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The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital.

A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS).

The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service’s selling price and variable costs incurred in providing that service.

The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital.

This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest service price.

Since the literature review found no study comparing RCA with TCS in a real-life health care setting, little is known about differences arising from applying these systems in this context. Thus, the current study fills this gap in the literature by comparing RCA with TCS for both open and laparoscopic gallbladder surgeries.

Gallstone‐related illnesses are one of the most common reasons for emergency hospital admissions, often with serious complications. Standard treatment of uncomplicated gallstone‐disease is by laparoscopic cholecystectomy, which can be safely and cost‐effectively performed during a short hospital stay or as day‐case. This paper aims to evaluate the referral pattern of patients with gallstones, which treatment is given and whether patients admitted as emergency could have benefited from earlier elective referral. The management of these patients is examined in the context of payment by results to determine cost and potential savings.

The approach takens was prospective clinical audit and patient questionnaire in a district general hospital. Cost comparisons were made using secondary care income (NHS tariff) and estimated cost of hospitalisation, investigations and treatment.

Between May and July 2007, 114 patients were admitted with symptomatic gallstones, 62 (54.4 per cent) were emergencies. Cholecystectomy was performed in all 52 elective patients and performed or planned for 59/62 (95.2 per cent) emergencies. A total 17/62 emergencies (27.4 per cent) presented with complications of gallstones. 38/62 (61.3 per cent) had similar symptoms before, with 21/38 (55.3 per cent) diagnosed in primary care or by another hospital department. 11 (52.4 per cent) of these had not been referred for a surgical opinion; taking account of age, co‐morbidity and data acquired for elective admissions, the cost of their treatment could have been reduced by at least £16,194.

A large proportion of patients admitted with symptomatic biliary disease could have been referred earlier and electively. Such referral practice could improve the quality of care and reduce cost for the NHS both in primary and secondary care.

Within the framework of learning from errors, this study focused on how operative risks and potential errors are addressed in guidance to surgical residents during authentic surgical operations. The purpose of this paper is to improve patient safety and to diminish medical complications resulting from possible operating errors. Further in the process of the optimal contexts for instruction aimed at preventing risks and errors in the practical hospital environment was evaluated.

The five authentic surgical operations were analyzed, all of which were organized as training sessions for surgical residents. The data (collected via video-recoding) were analyzed by a consultant surgeon and an education expert working together.

The results showed that the risks and potential errors in the surgical operations were rarely addressed in guidance during operations. The guidance provided mostly concerned technical issues, such as instrument handling, and exploration of critical anatomical structures. There was little guidance focusing on situation-based risks and potential errors, such as unexpected procedural challenges, teamwork and practical decision-making. The findings showed that optimal context of learning about risks and potential errors of surgical operation are not always the authentic operation context.

The study was conducted in an authentic surgical operation-cum-training context. The originality of the study derives from its focus on guidance related to risk and error prevention in surgical workplace learning. The findings can be used to create a meaningful learning environment – including powerful guidance – for practice-based surgical learning, maximally addressing patient safety, but giving possibilities also for other training options.

The introduction of laparoscopy in surgery offered clear advantages to patients. Surgeons, however, had to deal with various types of problems inherent to the essential differences in surgical approach. One of these problems, reduced dexterity, was solved at the end of the previous decade by the introduction of robotic surgery systems. Discusses the backgrounds for development of the Intuitive Surgical “Da Vinci” systems and gives an overview of current status and functionality.

In this chapter I explore how conflicting discursive claims made by the medical community are consequential for bariatric weight loss surgery patients. Bariatric surgery has become increasingly common in the United States since the 1990s, with over 177,000 Americans undergoing surgery in 2006. Despite the surgery's growing popularity, the US medical community does not wholeheartedly endorse the surgery. Rather, different members of the medical community espouse contradictory evaluations of weight loss surgery. I broadly characterize this intra-medical community controversy and, then, discuss how conflicting claims have helped shape the bariatric surgery industry's discursive conception of an “ideal patient.” Next, I analyze actual patients’ negotiations of the ideal patient archetype, and find that patients’ responses follow three paths: embracing the ideal, having a mixed response to the ideal, and strategically complying with the ideal. As patients are compelled to grapple with the ideal archetype in order to access surgery, I conclude that the ideal archetype acts as a discursive frame connecting individual patients to broad bariatric surgery discourses.

The purpose of this paper is to propose a control algorithm to improve the backdrivability performance of minimally invasive surgical robotic arms, so that precise manual manipulations of robotic arms can be performed in the preoperative operation.

