Surgical fatigue syndrome and EDiS3 intervention, should every surgeon need to know how to mitigate muscle skeletal discomfort?

Background: Surgical fatigue syndrome (SFS) is a frequent, but underestimated, entity that occurs during laparoscopic surgeries. It could impair surgical outcomes, patient safety, and surgeon health. Furthermore, current surgical education lacks effective interventions to avoid it. Discomfort represents the most common manifestation and includes musculoskeletal fatigue, numbness, or frank pain. The most common affected sites are the back neck, dominant hand shoulder, and high or low back. We propose an integral intervention (surgeon posture, instruments/devices design & use and discomfort improvement) that prevents or mitigates SFS. Methods: An experimental study was conducted on 57 general surgery residents and general surgeons. Participants in the experimental and control group executed standardized laparoscopic knots in a simulator and knowledge, body discomfort, and posture/ergonomic risk was evaluated before and after intervention application. Results: A statistically significant decrease in discomfort intensity was found in the experimental group. Also, discomfort presentation by the anatomic site diminishes and surgical performance improves. Conclusions: Intervention prevents or mitigates discomfort associated with muscle-skeletal component of SFS. ACGME competency: Practice Based-Learning and Improvement.

Image reconstruction algorithm for laser-induced ultrasonic imaging: The single sensor scanning synthetic aperture focusing technique.

This paper aims to implement a laser-induced ultrasound imaging reconstruction method based on the delay-and-sum beamforming through the synthetic aperture focusing technique (SAFT) for a circular scanning, performed with a tomograph that had one acoustic sensor and a system that rotates the sample around a fixed axis. The proposed method, called the Single-sensor Scanning Synthetic Aperture Focusing Technique, considers the size of the sensor and the detection procedure inside the SAFT's algebra. This image reconstruction method was evaluated numerically, using the Green function for the laser-induced ultrasound wave equation to generate a forward problem, and experimentally, using a solid object of polylactic acid, and a Sprague-Dawley rat heart located in a tissue-mimicking phantom. The resulting images were compared to those obtained from the time reversal and the conventional delay-and-sum reconstruction algorithms. The presented method removes the sidelobe artifacts and the comet tail sign, which produces a more distinguishable target on the image. In addition, the proposed method has a faster performance and lower computational load. The implementation of this method in photoacoustic microscopy techniques for image reconstruction is discussed.

Laparoscopic procedures experience in Mexico during 2015: ¿Where are we?

BACKGROUND: 26 years have passed from the first laparoscopic cholecystectomy in Mexico. Since then the laparoscopy has been adopted of variable way and has extended into different specialties. OBJECTIVE: To identify the place that laparoscopic approaches occupy at the present time in Mexico. METHOD: We searched the codes that had the word laparoscopy or laparoscopic in the records of the Automated System of Hospitable Discharges in 2015. Based on the obtained information there was realized a descriptive and retrospective study. RESULTS: We found 55 different procedures in a total of 30,174. Of them, 79.7% in women and 20.3% in men. The most common age was between 25 and 29 years. The ten first ones were cholecystectomy, appendectomy, total abdominal laparoscopic hysterectomy, procedures to create esophago-gastric sphincter competence, unilateral salpingo-oophorectomy, partial cholecystectomy, ovarian resection, umbilical hernia repair, incidental appendectomy and unilateral oophorectomy (94.6%). The States with the major number are Mexico City, State of Mexico, Jalisco, Guanajuato and Sonora. CONCLUSIONS: The laparoscopic procedures have increase in the national health systems and there is concordance of the most common with the international statistics. However, is necessary to diversify them and reduce the times of hospital stay. Its application is in process and it still face challenges in relation to availability of organizational elements, equipment, infrastructure and training, although there are different ways to overcome them.

ANTECEDENTES: Han pasado 26 años desde la primera colecistectomía laparoscópica en México. Desde entonces, la laparoscopía se ha adoptado de forma variable y se ha extendido a diferentes especialidades. OBJETIVO: Identificar el sitio que ocupan los abordajes laparoscópicos en México. MÉTODO: Se buscaron los códigos que tuvieran la palabra laparoscopia o laparoscópica en los registros del Sistema Automatizado de Egresos Hospitalarios en 2015. Con los datos obtenidos se realizó un estudio descriptivo y retrospectivo. RESULTADOS: Se encontraron 55 procedimientos diferentes en un total de 30,174. De ellos, el 79.7% en mujeres y el 20.3% en hombres. La edad más común fue entre los 25 y 29 años. Los diez primeros fueron colecistectomía, apendicectomía, histerectomía total abdominal laparoscópica, procedimientos para creación de competencia esfinteriana esofagogástrica, salpingo-ooforectomía unilateral, colecistectomía parcial, escisión local o destrucción de ovario, plastia umbilical, apendicectomía incidental y ooforectomía unilateral (94.6% del total). Los Estados con el mayor número reportado fueron Ciudad de México, Estado de México, Jalisco, Guanajuato y Sonora. CONCLUSIONES: Los procedimientos laparoscópicos han ido en aumento en los sistemas de salud nacionales y hay concordancia de los más comunes con las estadísticas internacionales. Sin embargo, es necesario diversificarlos y disminuir los tiempos de estancia hospitalaria. Su aplicación está en proceso y aún enfrentan retos en relación con la disponibilidad de elementos organizacionales, equipo, infraestructura y entrenamiento, aunque existen diferentes alternativas para vencerlos.