Applied Force during Piston Prosthesis Placement in a 3D-Printed Model: Freehand vs Robot-Assisted Techniques

Objectives To describe a 3D-printed middle ear model that quantifies the force applied to the modeled incus. To compare the forces applied during placement and crimping of a stapes prosthesis between the Robotic ENT Microsurgery System ( REMS) and the freehand technique in this model. Study Design Prospective feasibility study. Setting Robotics laboratory. Subjects and Methods A middle ear model was designed and 3D printed to facilitate placement and crimping of a piston prosthesis. The modeled incus was mounted to a 6–degree of freedom force sensor to measure forces/torques applied on the incus. Six participants—1 fellowship-trained neurotologist, 2 neurotology fellows, and 3 otolaryngology–head and neck surgery residents—placed and crimped a piston prosthesis in this model, 3 times freehand and 3 times REMS assisted. Maximum force applied to the incus was then calculated for prosthesis placement and crimping from force/torque sensor readings for each trial. Robotic and freehand outcomes were compared with a linear regression model. Results Mean maximum magnitude of force during prosthesis placement was 126.4 ± 73.6 mN and 105.0 ± 69.4 mN for the freehand and robotic techniques, respectively ( P = .404). For prosthesis crimping, the mean maximum magnitude of force was 469.3 ± 225.2 mN for the freehand technique and 272.7 ± 97.4 mN for the robotic technique ( P = .049). Conclusions Preliminary data demonstrate that REMS-assisted stapes prosthesis placement and crimping are feasible with a significant reduction in maximum force applied to the incus during crimping with the REMS in comparison with freehand.

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Laryngeal Force Sensor: Quantifying Extralaryngeal Complications after Suspension Microlaryngoscopy

Otolaryngology ◽

10.1177/0194599818768482 ◽

2018 ◽

Vol 159 (2) ◽

pp. 328-334 ◽

Cited By ~ 10

Author(s):

Allen L. Feng ◽

Phillip C. Song

Keyword(s):

Odds Ratio ◽

Assessment Tool ◽

Care Center ◽

Tertiary Care ◽

Force Sensor ◽

Maximum Force ◽

Dynamic Force ◽

Force Measurements ◽

The Mean ◽

The Relationship

Objectives To develop a novel sensor capable of dynamically analyzing the force exerted during suspension microlaryngoscopy and to examine the relationship between force and postoperative tongue complications. Study Design Prospective observational study. Setting Academic tertiary care center. Methods The laryngeal force sensor is a designed for use during microphonosurgery. Prospectively enrolled patients completed pre- and postoperative surveys to assess the development of tongue-related symptoms (dysgeusia, pain, paresthesia, and paresis) or dysphagia (10-item Eating Assessment Tool [EAT-10]). To prevent operator bias, surgeons were blinded to the force recordings during surgery. Results Fifty-six patients completed the study. Of these, 20 (36%) developed postoperative tongue symptoms, and 12 (21%) had abnormal EAT-10 scores. The mean maximum force across all procedures was 164.7 N (95% CI, 141.0-188.4; range, 48.5-402.6), while the mean suspension time was 34.3 minutes (95% CI, 27.4-41.2; range, 7.1-108.1). Multiple logistic regression showed maximum force (odds ratio, 1.15; 95% CI, 1.02-1.29; P = .019) and female sex (30.1%; 95% CI, 22.7%-37.5%; P < .001) as significant predictors for the development of tongue-related symptoms. The only significant predictor of an abnormal postoperative EAT-10 score was an increased maximum force (odds ratio, 1.03; 95% CI, 1.00-1.06; P = .045). Conclusions The laryngeal force sensor is capable of providing dynamic force measurements throughout suspension microlaryngoscopy. An increase in maximum force during surgery may be a significant predictor for the development of tongue-related symptoms and an abnormal EAT-10 score. Female patients may also be at greater risk for developing postoperative tongue symptoms.

