Evaluation of Scissor Glide Characteristics Through Surgeons' Subjective Assessment: The Application of Nitriding in Scissor Hardening Tests.

INTRODUCTION: In robotic surgery, studies on providing tactile feedback to users are ongoing. However, the accuracy of the subjective sensations of surgeons, as users, has been largely unassessed. This study aimed to assess the validity of surgeons' subjective evaluations of scissors resistance through interindividual, inter-surgeon, and objective evaluations. Furthermore, in this study, we explored the possibility of using nitriding to increase the hardness of the scissors and assessed changes in subjective resistance values before and after nitriding using this approach. METHOD: Five surgeons conducted validation of five curved surgical scissors (145 mm; Arakawa Seisakujyo Co., Ltd., Tokyo, Japan) and assessed their subjective resistance using a scale from 0 to 10, where a rating of 10 signified significant resistance impeding the scissors' closure. The temporal changes in subjective resistance values, from maximum open to close, were graphically recorded. To demonstrate the reproducibility of subjective resistance values, the subjective resistance values of the same control scissors were measured at intervals of at least two weeks, and the correlation coefficient was calculated. To analyze the closing characteristics of subjective resistance values between different pairs of scissors, the effect of scissor type and scissor closure position was compared as two independent variables using a two-factor analysis of variance. A comparative evaluation was conducted to assess the frictional properties of scissors after nitriding, comparing the subjective assessment by surgeons with the objective assessment using a digital force gauge. RESULTS: The correlation coefficient of subjective resistance values measured by surgeons demonstrated a high reproducibility of 0.746. A two-factor analysis of variance conducted on subjective resistance values demonstrated the presence of a primary effect for the sample factor (scissors), as well as for the position factor (closing process), with the additional observation of the interaction between these two factors. The results from the two-factor analysis of variance above provide evidence supporting the validity of the subjective resistance measurements. There was a significant increase in subjective resistance after the nitriding process. The graph of subjective resistance values and objective resistance values showed similarity. CONCLUSIONS: The surgeons' subjective assessment of scissors resistance showed high reproducibility and validity, as evidenced by distinguishable differences in scissor movement interactions and pre- and post-nitriding resistance. Further studies are warranted to expand on these findings.

Blood Perfusion Assessment by Indocyanine Green Fluorescence Imaging for Minimally Invasive Rectal Cancer Surgery (EssentiAL trial): A Randomized Clinical Trial.

OBJECTIVE: The aim of the present randomized controlled trial was to evaluate the superiority of indocyanine green fluorescence imaging (ICG-FI) in reducing the rate of anastomotic leakage in minimally invasive rectal cancer surgery. BACKGROUND: The role of ICG-FI in anastomotic leakage in minimally invasive rectal cancer surgery is controversial according to the published literature. METHODS: This randomized, open-label, phase 3, trial was performed at 41 hospitals in Japan. Patients with clinically stage 0-III rectal carcinoma less than 12 cm from the anal verge, scheduled for minimally invasive sphincter-preserving surgery were preoperatively randomly assigned to receive a blood flow evaluation by ICG-FI (ICG+ group) or no blood flow evaluation by ICG-FI (ICG- group). The primary endpoint was the anastomotic leakage rate (grade A+B+C, expected reduction rate of 6%) analyzed in the modified intention-to-treat population. RESULTS: Between December 2018 and February 2021, a total of 850 patients were enrolled and randomized. After the exclusion of 11 patients, 839 were subject to the modified intention-to-treat population (422 in the ICG+ group and 417 in the ICG- group). The rate of anastomotic leakage (grade A+B+C) was significantly lower in the ICG+ group (7.6%) than in the ICG- group (11.8%) (relative risk, 0.645; 95% confidence interval 0.422-0.987; P =0.041). The rate of anastomotic leakage (grade B+C) was 4.7% in the ICG+ group and 8.2% in the ICG- group ( P =0.044), and the respective reoperation rates were 0.5% and 2.4% ( P =0.021). CONCLUSIONS: Although the actual reduction rate of anastomotic leakage in the ICG+ group was lower than the expected reduction rate and ICG-FI was not superior to white light, ICG-FI significantly reduced the anastomotic leakage rate by 4.2%.

