Novel technique of a multifunctional electrosurgical system for minimally invasive surgery

2017 ◽  
Vol 126 (3) ◽  
pp. 997-1002 ◽  
Author(s):  
David Mittelstein ◽  
Jiahan Deng ◽  
Rachel Kohan ◽  
Mojdeh Sadeghi ◽  
Jean-Michel Maarek ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Limited Range ◽  
Surgical Instruments ◽  
Prototype System ◽  
Surgical Workflow ◽  
Limited Range Of Motion ◽  
Human Cadavers ◽  
Surgical Device ◽  
Bipolar Electrosurgery

Bipolar electrosurgery in the minimally invasive endoscopic surgery theater has been traditionally limited to the use of standard bipolar forceps, which are minimally versatile, have a limited range of motion, and are associated with visualization and handling constraints. The authors designed a novel surgical device system in which commonly used surgical instruments (suction, microscissors, micrograspers, and dissectors) co-function as individually insulated and modular electrodes for bipolar electrosurgery. In this feasibility study, the successful use of these prototypes in endonasal endoscopic transsphenoidal surgery was demonstrated on 2 human cadavers, and in an in vivo arterial coagulation model on 2 live rats. This prototype system provided improved bipolar instrument mobility, minimized the requirement to exchange surgical instruments when performing electrosurgery, and allowed for new maneuvers that optimized surgical workflow, such as the ability to suction blood and smoke while cauterizing. This multifunctional bipolar cautery system may improve surgical efficiency and workflow and facilitate surgical microdissection and electrocautery during minimally invasive, endoscopic, robotic or traditional open surgery.

Human cadavers to evaluate prototypes of minimally invasive surgical instruments: A feasibility study

2017 ◽  
Vol 25 (6) ◽  
pp. 1139-1146
Author(s):  
Lukas van den Haak ◽  
Chantal Alleblas ◽  
Johann P. Rhemrev ◽  
Jules Scheltes ◽  
Theodoor Elbert Nieboer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Feasibility Study ◽  
Surgical Instruments ◽  
Minimally Invasive Surgical ◽  
Human Cadavers

Deep Knee Activities: In Vitro Kinematic Measurements to Compare With In Vivo Studies

2007 ◽  
Author(s):  
Amber N. Reeve ◽  
Chadd W. Clary ◽  
Amit M. Mane ◽  
Kevin A. Dodd ◽  
Lorin P. Maletksy
Keyword(s):  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Knee Flexion ◽  
Daily Living ◽  
Limited Range ◽  
In Vivo Studies ◽  
Daily Living Activities ◽  
Limited Range Of Motion

Deep knee flexion is required for many activities of daily living during work, exercise, religious worship, and hobbies. Walker et al. [1] found that activities such as rising from a low chair or getting into or out of bath require between 100° and 160° of knee flexion. Other activities such as kneeling or squatting to pick an item off the ground can be difficult with a limited range of motion. Beside deep knee flexion being important for daily living activities, it is essential in non-Western cultures that commonly sit in deep knee-bending positions.

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

Enhanced Increases in Cytosolic Ca2+ in ADP-Stimulated Platelets from Patients with Delta-Storage Pool Deficiency – A Possible Indicator of Interactions between Granule-Bound ADP and the Membrane ADP Receptor

1997 ◽  
Vol 77 (02) ◽  
pp. 376-382 ◽  
Author(s):  
Bruce Lages ◽  
Harvey J Weiss
Keyword(s):  
Platelet Rich Plasma ◽  
Limited Range ◽  
Dense Granule ◽  
Receptor Desensitization ◽  
Fura 2 ◽  
Storage Pool ◽  
Low Levels ◽  
The Right

