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>
	<li>Huser, A. S., 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=Simulated+life-threatening+emergency+during+robot-assisted+surgery.">Simulated life-threatening emergency during robot-assisted surgery.</a> J Endourol. 28 (6), 717-721 (2014).</li><li>Berry, W. 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?...

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 border="0" cellpadding="0" cellspacing="0" width="573">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">ZOE Gynecologic Simulator</td>
			<td style="width:71px;">Gaumard</td>
			<td style="width:119px;">S504.100</td>
			<td style="width:167px;">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.&#160;</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">da Vinci Si Robotic System</td>
			<td style="width:71px;">Intuitive Surgical</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Tubing from Atrium Water Seal Chest Drain</td>
			<td style="width:71px;">Atrium</td>
			<td style="width:119px;"></td>
			<td>Suction tubing removed an colored</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Chest Tube Y-connector&#160;</td>
			<td style="width:71px;">Sorin Group</td>
			<td style="width:119px;">050525-000</td>
			<td>Connected to suction tubing for split from descending aorta to right and left iliac vessels</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">Reeve&#39;s Oil Colour Paint Set</td>
			<td style="width:71px;">Reeves</td>
			<td style="width:119px;"></td>
			<td>Coloring for venous and arterial vessel (Red and Blue)</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:216px;">Rust-oleum Clear Coat Enamel Spray</td>
			<td style="width:71px;">Rust-oleum</td>
			<td style="width:119px;"></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?...

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

Universidad de Cartagena UDEC

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

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

科研

医学

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Here, we introduce a method to evaluate transpedicular screws by using an in vivo porcine lumbar spine model.

用于评估椎弓根螺钉的麻醉，手术和收获方法<em&gt;体内</em&gt;猪腰椎模型

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

Mechanical Ventilation Boot Camp Curriculum

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased morbidity and mortality. A three-day simulation-based boot camp serves to provide one-on-one instruction with a critical care provider. These intensivists may dispense personalized immediate feedback as learners engage in hands-on practice with a real mechanical ventilator. Multiple different pathologies can be reviewed that may not be encountered in the clinical setting. Learners can visualize immediate consequences of their actions and may troubleshoot and ask questions, all while in a safe learning environment. We describe the use of human-patient simulators connected to breathing simulators and mechanical ventilators. Potential curriculum executors should be aware of the cost of the equipment and the time needed to dedicate to boot camp execution; however, this intensive interactive training has been shown to increase provider competency, knowledge, and confidence in ventilator management. This curriculum outline provides guidance on how to execute a simulation-based boot camp to train providers on the management of mechanically ventilated patients.

This curriculum outlines how to execute a simulation-based boot camp to teach providers how to manage mechanically ventilated patients.

机械通气训练营课程

Medical management of mechanically ventilated patients is challenging to novice providers. Incorrect management of this population may lead to increased ...

Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head

Pancreatic parenchyma sparing surgery for insulinomas avoids the risk of endocrine and exocrine insufficiency, and potential high-risk anastomoses associated with pancreatic resection. Robotic surgery may be used as an alternative for open pancreatic enucleation without compromising dexterity and 3D-vision.
We present the case of a 42-year old woman who presented with sweating, tremor and episodes of hypoglycemia. A fasting test confirmed endogenic insulin overproduction. After inconclusive CT- and MRI imaging, endoscopic ultrasonography showed a hypoechoic lesion, which was fully within the pancreatic head. Although consent was obtained for pancreatoduodenectomy, robotic enucleation seemed feasible. After mobilization, intraoperative ultrasonography was used to identify the lesion and its relation with the pancreatic duct. Dissection was performed using a traction suture, hot shears and bipolar diathermia. A sealant patch was applied for hemostasis and a drain placed. The patient developed a grade B pancreatic fistula for which endoscopic sphincterotomy was performed; the surgical drain could be removed in the outpatient clinic after 20 days. Prospective studies should confirm the short- and long-term benefits of robotic enucleation of insulinomas.

