Outcomes in video laryngoscopy studies from 2007 to 2017: systematic review and analysis of primary and secondary endpoints for a core set of outcomes in video laryngoscopy research.

BACKGROUND: Airway management is crucial and, probably, even the most important key competence in anaesthesiology, which directly influences patient safety and outcome. However, high-quality research is rarely published and studies usually have different primary or secondary endpoints which impedes clear unbiased comparisons between studies. The aim of the present study was to gather and analyse primary and secondary endpoints in video laryngoscopy studies being published over the last ten years and to create a core set of uniform or homogeneous outcomes (COS). METHODS: Retrospective analysis. Data were identified by using MEDLINE® database and the terms "video laryngoscopy" and "video laryngoscope" limited to the years 2007 to 2017. A total of 3351 studies were identified by the applied search strategy in PubMed. Papers were screened by two anaesthesiologists independently to identify study endpoints. The DELPHI method was used for consensus finding. RESULTS: In the 372 studies analysed and included, 49 different outcome categories/columns were reported. The items "time to intubation" (65.86%), "laryngeal view grade" (44.89%), "successful intubation rate" (36.56%), "number of intubation attempts" (23.39%), "complications" (21.24%), and "successful first-pass intubation rate" (19.09%) were reported most frequently. A total of 19 specific parameters is recommended. CONCLUSIONS: In recent video laryngoscopy studies, many different and inhomogeneous parameters were used as outcome descriptors/endpoints. Based on these findings, we recommend that 19 specific parameters (e.g., "time to intubation" (inserting the laryngoscope to first ventilation), "laryngeal view grade" (C&L and POGO), "successful intubation rate", etc.) should be used in coming research to facilitate future comparisons of video laryngoscopy studies.

¿Ha muerto la laringoscopia directa? Larga vida a la videolaringoscopia / Is direct laryngoscopy dead? Long live the video laryngoscopy

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[Robots in urology-an analysis of current and future devices]. / Der Roboter in der Urologie ­ eine Analyse aktueller und zukünftiger Gerätegenerationen.

The monopoly of robotic surgical devices of the last 15 years will end in 2019 when key patents of Intuitive Surgical expire. Thus, we can expect an interesting competitive situation in the coming years. Based on personal experience with robot-assisted surgery since 2001, we conducted a search of the current literature together with a search of relevant patents in this field. Finally, we visited the websites of manufacturers of existing and future robotic surgical devices with possible applications in urology. Such devices have to prove that they meet the high-quality standard of the current Da Vinci series (SI, X, XI). For this purpose, we propose to classify the main features of the different devices, such as type of console (closed/open), arrangement of robotic arms (single/multiple carts/attached to operating room table), type of three-dimensional videosystem (by mirror/ocular/using polarizing glasses) or degrees of freedom (DOF) of end effectors (5 vs. 7 DOF). In the meantime, there are also robotic systems used in endourology: Avicenna Roboflex® and the AquaBeam® system for robot-assisted aquablation therapy of the prostate. While Roboflex® improves the ergonomics of flexible ureteroscopy-similar to the Da Vinci robot, AquaBeam® may for the first time eliminate the surgeon, who might only be needed to manage severe postoperative bleeding.

Future of robotic surgery in urology.

OBJECTIVES: To provide a comprehensive overview of the current status of the field of robotic systems for urological surgery and discuss future perspectives. MATERIALS AND METHODS: A non-systematic literature review was performed using PubMed/Medline search electronic engines. Existing patents for robotic devices were researched using the Google search engine. Findings were also critically analysed taking into account the personal experience of the authors. RESULTS: The relevant patents for the first generation of the da Vinci platform will expire in 2019. New robotic systems are coming onto the stage. These can be classified according to type of console, arrangement of robotic arms, handles and instruments, and other specific features (haptic feedback, eye-tracking). The Telelap ALF-X robot uses an open console with eye-tracking, laparoscopy-like handles with haptic feedback, and arms mounted on separate carts; first clinical trials with this system were reported in 2016. The Medtronic robot provides an open console using three-dimensional high-definition video technology and three arms. The Avatera robot features a closed console with microscope-like oculars, four arms arranged on one cart, and 5-mm instruments with six degrees of freedom. The REVO-I consists of an open console and a four-arm arrangement on one cart; the first experiments with this system were published in 2016. Medicaroid uses a semi-open console and three robot arms attached to the operating table. Clinical trials of the SP 1098-platform using the da Vinci Xi for console-based single-port surgery were reported in 2015. The SPORT robot has been tested in animal experiments for single-port surgery. The SurgiBot represents a bedside solution for single-port surgery providing flexible tube-guided instruments. The Avicenna Roboflex has been developed for robotic flexible ureteroscopy, with promising early clinical results. CONCLUSIONS: Several console-based robots for laparoscopic multi- and single-port surgery are expected to come to market within the next 5 years. Future developments in the field of robotic surgery are likely to focus on the specific features of robotic arms, instruments, console, and video technology. The high technical standards of four da Vinci generations have set a high bar for upcoming devices. Ultimately, the implementation of these upcoming systems will depend on their clinical applicability and costs. How these technical developments will facilitate surgery and whether their use will translate into better outcomes for our patients remains to be determined.

