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Background: Veress needles (VN) are commonly used in establishing pneumoperitoneum in laparoscopic surgery. Previously, a VN with a new safety mechanism ‘VeressPLUS’ needle (VN +) was developed to reduce the amount of overshoot., Methods: Eighteen participants (novices, intermediates, and experts) performed in total of 248 insertions in a systematic way on Thiel-embalmed bodies with wide and small bore versions of the conventional VN (VNc) and the VN+. Insertion depth was measured by recording the graduations on the needle under direct laparoscopic vision., Results: Participants graded the bodies and the procedures as lifelike. Overall, a significant reduction (P, Conclusion: This study indicated that the VN+ significantly reduced the insertion depth in all tested conditions. Whether the difference between female and male performance can be linked to differences in muscle control or arm mass should be further investigated. Useful technical information was gathered from this study to further improve the VN +., peer-reviewed

Highlights: What are the main findings? Using the HSMEA, it is possible to systematically reduce operating room waste. The HSMEA identifies carbon hotspots of surgical waste based on waste stream analysis. Solutions for improvement are found by applying the six Rs of waste management. What is the implication of the main finding? A reproducible efficient approach to improve operating room sustainability. A structured and practical tool to reduce the environmental impact of surgical solid waste. The purpose of this study was to describe a new method to effectively improve the environmental impact of operating rooms through a systematic approach. A proven successful prospective risk analysis tool to improve the safety of complex healthcare processes (Healthcare Failure Mode and Effect Analysis) was adapted to reduce the environmental impact of surgical waste. For this novel method, named the Healthcare Sustainability Mode and Effect Analysis (HSMEA), a multidisciplinary team, using a structured step-by-step approach, systematically inventories surgical waste, quantifies its environmental impacts, identifies hotspots, and provides solutions for improvement. The five steps of the HSMEA are described (definition of the topic, team assembly, flowchart creation, hazard analysis, actions and outcome measures) and the surgical procedure of a caesarean section was used as a case study to assess the applicability of this method to improve its environmental impact. Applying the HSMEA to caesarean sections resulted in a 22% volume reduction and a 22% carbon footprint reduction in surgical waste. This was achieved by revising the disposable custom pack in order to reduce the overage that was present, and by intensifying waste stream segregation for plastic and paper recycling. The HSMEA is a practical work floor tool to aid in the reduction of the environmental impact of surgical waste that is applicable to all types of operations. It is reproducible, and because it identifies carbon hotspots, it enables an efficient approach to the issue of operating room pollution.

Background: Hospitals in low resource settings (LRS) can benefit from modern laparoscopic methodologies. However, cleaning, maintenance and costs requirements play a stronger role while training and technology are less available. Steerable laparoscopic instruments have additional requirements in these settings and need extra identified adaptations in their design. Method: Several modular detachability and tip steerability features were applied to the SATA-LRS instrument platform designed specifically for LRS. Ten subjects participated a dis- and reassembly experiment to validate the modularity, and in a steering experiment using a custom made set-up to validate steering. Results: A new steerable SATA-LRS instrument was developed with the ability to exchange end-effectors through a disassembly of the shafts. Experiments showed an average 34 and 90 s for complete dis- and reassembly, respectively. Participants were able to handle the instrument independently after a single demonstration and 4 rounds of repetitions. Precise tip-target alignment in the box set-up showed a very short learning-curve of 6 repetitions. Conclusion: A novel instrument platform with articulating and rotating end-effector was designed for LRS. Within a minute the SATA-LRS can be disassembled to component level for inspection, cleaning, maintenance and repair, and can be autonomously reassembled by novices after a minimal training. The modular buildup is expected to reduce purchasing and repair costs. The instrument has been shown intuitive by use without extensive training.

Introduction: Steering light is relevant to many medical applications that require tissue illumination, sensing, or modification. To control the propagation direction of light beams, a great variety of innovative fiber-optic medical devices have been designed. Areas covered: This review provides a comprehensive overview of the patent literature on light beam control in fiber-optic medical devices. The Web of Science Derwent Innovation Index database was scanned, and 81 patents on fiber-optic devices published in the last 20 years (2001–2021) were retrieved and categorized based on the working principle to steer light (refraction/reflection, scattering, diffraction) and the design strategy that was employed (within fiber, at fiber end, outside fiber). Expert opinion: Patents describing medical devices were found for all categories, except for generating diffraction at the fiber end surface. The insight in the different designs reveals that there are still several opportunities to design innovative devices that can collect light at an angle off-axis, reduce the angular distribution of light, or split light into multiple beams.

Introduction/Background* The most important prognostic facttor for the survival of advanced-stage ovarian cancer is the completeness of cytoreductive surgery (CRS). Therefore, an intraoperative technique to detect microscopic tumours would be of great value. The aim of this pilot study is to assess feasibility of near infrared (NIR) hyperspectral imaging (HSI) for the detection of malignant ovarian cancer, using ex vivo tissue samples collected during CRS. Methodology In this pilot-study, patients with proven or suspected ovarian cancer planned for CRS were enrolled in the study. Hyperspectral images with 25 spectral bands were acquired from the resected tissues in the wavelength range of 665-975 nm. All hyperspectral data were processed by image calibration and min-max normalisation, glare removal, feature selection and linear support vector machine (SVM) classifier training. The performance of the classification was evaluated by leave-one-out cross-validation. Result(s)* Ten patients who underwent cytoreductive surgery for advanced-stage epithelial ovarian cancer (EOC) were included in the study, from which 26 tissue samples were imaged, with a total of 26.446 data points that were matched to histopathology. Samples included tissue of the ovaries, fallopian tubes, uterus, omentum and/or part of the intestines. Overall, HSI combined with the SVM classifier was capable to discriminate tumour tissue from non-tumour tissue with a sensitivity of 0.81, specificity of 0.75, area under the curve of 0.83, and Matthew’s correlation coefficient of 0.41. Conclusion* This pilot study shows that hyperspectral imaging is a promising technique to discriminate ovarian carcinomas from the surrounding tissue. Hyperspectral imaging can scan a whole area, is fast, non-contact, non-invasive and can be used inside the operation room.

Distinguishing the diseased breast tissue from the healthy tissue is a sorely challenging task for the surgeons during breast conserving surgery (BCS) as both tissues own relatively similar visual and haptic characteristics. It has been shown that diffused reflectance spectroscopy (DRS) has the potential to be used as a real-time tumor margin detection technique during BCS. In this research, an electrosurgical knife is equipped with fiber-based DRS sensing to provide the surgeon with real-time oncological guidance during BCS. To prevent overheating of the fibers, they were placed inside quartz tubes which were mounted on the electrosurgical knife. The effect of using quartz tubes and debris formation during electrosurgery on the DRS measurements on porcine tissue was investigated. Furthermore to investigate the performance of the new device, a heterogeneous breast phantom representing optical properties and anatomical shape of the real breast was developed. The new device was then used to cut through the phantom’s layers to assess the performance of the new knife while cutting. Finally, a BCS was performed on the phantom using the new knife without receiving visual and haptic feedback from the tissue. The results show that both using the quartz tubes and the formed debris do not have a significant effect on the DRS output. Moreover, the DRS outputs obtained during cutting the layered phantom showed the transition between the layers clearly, demonstrating that the cutting effect on the phantom tissue does not significantly affect the measurements . The X-ray images from the phantom before and after BCS using the new device confirmed the complete resection of the tumors from the breast phantom. The results indicate that the electrosurgical knife equipped with DRS is a promising technique for simultaneously distinguishing and cutting the tissue, and assessing real-time tumor margins during BCS.