performed this anastomotic procedure in 18 patients with early gastric carcinoma. The mean time required for the anastomosis was 64.6±17.1 minutes (range 35 to 97 minutes), and the estimated blood loss was 53.0±91.0g. All operation was curative, and the mean number of retrieved lymph node was 27.1±10.8 (range 12 to 52). A nasogasiric tubes was removed on the first or second day. An upper gastrointestinal series per formed on the postoperative days 5 to 6 showed no anastomotic leakage and normal transit. Oral intake was started the 6 to 7 day. One patient developed anastomotic leakage, he was treated conservatively. With a mean follow-up of 15 months (range 4 to 25 months), no one suffered from symptoms indicative of anastomotic stenosis, bile reflex, or dumping. There was no mortality.
Postoperative endoscopy revealed that the anastomosis area was extremely soft, and no abnormalities were observed. Moreover, the only costs related to the anastomosis were for the thread and needles, and although more time was required compared to mechanical anastomosis, the cost was extremely low. The mean duration of hospitalization after surgery was 21 days (range: 11 to 37 days).
Conclusions
This method is economical, as it does not require the use of machinery for anastomosis, and the duodenal stump is short, and we believe this method, which can be performed-
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Dr Joseph Abdelmalak
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Laparoscopic colectomy for resectable colon cancer has been reported to be technically and oncologically feasible. The general consensus, based on the literature over the past several years, is that there is no significant difference in lymph node harvest between laparoscopic and open right hemicolectomies for cancer when strict oncologic principles of resection are followed. To date, patient survival, disease progression, and cancer recurrence at port sites have been found to be equivalent between laparoscopic colectomy and traditional open colectomy.
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Dr Joseph Abdelmalak
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Colorectal cancer may be highly preventable, yet it is second only to lung cancer in the number of lives it takes nationwide each year.
To cure it, surgeons have traditionally needed to create relatively large abdominal incisions in order to remove the cancer. Over the years, technological advancements have made it possible to perform the same curative cancer surgeries laparoscopically - inserting small tubes, cameras and specialized instruments, usually through three to five small incisions, each of which are smaller than one centimeter.
At Penn State Hershey Medical Center, doctors have taken things one step further - using a single incision of less than four centimeters discretely placed at the belly button to accomplish their mission to cure colorectal cancer. This approach is known as single-site laparoscopic (SSL) surgery.
"There are really very few hospitals where this technique is being routinely used," says Dr. David B. Stewart, Sr., a colorectal surgeon at Penn State Hershey. "We are one of the highest volume single-site laparoscopic colorectal practices in the country."
Not only do patients potentially experience less discomfort from a single small incision as opposed to several, in many cases their incision is barely visible. Using this technique, surgeons are able to provide surgical care for diseases such as colon and rectal cancer, achieving the same required margins of resection that were the aim of traditional open abdominal surgery.
SSL has been routinely performed for colorectal surgical patients at Penn State Hershey since 2010 and doctors have found it to be as safe and effective as using a larger incision or multiple points of entry.
"It's nice when patients wake up and they can barely see the incision," Stewart says.
Of course, laparoscopic surgery isn't for everyone.
With super morbidly obese patients - that is, people with a body mass index of 50 or higher - visualization is impaired because of fatty tissue in the abdominal cavity. Stewart says those who have had multiple abdominal surgeries may have widespread scar tissue that makes the procedure unsafe, and patients who have heart or lung disease may not be able to tolerate laparoscopic surgery. These patients may be best treated with traditional open colorectal surgery.
The best course of action, of course, is to try to prevent the need for surgery altogether by adhering to recommendations for people 50 and older to undergo a screening colonoscopy.
"You may feel healthy, but that doesn't mean you don't have a polyp or even colorectal cancer," Stewart says. In the vast majority of cases, the endoscopist performing the colonoscopy can remove any polyps and thus prevent them from potentially developing into cancer.
"Sadly, and maybe surprisingly to the public, we have younger people who develop colorectal cancer, as well," Stewart says. Those who have symptoms such as rectal bleeding or changes in bowel habits need to undergo a diagnostic colonoscopy, regardless of their age.
Colorectal cancer that is identified at an earlier stage - before the lymph nodes become involved - is more likely to be cured.
"We are curing more people with higher stages of cancer than we were 15 to 20 years ago," Stewart says.-
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Dr Joseph Abdelmalak
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Perhaps no organ is better suited for laparoscopic surgery than the adrenal gland because of its small size and relatively difficult location in the retroperitoneum, which requires a large, open excision for extraction. Since its first description by Gagner et al in 1992, laparoscopic adrenalectomy has become increasingly used and now has become the technique of choice for most benign adrenal lesions because of the decreased blood loss, lower morbidity, shorter hospitalization, faster recovery, and overall cost-effectiveness in comparison with the open approach.
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Dr Joseph Abdelmalak
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This is an unedited narrated video of a robotic hysterectomy by Dr. Lynn Kowalski, author of "Not Your Mother's Hysterectomy." The video is intended to demonstrate how efficient robotic surgery can be for routine hysterectomy.
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Dr Joseph Abdelmalak
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