¿Cómo implementar un programa de lobectomía VATS en España? El laboratorio experimental (Wet Lab) es una herramienta necesaria / Implementing a VATS lobectomy program in Spain. The Wet Lab, a necessary tool

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Advances in laparoscopic surgery in urology.

In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.

Predictive factors for myasthenic crisis after videoscopic thymectomy in patients with myasthenia gravis.

INTRODUCTION: Predictive factors for myasthenic crisis after transsternal thymectomy have been reported, but little is known about myasthenic crisis after videoscopic thymectomy (MCAVT). METHODS: We investigated 146 myasthenia gravis patients who underwent videoscopic thymectomy. RESULTS: Patients with MCAVT had a lower forced vital capacity (FVC) (2.1 vs. 3.0 L, P < 0.001) than those without. Low-frequency repetitive nerve stimulation showed decremental responses of the orbicularis oculi (47.1% vs. 18.1%, P = 0.001) and nasalis muscles (54.1% vs. 21.4%, P < 0.001), which were more pronounced in patients with MCAVT than those without. According to multivariate analysis, FVC (OR 0.144, 95% confidence interval [CI], 0.044-0.479, P = 0.002) and decremental response of orbicularis oculi (odds ratio, 1.029; 95% CI, 1.001-1.058, P = 0.044) were independently associated with MCAVT. CONCLUSIONS: FVC and decremental response of orbicularis oculi were associated with MCAVT.

[High-tech medical care in surgical endocrinology].

The number of patients with endocrine system diseases increases annually. Widespread introduction of screening programs and improvement of laboratory and instrumental diagnostic is one of the most important causes for this. Treatment of patients with endocrine system diseases within the high-tech medical care leads to perform the unique surgical interventions. It increases survival and patients' life quality.

Airway management in the critically ill.

Successful first attempt intubation of the critically ill patient is of extreme importance. While these patients are anatomically and physiologically complicated, making intubation particularly risky, several important steps have recently been shown to improve the chances of a safe first attempt success. Proper evaluation, planning, positioning, preoxygenation, and in select patients the use of a neuromuscular blocking agent have all been shown to be useful for minimizing the difficult intubation and intubation- related complications. Additionally, although there is significant controversy regarding video laryngoscopy, the use of a video laryngoscope as the primary method of intubation has been shown in all cases to be at least as good as, and often more successful than, direct laryngoscopy.

Video-assisted surgery implementation in the public health system of a developing country.

BACKGROUND: Over the last two decades, video-assisted surgery has become the preferential access route for many procedures. Despite cholecystectomy being the laparoscopic procedure most frequently performed in Brazilian public hospitals from 2008 to 2012, the lack of population-based studies led us to conduct a survey on the prevalence of video-assisted surgery in the treatment of patients using the Sistema Único de Saúde (SUS) (Unified Health System), which is the universal, free, and public healthcare system of Brazil. METHODS: By analyzing the DATASUS (national public health registry database), the prevalence of laparoscopic cholecystectomy and open cholecystectomy (OC) was calculated in the period from January to December in 2008, 2010 and 2012, taking into consideration their geographic distribution throughout Brazil. RESULTS: At the end of the study period, an increase in the number of laparoscopic cholecystectomies was observed, with a variation of 125.7%. However, OC was more prevalent despite an increase in the use of video-assisted surgery over the 5-year study period, increasing from 12 to 25% in 2012. CONCLUSIONS: In spite of a trend toward increased use of video-assisted surgery for treating SUS patients during the period under study, the data from 2012 are still far from being ideal. For this population, OC via laparotomy is still the most prevalent option in all regions. This information must encourage the Brazilian surgical societies to push for an improvement in the supply of the treatment provided by the public health system.