SummaryThe possible involvement of secreted platelet substances in agonist- induced [Ca2+]i increases was investigated by comparing these increases in aspirin-treated, fura-2-loaded normal platelets and platelets from patients with storage pool deficiencies (SPD). In the presence and absence of extracellular calcium, the [Ca2+]i response induced by 10 µM ADP, but not those induced by 0.1 unit/ml thrombin, 3.3 µM U46619, or 20 µM serotonin, was significantly greater in SPD platelets than in normal platelets, and was increased to the greatest extent in SPD patients with Hermansky-Pudlak syndrome (HPS), in whom the dense granule deficiencies are the most severe. Pre-incubation of SPD-HPS and normal platelets with 0.005-5 µM ADP produced a dose-dependent inhibition of the [Ca2+]i response induced by 10 µ M ADP, but did not alter the [Ca2+]i increases induced by thrombin or U46619. Within a limited range of ADP concentrations, the dose-inhibition curve of the [Ca2+]i response to 10 µM ADP was significantly shifted to the right in SPD-HPS platelets, indicating that pre-incubation with greater amounts of ADP were required to achieve the same extent of inhibition as in normal platelets. These results are consistent with a hypothesis that the smaller ADP-induced [Ca2+]i increases seen in normal platelets may result from prior interactions of dense granule ADP, released via leakage or low levels of activation, with membrane ADP receptors, causing receptor desensitization. Addition of apyrase to platelet-rich plasma prior to fura-2 loading increased the ADP-induced [Ca2+]i response in both normal and SPD-HPS platelets, suggesting that some release of ADP derived from both dense granule and non-granular sources occurs during in vitro fura-2 loading and platelet washing procedures. However, this [Ca2+]i response was also greater in SPD-HPS platelets when blood was collected with minimal manipulation directly into anticoagulant containing apyrase, raising the possibility that release of dense granule ADP resulting in receptor desensitization may also occur in vivo. Thus, in addition to enhancing platelet activation, dense granule ADP could also act to limit the ADP-mediated reactivity of platelets exposed in vivo to low levels of stimulation.

The Correlation of the Limitations of Movement of the Shoulder Joint with the Functional Ability of Frozen Shoulder Patients at the Medical Rehabilitation Institute Dr. Mohammad Hoesin Palembang

2020 ◽  
Vol 3 (3) ◽  
pp. 88-96
Author(s):  
Ine Sintia ◽  
Nyimas Fatimah
Keyword(s):  
Functional Ability ◽  
Shoulder Joint ◽  
Frozen Shoulder ◽  
Limited Range ◽  
Medical Rehabilitation ◽  
Cross Sectional ◽  
Shoulder Joints ◽  
Limited Range Of Motion ◽  
Active Flexion ◽  
Cross Sectional Design

Background: Frozen shoulder is a condition of the shoulder joint that experiences inflammation, pain, adhesions, atrophyand shortening of the joint capsule resulting in limited motion. In frozen shoulder patients, the limited range of motion ofthe shoulder joint can affect and reduce functional ability. This study aims to analyze the correlation between the limitedarea of motion of the shoulder joint with the functional ability of frozen shoulder patients at the Medical RehabilitationInstallation Dr. Mohammad Hoesin Palembang. Methods: This study was an observational analytic study, correlationtest, with a cross sectional design. There were 29 frozen shoulder patients who met the inclusion criteria in the MedicalRehabilitation Installation Dr. Mohammad Hoesin Palembang in November 2018 was taken as a sample using consecutivesampling techniques. Functional ability was assessed using the quickDASH questionnaire and the area of motion wasmeasured using a goniometer, then analyzed. Results: The results of the correlation test showed significant resultsbetween functional abilities and the area of motion of the shoulder joints. Active flexion (p = 0.000; r = -0.669), activeextension (p = 0.004; r = -0.520), active abduction (p = 0.000; r = -0.663), active adduction (p = 0.022; r = -0.423 ), passiveflexion (p = 0.001; r = -0.589), passive extension (p = 0.002; r = -0.543), passive abduction (p = 0.000; r = -0.676), passiveadduction (p = 0.038; r = -0.388). Conclusion: There is a significant correlation between limited joint motion andfunctional ability in frozen shoulder patients at the Medical Rehabilitation Installation of Dr. Mohammad HoesinPalembang

scholarly journals Ferromagnetic soft catheter robots for minimally invasive bioprinting

