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Decision Making↗
PubMed1999

The underestimated impact of personal watercraft injuries.

The popularity of personal watercraft is steadily increasing, as are injuries related to their use. Many of these injuries are not reported to law enforcement agencies, and available personal watercraft injury statistics are suspected to be inaccurate. All personal watercraft-related injuries treated within a four-hospital system (including the regional Level I trauma center) between January 1993 and December 1997 were retrospectively identified. Patient demographics, accident mechanism, injuries sustained, tourist status, outcome, and economic data were collected and compared with available government statistics for the same time period. Sixty-eight consecutive patients injured during personal watercraft use were identified. Of these, 78 per cent were treated and released, whereas 22 per cent required inpatient management. Fractures and soft tissue injuries were the most common injuries sustained. Ninety-seven per cent of patients were discharged home. There was one fatality. Comparison with state and federal statistics identified that personal watercraft injuries are significantly underreported and have an estimated yearly economic impact of more than $235 million. Personal watercraft injuries represent an increasing source of watersport-related trauma. Government statistics on personal watercraft injuries do not accurately reflect the true incidence and economic impact of such trauma. Mandatory educational programs and increased legislation to improve personal watercraft safety should be promoted.

Accidents↗
PubMed1999

3D-visualization improves the dry-lab coronary anastomoses using the Zeus robotic system.

BACKGROUND: Robotic surgical instruments enable quick and precise movements and may allow complete endoscopic coronary artery bypass grafting. However, cardiac surgeons will have to become familiar with this technology and endoscopic viewing. We present our training program with special focus on 2D- and 3D-visualization. METHODS: A thoracic skeleton, covered with a neoprene suit, served as model for the chest wall. Either a glove, fixed on a metal plate, or a pig heart were placed inside for training. On the glove, a suture line consisting of two lines of 16 points each, with a distance of 2 mm between each point, was stamped. On the pig heart, the LAD was prepared and incised; subsequently an anastomosis was done using the dissected right coronary artery as a graft. The time required was measured for both models. For suturing, the Zeus System (Computer Motion, Goleta, CA) was used and the third robotic arm positioned the endoscopic camera. The scopes were connected to a 3D-camera and the picture was displayed on a headset with two integrated monitors. Visualization was set to either 2D or 3D. Three surgeons were involved in the study. Each one did at least 12 anastomoses on 2D and 3D. RESULTS: The three surgeons involved showed a clear and rapid learning curve. The times required for the suture line decreased from 12.5 +/- 1.6 to 8.5 +/- 0.5 minutes with 2D and from 11.9 +/- 5.4 to 7.8 +/- 0.5 minutes for 3D respectively. This decrease did reach statistical significance (p = 0.03). In the pig heart model, the anastomosis times decreased from 33.2 +/- 8.4 to 15.7 +/- 0.3 minutes with 3D-visualization, and from 36.2 +/- 2.2 to 29.5 +/- 3.3 minutes with 2D. The decrease in anastomosis time did again reach significance (p = 0.025). At the end of the study, the times achieved with 2D-visualization were significantly longer than those with 3D (p = 0.01). CONCLUSIONS: A surgical training program is mandatory to become familiar with these new technologies. Both models showed learning curves over an acceptable time course. 3D-visualization facilitated quick and precise movements, thus resulting in shorter anastomosis times.

Anastomosis, Surgical↗