[Video-assisted surgery in children: current progress and future perspectives]. / Vidéochirurgie chez l'enfant : progrès actuels et perspectives.

This review presents the evidence of video-assisted surgery in the pediatric population and discusses future progress in this field. Videosurgery minimizes the cosmetic impact and the pain induced by open procedures and has been in constant development in adults and children. Earlier training of surgeons and residents combined with advances in anesthetics and technology have expanded the use of videosurgery for more complex interventions. Although most feasible surgical procedures have been performed by laparoscopy, the literature has not yet defined it as the gold standard for most interventions, especially because of the lack of evidence for many of them. However, laparoscopy for cholecystectomy is now the preferred approach with excellent postoperative outcomes and few complications. Although no evidence has been demonstrated in children, laparoscopy has been shown to be superior in adults for gastroesophageal reflux disease and splenectomy. Laparoscopic appendectomy remains controversial. Nevertheless, meta-analyses have concluded in moderate but significant advantages in terms of pain, cosmetic considerations, and recovery for the laparoscopic approach. Laparoscopy is now adopted for undescended testes and allows both localization and surgical treatment if necessary. For benign conditions, videosurgery can be an excellent tool for nephrectomy and adrenalectomy. However, laparoscopy remains controversial in pediatric surgical oncology.

Síndrome do desfiladeiro torácico - ressecção de costela cervical por videotoracoscopia / Thoracic outlet syndrome - cervical rib resection through videothoracoscopic surgery

A base do tratamento cirúrgico da Síndrome do Desfiladeiro Torácico (SDT) é a ressecção da primeira costela, podendo associar-se à escalenectomia ou ainda à ressecção de costela cervical. Esta última é feita tradicionalmente por meio de um acesso supraclavicular ou mesmo axilar, o qual é tecnicamente mais trabalhoso. Pode ser realizada também por meio de acesso paraescapular. Embora tecnicamente atrativa e associada à menor invasividade e maior segurança, com ótimo resultado estético, a ressecção da primeira costela torácica, por intermédio de cirurgia videoassistida transaxilar ou pela técnica videotoracoscópica, é pouco relatada na literatura, e nenhuma referência foi encontrada sobre ressecção de costela cervical mediante essa técnica. Neste artigo, apresentamos essa inovação cirúrgica realizada com sucesso para ressecção de costela cervical em duas pacientes.

The basis of Thoracic Outlet Syndrome (TOS) surgical treatment is the first rib resection and may be associated with scalenectomy or cervical rib resection. The latter is traditionally done through a supraclavicular or axillary access, which is the most technically challenging. It can also be achieved through parascapular access. Although technically attractive and associated with less invasiveness and increased security, with excellent aesthetic results, the first thoracic rib resection via video-assisted transaxillary surgery or videothoracoscopic technique is seldom reported in the literature, and no reference was found on cervical rib resection through this technique. In this article, we introduced this innovation successfully performed for surgical cervical rib resection in two patients.

Virtual chromoendoscopy can be a useful software tool in capsule endoscopy

Background: capsule endoscopy (CE) has revolutionized the study of small bowel. One major drawback of this technique is that we cannot interfere with image acquisition process. Therefore, the development of new software tools that could modify the images and increase both detection and diagnosis of small-bowel lesions would be very useful. The Flexible Spectral Imaging Color Enhancement (FICE) that allows for virtual chromoendoscopy is one of these software tools. Aims: to evaluate the reproducibility and diagnostic accuracy of the FICE system in CE. Methods: this prospective study involved 20 patients. First, four physicians interpreted 150 static FICE images and the overall agree - ment between them was determined using the Fleiss Kappa Test. Second, two experienced gastroenterologists, blinded to each other results, analyzed the complete 20 video streams. One interpreted conventional capsule videos and the other, the CE-FICE videos at setting 2. All findings were reported, regardless of their clinical value. Non-concordant findings between both interpretations were analyzed by a consensus panel of four gastroenterologists who reached a final result (positive or negative finding). Results: in the first arm of the study the overall concordance between the four gastroenterologists was substantial (0.650). In the second arm, the conventional mode identified 75 findings and the CE-FICE mode 95. The CE-FICE mode did not miss any lesions identified by the conventional mode and allowed the identification of a higher number of angiodysplasias (35 vs 32), and erosions (41 vs. 24). Conclusions: there is reproducibility for the interpretation of CE-FICE images between different observers experienced in conventional CE. The use of virtual chromoendoscopy in CE seems to increase its diagnostic accuracy by highlighting small bowel erosions and angiodysplasias that weren’t identified by the conventional mode(AU)

When will video-assisted and robotic-assisted endoscopy replace almost all open surgeries?

