后腹腔镜与开放肾孟切开取石术效果比较

目的通过对比分析,探讨后腹腔镜取石术的效果。方法选取我院58例行开放肾孟切开取石术(开放组)与58例后腹腔镜肾孟切开取石术(腹腔镜组)患者进行比较。结果手术时间、术中出血、术后下床活动、肛门排气时间、术后引流时间、住院时间、术后用药时间腹腔镜组优于开放组,比较有统计学意义(P<0.05)。结论后腹腔镜肾孟切开取石效果确切,安全性高,疼痛小,促进患者尽早康复。     

腹腔镜诊治女性不孕症50例临床研究

目的对应用腹腔镜诊治女性不孕症进行临床研究。方法 2001年9月至2009年12月,本院对女性不孕症患者行腹腔镜检查及手术的患者50例。结果在我院女性不孕症患者中,发现盆腔异常者占95.55%。继发不孕和原发不孕患者的病因构成比较差异有统计学意义(P<0.05)。结论对于药物治疗效果不佳的多囊卵巢患者来说,腹腔镜是一种有效的治疗方法。     

Stereoscopic visualization of laparoscope image using depth information from 3D model

Laparoscopic surgery is indispensable from the current surgical procedures. It uses an endoscope system of camera and light source, and surgical instruments which pass through the small incisions on the abdomen of the patients undergoing laparoscopic surgery. Conventional laparoscope (endoscope) systems produce 2D colored video images which do not provide surgeons an actual depth perception of the scene. In this work, the problem was formulated as synthesizing a stereo image of the monocular (conventional) laparoscope image by incorporating into them the depth information from a 3D CT model. Various algorithms of the computer vision including the algorithms for the feature detection, matching and tracking in the video frames, and for the reconstruction of 3D shape from shading in the 2D laparoscope image were combined for making the system. The current method was applied to the laparoscope video at the rate of up to 5 frames per second to visualize its stereo video. A correlation was investigated between the depth maps calculated with our method with those from the shape from shading algorithm. The correlation coefficients between the depth maps were within the range of 0.70–0.95 (P < 0.05). A t-test was used for the statistical analysis.     

腹腔镜胆囊切除术并发症40例的临床分析

目的探讨腹腔镜胆囊切除术并发症的原因及处理措施。方法选取我院2006年6月至2010年3月腹腔镜胆囊切除术患者800例,对其术后并发症及其治疗措施进行分析总结。结果腹腔镜胆囊切除术800例中,并发症40例(4.0%)采取有效的护理治疗措施,均痊愈出院。结论术前进行严格检查,术中规范手术操作能够显著减少腹腔镜胆囊切除术的并发症;术后加强观察及护理是及早发现并发症的前提,并能提高工作效率和护理质量,使患者快速康复,减轻痛苦,防止腔镜胆囊切除术手术不良反应。     

Ergonomic factors on task performance in laparoscopic surgery training

This paper evaluates the effect of ergonomic factors on task performance and trainee posture during laparoscopic surgery training. Twenty subjects without laparoscopic experience were allotted into 2 groups. Group 1 was trained under the optimal ergonomic simulation setting according to current ergonomic guidelines (Condition A). Group 2 was trained under non-optimal ergonomic simulation setting that can often be observed during training in a skills lab (Condition B). Posture analysis showed that the subjects held a much more neutral posture under Condition A than under Condition B (p < 0.001). The subjects had less joint excursion and experienced less discomfort in their neck, shoulders, and arms under Condition A. Significant difference in task performance between Conditions A and B (p < 0.05) was found. This study shows that the optimal ergonomic simulation setting leads to better task performance. In addition, no significant differences of task performance, for Groups 1 and 2 using the same test setting were found. However, better performance was observed for Group 1. It can be concluded that the optimal and non-optimal training setting have different learning effects on trainees’ skill learning.     

