IntroductionDuring robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members’ ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these constraints.ObjectivesExplore the use of microanalysis to describe and evaluate communicative efficiency in RAS through examination of referencing in surgical tasks.MethodsAll communications during ten robot-assisted pelvic surgeries (radical cystectomies and prostatectomies) were fully transcribed. Forty-six referencing events were identified within these and subjected to a process of microanalysis. Microanalysis employs detailed transcription of speech and gesture along with their relative timing/sequencing to describe and analyse interactions. A descriptive taxonomy for referencing strategies was developed with categories including references reliant exclusively on speech (anatomic terms/directional language and context dependent words (CD)); references reliant exclusively on gesture or available aspects of the environment (point/show, camera focus/movement in the visual field and functional movement); and references reliant on the integrated use of speech and gesture/environmental support (integrated communication (IC)). Frequency of utilisation and number/percent ‘miscommunication’, were collated within each category when miscommunication was defined as any reference met with incorrect or no identification of the target.ResultsIC and CD were the most frequently used strategies (45% and 26%, respectively, p≤0.01). Miscommunication was encountered in 22% of references. The use of IC resulted in the fewest miscommunications, while CD was associated with the most miscommunications (42%). Microanalysis provided insight into the causes and nature of successful referencing and miscommunication.ConclusionsIn RAS, surgeons complete referencing tasks in a variety of ways. IC may provide an effective means of referencing, while other strategies may not be adequately supported by the environment.
estimated on a per-use basis. This was compared to the purchasing price of Isiris.RESULTS: A total of 1775 cystoscopic procedures were performed, and the reusable cystoscope was used for stent removal in 871 cases. The per-use cost for stent removal procedures using the reusable cystoscope was estimated to be $161.85. The per-use purchasing price for the Isiris device is $200. After 704 stent pulls, micro-costing analysis appears to favor the reusable cystoscope compared to the disposable.CONCLUSIONS: Based on this micro-cost analysis, per-use costs appear to favor the reusable cystoscope for stent removal. It appears that centers with high volumes of stent pulls may find the reusable cystoscope and stent grasper more cost-beneficial than the single-use system. Further study addressing performance and convenience of single-use system is needed.
does not cross the intact urothelium but diffuses rapidly up to 1.5 mm into tissue when the Urothelium is compromised. 525 nm photosensitizer activation light was used to attain a steep PDT dose gradient. The activation light was delivered via an optical fiber with spherical diffuser positioned centrally in the bladder void. The target radiance exposure was 90 J/cm 2 , and the irradiance [mW/cm 2 ] was monitored at up to 12 positions, allowing for optimum diffuser positioning and treatment time control. Measured irradiances were compared to light propagation simulations based on the patients' CT images used to create tetrahedral meshes of the bladder and adjacent soft tissues. Simulations using the FullMonte simulation software provided the bladder wall surface irradiance and the fluence-rate in-depth and dose-surface-histograms. RESULTS: Instillation of TLD1433 for one hour resulted in a patchy discolouration of the bladder wall, often co-localized with known presence of carcinomas. In situ monitoring of the irradiance at the bladder wall surface ensured reaching the target radiant exposure in all 6 patients, independent of the bladder volume, shape and optical properties. The measured median irradiance varied from 5.7 to 32 mW/cm 2. Matching of the in situ measured irradiances with the simulated dose-surface histograms was possible by adjusting the tissue optical properties, absorption and light scattering, of the bladder wall and also of the bladder void. Light scattering by protein aggregates inside the bladder was identified as a cause for low irradiance measurements on the bladder wall surface. Bladder void light scattering caused by proteinaceous materials ranged from 0.2 to 1.42 cm-1. Time to achieve 90 J/cm 2 required between 68 min and 165 min. CONCLUSIONS: Variations in the bladder wall's optical properties varied between individuals and over the course of TLD-1433 mediated PDT. Bladder shapes influence the ability to achieve flat dose-surface-histogram. Monitoring of the irradiance or radiant exposure is strongly recommended for accurate PDT dosimetry.
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