On August 26th 2014 Ethicon released several new laparoscopic devices with a Bariatric focus. These devices included:
ECHELON FLEX™ GST SYSTEM – A new powered laparoscopic stapling system that grips the tissues to prevent slipping and allowing better formed staples, and may result in fewer staple loads used in a case. I suspect most likely to use less staple loads in a gastric sleeve resection.
ENSEAL® G2 Articulating Tissue Sealer – a 5mm – 45cm articulating energy device. Giving extra length for dividing tissues plus the ability to come across vessels at a 90 degree angle. They tout that 90 degree angle is 28% stronger than coming across a vessel at a 45 degree angle.
HARMONIC ACE®+7 Shears – the only purely ultrasonic device with a 7mm vessel indication. “Provides advanced hemostasis and precision dissection, while generating less heat.”
Whether or not you believe pain is the fifth vital sign, a new objective measurement of “intestinal rate is being tested out called “Abstat”. The device is essentially an electronic stethoscope that is placed on the patients lower abdomen. The sound is then analyzed by a computer to detect bowel function and more specifically to identify the lack of intestinal function in conditions such as Post Operative Ileus(POI).
I can see this being most useful to avoid the immediate re-admission of the post-surgical patient who begins to manifest his ileus on the car ride home. Post operative ileus is the enemy of ERAS(Enhanced Recovery After Surgery) protocols, and I don’t believe it will be two long before this integrated into these programs. Objective measurements of bowel function will go a long way in helping us figure out how to prevent and maybe even solve many of our post operative ileus problems.
How many pixels do we need to safely perform surgery? The standard definition televions used when laparoscopy first became standard had a resolution of about 640×480 and were viewed on CRT monitors. More recently we have seen high definition laparoscopy systems of 1920×1080 despite some of them using model numbers like 1288 that made me think they were higher than 1080p camera’s until I recently looked it up.
I recently read a few news articles about the testing of an 8K Ultra High Def Laparoscope. It was tested on animal and a cholecystectomy was actually performed. While the researchers interviewed in these articles rant and rave about the level of detail they could now see with this technology I doubt this detail influenced how the procedure was performed or any clinical impact. So what is the advantage of having such high resolution to laparoscopy:
Digital Zoom. An 8K camera has the resolution of 16 1080p(1920×1080 cameras). This may allow the camera to better stay out of the way of the instruments.
Digital Zoom w/ Pan capabilities. You may be able to require less of your camera driver if the surgeon has the ability to digital zoom and pan the camera to view the working field. This will require a wider angle lens and much better lighting system through the camera but could definately save the surgeon some frustration.
3d 4k laparoscopy. While 8k is obviously too much, our next step would be to 4k, and if we can do 8k resolutions, then 4k 3d is within the realm of our possibility.
Some interesting facts about resolutions of Laparoscopy:
Original davinci robot is 1280×720, the HD version is 1920×1080.
A single 8k Image is the equivalent of a 33 megapixel camera image.
If the detail you can see with images of resolution are compared to the 20/20 optometrist model. 1920×1080 is the equivalent of 20/20.4 whereas 8k is 20/4.68
If you were surfing anywhere techy or healthcare related today, you probably noticed Google’s announcement about their new contact lens that senses glucose levels and transmits it to a smart phone. They refer to it as their “Smart Contact Lens Project” but I like Google Glass Glucose edition better. This is a gigantic step forward in Google’s wearables, and possibly a huge pain killer for diabetics around the world.
I am curious how long it will be until my surgical patients come in wearing a glucose sensing contact lens and I have to answer a nurses phone call about whether or not to do Q6H or QACHS fingersticks or how often to get a reading from a contact lens. Will the anesthesiologists leave the contact in during general anesthesia and be expected to provide tight glycemic control during procedures on diabetics(likely some piece of code in the Google Cloud will control the drip for them). Maybe we can finally sort out the literature on tight glycemic control and surgical outcomes. If this solution works it will have huge ramifications on the treatment of our diabetic patients.
SICKO is a surgery related educational game designed to aid learners in applying didactic learning to clinical situations. I found the game to be both entertaining and educational. It broke free from the boredom of standard case presentation interactive software by having you manage multiple patients under time constraints, and giving you feedback as you correctly manage the patient rather than waiting till the simulation is over. The patients are represented by cards, and give you an idea of how they are doing by dropping to the bottom of the screen.
I did notice that I kept getting docked points for putting NG tubes in patients, I guess I was trained to aggressively put NG tubes in early on patients with vomitting or obstructive patterns on imaging.
While playing around with the software I was chatting online and let a patient sit too long who I ultimately diagnosed with appendicitis. Apparently as a result of my delay the patient perforated and developed an abscess there in the ER. I lost points for that.
After you make a decision to operate, you have to know enough of the diagnosis to pick out an operation to perform. You then answer multiple choice questions about different problems that you could encounter with intra-operatively and post-operatively.
Overall I thought the simulator was one of the better ones I have tried. I think that it would be a great tool for medical students and lower level residents and maybe even higher level residents working with more diagnosis.
GE is working on a robot that will run behind the scenes in the operating room. Their intent is to automate instrument transport and processing and hopefully will cut costs and demonstrate quality improvement effects unlike other robots in the operating room that still have controversy about their use. Part of this system will involve technology to identify surgical instruments via RFID during the collection process as well as building trays for future cases. I’m interested to see if the robot will participate in counting at the end of the case to standardize instrument counting and use the RFID as an extra layer of protection. The video is a little anti-climactic but explains the idea behind developing this technology for the OR.