No abstract

No abstract

Deep inferior epigastric perforator (DIEP) flap is a surgical procedure using tissue harvested from the abdominal area to reconstruct the breast after a mastectomy. Primary surgical phases include the abdominal flap harvest, chest dissection, and anastomosis. In this study, inertial measurement units (IMUs) were used to measure surgeon upper body postures while performing DIEP flap procedures. Ergonomic risks of musculoskeletal disorders were evaluated using the Rapid Upper Limb Assessment (RULA) based on the postures obtained from the IMUs. Joint angles were analyzed using a one-way ANOVA. The neck and back had higher joint angles during the abdominal flap (M=32°, 17°, respectively) and chest dissection (M=31°, 18°, respectively) phases than the anastomosis phase. These high-risk postures may lead to musculoskeletal disorders. Future interventions should focus on improving the postures of the neck and back during the abdominal flap and chest dissection phases of the procedure.

The main goal of this pilot study was to create, implement and evaluate a strategy for introducing exoskeletons in the operating room (OR) at a quaternary care academic hospital. The strategy consisted of operating-room-specific considerations, introducing exoskeletons to surgeons, and a post-surgery survey. Three male attending vascular surgeons participated in eleven data collections to date. Low interference with surgeon’s ability to perform surgery was found for all surgical procedures, except for two open abdominal aortic procedures. The surgeons reported little to no limit on range of motion, except for one open abdominal aortic procedure. Lower than expected perceived improvement of ability to perform surgery and increase of physical comfort was self-reported. The responses indicate that the surgeons are willing to keep trying an exoskeleton intervention. In conclusion, a feasible process was created to introduce passive exoskeleton as an ergonomic intervention to vascular surgeons in their ORs.

Rationale:Clear cell renal cell carcinoma (CCRCC) metastasis to pancreas is clinically rare. Misdiagnosis for these cases is frequently due to the low incidence, lack of specific clinical symptoms, and laboratory results.Patient concerns:Three female patients aged 47 years, 69 years, and 76 years, respectively, were admitted to hospital for routine examination after resection of clear cell carcinoma of kidney for 69 months, 57 months, and 123 months, respectively. All 3 cases had no specific clinical symptoms. Routine laboratory tests and common tumor markers including CEA, AFP, CA19-9, and CA125 showed no obvious abnormality.Diagnosis:All 3 cases were finally diagnosed with CCRCC metastasis to pancreas on the basis of CT and pathological findings. On unenhanced CT, foci of the pancreas showed single or multiple nodules or masses with mildly low or equal density and obscure boundary. On enhanced CT, the enhanced mode of foci was similar to CCRCC and showed “fast in fast out.” The main body was confined in the pancreas. The peripheral structure was clear relatively. Obstruction of common bile duct, main pancreatic duct, and local infringement of foci cannot be seen. Additional metastases of right adrenal gland can be seen in one case.Interventions:All 3 cases underwent CT examination and surgical treatment, with complete removal of metastatic tumors.Outcomes:All 3 cases underwent surgical treatment successfully, and recovered successfully after operation.Lessons:The manifestations of pancreatic metastases from CCRCC on CT show certain characteristics, which may be useful to assess the histological features of pancreatic metastases from CCRCC and facilitate the preoperative diagnosis.

No abstract

No abstract

Musculoskeletal disorders and intraoperative pain are prevalent among vascular surgeons which can negatively affect their surgical performance and quality of life. The effectiveness of a lower back support exoskeleton to reduce discomfort of the back, subjective fatigue, and the workload associated with performing vascular surgery was evaluated, as well as the participants’ intraoperative upper body postures. Three vascular surgeons were asked to rate their discomfort and fatigue before, during and after performing surgery, and their subjective workload post-operatively. Inertial measurement units (IMUs) were used to measure their intraoperative body postures. No significant differences were found between exoskeleton and baseline discomfort, fatigue, workload, or intraoperative postures. This indicates that although the exoskeleton did not restrict the vascular surgeons’ postures, this exoskeleton was ineffective at reducing their discomfort or workload. Future studies with exoskeletons specifically designed for healthcare applications may show more efficacy in reducing the ergonomic risks to surgeons.