In order to improve the flexibility of the surgical instruments, a wire-driven wrist-like structure is proposed in this paper. The instrument has three degrees of freedom (DOFs) of rotation, yaw, opening and closing. ...In order to improve the flexibility of the surgical instruments, a wire-driven wrist-like structure is proposed in this paper. The instrument has three degrees of freedom (DOFs) of rotation, yaw, opening and closing. Furthermore, we also acknowledge no coupling motion for each DOF. Moreover, the self-locking motion contributes to sustaining joint posture under external force. A static analysis for the end effector was conducted using the ANSYS software. At the end of this paper, a series of experiments for the prototype was performed. The results revealed that for the same surgical task, the proposed instrument had higher flexibility and the completion time of the operation tasks was obviously less than that of the traditional instrument. The results of the self-locking and operating force test showed that the surgical instruments perform well in maintaining joint posture under the force of 8.2N. The proposed surgical instrument meets the requirements of minimally invasive surgery (MIS).展开更多
Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Meth...Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Methods:In 2017,to improve the safety of patients who underwent invasive procedures outside of the OR,the hospital quality and safety committee established the surgery safety check committee responsible for developing a new working plan,revise the surgery safety check policy,surgery safety check Keywords:Invasive procedures outside the operating room Safety management Surgical safety checklist Patient safety form,and provide training to the related staff,evaluated their competency,and implemented the updated surgical safety check policy and checklist.The study compared the data of pre-implementation(Apr to Sep 2017)and two post-implementation phases(Apr to Sep 2018,Apr to Sep 2019).It also evaluated the number of completed surgery safety checklist,correct signature,and correct timing of signature.Results:The results showed an increase in the completion rate of the safety checklist after the program implementation from 41.7%(521/1,249)to 90.4%(3,572/3,950),the correct rates of signature from 41.9%(218/521)to 99.0%(4,423/4,465),and the correct timing rates of signature from 34.4%(179/521)to 98.5%(4,401/4,465),with statistical significance(P<0.01).Conclusion:Implementing the updated surgery safety check significantly is a necessary and effective measure to ensure patient safety for those who underwent invasive procedures outside the OR.Implementing surgical safety checks roused up the clinical staff's compliance in performing safety checks,and enhanced team collaboration and communication.展开更多
The successful outcome of any minimally invasive procedure is highly dependent on the imaging chain, as the medical team has to rely on indirect visualization of the surgical field during the entire procedure. During ...The successful outcome of any minimally invasive procedure is highly dependent on the imaging chain, as the medical team has to rely on indirect visualization of the surgical field during the entire procedure. During the last decade, the quality of the images obtainable pre- and intraoperatively has evolved significantly. In addition to the introduction of intra-operative image acquisition techniques such as ultrasound, X-ray, CT or MR, optical imaging technology as well as the corresponding processing units have undergone a rapid development. The article will review the activity related to minimally invasive procedures at the Operating Rooms of the Future (FOR) at St. Olavs Hospital, University Hospital of Trondheim, Norway. The imaging related demands of several surgical fields are introduced and the evolution of the imaging and visualization techniques at FOR will be presented. Subsequently, ongoing research projects in a dedicated visualization laboratory will be discussed and the advantages of updating the imaging equipment continuously in order to keep up with the latest developments in the field will be presented. It will be shown that the quality of the image acquisition and display can be significantly improved when compared to today’s standard. In addition to increasing the surgeon’s confidence, better imaging will lead to increased patient safety as well as more efficient interventions.展开更多