Here, we present a robotic approach to enucleate an insulinoma in the pancreatic head.

胰腺内胰岛素瘤在胰腺头的机器人Enuen

Pancreatic parenchyma sparing surgery for insulinomas avoids the risk of endocrine and exocrine insufficiency, and potential high-risk anastomoses ...

Robotic Lateral Pancreaticojejunostomy for Chronic Pancreatitis

Lateral pancreaticojejunostomy (LPJ) has shown good postoperative outcomes in patients with painful, morphine dependent, chronic pancreatitis (CP). The recent rise of robotic and laparoscopic pancreatic surgery has found benefits such as reduced time to functional recovery. Few studies have reported on the feasibility, technique and outcome of robotic LPJ, especially including transection of the gastroduodenal artery. The present study describes the main steps for robotic LPJ in a patient with painful chronic pancreatitis with a dilated main pancreatic duct. The patient underwent robotic LPJ. The LPJ anastomosis is performed using a running suture technique in a longitudinal side-to-side manner. Routinely, the gastroduodenal artery is transected to drain the entire length of the main pancreatic duct. The patient is in French position; 7 trocars are placed (4 robotic, 2 laparoscopic assistants, 1 liver-retractor). After docking of the robot system, the omental bursa is opened, and the right gastroepiploic artery and vein are ligated at their base at the lower border of the pancreas. Intraoperative ultrasonography is performed in order to determine trajectory of the dilated main pancreatic duct which is opened for its entire length after the gastroduodenal artery has been suture ligated both cranially and caudally from the main pancreatic duct. A Roux limb is created, and a latero-lateral PJ is fashioned using several 3-0 barbed sutures. A stapled jejuno-jejunostomy is created at sufficient distance from the pancreatic anastomosis, aided by a 50 cm suture. The described technique for robotic LPJ is a complex but feasible operation for patients with treatment refractory CP and a dilated main pancreatic duct. Due to its complexity, implementation in high volume centers with extensive experience with CP surgery may improve outcomes.

Robotic lateral pancreaticojejunostomy (RLPJ) may be used in patients with painful, morphine dependent, chronic pancreatitis and a dilated main pancreatic duct. We describe a standardized and reproducible technique for RLPJ, which includes transection of the gastroduodenal artery.

慢性胰腺炎的机器人侧胰腺肌切除术

Lateral pancreaticojejunostomy (LPJ) has shown good postoperative outcomes in patients with painful, morphine dependent, chronic pancreatitis (CP). The ...

A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the luminal surface area in arteries thereby reducing adequate blood flow to organs and distal tissues. Clinically, revascularization procedures such as balloon angioplasty with or without stent placement aim to restore blood flow. Although these procedures reestablish blood flow by reducing plaque burden, they damage the vessel wall, which initiates the arterial healing response. The prolonged healing response causes arterial restenosis, or re-narrowing, ultimately limiting the long-term success of these revascularization procedures. Therefore, preclinical animal models are integral for analyzing the pathophysiological mechanisms driving restenosis, and provide the opportunity to test novel therapeutic strategies. Murine models are cheaper and easier to operate on than large animal models. Balloon or wire injury are the two commonly accepted injury modalities used in murine models. Balloon injury models in particular mimic the clinical angioplasty procedure and cause adequate damage to the artery for the development of restenosis. Herein we describe the surgical details for performing and histologically analyzing the modified, pressure-controlled rat carotid artery balloon injury model. Additionally, this protocol highlights how local periadventitial application of therapeutics can be used to inhibit neointimal hyperplasia. Lastly, we present light sheet fluorescence microscopy as a novel approach for imaging and visualizing the arterial injury in three-dimensions.

The rat carotid artery balloon injury mimics the clinical angioplasty procedure performed to restore blood flow in atherosclerotic vessels. This model induces the arterial injury response by distending the arterial wall, and denuding the intimal layer of endothelial cells, ultimately causing remodeling and an intimal hyperplastic response.

