Appendiceal tumors are uncommon and most often present as appendicitis. Most are benign and can be managed by appendectomy, except adenocarcinomas and carcinoids larger than 2 cm, which are most appropriately managed by right hemicolectomy. A suggested management algorithm is provided. Controversy exists over the management of carcinoids 1 to 2 cm in size and adenocarcinoids. All types of appendiceal tumors have a high incidence of synchronous and metachronous colorectal cancer.
Port location is crucial for endoscopic manipulations. The aim of the study was to investigate the influence of manipulation, azimuth, and elevation angles of instruments on endoscopic intracorporeal knotting. The standard task was tying a surgeon's knot. Manipulation angles of 30 degrees , 45 degrees , 60 degrees , 75 degrees , and 90 degrees with equal and unequal azimuth angles and elevation angles of 0 degrees , 30 degrees , and 60 degrees were investigated. The endpoints were the execution time and parameters of knot analysis. The execution time was shorter with 60 degrees than with either 90 degrees or 30 degrees manipulation angles (p < 0.0001 and p < 0. 01). Equal azimuth angles resulted in a shorter execution time than wide unequal angles (p < 0.001). A combination of 60 degrees manipulation angle with 60 degrees elevation angle had the shortest execution time (p < 0.001) and highest performance quality score (p < 0.02). A range of 45 degrees -75 degrees manipulation angles with equal azimuth angles is recommended. As the manipulation angle increases, the elevation angle has to increase accordingly.
We have devised an advanced computer-controlled system (ADEPT) for the objective evaluation of endoscopic task performance. The system's hardware consists of a dual gimbal mechanism that accepts a variety of 5.0-mm standard endoscopic instruments for manipulation in a precisely mapped and enclosed work space. The target object consists of a sprung base plate incorporating various tasks. It is covered by a sprung perforated transparent top plate that has to be moved and held in the correct position by the operator to gain access to the various tasks. Standard video endoscope equipment provides the visual interface between the operator and the target-instrument field. Different target modules can be used, and the level of task difficulty can be adjusted by varying the manipulation, elevation, and azimuth angles. The system's software is designed to (a) prompt the surgeon with the information necessary to perform the task, (b) collect and collate data on performance during execution of specified tasks, and (c) save the data for future analysis. The system was alpha and beta tested to ensure that all functions operated correctly.
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