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Advantages and limitations of the endoscopic tympanoscopy a prospective study

10.30574/ijsra.2020.1.1.0016 ◽

2020 ◽

Vol 1 (1) ◽

pp. 012-017

Author(s):

Najib Zouhair ◽

Anass Chaouki ◽

Amine M’khatri ◽

Youssef Oukessou ◽

Sami Rouadi ◽

...

Keyword(s):

Middle Ear ◽

Operating Time ◽

Cross Sectional Study ◽

Cross Sectional ◽

Invasive Approach ◽

Intraoperative Bleeding ◽

Advantages And Disadvantages ◽

Early Return ◽

The Mean ◽

Endoscopic Tympanoplasty

Tympanoplasty is one of the most performed procedures in ENT. The aggressiveness of its microscopic approach has led otologists to adopt the endoscopic approach as a less invasive alternative. The purpose of this work is to appreciate the advantages and disadvantages of this surgical technique. We conducted a prospective descriptive cross-sectional study on 20 interventions within the ENT department of August the 20th 1953 Hospital of Casablanca from April 2019 to June 2019. The average age of operated patients was 36.3 years. Perforations were unilateral in (71%) of the cases with a predominance of the anterior (29%) and subtotal (36%) locations. The tympanoplasties were performed by 3 different senior otologic surgeons, and were left in (57%). The mean operating time was (59.5 min) and the mean anesthesia duration was 75.1 min. Intraoperative vision allowed us to fully visualize the margins of all perforations (100%) and anatomical structures of the middle ear in almost all interventions. The first procedures carried out were filled with difficulties whose management of intraoperative bleeding was the main one in (42.8%) of the cases. (57%) procedures were described as easy. No complication was detected intraoperatively or immediately postoperatively. Endoscopic tympanoplasty has several advantages, including: Minimally invasive approach to the middle ear; panoramic perioperative vision; Gain of operating time; decrease in the duration of anesthesia; Valuable educational tool; postoperative comfort; Decrease in hospital stay and early return to daily activities; Better aesthetic rendering; cost and transportability. However, we also note a number of disadvantages of endoscopic tympanoplasty, particularly: performing the procedure with one hand; difficulty passing through the EAC; 2D vision that alters the perception of depth; management of intraoperative bleeding; fogging; learning curve.

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Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

Urologia Internationalis ◽

10.1159/000371726 ◽

2015 ◽

Vol 95 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Maria Angela Cerruto ◽

Carolina D'Elia ◽

Francesca Maria Cavicchioli ◽

Stefano Cavalleri ◽

Matteo Balzarro ◽

...

Keyword(s):

Uterine Prolapse ◽

Pelvic Organ ◽

Consecutive Series ◽

Complication Rates ◽

Early Complications ◽

Robot Assisted ◽

Female Patients ◽

The Mean ◽

Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

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Quality Control in 3D Printing: Accuracy Analysis of 3D-Printed Models of Patient-Specific Anatomy

Materials ◽

10.3390/ma14041021 ◽

2021 ◽

Vol 14 (4) ◽

pp. 1021

Author(s):

Bernhard Dorweiler ◽

Pia Elisabeth Baqué ◽

Rayan Chaban ◽

Ahmed Ghazy ◽

Oroa Salem

Keyword(s):