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Cheng Zhou ◽  
Youzhou Yang ◽  
Jiaxin Wang ◽  
Qingyang Wu ◽  
Zhuozhi Gu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
The Body ◽  
Magnetic Actuation ◽  
Internal Organs ◽  
Planar Surfaces ◽  
Reinforced Polymer ◽  
Direct Fabrication ◽  
Digitally Controlled

AbstractIn vivo bioprinting has recently emerged as a direct fabrication technique to create artificial tissues and medical devices on target sites within the body, enabling advanced clinical strategies. However, existing in vivo bioprinting methods are often limited to applications near the skin or require open surgery for printing on internal organs. Here, we report a ferromagnetic soft catheter robot (FSCR) system capable of in situ computer-controlled bioprinting in a minimally invasive manner based on magnetic actuation. The FSCR is designed by dispersing ferromagnetic particles in a fiber-reinforced polymer matrix. This design results in stable ink extrusion and allows for printing various materials with different rheological properties and functionalities. A superimposed magnetic field drives the FSCR to achieve digitally controlled printing with high accuracy. We demonstrate printing multiple patterns on planar surfaces, and considering the non-planar surface of natural organs, we then develop an in situ printing strategy for curved surfaces and demonstrate minimally invasive in vivo bioprinting of hydrogels in a rat model. Our catheter robot will permit intelligent and minimally invasive bio-fabrication.

scholarly journals Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Terézia B. Andrási ◽  
Nunijiati Abudureheman ◽  
Alannah Glück ◽  
Maximilian Vondran ◽  
Gerhard Dinges ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Surgical Instruments ◽  
Tricuspid Valve Repair ◽  
Long Term Outcome ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
Neurosurgical Intervention

Abstract Background The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case presentation A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. Conclusion The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

scholarly journals Performance of a novel protease-activated fluorescent imaging system for intraoperative detection of residual breast cancer during breast conserving surgery

2021 ◽  
Vol 187 (1) ◽  
pp. 145-153
Author(s):  
Conor R. Lanahan ◽  
Bridget N. Kelly ◽  
Michele A. Gadd ◽  
Michelle C. Specht ◽  
Carson L. Brown ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Real Time ◽  
Imaging System ◽  
Ex Vivo ◽  
Menopausal Status ◽  
Fluorescent Imaging ◽  
Cancer Subtypes ◽  
Surgical Workflow ◽  
Tumor Types

Abstract Purpose Safe breast cancer lumpectomies require microscopically clear margins. Real-time margin assessment options are limited, and 20–40% of lumpectomies have positive margins requiring re-excision. The LUM Imaging System previously showed excellent sensitivity and specificity for tumor detection during lumpectomy surgery. We explored its impact on surgical workflow and performance across patient and tumor types. Methods We performed IRB-approved, prospective, non-randomized studies in breast cancer lumpectomy procedures. The LUM Imaging System uses LUM015, a protease-activated fluorescent imaging agent that identifies residual tumor in the surgical cavity walls. Fluorescent cavity images were collected in real-time and analyzed using system software. Results Cavity and specimen images were obtained in 55 patients injected with LUM015 at 0.5 or 1.0 mg/kg and in 5 patients who did not receive LUM015. All tumor types were distinguished from normal tissue, with mean tumor:normal (T:N) signal ratios of 3.81–5.69. T:N ratios were 4.45 in non-dense and 4.00 in dense breasts (p = 0.59) and 3.52 in premenopausal and 4.59 in postmenopausal women (p = 0.19). Histopathology and tumor receptor testing were not affected by LUM015. Falsely positive readings were more likely when tumor was present < 2 mm from the adjacent specimen margin. LUM015 signal was stable in vivo at least 6.5 h post injection, and ex vivo at least 4 h post excision. Conclusions Intraoperative use of the LUM Imaging System detected all breast cancer subtypes with robust performance independent of menopausal status and breast density. There was no significant impact on histopathology or receptor evaluation.