The usefulness of indocyanine green fluorescence imaging for intestinal perfusion assessment of intracorporeal anastomosis in laparoscopic colon cancer surgery.

PURPOSE: The purpose of this study was to clarify the usefulness of indocyanine green fluorescence imaging (ICG-FI) in the assessment of intestinal vascular perfusion in patients who receive intracorporeal anastomosis (IA) in colon cancer surgery. METHODS: This was a single-center, retrospective study using propensity score matching. We compared the surgical outcomes of colon cancer patients who underwent laparoscopic colonic resection with IA or external anastomosis (EA) with the intraoperative evaluation of anastomotic perfusion using ICG-FI from January 2019 to July 2021. The detection rate of poor anastomotic perfusion by ICG-FI was examined. RESULTS: A total of 223 patients were enrolled. After matching, 69 patients each were classified into the IA and EA groups. There were no significant differences in age, sex, body mass index, tumor localization, or progression between the two groups. The operation time was similar (172 min vs. 171 min, p = 0.62) and the amount of bleeding was significantly lower (0 ml vs. 2 ml, p = 0.0023) in the IA group. The complication rates (grade ≥ 2) of the two groups were similar (14.5% vs. 11.6%, p = 0.59). ICG-FI identified four patients (5.8%) with poor anastomotic perfusion in the IA group, but none in the EA group (p = 0.046). All four patients with poor perfusion in the IA group underwent additional resection; none of these patients developed postoperative complications. CONCLUSION: Poor anastomotic perfusion was detected in 5.8% of cases who underwent laparoscopic colon cancer surgery with IA. ICG-FI is useful for evaluating anastomotic perfusion in IA in order to prevent AL.

Body composition assessment and sarcopenia in patients with biliary tract cancer: A systematic review and meta-analysis.

BACKGROUND: Sarcopenia, as assessed by body composition, can affect morbidity and survival in several gastrointestinal cancer. However, the impact of sarcopenia, referring to both quantity and quality of skeletal muscle, in biliary tract cancer (BTC) is debatable. We aimed to investigate the impact of sarcopenia on morbidity and mortality in patients with BTC. METHODS: Electronic databases and trial registries were searched through July 2021 to perform random-effects meta-analyses. Study selection, data abstraction and quality assessment were independently performed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Twenty-nine studies (4443 patients) were included; 28 used computed tomography and one used dual-energy X-ray absorptiometry to assess body composition. Eighteen studies reported the impact of pre-operative sarcopenia on postoperative outcomes; namely, sarcopenia increased postoperative complications (risk ratio = 1.23, 95% confidence interval [CI] = 1.07 to 1.41; I2 = 2%), and decreased recurrence-free survival (hazard ratio [HR] = 2.20, 95% CI = 1.75 to 2.75; I2 = 0%) in multivariable analyses. Low muscle quantity (HR = 2.26, 95% CI = 1.75 to 2.92; I2 = 66%) and quality (HR = 1.75, 95% CI = 1.33 to 2.29; I2 = 50%) decreased overall survival in multivariable analyses. The certainty of the evidence was low because of heterogeneity and imprecision. CONCLUSIONS: In sarcopenia, low muscle quantity and quality by body composition conferred an independent risk of morbidity and mortality in patients with BTC. Further studies are needed to confirm these findings and mitigate risk.

Exploring relationship between face-to-face interaction and team performance using wearable sensor badges.

Quantitative analyses of human-generated data collected in various fields have uncovered many patterns of complex human behaviors. However, thus far the quantitative evaluation of the relationship between the physical behaviors of employees and their performance has been inadequate. Here, we present findings demonstrating the significant relationship between the physical behaviors of employees and their performance via experiments we conducted in inbound call centers while the employees wore sensor badges. There were two main findings. First, we found that face-to-face interaction among telecommunicators and the frequency of their bodily movements caused by the face-to-face interaction had a significant correlation with the entire call center performance, which we measured as "Calls per Hour." Second, our trial to activate face-to-face interaction on the basis of data collected by the wearable sensor badges the employees wore significantly increased their performance. These results demonstrate quantitatively that human-human interaction in the physical world plays an important role in team performance.

Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost.

BACKGROUND: Single-incision laparoscopic surgery (SILS) has been used for colorectal cancer as a minimally invasive procedure. However, there are still difficulties concerning effective triangulation and countertraction. The study's purpose was to clarify the usefulness of the colon-lifting technique (CLT) in SILS for colorectal cancer. METHODS: SILS was performed for cancer (cT2N0 or less) of the right-sided colon (near the ileocecum), sigmoid, or rectosigmoid. The SILS™ Port was used for transumbilical access. A suture string was inserted through the abdominal wall and passed through the mesocolon. The colon was retracted anteriorly and fixed to the abdominal wall. The main mesenteric vessels were placed under tension. Lymph node dissection was performed by medial approach. Short-term surgical outcomes and access port costs were compared between SILS (using CLT) and the standard multiport technique (MPT). The two groups were case-matched by propensity scoring. Analyzed variables included preoperative Dukes stage and tumor location. RESULTS: From June 2009 to April 2011, 27 patients underwent SILS, and from April 2005 to April 2011, 85 patients underwent MPT. Propensity scoring generated 23 matched patients per group for SILS versus MPT comparisons. There were no significant differences in operating time, blood loss, early complications, postoperative analgesic frequency, or length of hospital stay. One MPT patient was converted to open surgery (4.5%); no SILS patients were converted. There were no significant differences in the length of distal cut margin and the number of harvested lymph nodes, except incision length (SILS vs. MPT: 33 vs. 55 mm, P < 0.001). Significant differences favored SILS in access instrument cost (SILS vs. MPT: 62,761 vs. 77,130 Japanese yen, P < 0.001). CONCLUSIONS: SILS performed using CLT was safe and effective in providing radical treatment of cT2N0 cancer in the right-sided colon, sigmoid, or rectosigmoid. SILS was advantageous with respect to cosmesis and lower cost of access instruments.

Antiferromagnetic character of workplace stress.

We study the nature of workplace stress from the aspect of human-human interactions. We investigated the distribution of Center for Epidemiological Studies Depression Scale scores, a measure of the degree of stress, in workplaces. We found that the degree of stress people experience when around other highly stressed people tends to be low, and vice versa. A simulation based on a model describing microlevel human-human interaction reproduced this observed phenomena and revealed that the energy state of a face-to-face communication network correlates with workplace stress macroscopically.

Rationale, design, and organization of the Diastolic Heart Failure Assessment Study in Tohoku District (DIAST).

BACKGROUND: High mortality and a high readmission rate characterize diastolic heart failure (DHF), but evidence-based therapeutic strategies have not been established for DHF. METHODS: The aim of a multicenter, randomized open trial (the Diastolic Heart Failure Assessment Study in Tohoku District, DIAST) is to evaluate the safety and prognostic efficacy of the multiple action non-selective beta-blocker carvedilol in 160 patients with DHF (left-ventricular ejection fraction > or =50%). The target dose of carvedilol is 10 mg twice a day and the mean follow-up is estimated to be 2 years. The primary endpoints are to evaluate (1) all-cause mortality or hospitalization, (2) cardiovascular mortality or hospitalization and (3) worsening heart failure. The secondary endpoints are to assess (1) cardiovascular events, (2) the individual components of the above combined endpoints, (3) the duration of hospitalization, (4) the functional class and exercise capacity and (5) the safety and tolerability. All patients' data are processed using an original registration system on an internet homepage. Several substudies to assess neurohumoral factors, heart rate variability, oxidative stress and sleep apnea will clarify the pathophysiology of DHF. CONCLUSIONS: The DIAST will contribute to establish therapeutic guidelines for DHF.