Raffy L. Karamanoukian

Transfer of training in robotic-assisted microvascular surgery.

Background:Transfer of training refers to the ability to transfer acquired skills from one discipline to another. This study aims to determine whether experience in traditional freehand microsurgery facilitates mastery of robotic microsurgery. Methods:Microsurgical anastomoses of coronary arteries harvested from explanted pig models were used to demonstrate whether prior experience with microsurgery is required in learning robot-assisted microsuturing. Eighty microsurgical anastomoses were performed. Three fully trained vascular surgeons (n = 3) (Group A) and 5 midlevel surgical residents (n = 5) (Group B) performed the anastomoses. Each subject performed 5 freehand and 5 robotic-assisted (Zeus robotic system) anastomoses. Anastomosis time and integrity of anastomoses were recorded, including errors of management (EOM) (breaking suture, breaking knots, breaking or damaging needles). Results:For fully trained surgeons, all anastomoses in the robotic-assisted group were mechanically intact. There was significantly increased anastomosis time with the robot (Robot: 14 minutes, versus freehand: 7.2 minutes, P < 0.01). The robotic-assisted anastomoses were associated with a higher EOM (Robot: 1.2, versus freehand: 0.3, P < 0.01). Surgical trainees had longer anastomosis times with robotic assistance (Robot: 14.8 minutes, versus freehand, 12.7 minutes; P < 0.01) and increased EOM (Robot: 1.6, versus freehand: 1.0; P < 0.05). Overall, surgical trainees and fully trained vascular surgeons had longer anastomotic times with robotic assistance [Robot: 14.0 versus 14.8 minutes; P = not significant (NS)], and EOM (Robot: 1.6, versus freehand: 1.2; P = NS) were not significantly different. Conclusion:The technical feasibility of performing a safe and efficient robotic-assisted microsurgical anastomosis in explanted vessels was repeatedly tested and demonstrated in this study within reasonable time required for the anastomosis. Compared with conventional microanastomosis, both fully trained surgeons and residents demonstrated an ability to master the robotically assisted procedure with similarly longer anastomosis times and EOM. This study indicates that robotically assisted microanastomosis can be mastered equally well by surgical trainees and fully trained vascular surgeons.

Pediatric burns with snap-cap fireworks.

Snap-caps are marketed as a relatively safe pyrotechnic (explosive) device for children 8 years and older. Individually, the snap-caps pose very little threat because the amount of explosive compounds contained in each is limited to 1 mg. However, the accidental explosion of numerous snap-caps may cause significant burns. This study highlights a series of pediatric patients who presented with severe second- and third-degree burns as a result of accidental explosion of snap-caps. Seven patients with snap-caps-related injuries were treated at the University of California, San Diego Regional Burn Center from January 1996 to April 1999. Study foci included 1) mode and extent of injury, 2) management, 3) associated morbidity, and 4) functional outcome. Six patients (84%) required hospital admission. Four patients (57%) underwent split-thickness skin grafting to repair mean TBSA burns of 4.1% (range, 2–8%). Three patients (43%) received aggressive management of burns with topical medications and dressing changes. The nature and extent of snap-cap injuries support the contention that snap-caps have the potential to harm children to whom they are marketed.