scholarly journals 1700 nm optical coherence microscopy enables minimally invasive, label-free, in vivo optical biopsy deep in the mouse brain

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jun Zhu ◽  
Hercules Rezende Freitas ◽  
Izumi Maezawa ◽  
Lee-way Jin ◽  
Vivek J. Srinivasan
Keyword(s):  
Minimally Invasive ◽  
Mouse Brain ◽  
Numerical Aperture ◽  
Optical Biopsy ◽  
Optical Coherence ◽  
Label Free ◽  
Optical Coherence Microscopy ◽  
Minimal Invasiveness ◽  
Cortical Regions

AbstractIn vivo, minimally invasive microscopy in deep cortical and sub-cortical regions of the mouse brain has been challenging. To address this challenge, we present an in vivo high numerical aperture optical coherence microscopy (OCM) approach that fully utilizes the water absorption window around 1700 nm, where ballistic attenuation in the brain is minimized. Key issues, including detector noise, excess light source noise, chromatic dispersion, and the resolution-speckle tradeoff, are analyzed and optimized. Imaging through a thinned-skull preparation that preserves intracranial space, we present volumetric imaging of cytoarchitecture and myeloarchitecture across the entire depth of the mouse neocortex, and some sub-cortical regions. In an Alzheimer’s disease model, we report that findings in superficial and deep cortical layers diverge, highlighting the importance of deep optical biopsy. Compared to other microscopic techniques, our 1700 nm OCM approach achieves a unique combination of intrinsic contrast, minimal invasiveness, and high resolution for deep brain imaging.

scholarly journals Effect of valproic acid on functional bleb morphology in a rabbit model of minimally invasive surgery

2021 ◽  
pp. bjophthalmol-2020-318691
Author(s):  
Zhu Li Yap ◽  
Li-Fong Seet ◽  
Stephanie WL Chu ◽  
Li Zhen Toh ◽  
Farah Ilyana Ibrahim ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Cell Growth ◽  
Minimally Invasive ◽  
Transforming Growth Factor Beta ◽  
Transforming Growth Factor ◽  
Rabbit Model ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Label Free ◽  
Collagen Fibres

AbstractPurposeTo determine the effect of valproic acid (VPA) on bleb morphology and scar characteristics in a rabbit model of minimally invasive glaucoma surgery (MIGS).MethodsNine New Zealand white rabbits were subjected to MIGS with intraoperative implantation of the PreserFlo MicroShunt. Rabbits were then administered with subconjunctival injections of phosphate buffered saline (PBS) (n=4) or with VPA (n=5). Bleb morphology was examined by slit-lamp biomicroscopy and in vivo confocal microscopy. Postoperative day 28 tissues were examined by immunohistochemical evaluation and label-free multiphoton microscopy to visualise the collagen matrix, by terminal deoxynucleotidyl transferase dUTP nick-end labelling assay and immunofluorescent labelling for Ki67 expression to detect apoptosis and cell growth, and by real-time quantitative PCR to measure Col1a1, Fn, and Smad6 transcript expression.ResultsVPA-treated blebs were detectable on day 28, while the PBS-treated blebs were not detectable by day 14. VPA-treated blebs were diffuse, extended posteriorly with near normal conjunctival vascularity and featured a combination of reticular/blurred stromal pattern with evidence of relatively large stromal cysts. Instead of the deposition of thick, disorganised collagen fibres characteristic of the PBS bleb, the VPA bleb contained conspicuously thinner collagen fibres which were associated with similarly thinner fibronectin fibres. In corroboration, Col1a1 and Fn mRNA expression was reduced in the VPA blebs, while increased Smad6 expression implicated the disruption of the transforming growth factor beta pathway. Apoptosis and cell growth profiles appeared similar with both treatments.ConclusionsThe results support the application of VPA to enhance bleb morphology associated with good bleb function in MIGS with no apparent cytotoxicity.

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