Transvaginal cholecystectomy by using a prototype flexible clip applier

Whang, Susan H.; Satgunam, Shean; Miedema, Brent W.; Thaler, Klaus

doi:10.1016/j.gie.2010.02.050

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…In 2009, a new set of endoscopic instruments dedicated to NOTES, the generation 1 NOTES tool box (Ethicon Endo-Surgery Inc. (EES), Cincinnati, OH) was introduced. The tools were experimented in NOTES cholecystectomy procedures on porcine models [34, 35]. In spite of the encouraging results, these studies pointed out some limitations (such as visibility of the endoscopic clip applier tool tip) that can prevent this set of tools from being used successfully for humans.…”

Section: Discussionmentioning

confidence: 99%

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

et al. 2014

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Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The NOTES continuum of invasiveness is proposed here as a classification scheme for these methods, which was used to construct a clear roadmap for training and technology development.

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Section: Discussionmentioning

confidence: 99%

Toward scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES

et al. 2014

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“…A thumb screw on the side of the handle controls retraction and extension of the hook. A knob at the end of the handle can be turned to provide 360°rotation of the hook knife [18].…”

Section: Generation 1 Notes Toolbox Prototype Flexible Instrumentsmentioning

confidence: 99%

“…Once the clip applier is loaded, the tip can be rotated 360°. When in position the clip is deployed by squeezing a grip handle [18].…”

Section: Generation 1 Notes Toolbox Prototype Flexible Instrumentsmentioning

confidence: 99%

“…A monopolar electrocautery can be applied to the scissor for coagulation. The scissor cannot be rotated at the tip but some rotation is possible by twisting the shaft of the scissor [18].…”

Section: Generation 1 Notes Toolbox Prototype Flexible Instrumentsmentioning

confidence: 99%

“…The trocar measures 35 cm and the distal 15 cm can be articulated up to 180°in a single direction. The tip can be locked to maintain scope tip position [18].…”

Section: Generation 1 Notes Toolbox Prototype Flexible Instrumentsmentioning

confidence: 99%

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