First, the flexible-joint dynamic model of the 3-degree of freedom remote center motion (RCM) mechanisms of minimally invasive surgery (MIS) robot is derived and its dynamic parameters and friction parameters are identified. Next, the angular velocities and angular accelerations of joints are estimated in real time by the designed Kalman filter. Finally, a control algorithm based on Kalman filter is proposed to enhance the backdrivability of RCM mechanisms by compensating for the internally generated gravitational, frictional and inertial resistances experienced during the positioning and orientating.

The parameter identification for RCM mechanisms can be experimentally evaluated from comparison between the measured torques and the reconstructed torques. The accuracy and convergence of the real-time estimation of angular velocity and acceleration of the joint by the designed Kalman filter can be verified from corresponding simulation experiments. Manual adjustment experiments and animal experiments validate the effectiveness of the proposed backdrivability control algorithm.

The backdrivability control algorithm presented in this paper is a universal method to enhance the manual operation performance of robots, which can be used not only in the medical robot preoperative manual manipulation but also in robot haptic interaction, industrial robot direct teaching and active rehabilitation training of rehabilitation robot and so on.

Compared with other backdrivability design methods, the proposed algorithm achieves good backdrivability for RCM mechanisms without using force sensors and accelerometers. In addition, this paper presents a new static friction compensation approach for a joint moving with very low velocity.

This paper aims to illustrate the growing importance of surgical robots by providing a short historical background and details of a selection of today’s products and their applications.

Following a short introduction, this first provides an historical perspective. It then discusses systems used in minimally invasive surgery (MIS). This is followed by examples of products aimed at other surgical applications and, finally, brief concluding comments are drawn.

The concept of robotic surgery arose in the 1960s and trials commenced in the 1980s. The business is now in a highly dynamic phase with numerous recent product launches and a growing number late-stage developments. MIS systems are attracting much interest but robotic technology is also being applied to many additional surgical procedures.

This provides an insight into the emergence and commercialisation of robotic surgical systems.

The purpose of this paper is to design a model-based bilateral teleoperation method to improve the feedback force and velocity/position tracking for robotic-assisted tasks (such as palpation, etc.) under constant and/or varying time delay with environment dynamic property. Time delay existing in bilateral teleoperation easily destabilizes the system. Proper control strategies are able to make the system stable, but at the cost of compromised performance. Model-based bilateral teleoperation is designed to achieve enhanced performance of this time-delayed system, but an accurate model is required.

Viscoelastic model has been used to describe the robot tool-soft tissue interaction behavior. Kevin-Boltzmann (K-B) model is selected to model the soft tissue behavior due to its good accuracy, transient and linearity properties among several viscoelastic models. In this work, the K-B model is designed at the master side to generate a virtual environment of remote robotic tool-soft tissue interaction. In order to obtain improved performance, a self perturbing recursive least square (SPRLS) algorithm is developed to on-line update the necessary parameters of the environment with varying dynamics.

With fast and optimal on-line estimation of primary parameters of the K-B model, the reflected force of the model-based bilateral teleoperation at the master side is improved as well as the position/velocity tracking performance. This model-based design in the bilateral teleoperation avoids the stability issue caused by time delay in the communication channel since the exchanged information become position/velocity and estimated parameters of the used model. Even facing with big and varying time delay, the system keeps stably and enhanced tracking performance. Besides, the fast convergence of the SPRLS algorithm helps to track the time-varying dynamic of the environment, which satisfies the surgical applications as the soft tissue properties usually are not static.

The originality of this work lies in that an enhanced perception of bilateral teleoperation structure under constant/varying time delay that benefits robotic assisted tele-palpation (time varying environment dynamic) tasks is developed. With SPRLS algorithm to on-line estimate the main parameters of environment, the feedback perception of system can be enhanced with stable velocity/position tracking. The superior velocity/position and force tracking performance of the developed method makes it possible for future robotic-assisted tasks with long-distance communication.

The purpose of this paper is to estimate the possible impact of the COVID-19 pandemic on the hospitalization and hospital mortality of the patients with gallstone disease and chronic liver diseases (CLD) in the worst pandemic period in Ukraine.

A retrospective comparative analysis of annual reports data of all economy subjects, which conducted economic activity in medical practice for 2019 and 2021. Data was accepted from the Ministry of Health of Ukraine, the National Security and Defense Council of Ukraine (NSDC) and the State Statistics Service of Ukraine (SSSU).

The total hospitalization rates for diffuse liver disease and cholelithiasis significantly decreased during the peak of the COVID-19 pandemic in Ukraine, compared to the values of 2019. At the same time, the rates of in-hospital mortality for these diseases have significantly grown. Also, various proportions of similar trends were described in other countries during the first wave of the pandemic.

This paper highlights the fact that regulatory restrictions and the fear of the population of referring to healthcare facilities considering the high risk of getting an infection had significant disruption to medical care for patients with gallstone disease and CLD. Improving the management of medical resources and strengthening all kinds of institutions in the healthcare system must be thought about if similar challenges appear in the future.