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J J Jakimowicz

Publications and source records attributed to J J Jakimowicz.

At least 19 recordsLinked to original sources
PubMed2006

Intraoperative ultrasonography in open and laparoscopic abdominal surgery: an overview.

This article reviews the current state of intraoperative ultrasonography in open surgery (IOUS) and laparoscopic surgery (LUS). The review is based on extensive study of data published (Pubmed search) and on 25 years of personal experience with intraoperative ultrasonography. The main application areas of IOUS and LUS and its use during liver, biliary tract, and pancreatic surgery are discussed. The benefits and limitations as well as future expectations with regard to the existing and emerging applications also are discussed. New developments in ultrasound technology and the increasing experience of surgeons in ultrasonography secure the future for IOUS and LUS.

Abdomen↗
PubMed2006

Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease.

Occasionally patients awaiting heart or lung transplant because of terminal disease require other types of surgery, but present significant challenges to the anaesthetist because of impaired organ function. Regional anaesthesia may have much to offer such patients and we here report one who underwent successfully a laparoscopic cholecystectomy under segmental subarachnoid (spinal) anaesthesia performed at the low thoracic level. The anatomical and physiological consequences of such a technique are discussed.

Anesthesia, Epidural↗
PubMed2006

Determination of face validity for the Simbionix LAP mentor virtual reality training module.

This study determines the expert and referent face validity of LAP Mentor, the first procedural virtual-reality (VR) trainer. After a hands-on introduction to the simulator a questionnaire was administered to 49 participants (21 expert laparoscopists and 28 novices). There was a consensus on LAP Mentor being a valid training model for basic skills training and the procedural training of laparoscopic cholecystectomies. As 88% of respondents saw training on this simulator as effective and 96% experienced this training as fun it will likely be accepted in the surgical curriculum by both experts and trainees. Further validation of the system is required to determine whether its performance concurs with these favourable expectations.

Computer Simulation↗
PubMed2005

Consensus guidelines for validation of virtual reality surgical simulators.

The Work Group for Evaluation and Implementation of Simulators and Skills Training Programmes is a newly formed sub-group of the European Association of Endoscopic Surgeons (EAES). This work group undertook a review of validation evidence for surgical simulators and the resulting consensus is presented in this article. Using clinical guidelines criteria, the evidence for validation for six different simulators was rated and subsequently translated to a level of recommendation for each system. The simulators could be divided into two basic types; systems for laparoscopic general surgery and flexible gastrointestinal endoscopy. Selection of simulators for inclusion in this consensus was based on their availability and relatively widespread usage as of July 2004. Whilst level 2 recommendations were achieved for a few systems, it was clear that there was an overall lack of published validation studies with rigorous experimental methodology. Since the consensus meeting, there have been a number of new articles, system upgrades and new devices available. The work group intends to update these consensus guidelines on a regular basis, with the resulting article available on the EAES website (http://www.eaes-eur.org ).

Computer Simulation↗
PubMed2005

The Eindhoven laparoscopic cholecystectomy training course--improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum.

BACKGROUND: This study was undertaken to investigate operating room performance of surgical residents, after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course. This course is the first formal surgical resident trainings course, using a variety of complementary virtual reality (VR) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy. The course was granted EAES certification. METHODS: The four-day course is based on multimedia and multimodality approach. A variety of increasingly difficult simulation training sessions, next to intimate focus-group "knowledge sessions" are included. Both basic and procedural VR simulation is featured, using MIST-VR and the Xitacts' LapChol simulation software. The operating room performance of twelve surgical residents who participated in the course and twelve case-control counterparts were compared. The case-control group was matched for clinical number laparoscopic cholecystectomy performance (maximum of 4 procedures). Two observers analyzed a randomly mixed videotape, featuring the part of the "clip-and-cut" procedure of the laparoscopic cholecystectomy, and were blinded for participants' group status. Structured questionnaires including multiple observation scales were used to assess performance. RESULTS: Residents of both the experimental and control group did not differ in demographic parameters, except for number of laparoscopic cholecystectomies in favor of the control group (p-value 0.008). Both observers judge the experimental group to perform significantly better (p-value 0.004 and 0.013). Experimental group residents valued their course highly in terms of their laparoscopic surgical skills improvement and the use of VR simulators in the surgical curriculum. CONCLUSIONS: The Eindhoven Virtual Reality laparoscopic cholecystectomy training course improves surgical skill in the operating room above the level of residents trained by a variety of other training methods.

