Ultrasonic surgical devices driven by piezoelectric tubes

Abstract BACKGROUND With the incorporation of the robotic alignment module Cirq (Brainlab, Germany) into our neurosurgical armamentarium, we aimed to know our baseline accuracy in stererotactic biopsies. We therefore retrospectively reviewed our data on biopsy accuracy for brain(stem) tumors using the non-robotic alignment instrument Varioguide (Brainlab, Germany). Because of unexpectedly large deviations from the intended target, we sought to improve our registration accuracy when we introduced Cirq. Intraoperative 3D CT with bone fiducials was added to the pre-operative 3D T1 MRI with skin fiducials. This made it possible to compare surgical devices as well as registration methods. AIMS To share our experience with the new robotic alignment module Cirq for navigated brain(stem) tumor biopsies and to evaluate its target accuracy with bone fiducial registration, as compared to the previously used Varioguide with skin fiducial registration. METHODS All patients (0–18 years old) that underwent a brain(stem) biopsy in our institution were included. Over 2018–2020, data were collected retrospectively (cohort Varioguide with 3D T1 MRI registration with skin fiducials). From 2021, data were collected prospectively (cohort Cirq with both 3D T1 MRI registration with skin fiducials and intraoperative CT registration with bone fiducials). For both cohorts, Euclidian distances were calculated between the intended target and the obtained target. For the prospective cohort, registration errors were calculated for bone versus skin fiducials. PRELIMINARY REUSLTS The deviation from the intended target was much smaller in the Cirq cohort versus the Varioguide cohort. Within the Cirq cohort, registration errors were submillimetric for bone fiducial registration as compared to several millimeters for skin fiducial registration. CONCLUSION: The Cirq robotic arm is convenient, safe and highly accurate, especially when combined with intraoperative 3D CT bone fiducial registration. Skin fiducial registration does not offer the level of precision that is mandatory in brainstem tumor biopsies.

Download Full-text

What is Being Reported About Vaginal “Lasers”?: An Examination of Adverse Events Reported to the Food and Drug Administration on Energy-Based Devices

Aesthetic Surgery Journal ◽

10.1093/asj/sjab299 ◽

2021 ◽

Author(s):

Linda Burkett ◽

Pamela Moalli ◽

Mary Ackenbom

Keyword(s):

Adverse Events ◽

Local Treatment ◽

Safety Data ◽

Co2 Lasers ◽

Laser Technologies ◽

Surgical Devices ◽

Device Type ◽

User Facility ◽

Similar Risk ◽

Sensation Loss

Abstract Background Description of energy-based genitourinary non-surgical devices (energy-based devices) safety data is outlined given their rapid adoption. Objectives To describe adverse events (AEs) for energy-based devices in the Manufacturer and User Facility Device Experience (MAUDE) database, and to compare to similar devices and other subspecialty applications. We hypothesized that products with genitourinary applications had similar AEs to dermatologic or general surgery applications. Methods Reed Tech™ Navigator compiled AE reports for all registered energy-based devices. Individual AE reports associated with 1) non-ablative, 2) fractionated, 3) unfractionated 4) radiofrequency, and 5) hybrid laser technologies were categorized. AE characteristics were compared among genitourinary applications (n=39) and other subspecialty applications within the same devices (n=79). Results Eighteen manufacturers were identified, which collectively manufacture 43 products with genitourinary applications. Thirty-nine genitourinary AEs were reported and isolated to 6 manufacturers with 11 products, of which 82% (n=32) were injuries, 15% (n=6) were device malfunction, and 3% (n=1) related to improper maintenance. Local treatment reactions were the most commonly reported injury (62%, n=21). AEs varied by device type with CO2 lasers having more burns and radiofrequency devices having higher rates of sensation loss. When comparing similar technology types, genitourinary energy-based devices had the least AE reports per device in MAUDE database. Conclusions AEs were reported on a quarter of the products currently available, and most were local treatment reactions. The reporting of AEs is equal to that of other subspecialties suggesting similar risk profiles. Improved reporting is needed to fully evaluate the safety of individual energy-based devices.

Download Full-text

Detection of tissue coagulation for microwave surgical devices

IEICE Electronics Express ◽

10.1587/elex.14.20161223 ◽

2017 ◽

Vol 14 (3) ◽

pp. 20161223-20161223

Author(s):

Naoyuki Ogasawara ◽

Kazuyuki Saito

Keyword(s):

Surgical Devices

Download Full-text

Robot-assisted tremor control for performance enhancement of retinal microsurgeons

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313318 ◽

2018 ◽

Vol 103 (8) ◽

pp. 1195-1200 ◽

Cited By ~ 3

Author(s):

Marina Roizenblatt ◽

Alex Treiger Grupenmacher ◽

Rubens Belfort Junior ◽

Mauricio Maia ◽

Peter L Gehlbach

Keyword(s):

Performance Enhancement ◽

Internal Limiting Membrane ◽

Robot Assisted ◽

Ophthalmic Surgery ◽

Skills Transfer ◽

Human Capabilities ◽

Hand Tremor ◽

Physiological Limits ◽

Surgical Devices ◽

Pars Plana

Pars plana vitrectomy is a challenging, minimally invasive microsurgical procedure due to its intrinsic manoeuvres and physiological limits that constrain human capability. An important human limitation is physiological hand tremor, which can significantly increase the risk of iatrogenic retinal damage resulting from unintentional manoeuvres that affect anatomical and functional surgical outcomes. The limitations imposed by normal physiological tremor are more evident and challenging during ‘micron-scale’ manoeuvres such as epiretinal membrane and internal limiting membrane peeling, and delicate procedures requiring coordinated bimanual surgery such as tractional retinal detachment repair. Therefore, over the previous three decades, attention has turned to robot-assisted surgical devices to overcome these challenges. Several systems have been developed to improve microsurgical accuracy by cancelling hand tremor and facilitating faster, safer and more effective microsurgeries. By markedly reducing tremor, microsurgical precision is improved to a level beyond present human capabilities. In conclusion, robotics offers potential advantages over free-hand microsurgery as it is currently performed during ophthalmic surgery and opens the door to a new class of revolutionary microsurgical modalities. The skills transfer that is beyond human capabilities to robotic technology is a logical next step in microsurgical evolution.

Download Full-text