目的:比较微创全髋关节置换术(minimal invasive surgery total hip arthroplasty,MIS-THA)直接前侧入路与外侧小切口入路在手术创伤、临床疗效及安全性方面的差异。方法:选取71例接受单侧MIS-THA手术的患者,33例采用直接前侧入路(前侧...目的:比较微创全髋关节置换术(minimal invasive surgery total hip arthroplasty,MIS-THA)直接前侧入路与外侧小切口入路在手术创伤、临床疗效及安全性方面的差异。方法:选取71例接受单侧MIS-THA手术的患者,33例采用直接前侧入路(前侧入路组)、38例采用外侧小切口入路(外侧入路组)。记录并比较2组患者的切口长度、手术时间、术中出血量、输血量、术后红细胞沉降率(erythrocyte sedimentation rate,ESR)、术后C反应蛋白(C-reactive protein,CRP)含量、手术前后血红蛋白差值、住院时间及并发症发生情况。术后血红蛋白含量、ESR、CRP含量在术后第2天测定。定期随访,测定患侧髋臼外展角和前倾角,并采用髋关节Harris评分量表评定髋关节功能。结果:与外侧入路组相比,前侧入路组切口较小、手术时间长、术中出血少、输血少、术后ESR低、CRP含量低、手术前后血红蛋白差值小、住院时间短[(7.24±0.61)cm,(9.74±0.92)cm,t=-13.852,P=0.000;(67.39±10.71)min,(61.84±5.33)min,t=2.702,P=0.010;(255.30±20.22)m L,(364.95±30.79)m L,t=-177.441,P=0.000;(1.85±1.20)单位,(3.47±1.29)单位,t=-5.467,P=0.000;(55.33±7.23)mm·h^(-1),(78.74±13.91)mm·h^(-1),t=-9.058,P=0.000;(36.51±3.66)mg·L^(-1),(55.81±7.07)mg·L^(-1),t=-14.712,P=0.000;(22.18±14.53)g·L^(-1),(30.76±15.22)g·L^(-1),t=-2.420,P=0.018;(9.22±1.01)d,(10.83±1.63)d,t=-5.062,P=0.000]。术后6个月2组患者的髋臼前倾角、髋臼外展角比较,组间差异均无统计学意义(20.15°±5.32°,21.21°±3.66°,t=-0.963,P=0.340;38.21°±4.28°,38.63°±3.12°,t=-0.466,P=0.643)。术前2组患者的Harris评分比较,差异无统计学意义(t=1.190,P=0.238);术后6个月2组患者的评分均增加[(39.12±11.47)分,(90.76±3.76)分,t=-26.055,P=0.000;(42.21±10.41)分,(89.47±3.41)分,t=-27.015,P=0.000];2组患者手术前后Harris评分差值比较,组间差异无统计学意义[(51.64±11.39)分,(47.26±10.79)分,t=1.661,P=0.101]。前侧入路组1例发生股外侧皮神经损伤、2例发生阔筋膜张肌损伤,外侧入路组2例出现血肿、3例因术中拉钩牵拉造成皮肤挫伤;2组患者的并发症发生率比较,差异无统计学意义(P=0.716)。结论:采用直接前侧入路和外侧小切口入路行MIS-THA手术,临床疗效和安全性相当,均可有效改善患者髋关节功能,术后人工关节稳定性好、并发症少。但直接前侧入路创伤较小,有利于患者术后康复。展开更多
基金Supported by the National Natural Science Foundation of China(61305102)the Foundation for Outstanding Young Scholars of Jilin Province(20170520106JH)
文摘In order to improve the flexibility of the surgical instruments, a wire-driven wrist-like structure is proposed in this paper. The instrument has three degrees of freedom (DOFs) of rotation, yaw, opening and closing. Furthermore, we also acknowledge no coupling motion for each DOF. Moreover, the self-locking motion contributes to sustaining joint posture under external force. A static analysis for the end effector was conducted using the ANSYS software. At the end of this paper, a series of experiments for the prototype was performed. The results revealed that for the same surgical task, the proposed instrument had higher flexibility and the completion time of the operation tasks was obviously less than that of the traditional instrument. The results of the self-locking and operating force test showed that the surgical instruments perform well in maintaining joint posture under the force of 8.2N. The proposed surgical instrument meets the requirements of minimally invasive surgery (MIS).
文摘Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Methods:In 2017,to improve the safety of patients who underwent invasive procedures outside of the OR,the hospital quality and safety committee established the surgery safety check committee responsible for developing a new working plan,revise the surgery safety check policy,surgery safety check Keywords:Invasive procedures outside the operating room Safety management Surgical safety checklist Patient safety form,and provide training to the related staff,evaluated their competency,and implemented the updated surgical safety check policy and checklist.The study compared the data of pre-implementation(Apr to Sep 2017)and two post-implementation phases(Apr to Sep 2018,Apr to Sep 2019).It also evaluated the number of completed surgery safety checklist,correct signature,and correct timing of signature.Results:The results showed an increase in the completion rate of the safety checklist after the program implementation from 41.7%(521/1,249)to 90.4%(3,572/3,950),the correct rates of signature from 41.9%(218/521)to 99.0%(4,423/4,465),and the correct timing rates of signature from 34.4%(179/521)to 98.5%(4,401/4,465),with statistical significance(P<0.01).Conclusion:Implementing the updated surgery safety check significantly is a necessary and effective measure to ensure patient safety for those who underwent invasive procedures outside the OR.Implementing surgical safety checks roused up the clinical staff's compliance in performing safety checks,and enhanced team collaboration and communication.