Adult↗
PubMed2004

Prevention of lens condensation in laparoscopic surgery by lens heating with a thermos flask.

Condensation on the scope lens as a result of differences between room and intraabdominal temperatures is a disturbing problem for laparoscopic surgeons. Despite the use of anti-lens condensation solutions, this cannot be entirely avoided. The authors report a simple, cheap, and effective method for preventing lens condensation by lens heating using a sterilized thermos flask filled with hot water.

Body Temperature↗
PubMed2004

Minimal-access surgery training in the Netherlands: a survey among residents-in-training for general surgery.

BACKGROUND: The purpose of this study was to assess the state of surgical training and its possible shortcomings in minimal-access surgery (MAS) among Dutch surgical residents. METHODS: A pretested questionnaire was distributed to all residents-in-training for general surgery in The Netherlands. RESULTS: The questionnaire was sent to 407 surgical residents. The response rate was 65%. Overall, 87.7% of all the responders were highly interested in the autonomous performance of laparoscopic surgery. Residents interested in gastrointestinal (GI) or oncologic surgery (n = 137) are significantly more interested than residents interested in non-GI/oncologic surgery. All the residents (100%) thought it was important to be able to perform the three basic MAS procedures (diagnostic laparoscopy, laparoscopic cholecystectomy, and laparoscopic appendectomy) autonomously at the end of their surgical training. Other MAS procedures were considered to be advanced procedures. Gastrointestinal/oncologic residents were most interested in performing advanced MAS procedures, although only 17.8% expected to be adequately prepared at the end of their surgical training. Most residents had the opportunity to attend MAS skills education. Irrespective of the format or training method, only 26.9% of residents stated their MAS skills training was objectively evaluated. The residents thought every surgical hospital department in the Netherlands should have a surgeon specialized in laparoscopic surgery (86.9%). CONCLUSIONS: The current study showed that Dutch residents believe it is very important to perform basic MAS autonomously. Of the GI/oncologic-interested residents, the majority want to be able to perform advanced MAS, but expect to be unable to do so at the end of their training. They attribute this discrepancy to "not having enough chance to be the first operator" and to "lack of volume of procedures in the hospital." Specific and properly implemented, monitored, and evaluated MAS skills training programs in skills laboratory settings could offer a promising environment for overcoming this discrepancy.

Adult↗
PubMed2004

Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES).

BACKGROUND: The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on the laparoscopic resection of colon cancer during the annual congress in Lisbon, Portugal, in June 2002. METHODS: A systematic review of the current literature was combined with the opinions, of experts in the field of colon cancer surgery to formulate evidence-based statements and recommendations on the laparoscopic resection of colon cancer. RESULTS: Advanced age, obesity, and previous abdominal operations are not considered absolute contraindications for laparoscopic colon cancer surgery. The most common cause for conversion is the presence of bulky or invasive tumors. Laparoscopic operation takes longer to perform than the open counterpart, but the outcome is similar in terms of specimen size and pathological examination. Immediate postoperative morbidity and mortality are comparable for laparoscopic and open colonic cancer surgery. The laparoscopically operated patients had less postoperative pain, better-preserved pulmonary function, earlier restoration of gastrointestinal function, and an earlier discharge from the hospital. The postoperative stress response is lower after laparoscopic colectomy. The incidence of port site metastases is <1%. Survival after laparoscopic resection of colon cancer appears to be at least equal to survival after open resection. The costs of laparoscopic surgery for colon cancer are higher than those for open surgery. CONCLUSION: Laparoscopic resection of colon cancer is a safe and feasible procedure that improves short-term outcome. Results regarding the long-term survival of patients enrolled in large multicenter trials will determine its role in general surgery.

Colectomy↗
PubMed2003

Ergonomic problems encountered by the medical team related to products used for minimally invasive surgery.

