BACKGROUND: As the 2019 Coronavirus Disease (COVID-19) repeated, the prevention and treatment will be normalized in a period. \"Large number of patients\" and \" Turnover quickly\" of the day surgery ward greatly increased the difficulty of policy formulation and implementation. The normalization also had a huge negative psychological impact on patients/family members. This study aims to introduce effective epidemic prevention and control measures in day surgery wards, and to clarify the influencing factors of anxiety and subjective discomfort of patients and their families during the normalization of COVID-19.
METHODS: To prepare for normalization of epidemic, research discuss improvements in the management of staff, environment, process. A total of 148 patients admitted to West China Hospital from December 2021 to March 2022 and their relatives were asked to complete a questionnaire effectively. Using the Self-rating Anxiety Scale, Social Support Rating Scale and Subjective Units of Distress scales to analyze anxiety and its risk factors.
RESULTS: Under normalized control measures, no staff was infected. The subjective discomfort score was higher in people with lower body mass index (BMI). Young and high social support score were risk factors for anxiety (P < .05), and social support was positively correlated with anxiety.
CONCLUSIONS: The normalization of epidemic is an inevitable trend in a period. A stable and safe medical environment needs to fully eliminate the policy defects, to fit the people and focus on mental health of the people. For patients/family members, who are younger,a lower BMI and higher social support should be attention more.

Background. Most robotic camera steering devices (RCSDs) require active steering by the surgeon and necessarily increase workload. Clinical experience shows that standard laparoscopic procedures can be performed safely as solo surgery aided by RCSDs. No evidence exists concerning exploratory or emergency procedures. We compared the performance during unexpected laparoscopic tasks on surgical simulators aided either by an RCSD controllable by head movements of the surgeon or by a human camera assistant. Methods. Forty-five medical students without previous experience with minimal invasive surgery were randomized in 2 groups, and they performed standard and unexpected laparoscopic tasks requiring complex camera movements on box trainers either using an RCSD or assisted by a human camera assistant. Efficiency and performance parameters were recorded. Results. Performance in simulated standard procedures was equivalent. In simulated exploratory procedures, we saw significantly better performance scores in the conventional group versus the RCSD group. The strongest factor for these differences was the longer camera-adjusting time in the RCSD group versus the conventional group (PEG task = 208 ± 51 seconds vs 170 ± 36 seconds, P = .005; suture task = 563 ± 126 seconds vs 454 ± 201 seconds, P = .041). Conclusion. These results, obtained on surgical simulators, indicate that the solo approach to standard surgical tasks, facilitated by an RCSD controllable by head movements, can most likely be viewed as safe. Exploratory procedures with a relevant chance for complications or procedures that require rapid, often, or complex camera movements should rather be performed with a human camera assistant.

Introduction. Our aim was to determine how self-reported and objectively measured fatigue of upper limb differ between laparoscopic and robotic surgical training environments. Methods. Surgeons at the 2016 SAGES Conference Learning Center and at our institution were enrolled. Two standardized surgical tasks (peg transfer [PT] and needle passing [NP]) were performed twice in each surgical skills practical environments: (1) laparoscopic training-box environment (Fundamentals of Laparoscopic Surgery [FLS]) and (2) Mimic dV-trainer (MIMIC). Muscle activation of upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis, and extensor digitorum were recorded using surface electromyography (EMG; Trigno, Delsys, Inc, Natick, MA). Subjective fatigue was self-reported using Piper Fatigue Scale-12. Analysis was done using SPSS v25.0, α = .05. Results. Demographics were similar between FLS (N = 14) and MIMIC (N = 12). For PT, MIMIC had a significant increase in EMGRMS of UT (P < .001) and AD (P < .001). Conversely, FLS led to significant decreased muscle fatigue in UT (P = .015). For NP, MIMIC had a significant increase in EMGRMS for UT (P = .034) and AD (P = .031), but FLS induced more muscle fatigue for AD (P = .004). There was significant decrease in self-reported fatigue after performing FLS tasks (P = .030) but not after MIMIC (P = .663). Conclusion. Our results showed that practice with MIMIC resulted in greater activation of shoulder muscles, while FLS caused more significant muscle fatigue in the same muscles. This could be due to ergonomic disadvantages and nonoptimal ergonomic settings. Further studies are needed to understand the optimal ergonomics and its impact on fatigue and muscle activation during use of both the FLS and MIMIC training systems.

Minimally invasive surgery (MIS) poses visual challenges to the surgeons. In MIS, binocular disparity is not freely available for surgeons, who are required to mentally rebuild the 3-dimensional (3D) patient anatomy from a limited number of monoscopic visual cues. The insufficient depth cues from the MIS environment could cause surgeons to misjudge spatial depth, which could lead to performance errors thus jeopardizing patient safety. In this article, we will first discuss the natural human depth perception by exploring the main depth cues available for surgeons in open procedures. Subsequently, we will reveal what depth cues are lost in MIS and how surgeons compensate for the incomplete depth presentation. Next, we will further expand our knowledge by exploring some of the available solutions for improving depth presentation to surgeons. Here we will review the innovative approaches (multiple 2D camera assembly, shadow introduction) and devices (3D monitors, head-mounted devices, and auto-stereoscopic monitors) for 3D image presentation from the past few years.