文摘The successful outcome of any minimally invasive procedure is highly dependent on the imaging chain, as the medical team has to rely on indirect visualization of the surgical field during the entire procedure. During the last decade, the quality of the images obtainable pre- and intraoperatively has evolved significantly. In addition to the introduction of intra-operative image acquisition techniques such as ultrasound, X-ray, CT or MR, optical imaging technology as well as the corresponding processing units have undergone a rapid development. The article will review the activity related to minimally invasive procedures at the Operating Rooms of the Future (FOR) at St. Olavs Hospital, University Hospital of Trondheim, Norway. The imaging related demands of several surgical fields are introduced and the evolution of the imaging and visualization techniques at FOR will be presented. Subsequently, ongoing research projects in a dedicated visualization laboratory will be discussed and the advantages of updating the imaging equipment continuously in order to keep up with the latest developments in the field will be presented. It will be shown that the quality of the image acquisition and display can be significantly improved when compared to today’s standard. In addition to increasing the surgeon’s confidence, better imaging will lead to increased patient safety as well as more efficient interventions.
文摘目的:比较微创全髋关节置换术(minimal invasive surgery total hip arthroplasty,MIS-THA)直接前侧入路与外侧小切口入路在手术创伤、临床疗效及安全性方面的差异。方法:选取71例接受单侧MIS-THA手术的患者,33例采用直接前侧入路(前侧入路组)、38例采用外侧小切口入路(外侧入路组)。记录并比较2组患者的切口长度、手术时间、术中出血量、输血量、术后红细胞沉降率(erythrocyte sedimentation rate,ESR)、术后C反应蛋白(C-reactive protein,CRP)含量、手术前后血红蛋白差值、住院时间及并发症发生情况。术后血红蛋白含量、ESR、CRP含量在术后第2天测定。定期随访,测定患侧髋臼外展角和前倾角,并采用髋关节Harris评分量表评定髋关节功能。结果:与外侧入路组相比,前侧入路组切口较小、手术时间长、术中出血少、输血少、术后ESR低、CRP含量低、手术前后血红蛋白差值小、住院时间短[(7.24±0.61)cm,(9.74±0.92)cm,t=-13.852,P=0.000;(67.39±10.71)min,(61.84±5.33)min,t=2.702,P=0.010;(255.30±20.22)m L,(364.95±30.79)m L,t=-177.441,P=0.000;(1.85±1.20)单位,(3.47±1.29)单位,t=-5.467,P=0.000;(55.33±7.23)mm·h^(-1),(78.74±13.91)mm·h^(-1),t=-9.058,P=0.000;(36.51±3.66)mg·L^(-1),(55.81±7.07)mg·L^(-1),t=-14.712,P=0.000;(22.18±14.53)g·L^(-1),(30.76±15.22)g·L^(-1),t=-2.420,P=0.018;(9.22±1.01)d,(10.83±1.63)d,t=-5.062,P=0.000]。术后6个月2组患者的髋臼前倾角、髋臼外展角比较,组间差异均无统计学意义(20.15°±5.32°,21.21°±3.66°,t=-0.963,P=0.340;38.21°±4.28°,38.63°±3.12°,t=-0.466,P=0.643)。术前2组患者的Harris评分比较,差异无统计学意义(t=1.190,P=0.238);术后6个月2组患者的评分均增加[(39.12±11.47)分,(90.76±3.76)分,t=-26.055,P=0.000;(42.21±10.41)分,(89.47±3.41)分,t=-27.015,P=0.000];2组患者手术前后Harris评分差值比较,组间差异无统计学意义[(51.64±11.39)分,(47.26±10.79)分,t=1.661,P=0.101]。前侧入路组1例发生股外侧皮神经损伤、2例发生阔筋膜张肌损伤,外侧入路组2例出现血肿、3例因术中拉钩牵拉造成皮肤挫伤;2组患者的并发症发生率比较,差异无统计学意义(P=0.716)。结论:采用直接前侧入路和外侧小切口入路行MIS-THA手术,临床疗效和安全性相当,均可有效改善患者髋关节功能,术后人工关节稳定性好、并发症少。但直接前侧入路创伤较小,有利于患者术后康复。