Wall Thickness ◽

Large Scale ◽

Fused Deposition Modeling ◽

Vascular Anatomy ◽

3D Models ◽

Patient Specific ◽

Stl File ◽

Fused Deposition ◽

3D Printed ◽

The Mean

As comparative data on the precision of 3D-printed anatomical models are sparse, the aim of this study was to evaluate the accuracy of 3D-printed models of vascular anatomy generated by two commonly used printing technologies. Thirty-five 3D models of large (aortic, wall thickness of 2 mm, n = 30) and small (coronary, wall thickness of 1.25 mm, n = 5) vessels printed with fused deposition modeling (FDM) (rigid, n = 20) and PolyJet (flexible, n = 15) technology were subjected to high-resolution CT scans. From the resulting DICOM (Digital Imaging and Communications in Medicine) dataset, an STL file was generated and wall thickness as well as surface congruency were compared with the original STL file using dedicated 3D engineering software. The mean wall thickness for the large-scale aortic models was 2.11 µm (+5%), and 1.26 µm (+0.8%) for the coronary models, resulting in an overall mean wall thickness of +5% for all 35 3D models when compared to the original STL file. The mean surface deviation was found to be +120 µm for all models, with +100 µm for the aortic and +180 µm for the coronary 3D models, respectively. Both printing technologies were found to conform with the currently set standards of accuracy (<1 mm), demonstrating that accurate 3D models of large and small vessel anatomy can be generated by both FDM and PolyJet printing technology using rigid and flexible polymers.

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Noise in Otolaryngology – Head and Neck Surgery operating rooms: a systematic review

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00487-6 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Gianluca Sampieri ◽

Amirpouyan Namavarian ◽

Marc Levin ◽

Justine Philteos ◽

Jong Wook Lee ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Patient Outcomes ◽

Noise Level ◽

Neck Surgery ◽

Operating Rooms ◽

Head And Neck Surgery ◽

Noise Levels ◽

Surgical Performance ◽

The Mean

Abstract Objective Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. Methods Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. Results This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. Conclusions This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs. Graphical abstract

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Comparison of implant placement accuracy in two different preoperative digital workflows: navigated vs. pilot-drill-guided surgery

International Journal of Implant Dentistry ◽

10.1186/s40729-021-00322-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Johannes Spille ◽

Feilu Jin ◽

Eleonore Behrens ◽

Yahya Açil ◽

Jürgen Lichtenstein ◽

...

Keyword(s):

Navigation System ◽

Entry Point ◽

Angular Deviation ◽

Guided Surgery ◽

Implant Placement ◽

Drill Guide ◽

Navigation Group ◽

3D Printed ◽

The Mean ◽

Master Model

Abstract Background The aim of the study is to evaluate the accuracy of a new implant navigation system on two different digital workflows. Methods A total of 18 phantom jaws consisting of hard and non-warping plastic and resembling edentulous jaws were used to stimulate a clinical circumstance. A conventional pilot-drill guide was conducted by a technician, and a master model was set by using this laboratory-produced guide. After cone beam computed tomography (CBCT) and 3D scanning of the master models, two different digital workflows (marker tray in CBCT and 3D-printed tray) were performed based on the Digital Imaging Communication in Medicine files and standard tessellation language files. Eight Straumann implants (4.1 mm × 10 mm) were placed in each model, six models for each group, resulting in 144 implant placements in total. Postoperative CBCT were taken, and deviations at the entry point and apex as well as angular deviations were measured compared to the master model. Results The mean total deviations at the implant entry point for MTC (marker tray in CBCT), 3dPT (3d-printed tray), and PDG (pilot-drill guide) were 1.024 ± 0.446 mm, 1.027 ± 0.455 mm, and 1.009 ± 0.415 mm, respectively, and the mean total deviations at the implant apex were 1.026 ± 0.383 mm, 1.116 ± 0.530 mm, and 1.068 ± 0.384 mm. The angular deviation for the MTC group was 2.22 ± 1.54°. The 3dPT group revealed an angular deviation of 1.95 ± 1.35°, whereas the PDG group showed a mean angular deviation of 2.67 ± 1.58°. Although there were no significant differences among the three groups (P > 0.05), the navigation groups showed lesser angular deviations compared to the pilot-drill-guide (PDG) group. Implants in the 3D-printed tray navigation group showed higher deviations at both entry point and apex. Conclusions The accuracy of the evaluated navigation system was similar with the accuracy of a pilot-drill guide. Accuracy of both preoperative workflows (marker tray in CBCT or 3D-printed tray) was reliable for clinical use.