Purpose This study investigates the feasibility and potential utility of head-mounted displays for real-time wireless vital sign monitoring during surgical procedures. Methods In this randomized controlled pilot study, surgery residents (n = 14) performed simulated bedside procedures with traditional vital sign monitors and were randomized to addition of vital sign streaming to Google Glass. Time to recognition of preprogrammed vital sign deterioration and frequency of traditional monitor use was recorded. User feedback was collected by electronic survey. Results The experimental group spent 90% less time looking away from the procedural field to view traditional monitors during bronchoscopy (P = .003), and recognized critical desaturation 8.8 seconds earlier; the experimental group spent 71% (P = .01) less time looking away from the procedural field during thoracostomy, and recognized hypotension 10.5 seconds earlier. Trends toward earlier recognition of deterioration did not reach statistical significance. The majority of participants agreed that Google Glass increases situational awareness (64%), is helpful in monitoring vitals (86%), is easy to use (93%), and has potential to improve patient safety (85%). Conclusion In this early feasibility study, use of streaming to Google Glass significantly decreased time looking away from procedural fields and resulted in a nonsignificant trend toward earlier recognition of vital sign deterioration. Vital sign streaming with Google Glass or similar platforms is feasible and may enhance procedural situational awareness.

OBJECTIVE: Laparoscopic surgery has undeniable advantages, such as reduced postoperative pain, smaller incisions, and faster recovery. However, to improve surgeons\' performance, ergonomic adaptations of the laparoscopic instruments and introduction of robotic technology are needed. The aim of this study was to ascertain the influence of a new hand-held robotic device for laparoscopy (HHRDL) and 3D vision on laparoscopic skills performance of 2 different groups, naïve and expert.
METHODS: Each participant performed 3 laparoscopic tasks-Peg transfer, Wire chaser, Knot-in 4 different ways. With random sequencing we assigned the execution order of the tasks based on the first type of visualization and laparoscopic instrument. Time to complete each laparoscopic task was recorded and analyzed with one-way analysis of variance.
RESULTS: Eleven experts and 15 naïve participants were included. Three-dimensional video helps the naïve group to get better performance in Peg transfer, Wire chaser 2 hands, and Knot; the new device improved the execution of all laparoscopic tasks (P < .05). For expert group, the 3D video system benefited them in Peg transfer and Wire chaser 1 hand, and the robotic device in Peg transfer, Wire chaser 1 hand, and Wire chaser 2 hands (P < .05).
CONCLUSIONS: The HHRDL helps the execution of difficult laparoscopic tasks, such as Knot, in the naïve group. Three-dimensional vision makes the laparoscopic performance of the participants without laparoscopic experience easier, unlike those with experience in laparoscopic procedures.

OBJECTIVE: To conduct a review of the state of virtual reality (VR) simulation technology, to identify areas of surgical education that have the greatest potential to benefit from it, and to identify challenges to implementation.
BACKGROUND: Simulation is an increasingly important part of surgical training. VR is a developing platform for using simulation to teach technical skills, behavioral skills, and entire procedures to trainees and practicing surgeons worldwide. Questions exist regarding the science behind the technology and most effective usage of VR simulation. A symposium was held to address these issues.
METHODS: Engineers, educators, and surgeons held a conference in November 2013 both to review the background science behind simulation technology and to create guidelines for its use in teaching and credentialing trainees and surgeons in practice.
RESULTS: Several technologic challenges were identified that must be overcome in order for VR simulation to be useful in surgery. Specific areas of student, resident, and practicing surgeon training and testing that would likely benefit from VR were identified: technical skills, team training and decision-making skills, and patient safety, such as in use of electrosurgical equipment.
CONCLUSIONS: VR simulation has the potential to become an essential piece of surgical education curriculum but depends heavily on the establishment of an agreed upon set of goals. Researchers and clinicians must collaborate to allocate funding toward projects that help achieve these goals. The recommendations outlined here should guide further study and implementation of VR simulation.

BACKGROUND: Untrained laparoscopic camera assistants in minimally invasive surgery (MIS) may cause suboptimal view of the operating field, thereby increasing risk for errors. Camera navigation is often performed by the least experienced member of the operating team, such as inexperienced surgical residents, operating room nurses, and medical students. The operating room nurses and medical students are currently not included as key user groups in structured laparoscopic training programs. A new virtual reality laparoscopic camera navigation (LCN) module was specifically developed for these key user groups.
METHODS: This multicenter prospective cohort study assesses face validity and construct validity of the LCN module on the Simendo virtual reality simulator. Face validity was assessed through a questionnaire on resemblance to reality and perceived usability of the instrument among experts and trainees. Construct validity was assessed by comparing scores of groups with different levels of experience on outcome parameters of speed and movement proficiency.
RESULTS: The results obtained show uniform and positive evaluation of the LCN module among expert users and trainees, signifying face validity. Experts and intermediate experience groups performed significantly better in task time and camera stability during three repetitions, compared to the less experienced user groups (P < .007). Comparison of learning curves showed significant improvement of proficiency in time and camera stability for all groups during three repetitions (P < .007).
CONCLUSIONS: The results of this study show face validity and construct validity of the LCN module. The module is suitable for use in training curricula for operating room nurses and novice surgical trainees, aimed at improving team performance in minimally invasive surgery.

Laparoscopic instruments that are newly inserted into trocars are initially outside the surgeon\'s endoscopic field of view. This can make it difficult to accurately position the instrument at the operative site and presents a potential risk to patients since the tip of the instrument could potentially perforate organs and blood vessels while it is advanced blindly. To solve this problem, I have designed a trocar that incorporates a laser pointer to guide laparoscopic instruments while they are outside the endoscopic field of view. The laser dot is projected along the long axis of the trocar. This allows the surgeon to instantly determine the direction and target of the introduced instrument. Furthermore, the projected laser dot serves as evidence of an unobstructed path from the trocar to the target. This modification improves safety in laparoscopic surgery.