Methods for Mass Tissue Removal by Minimally Invasive Reproductive Surgery

Mechanical loosening of implants is in the majority accompanied with a periprosthetic interface membrane, which has to be removed during revision surgery. The same is true if a minimal invasive (percutaneous) refixation of a loose implant is done. We describe the requirements for a waterjet applicator for interface tissue removal for this percutaneous hip refixation technique. The technical requirements were either obtained from a literature review, a theoretical analysis, or by experimental setup. Based on the requirements, a waterjet applicator is designed which is basically a flexible tube (outer diameter 3 mm) with two channels. One channel for the water supply (diameter 0.9 mm) and one for suction to evacuate water and morcellated interface tissue from the periprosthetic cavity. The applicator has a rigid tip (length 6 mm), which directs the water flow to create two waterjets (diameter 0.2 mm), both focused into the suction channel. The functionality of this new applicator is demonstrated by testing a prototype of the applicator tip in an in vitro experimental setup. This testing has shown that the designed applicator for interface tissue removal will eliminate the risk of water pressure buildup; the ejected water was immediately evacuated from the periprosthetic cavity. Blocking of the suction opening was prevented because the jets cut through interface tissue that gets in front of the suction channel. Although further development of the water applicator is necessary, the presented design of the applicator is suitable for interface tissue removal in a minimally invasive hip refixation procedure.

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Comparison of Ho:YAG laser and coblation for interface tissue removal in minimally invasive hip refixation procedures

Medical Engineering & Physics ◽

10.1016/j.medengphy.2011.07.029 ◽

2012 ◽

Vol 34 (3) ◽

pp. 370-377 ◽

Cited By ~ 8

Author(s):

Gert Kraaij ◽

Daniel F. Malan ◽

Huub J.L. van der Heide ◽

Jenny Dankelman ◽

Rob G.H.H. Nelissen ◽

...

Keyword(s):

Minimally Invasive ◽

Ho:Yag Laser ◽

Tissue Removal

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Office-based uterine polypectomy using a minimally invasive Hysteroscopic tissue removal device saves Healthcare resources

Value in Health ◽

10.1016/j.jval.2015.03.294 ◽

2015 ◽

Vol 18 (3) ◽

pp. A50

Author(s):

R.W. Williams ◽

P.M. Just ◽

A. Maxwell ◽

J. McCauley

Keyword(s):

Minimally Invasive ◽

Healthcare Resources ◽

Tissue Removal

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Minimally Invasive Surgery for Axillary Osmidrosis Using a Combination of Subcutaneous Tissue Removal and a 1,444-nm Nd:YAG Laser

Annals of Dermatology ◽

10.5021/ad.2014.26.6.755 ◽

2014 ◽

Vol 26 (6) ◽

pp. 755 ◽

Cited By ~ 8

Author(s):

Sang Geun Lee ◽

Hwa Jung Ryu ◽

Il-Hwan Kim

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Nd:Yag Laser ◽

Subcutaneous Tissue ◽

Tissue Removal ◽

Axillary Osmidrosis

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Periprosthetic Tissue Removal in Minimally Invasive Hip Refix Procedures

Journal of Medical Devices ◽

10.1115/1.3442760 ◽

2010 ◽

Vol 4 (2) ◽

Author(s):

Gert Kraaij

Keyword(s):

Minimally Invasive ◽

Thermal Damage ◽

Hip Prosthesis ◽

Fibrous Tissue ◽

Clinical Situation ◽

Pulse Frequency ◽

Periprosthetic Tissue ◽

Ho:Yag Laser ◽

Tissue Removal

An alternative to conventional revision surgery of loosened hip prostheses is a new minimally invasive refixation procedure. This procedure requires the removal of periprosthetic fibrous tissue. The aim of this preliminary study is to evaluate which technique is most suitable for minimally invasive periprosthetic tissue removal: a Ho:YAG laser or a VAPR-2 coblation system. The clinical situation of a loosened prosthesis was simulated by several cadaveric femora, each implanted with a hip prosthesis. Artificially created periprosthetic lesions were filled with a fibrous tissue substitute. Using this fibrous tissue substitute, we measured temperatures in vitro at different distances from the site of removal. Temperatures during removal were recorded both inside the fibrous tissue and in the surrounding bone. This study demonstrated that temperatures generated in the bone do not result in thermal damage. Temperatures inside the fibrous tissue are sufficiently high to remove the fibrous tissue. Using the laser instead of the coblation system for the removal of fibrous tissue resulted in higher temperatures, thus, a faster removal of fibrous tissue. Additionally, the laser takes less effort to be integrated with the new surgical instrument and, therefore, we consider it a promising tool. However, when translating the results to clinical practice, the limitations of this study should be kept in mind. The equipment was set to typical presets; different settings (pulse frequency, pulse energy, and activated time) might affect the procedure’s success and risks. Care must be taken with respect to generated temperatures at larger distances from the place of removal. The use of the Ho:YAG laser, as well as VAPR coblation, might form a small risk for thermal damage to healthy surrounding tissues. Further research on apparatus settings and removal strategy is necessary before this technique can be applied for the removal of fibrous tissue in the clinical setting.

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Considerations in Dysphagia Management Following Esophagectomy

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig13.169 ◽

2016 ◽

Vol 1 (13) ◽

pp. 169-176

Author(s):

Lisa M. Evangelista ◽

James L. Coyle

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Surgical Procedures ◽

Esophageal Resection ◽

Minimally Invasive Surgical ◽

Operative Complications ◽

Swallowing Difficulties ◽

Epidemiological Impact ◽

Invasive Techniques ◽

Management Of Dysphagia

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Esophageal resection is the mainstay treatment for cancers of the esophagus. While curative, surgical resection may result in swallowing difficulties that require intervention from speech-language pathologists (SLPs). Minimally invasive surgical procedures for esophageal resection have aimed to reduce morbidity and mortality associated with more invasive techniques. Both intra-operative and post-operative complications, regardless of the surgical approach, can result in dysphagia. This article will review the epidemiological impact of esophageal cancers, operative complications resulting in dysphagia, and clinical assessment and management of dysphagia pertinent to esophageal resection.

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