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Pregnancy and Fertility Trends Among Female Otolaryngologists

Otolaryngology ◽

10.1177/01945998211064574 ◽

2021 ◽

pp. 019459982110645

Author(s):

Makenzie Huguet ◽

Angela Beliveau ◽

Sandra L. Taylor ◽

Debbie A. Aizenberg

Keyword(s):

Decision Making ◽

Family Planning ◽

General Population ◽

Career Decision ◽

Neck Surgery ◽

Career Decision Making ◽

Workplace Support ◽

Fertility Trends ◽

Planning Decisions ◽

The Mean

Objective This study sought to determine childbearing patterns and decision making among female otolaryngologists. Study Design Anonymous survey. Setting An anonymous survey was sent in 2020 to female otolaryngologists identified through their membership with the American Academy of Otolaryngology–Head and Neck Surgery. Methods Data were analyzed concerning individual fertility and childbearing history, reflections regarding decision making, perceptions of workplace support, and estimations of objective childbearing potential. Results There were 398 responses. The mean age at first pregnancy was 32.3 years. Almost one-third of respondents who attempted to conceive (30.4%) were diagnosed with infertility. Of those who had their first pregnancy during training, 55% reported having substantial workplace support, as opposed to 70% of those whose first pregnancies followed completion of training ( P = .01). When asked what they would do differently in retrospect, most women with infertility (65.0%) would have attempted conception earlier; 41 (41.0%) would have used cryopreservation to extend fertility; and 14 (14.0%) would have gone into a different specialty. Conclusion Female otolaryngologist respondents have children later in life than the general population, and a substantial proportion face infertility or have regrets about family planning decisions and career decision making. Increased awareness, further investigation, and targeted programs are needed to support the growing number of female otolaryngologists who desire both a career and a family.

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The Use of Patient-Specific 3D Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000018 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Samuel Adams ◽

Travis Dekker ◽

John Steele ◽

Kamran Hamid

Keyword(s):

Lower Extremity ◽

Deformity Correction ◽

Titanium Implants ◽

Patient Specific ◽

Allograft Bone ◽

Foot And Ankle ◽

Sf 36 ◽

3D Printed ◽

The Mean

Category: Ankle,Ankle Arthritis,Basic Sciences/Biologics,Trauma Introduction/Purpose: Large lower extremity bony defects, complex foot and ankle deformities, and high-risk arthrodesis situations can be difficult to treat. These challenging pathologies, often require a critical-sizes and/or shaped structural bone void filler which may not be available with allograft bone. The advancement of 3D printing technology has allowed for the use of custom designed implants for foot and ankle surgery. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D printed titanium implants. Methods: Seven consecutive patients who were treated with custom designed 3D printed implant cages for severe bone loss, deformity correction, and arthrodesis procedures were included in this study. A minimum of 1-year follow-up was required. No patients were lost to follow-up. Patients completed preoperative and most recent follow-up VAS for pain, FAAM, and SF-36 outcomes questionnaires. All patients had post-operative radiographs and CT scans to assess bony incorporation. Results: The mean age of these patients was 54.6 (35-73 years of age). The mean follow-up of these seven patients was 17.1 months (range 12 to 31). Radiographic fusion with cage ingrowth and integration occurred in all seven patients verified by CT scan. There was statistically significant improvement in all functional outcome score measures (VAS for pain, FAAM, and SF-36). All patients returned were satisfied with surgery. There were no failures. Case examples are demonstrated in Figure 1. Conclusion: This cohort of patients demonstrated the successful use of custom 3D printed implants to treat complex large bony defects, deformities and arthrodesis procedures of the lower extremity. These implants offer the surgeon a patient specific approach to treat both pain and deformity that is not necessarily available with allograft bone.