大鼠胡萝卜动脉压力控制段气球损伤与腹腔ventit 治疗应用

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the ...

Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and unexpected, to patients and family members without any previous relationship. Unskilled death notification after unexpected events can lead to the development of pathologic grief and posttraumatic stress disorder. It is paramount for Emergency Medicine physicians to be trained in and practice death notification techniques. The GRIEV_ING curriculum provides a conceptual framework for death notification. The curriculum has demonstrated improvement in learners&#8217; confidence and competence when delivering bad news. Rapid Cycle Deliberate Practice is a simulation-based medical education technique that uses within the scenario debriefing. This technique uses the concepts of mastery learning and deliberate practice. It allows educators to pause a scenario, provide directed feedback, and then let learners continue the simulation scenario the &#8220;right way.&#8221; The purpose of this scholarly work is to describe how to apply the Rapid Cycle Deliberate Practice debriefing technique to the GRIEV_ING death notification curriculum to more effectively train learners in the delivery of bad news.

The goal is to demonstrate how to apply the rapid cycle deliberate practice debriefing technique to the GRIEV_ING death notification curriculum.

快速循环故意练习死亡通知课程的设置和执行

Death notification is an important and challenging aspect of Emergency Medicine. An Emergency Medicine physician must deliver bad news, often sudden and ...

Use of 3D Robotic Ultrasound for In Vivo Analysis of Mouse Kidneys

Common modalities for in vivo imaging of rodents include positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). Each method has limitations and advantages, including availability, ease of use, cost, size, and the use of ionizing radiation or magnetic fields. This protocol describes the use of 3D robotic US for in vivo imaging of rodent kidneys and heart, subsequent data analysis, and possible research applications. Practical applications of robotic US are the quantification of total kidney volume (TKV), as well as the measurement of cysts, tumors, and vasculature. Although the resolution is not as high as other modalities, robotic US allows for more practical high throughput data collection. Furthermore, using US M-mode imaging, cardiac function may be quantified. Since the kidneys receive 20%-25% of the cardiac output, assessing cardiac function is critical to the understanding of kidney physiology and pathophysiology.

Use of 3D Robotic Ultrasound for In Vivo Analysis of Mouse Kidneys

This protocol demonstrates robotic ultrasound (US) as a practical, cost-effective, and quick alternative to traditional non-invasive image modalities.

使用3D机器人超 声进行小鼠 肾脏体内分析

Common modalities for in vivo imaging of rodents include positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), ...

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 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.

机器人手术中的紧急脱位: 一个模拟课程

摘要

探索更多视频

此视频中的章节

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

用于评估椎弓根螺钉的麻醉，手术和收获方法

机械通气训练营课程

胰腺内胰岛素瘤在胰腺头的机器人Enuen

慢性胰腺炎的机器人侧胰腺肌切除术

大鼠胡萝卜动脉压力控制段气球损伤与腹腔ventit 治疗应用

快速循环故意练习死亡通知课程的设置和执行

使用3D机器人超声进行小鼠肾脏体内分析

机器人中央胰腺切除术与鲁恩-Y胰腺切除术

机器人 D3 十二指肠部分切除术与初级侧对侧吻合术

机器人手术中的紧急脱位: 一个模拟课程

摘要

探索更多视频

此视频中的章节

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

用于评估椎弓根螺钉的麻醉，手术和收获方法

机械通气训练营课程

胰腺内胰岛素瘤在胰腺头的机器人Enuen

慢性胰腺炎的机器人侧胰腺肌切除术

大鼠胡萝卜动脉压力控制段气球损伤与腹腔ventit 治疗应用

快速循环故意练习死亡通知课程的设置和执行

使用3D机器人超 声进行小鼠 肾脏体内分析

机器人中央胰腺切除术与鲁恩-Y胰腺切除术

机器人 D3 十二指肠部分切除术与初级侧对侧吻合术

使用3D机器人超声进行小鼠肾脏体内分析