This article traces the development of laparoscopy, and establishment resistance to its emergence as the technique to replace almost all laparotomies.

Intraoperative stereoscopic 3D video imaging: pushing the boundaries of surgical visualisation and applications for neurosurgical education.

OBJECTIVE: In the past decades, we have witnessed waves of interest in three-dimensional (3D) stereoscopic imaging. Previously, the complexity associated with 3D technology led to its absence in the operating room. But recently, the public's resurrection of interest in this imaging modality has revived its exploration in surgery. Technological advances have also paved the way for incorporation of 3D stereoscopic imaging in neurosurgical education. METHODS: Herein, the authors discuss the advantages of intraoperative 3D recording and display for neurosurgical learning and contemplate its future directions based on their experience with 3D technology and a review of the literature. RESULTS: Potential benefits of stereoscopic displays include an enhancement of subjective image quality, proper identification of the structure of interest from surrounding tissues and improved surface detection and depth judgment. Such benefits are critical during the intraoperative decision-making process and proper handling of the lesion (specifically, for surgery on aneurysms and tumours), and should therefore be available to the observers in the operating room and residents in training. Our trainees can relive the intraoperative experience of the primary surgeon by reviewing the recorded stereoscopic 3D videos. CONCLUSION: Proper 3D knowledge of surgical anatomy is important for operative success. 3D stereoscopic viewing of this anatomy may accelerate the learning curve of trainees and improve the standards of surgical teaching. More objective studies are relevant in further establishing the value of 3D technology in neurosurgical education.

Anestesia en pacientes geriátricos intervenidos por vía video laparoscópica: Tema de revisión / Anesthesia in elderly patients undergoing laparoscopic by video: Subject to review

El envejecimiento es un proceso fisiológico que transcurre a lo largode la vida y constituye la última fase del ciclo vital. Cuando se discutela cirugía del anciano, obviamente aparece la barrera cronológica ybiológica. Con el propósito de aunar literatura referente a lamorbilidad anestésica del paciente geriátrico en cirugíavideolaparoscópica se presenta esta revisión de pequeño alcance.Considerando sea de mucha utilidad e importancia ya que permite unpunto de partida para continuar el mejoramiento de las normas deatención que aporten elementos y sirvan de experiencia en lospacientes geriátricos(AU)

Aging is a physiological process that takes place throughout life and the last phase of life cycle. When discussing surgery in the elderly is presented, appears obviously chronological and biological barrier. In order to combine literature on anesthesia morbidity of laparoscopic surgery in geriatric patients presents this small revision. Whereas it is very useful and important because it allows us a starting point for further improvement of standards of care and serve to provide elements of experience in geriatric patients(AU)

Advances in videoassisted anterior surgical approach to the craniovertebral junction.

At the present time, an update to the classical microsurgical transoral decompression is supported by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present all the reported experience on the surgical approaches to anterior cranioveretebral junction (CVJ) compressive pathology managed by endoscopy. Surgical strategies dealing with decompressive procedures by using an open access, microsurgical technique, neuronavigation and endoscopy are summarized.Endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ. Endoscopy can be used via transnasal, transoral and transcervical routes; it facilitates visualisation and better decompression without the need for soft palate splitting, hard palate resection, or extended maxillotomy. Although neuronavigation enhances orientation within the surgical field, intraoperative fluoroscopy helps to recognize residual compression.Under normal anatomical conditions, there appear to be no surgical limitations for the endoscopically assisted transoral approach compared with the pure endonasal and transcervical endoscopic approaches.The endoscope has a clear role as "support" to the standard transoral microsurgical approach since 30° angulated endoscopy increases the surgical area exposed over the posterior pharyngeal wall and the extent of the clivus.