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Evaluation of hearing status after type I tympanoplasty

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i1.45341 ◽

2020 ◽

Vol 24 (1) ◽

pp. 50-55

Author(s):

Mashuque Mahamud ◽

Mani Lal Aich ◽

Abdullah Al Mamun ◽

Rafiul Alam

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Neck Surgery ◽

Cross Sectional Study ◽

Type I ◽

Cross Sectional ◽

Female Ratio ◽

The Mean ◽

Type I Tympanoplasty ◽

Air Conduction

Objective: To evaluate hearing outcome after type I tympanoplasty in inactive mucous type of chronic otitis media. Methods: It was a cross-sectional study conducted in the department of Otolaryngology & Head Neck Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, from July 2014 to June 2016. 50 cases were selected by matching inclusion and exclusion criteria. Paired t-test and Z test was used to analyze the variables. P values <0.05 was considered as statistically significant. Results: The mean age was found 28.5 years with range from 15 to 41 years and male female ratio was 1.3:1. All patients had intermittent otorrhoea and varying degree of hearing loss. The mean air conduction threshold was 40.2 dB preoperatively and 27.1 dB post-operatively. Air-bone gap was found 26.9 dB in preoperative and 16.1 dB in post-operative group. The differences were statistically significant between preoperative and post-operative group. Thus mean improvement of air conduction threshold was 13.1 dB and air-bone gap was 10.8 dB. Two third (66.%) patients improved <15 db air conduction thresholds and 17(34%) improved ≥15 db air conduction thresholds. Using the proportion of patients with a postoperative hearing within 40 dB as the criterion, this study showed 46(92%) patients achieving this and 40(80%) patients achieving AB gap within 20 db postoperatively. Conclusion: Improvement of air conduction threshold and AB gap after type I tympanoplasty was statistically significant. Thus from this study it can be concluded that type I tympanoplasty is an effective technique for hearing improvement in inactive mucous type of chronic otitis media. Bangladesh J Otorhinolaryngol; April 2018; 24(1): 50-55

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3D Printing 18F Radioactive Phantoms for PET Imaging

10.21203/rs.3.rs-136006/v1 ◽

2020 ◽

Author(s):

Daniel Gillett ◽

Daniel Marsden ◽

Safia Ballout ◽

Bala Attili ◽

Nick Bird ◽

...

Keyword(s):

Double Helix ◽

Human Anatomy ◽

Radioactive Material ◽

Ct Scanner ◽

Pet Ct ◽

Radioactive Concentration ◽

3D Printed ◽

Single Use ◽

The Mean ◽

Cylinders And Spheres

Abstract Purpose: Phantoms are routinely used in molecular imaging to assess scanner performance. However, traditional phantoms with fillable shapes do not replicate human anatomy. 3D printed phantoms have overcome this by creating phantoms which replicate human anatomy which can be filled with radioactive material. The problem with these is that small objects suffer from boundary effects and therefore boundary-free objects are desirable. The purpose of this study was to explore the feasibility of creating resin-based 3D printed phantoms using 18 F-FDG. Methods: Radioactive resin was created using an emulsion of printer resin and 18 F-FDG. A series of test objects were printed including twenty identical cylinders, ten spheres with increasing diameters (2 mm to 20 mm) and a double helix. Radioactive concentration uniformity, printing accuracy and the amount of leaching were assessed. Results: Creating radioactive resin was simple and effective. The radioactivity remained bound to the resin for the duration that it was radioactive. The radioactive concentration was uniform among identical objects; the CoV of the mean, max and total signal were 3.6%, 3.8% and 2.6%, respectively. The printed cylinders and spheres were found to be within 4% of the model dimensions. A double helix was successfully printed as a test for the printer and appeared as expected on the PET scanner. The amount of radioactivity leached into the water was measurable (0.72%) but not visible above background on the imaging. Conclusions: Creating an 18F-FDG radioactive resin emulsion is a simple and effective way to create boundary-free, accurate, complex 3D phantoms that can be imaged using a PET/CT scanner. This technique could be used to print clinically realistic phantoms, however, they are single use, and cannot be made hollow without an exit hole. Also, there is a small amount of leaching of the radioactivity to take into consideration.

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