BACKGROUND: The aim of this study is to gain insight into the problems encountered by the medical team related to products used for minimally invasive surgery. METHODS: An inventory was made of the problems encountered during 12 endoscopic operations performed in one city hospital (Eindhoven, the Netherlands). After the observation, a questionnaire was distributed to all medical staff involved. RESULTS: All categories of personnel had physical, perceptional, and cognitive problems, especially surgeons, residents, and the sterile operation nurse. The main causes were the positioning of apparatus and staff, work clothing, and the limited reach of apparatus and/or instruments. Of the questionnaires, 80% were returned: 50% of the medical staff experienced perceptional problems and 63% had physical discomfort during the surgical procedure. CONCLUSION: The diversity of problems observed and/or reported by the staff during minimally invasive surgery decrease the comfort, efficiency, and safety of the operating-room work environment. Therefore, a new design approach is needed for MIS products in order to address the problems that occur with the current equipment.

Ergonomics↗
PubMed2002

Quantitative evaluation of three advanced laparoscopic viewing technologies: a stereo endoscope, an image projection display, and a TFT display.

BACKGROUND: Compared to open surgery, minimally invasive surgery (MIS) relies heavily on advanced technology, such as endoscopic viewing systems and innovative instruments. The aim of the study was to objectively compare three technologically advanced laparoscopic viewing systems with the standard viewing system currently used in most Dutch hospitals. METHODS: We evaluated the following advanced laparoscopic viewing systems: a Thin Film Transistor (TFT) display, a stereo endoscope, and an image projection display. The standard viewing system was comprised of a monocular endoscope and a high-resolution monitor. Task completion time served as the measure of performance. Eight surgeons with laparoscopic experience participated in the experiment. RESULTS: The average task time was significantly greater (p <0.05) with the stereo viewing system than with the standard viewing system. The average task times with the TFT display and the image projection display did not differ significantly from the standard viewing system. CONCLUSION: Although the stereo viewing system promises improved depth perception and the TFT and image projection displays are supposed to improve hand-eye coordination, none of these systems provided better task performance than the standard viewing system in this pelvi-trainer experiment.

Analysis of Variance↗
PubMed2002

Hyaline vascular Castleman's disease: a case report and brief review of the literature.

We describe a 27-year-old female with a mesenterial localisation of the hyaline vascular type of Castleman's disease. A review of the literature is given with emphasis on the different pathogenesis of the subtypes. The hyaline vascular type is a disorder of stromal cells, which can be complicated by the development of soft tissue sarcomas. The plasma cell type is a plasma cell disorder with elevated levels of interleukin-6 (IL-6). In the multicentric type, infection with human herpes virus-8 (HHV-8) plays an important role in the pathogenesis. The development of Kaposi's sarcoma and some lymphomas are related to the presence of HHV-8. As the different subtypes have a different pathogenesis they should be regarded as distinct diseases.

Adult↗
PubMed2001

Evaluation of the usability of two types of image display systems, during laparoscopy.

BACKGROUND: This study was performed to assess the optimal display location of a flat-screen monitor for laparoscopy. It was also performed to assess the posture (objective), opinion, and preference (subjective) of subjects using a flat-screen monitor positioned in the optimal display location and a cathode-ray tube monitor on a tower next to the operating table (current situation). METHODS: Twelve surgeons performed cholecystectomies using the two display systems alternately. The postures of the operator and the assistant were assessed by an infrared video analysis system. RESULTS: The posture of the assistant is significantly better when using a flat-screen monitor [more neutral head flexions (p = 0.036) and neutral neck torsions (p = 0.012)]. No significant differences were found for the posture of the operator. The operators and assistants felt more comfortable when using a flat-screen monitor (p = 0.008) and they preferred this display to the use of a monitor on a tower. CONCLUSIONS: The use of flat-screen monitors is better for the physical and psychological comfort of the users, even though the technical performance is inferior in comparison with that of regular monitors.

Cholecystectomy↗
PubMed2001

Improved usability of a new handle design for laparoscopic dissection forceps.