Control of laparoscopic instrument motion in an inanimate bench model: implications for the training and the evaluation of technical skills

Computer-assisted analysis of wrist movement has recently emerged as an objective laparoscopic performance evaluation method. The first purpose of this study was to assess the differences in motion characteristics between the tip of the instrument and the wrist. The second purpose was to describe the control strategies used to move laparoscopic instruments. During a bead transfer task, motions of a laparoscopic needle driver's tip, heel, and the participants' wrist were monitored. Results showed that large amplitude movements were best described by movements of the wrist, and small amplitude movements were evidenced by motions of the instrument tip. Thus, for describing expertise, and for evaluation and feedback, motion of the tip of the laparoscopic instrument should be quantified, in addition to motion of the wrist. The motions of the instrument were controlled by utilizing the flexibility of the skin of the laparoscopic trainer in addition to using the fulcrum, and sliding through the trocar. In order to increase fidelity, virtual reality trainers should simulate the flexibility of the real structures around the insertion of the instrument.     

腹腔镜与开腹脾切除术治疗创伤性脾破裂的临床对比

目的 比较腹腔镜辅助脾切除术与传统开腹脾切除术治疗创伤性脾破裂的临床效果及其安全可行性。方法 将60例外伤性脾破裂患者随机分为腹腔镜组(LS组)和开腹组(OS组),每组30例,分别行腹腔镜辅助小切口脾切除术和传统开腹脾切除术,比较2种术式的手术时间、术中出血量、术后排气时间、术后恢复进食时间、术后住院时间及并发症发生率。结果 腹腔镜组的平均手术时间与开腹组差异无统计学意义(P>0.05),术中出血量、术后排气时间、术后恢复进食时间、术后住院时间及并发症发生率均优于开腹组,差异有统计学意义(P<0.05)。结论 腹腔镜辅助小切口脾切除术治疗创伤性脾破裂的临床效果明显优于传统开腹手术,具有创伤小、恢复快、安全、有效等优点。     

微型腹腔镜与传统手术在治疗小儿疝气中的临床效果观察

目的探讨微型腹腔镜治疗小儿疝气相对于传统手术方式的优越性。方法对416例小儿疝气分为2组,1组采用传统手术方法,另1组采用微型腹腔镜手术治疗,比较2组在手术效果和并发症方面的差异。结果微型腹腔镜手术治疗相较于传统手术具有手术时间短,自主活动时间少,出血量少和住院时间短的优点,同时并发症及复发的发生率明显减少。结论微型腹腔镜手术具有创伤小,操作简单,手术时间短,易恢复,瘢痕细微,比传统的高位结扎术具有明显的优越性。     

Investigations for chronic pelvic pain

Chronic pelvic pain (CPP) is a common problem with a prevalence of about 38/1000 among women aged 20–50 years. The main gynaecological diagnoses include endometriosis, pelvic inflammatory disease and adhesions. The most common gastrointestinal diagnosis is irritable bowel syndrome and genitourinary diagnosis includes pathology such as interstitial cystitis. It is a challenge instigating the right investigations for patients with chronic pelvic pain because there is a considerable symptom overlap. They also have a higher prevalence for symptoms such as dysmenorrhea and dyspareunia. In this review, we aim to discuss the clinical consultation necessary to help us decide upon which investigative tools we need to use to help diagnose the cause(s) of CPP, although one needs to stress that a specific cause may not be found in patients with CPP and symptom focused multidisciplinary management of CPP is at least as important as diagnosis of specific pathology and disease focused treatment.     

Effect of handle design and target location on insertion and aim with a laparoscopic surgical tool

Two laparoscopic tools, a scissor-type grasper and an ergonomically designed grasper, were compared in terms of operation efficiency and physical workload while inserting into a simulated abdomen and aiming five cross-shaped targets. Thirty right-handed novice participants performed the tasks with five tool-grasping hand postures at two computer monitor angles that simulated reaching an organ during laparoscopic surgery. When comparing the two free style hand postures used, there was a significant improvement in operation efficiency. This demonstrated that the participants quickly became familiar with the Intuitool by finding new hand postures that will significantly help them reach the target faster and more accurately. The 45( composite function) monitor angle showed the worst accuracy and deviation, the 0( composite function) monitor angle showed the best accuracy and smallest deviation with the upper target. Thus it is recommended that the camera trocar be placed directly above the organ of interest, and the part of the organ to be reached should be displayed slightly above the center of the feedback monitor. For physical workload, the method of gripping the tools was the most important factor. The scissors-type tool caused the largest wrist flexion, in contrast both free styles hand postures with the Intuitool showed the least wrist flexion.