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Background: Simulated environments present challenges to both clinical experts and novices in laparoscopic surgery. Experts and novices may have different expectations when confronted with a novel simulated environment. The LapSim is a computer‐based virtual reality laparoscopic trainer. Our aim was to analyze the performance of experienced basic laparoscopists and novices during their first exposure to the LapSim Basic Skill set and Dissection module. Methods: Experienced basic laparoscopists (n=16) were defined as attending surgeons and chief residents who performed >30 laparoscopic cholecystectomies. Novices (n=13) were surgical residents with minimal laparoscopic experience. None of the subjects had used a computer‐based laparoscopic simulator in the past. Subjects were given one practice session on the LapSim tutorial and dissection module and were supervised throughout the testing. Instrument motion, completion time, and errors were recorded by the LapSim. A Performance Score (PS) was calculated using the sum of total errors and time to task completion. A Relative Efficiency Score (RES) was calculated using the sum of the path lengths and angular path lengths for each hand expressed as a ratio of the subject's score to the worst score achieved among the subjects. All groups were compared using the Kruskal‐Wallis and Mann‐Whitney U‐test. Results: Novices achieved better PS and/or RES in Instrument Navigation, Suturing, and Dissection (p<0.05). There was no difference in the PS and RES between experts and novices in the remaining skills. Conclusion: Novices tended to have better performance compared to the experienced basic laparoscopists during their first exposure to the LapSim Basic Skill set and Dissection module. [ABSTRACT FROM AUTHOR]

Background: There currently exist several training modules to improve performance during video‐assisted surgery. The unique characteristics of robotic surgery make these platforms an inadequate environment for the development and assessment of robotic surgical performance. Methods: Expert surgeons (n=4) (>50 clinical robotic procedures and >2 years of clinical robotic experience) were compared to novice surgeons (n=17) (<5 clinical cases and limited laboratory experience) using the da Vinci Surgical System. Seven drills were designed to simulate clinical robotic surgical tasks. Performance score was calculated by the equation Time to Completion + (minor error) × 5 + (major error) × 10. The Robotic Learning Curve (RLC) was expressed as a trend line of the performance scores corresponding to each repeated drill. Results: Performance scores for experts were better than novices in all 7 drills (p<0.05). The RLC for novices reflected an improvement in scores (p<0.05). In contrast, experts demonstrated a flat RLC for 6 drills and an improvement in one drill (p=0.027). Conclusion: This new drill set provides a framework for performance assessment during robotic surgery. The inclusion of particular drills and their role in training robotic surgeons of the future awaits larger validation studies. [ABSTRACT FROM AUTHOR]

: ObjectivesVentricular resynchronization might be achieved in a minimally invasive fashion using a robotically assisted, direct left ventricular (LV) epicardial approach.: BackgroundApproximately 10% of patients undergoing biventricular pacemaker insertion have a failure of coronary sinus (CS) cannulation. Rescue therapy for these patients currently is limited to standard open surgical techniques.: MethodsTen patients with congestive heart failure (New York Heart Association class 3.4 ± 0.5) and a widened QRS complex (184 ± 31 ms) underwent robotic LV lead placement after failed CS cannulation. Mean patient age was 71 ± 12 years, LV ejection fraction (EF) was 12 ± 6%, and LV end-diastolic diameter was 7.1 ± 1.3 cm. Three patients had previous cardiac surgery, and five patients had a prior device implanted.: ResultsNineteen epicardial leads were successfully placed on the posterobasal surface of the LV. Intraoperative lead threshold was 1.0 ± 0.5 V at 0.5 ms, R-wave was 18.6 ± 8.6 mV, and impedance was 1,143 ± 261 ohms at 0.5 V. Complications included an intraoperative LV injury and a postoperative pneumonia. Improvements in exercise tolerance (8 of 10 patients), EF (19 ± 13%, p = 0.04), and QRS duration (152 ± 21 ms, p = 0.006) have been noted at three to six months follow-up. Lead thresholds have remained unchanged (2.1 ± 1.4 V at 0.5 ms, p = NS), and a significant drop in impedance (310 ± 59 ohms, p < 0.001) has been measured.: ConclusionsRobotic LV lead placement is an effective and novel technique which can be used for ventricular resynchronization therapy in patients with no other minimally invasive options for biventricular pacing. [Copyright &y& Elsevier]

Patients with congestive heart failure and altered interventricular conduction enjoy improvements in quality of life and ventricular function after successful resynchronization therapy with biventricular pacing. Technical limitations owing to individual coronary sinus and coronary venous anatomy result in a 10% to 15% failure rate of left ventricular (LV) lead placement through percutaneous approaches. To provide a minimally invasive option for these patients with LV lead failures, we developed a technique of endoscopic, epicardial LV lead implantation with the use of the da Vinci robotic system. The surgical approach targets the posterolateral wall through a novel posterior approach. [Copyright &y& Elsevier]

The diagnosis and management of mediastinal masses frequently necessitates biopsy and surgical resection. The use of videothorascopic techniques has broadened the surgeon’s ability to evaluate and treat such tumors using a minimally invasive approach. We describe herein the use of the da Vinci Robotic Surgical System for evaluating a mediastinal mass in a young woman. [Copyright &y& Elsevier]

The current recommendations for treating myasthenia gravis include surgical thymectomy for patients between puberty and 60 years of age. This is a report of a new method for surgical thymectomy using the robotic da Vinci surgical system for a totally endoscopic approach. This new procedure combines the potential advantages of minimally invasive methods with the efficacy of open procedures. [Copyright &y& Elsevier]

Late aneurysm formation is a well-described complication after surgical correction of aortic coarctation. Endovascular repair of such aneurysms avoids the morbidity of conventional reoperative thoracic surgery. We describe a unique case of antegrade endovascular repair of a distal coarctation-associated aneurysm with vascular access acquired through the aortic arch by an upper hemi-sternotomy. [Copyright &y& Elsevier]