Background The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.

The purpose of the study was to obtain safety and performance data for the microwave coagulation modality of the CROMA Electrosurgical System (Creo Medical Ltd, UK) and RS2 polyp resection device to complement existing data and support a CE marking application1.

We describe a virtual reality telecommunications ecosystem developed under funding from NASA entitled ANSIBLE: A Network of Social Interactions for Bilateral Life Enhancement. ANSIBLE is a communication support toolset which enables multi-faceted human-human and human-virtual agent interactions designed to accommodate technical and environmental limitations of long duration space flight. The primary objectives are to address communication limitations and provide telehealth options to combat behavioral health threats in future long duration exploration class missions. The system is current being evaluated in a human subject study that takes place at the Hawaii Space Exploration Analog and Simulation (HI-SEAS) facilities in Waimea, HI. There, an international mixed gender group of scientists are undergoing adjustments in physiology and lifestyle that are analogous to some of the challenges in a confined environment over twelve month isolation mission under Mars-exploration conditions (e.g. with communication latencies and blackouts, in close quarters, under restricted water and energy use). Preliminary analysis show that the ANSIBLE treatment group scored better perceived social closeness and perceived relationship satisfaction in self-report surveys compared to a control group who participated in a prior eight month isolation mission in the same facility and used only conventional asynchronous communication methods (i.e. email, voice and video recordings). In the real world, verbal interactions go hand-in-hand with interactions with tangible things. Virtual items can be called upon to serve as powerful and meaningful aides for communications. We posit that the observed increase in social connectedness is due to the affordances of VR, where situational contexts that are often not communicated in traditional telecommunications are made explicit in the virtual world.

We describe preliminary evaluation data for ATHENA (Appraisal of Task Health and Effort through Non-intrusive Assessments), a completely no contact, zero-intrusion workload measurement method which harnesses multi-modal metrics (e.g. linguistic markers, keyboard dynamics and computer vision). Preliminary results reflect the existence of different types of workload, with our zero-intrusion metrics demonstrating respectable classification accuracies when the variable causing workload (e.g. time) is matched with the type of workload assessed (e.g. temporal). By not requiring extra equipment or interrupting workflow, ATHENA represents a valuable step forward in providing automated workload support tools as well as a tool for understanding the workload concept.

We describe preliminary results of ANSIBLE – A Network of Social Interactions for Bilateral Life Enhancement. ANSIBLE leverages virtual worlds to deliver evidence based wellness promoting strategies and virtual agents as tools to facilitate asynchronous human-human communication in order to counteract behavioral health challenges associated with prolonged isolation and deep space exploration. ANSIBLE was deployed in August 2015 in a 12 month study with six crew members in an isolation simulated Mars habitat facility. In this paper, we compare the data for the first five months of this mission to a previous control mission for which ANSIBLE was not used. We found initial support for ANSIBLE to increase perceptions of closeness and satisfaction with friend and family relationships (but not other crew members) during prolonged isolation as well as a trend in stress reduction and increased feelings of ANSIBLE usability over time.

In future long duration Mars exploration missions, network limitations and the lack of real-time communication capabilities will impact various aspects of space crew performance as well as behavioral health. Studies in ground-based analogs of Isolated and Confined Environments (ICE) such as Antarctica have identified sensory and social monotony as threats to crew psychological well-being. Given the importance of behavioral health to mission success and the extreme conditions of space travel, new methods of maintaining psycho-social health and social connections to support systems are critical. We describe ANSIBLE -- A Network of Social Interactions for Bilateral Life Enhancement. ANSIBLE leverages Virtual Environments (VEs) to deliver evidence based wellness promoting strategies and socially intelligent Virtual Agents (VAs) as tools to facilitate asynchronous human-human communication, and counteract behavioral health challenges associated with prolonged isolation and deep space exploration.

Ultravision™ is a new device that utilizes electrostatic precipitation to clear surgical smoke. The aim was to evaluate its performance during laparoscopic cholecystectomy.

Smoke is generated by energy-based surgical instruments. The airborne byproducts may have potential health implications. This study aimed to evaluate the properties of surgical smoke and the evidence for the harmful effects to the theater staff.

BACKGROUND:Goal-directed therapy has a secure place in perioperative care. Algorithms are based on Starling's law of the heart, notwithstanding that this does not numerically define volume or heart performance variables. These have been developed based on a Guytonian view of the circulation and are implemented in a computerized decision support system (Navigator™). We studied the feasibility and performance of the graphical display of the system in an intervention and a control group of patients undergoing major abdominal surgery.METHODS:Patients were randomized to either graphically (intervention) or numerically (control) guided administration of therapy. Goals were set and treatments and concordance with guidance noted, where applicable. Anaesthesia was provided by one of three experienced anaesthetists well acquainted with Navigator™. The primary objective was to determine whether the use of graphical display decision support more efficiently enables the achievement of oxygen delivery targets. This was quantitated as percentage time in the target zone and averaged standardized distance from the target centre.RESULTS:The mean percentage time in the target zone was 36.7% for control and 36.5% for intervention. The averaged standardized difference was 1.5 in control and 1.6 in intervention. There was no significant difference in fluid balances. There was a high level of concordance between decision support recommendation and anaesthetist action (84.3%).CONCLUSIONS:In experienced hands, the addition of a graphical display for haemodynamic guidance resulted in a similar time in target and averaged standardized difference. The haemodynamic guidance system should be explored in a comparative study to anaesthesia management without guidance.

A prototype system has been developed for producing controllable ablation of spherical lesions with a diameter of up to 2 cm. The system is based on a solid-state energy source operating in the super high frequency (SHF is sdefined as being a frequency of between 3 and 30 GHz) region of the electromagnetic spectrum. Results obtained from preliminary tissue testing, performed on morbid tissue samples prepared in a laboratory environment, show repeatability in terms of shape and size of ablation, and demonstrate the ability to produce controlled ablation in morbid liver and kidney models.