BACKGROUND: Recent studies have shown that the shape of most instrument handles causes user discomfort and that none of the handles currently available on the market satisfies all ergonomic criteria. Therefore, we designed a handle with improved usability; i.e., it is easier to manipulate and its use entails less risk of injury for the operator. The aim of this study was to demonstrate that the intended improvements of the new design were successful. METHODS: Six handles representative of the types that are currently available were compared with the new version. Eight surgeons used the seven handles during a precision task and a rough task in a pelvi-trainer. A questionnaire and video analyses were used to assess the usability of the handles. RESULTS: Based on the responses to the questionnaire, we determined that there were significant differences between the new handle and the Aesculap handle (means of rotation and angle between handle and shaft). No significant differences were found between the new handle and the five other handles. The video analyses (documenting extreme vs neutral wrist excursions) showed significant differences between the new handle and the six other handles. CONCLUSION: Compared to the six existing handles, the new handle has significantly improved usability; in particular, its hinged design obviates the need to make extreme wrist excursions.

Adult↗
PubMed2000

Hand-assisted laparoscopic surgery: an overview.

BACKGROUND: Advanced laparoscopic surgery is complex and time-consuming. Achieving consistent efficacy and safety throughout the entire procedure is always a problem. For this reason, hand-assisted laparoscopic surgery (HALS) was developed. METHODS: Devices were designed to allow manual access to the abdomen through the utility laparotomy. By using one hand in the abdomen during laparoscopy, the surgeon regains direct tactile sensation and acquires improved hand-eye coordination. The safety of the individual devices has been tested in RCT for the registration of the individual devices. An index known as Surgical Action Efficiency was calculated for in six patients undergoing laparoscopic colon resection and six patients with hand-assisted colon resections. RESULTS: All of the registered devices are safe. Surgical Action Efficiency for the laparoscopy group was 55 +/- 14%; for the HALS group, it was 71 +/- 4%. This result is statistically significant (p < 0.05). CONCLUSION: HALS is a safe and efficient method by which it is possible to combine the established convenience and safety of open surgery with the advantages of minimally invasive surgery.

Hand↗
PubMed2000

Observation in laparoscopic surgery: overview of impeding effects and supporting aids.

Within a Dutch research program on minimally invasive surgery, a large literature survey has been carried out. This article describes the state of the art in research on observation in laparoscopy. It gives an overview of factors impeding the surgeon and technical developments designed to overcome these problems. A large number of journals, proceedings, patents, and books starting from the year 1991 have been consulted. The survey was completed with a thorough MEDLINE search. The survey showed that many authors have an incomplete background in the fundamentals of visual perception. This leads to a lack of understanding and to the design of supporting aids that often are not very useful. The new aspect of this study is that it gives a complete and structured overview of laparoscopic observation problems and current solutions. The observation problems are structured according to visual perception theory. The solutions are critically considered, and their benefits and drawbacks are identified. The study shows that the benefits of stereo-endoscopes and motorized endoscope positioners are questionable. The addition of shadows and movement parallax is still a very important research topic.

Humans↗
PubMed1999

Manipulation in laparoscopic surgery: overview of impeding effects and supporting aids.

Within a Dutch research program on minimally invasive surgery, a large literature survey has been carried out. This article describes the state of the art in research on manipulation in laparoscopy. It gives an overview of factors impeding the surgeon and technical developments designed to overcome these problems. Starting from the year 1991, a large number of journals, proceedings, patents, and books have been consulted. The survey was completed with a thorough MEDLINE search. The impeding effects have been subdivided into two groups: transformation of spatial and grasping movements of the hand. The article gives an overview of these effects and of supporting aids that have been developed. The studies show that many aids are based on a technology-driven rather than a clinically-driven approach. The development of simple instruments that can be used for a large range of tasks instead of only one is still a very important topic of research.

Ergonomics↗
PubMed1999

Splenectomy revised: manually assisted splenectomy with the dexterity device--a feasibility study in 22 patients.

Laparoscopic splenectomy claims a number of advantages over open surgery: less trauma, quicker recovery, and faster return to normal activity. On the other hand, laparoscopic splenectomy is complex and time consuming, and so far, many surgeons are reluctant to perform such an operation. A new device was designed to give manual access to the abdomen through a utility laparotomy. By using one hand in the abdomen during laparoscopy, the surgeon regains direct tactile sense and hand-eye coordination. A pilot study to assess the feasibility of this method has been performed in 22 patients. The operation could be completed easily in 21 patients (95%). The average blood loss was 230 mL, and the average postoperative stay was 3.9 days. With this simple, inexpensive method, it is possible to combine the established convenience, safety, efficacy of open surgery with the advantages of minimally invasive surgery.

Adolescent↗