Robotic Surgery in Crohn's Disease

Surgery for Crohn's disease presents unique challenges secondary to the inflammatory nature of the disease. While a minimally invasive approach to colorectal surgery has consistently been associated with better patient outcomes, adoption of laparoscopy in Crohn's disease has been limited due to these challenges. Robotic assisted surgery has the potential to overcome these challenges and allow more complex patients to undergo a minimally invasive operation. Here we describe our approach to robotic assisted surgery for terminal ileal Crohn's disease.

Emergency treatment of bleeding hemorrhoids in a patient taking aspirin and clopidogrel using a 1470 nm diode laser and the ELITE minimal invasive technique

A 74-year-old male patient, receiving anticoagulation treatment after previous angioplasty stenting for severe coronary artery disease, was admitted to the clinic with a 2-day rectal bleeding. Clinical examination followed by an urgent colonoscopy to exclude other potential reasons for his symptoms both confirmed the diagnosis of Grade III thrombosed hemorrhoids. Due to the acute presentation of the case along with the existing medication of the patient, the decision was made to treat the problem using the expert laser intrahemorrhoidal therapy technique, which is a diode laser minimally invasive operation without the need to stop any of the patient’s medication.

Design of a low-cost tactile robotic sleeve for autonomous endoscopes and catheters

Recent developments in medical robotics have been significant, supporting the minimally invasive operation requirements, such as smaller devices and more feedback available to surgeons. Nevertheless, the tactile feedback from a catheter or endoscopic type robotic device has been restricted mostly on the tip of the device and was not aimed to support the autonomous movement of the medical device during operation. In this work, we design a robotic sheath/sleeve with a novel and more comprehensive approach, which can function for whole body or segment-based feedback control as well as diagnostic purposes. The robotic sleeve has several types of piezo-resistive pressure and extension sensors, which are embedded at several latitudes and depths of the silicone substrate. The sleeve takes the human skin as a biological model for its structure. It has a better tactile sensation of the inner tissues in the torturous narrow channels such as cardiovascular or endoluminal tracts in human body and thus can be used to diagnose abnormalities. In addition to this capability, using the stretch sensors distributed alongside its body, the robotic sheath/sleeve can perceive the ego-motion of the robotic backbone of the catheter and can act as a position feedback device. Because of the silicone substrate, the sleeve contributes toward safety of the medical device passively by providing a compliant interface. As an active safety measure, the robotic sheath can sense blood clots or sudden turns inside a channel and by modifying the local trajectory and can prevent embolisms or tissue rupture. In the future, advanced manufacturing techniques will increase the capabilities of the tactile robotic sleeve.

A near-infrared light-triggered shape-memory polymer for long-time fluorescence imaging in deep tissues

Implanting a stent in the body through a minimally invasive operation and tracking its location in real-time is still a challenge.

Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease

As a minimally invasive surgery, percutaneous cement discoplasty (PCD) is now contemplated to treat lumbar disc degeneration disease in elder population. Here, we investigated whether the osteogenic mineralized collagen (MC) modified polymethylmethacrylate (PMMA) cement could be a suitable material in PCD surgery. Injectability, hydrophilicity and mechanical properties of the MC-modified PMMA (PMMA-MC) was characterized. The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation. Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress. Then, PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA. Three months after implantation, micro-computed tomography analysis revealed a 36.4% higher circumferential contact index between PMMA-MC and bone, as compared to PMMA alone. Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone, while the PMMA was covered by fibrous tissue. The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation. Therefore, the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro. We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages. Moreover, expressions of fibroblast-stimulating growth factors, insulin-like growth factor, basic fibroblast growth factor and tumor necrosis factor-β were significantly down-regulated in the macrophages cocultured with PMMA-MC. Together, the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.

Development and evaluation of a minimally aggressive method of patellofemoral osteoarthritis surgical treatment

Purpose: The purpose of this study was to assess the impact of developed minimally invasive operation such as the partial lateral facetectomy (PLFE) with patella thickness resection in patients with lateral patellofemoral (PF) osteoarthritis on short-term clinical and radiographic outcomes. Methods: This is a prospective study of 27 knees in 27 patients (18 females and 9 males, mean aged at surgery 59.1-year old) whom a PLFE with patella thickness resection using developed minimally invasive method was performed. Data of preoperative and postoperative questionnaires, physical examinations, and radiographs were analyzed. The minimum follow-up was 12 months (mean, 24.1 months; range, 12–36 months). Results: The subjective outcomes included the anterior pain relief assessed by scores using the Western Ontario and McMaster Universities Arthritis Index score (scores improved considerably by 2.34 points with respect to pain and by 1.63 points with respect to function), visual analog scale, and Knee Society Score (that improved in 78% of the knees). The majority of these patients experienced improvement in their PF symptoms. The PF index decreased considerably after surgery. The mean patellar width and thickness were decreased after surgery, maintaining a width/thickness ratio of 1.8:1.0 after surgery. Conclusion: PLFE with patella thickness resection aiming to decrease the high pressure in the lateral facet and improving congruence of the patella confirmed frequent pain relief. This surgical procedure is minimally invasive, relatively simple, and effective in selected patients and can be a valid early alternative to more complex operations. Level of Evidence: Level IV Therapeutic study.

Fiber-Optic System for Intraoperative Study of Abdominal Organs during Minimally Invasive Surgical Interventions

The paper presents the results of experimental measurements of endogenous fluorescence and blood perfusion in patients with pathology of the organs of hepatopancreatoduodenal area in vivo. A custom setup combining channels for fluorescence spectroscopy (excitation wavelengths of 365 nm and 450 nm) and laser Doppler flowmetry (1064 nm) with fibre optical probe for nondestructive laparoscopic measurements has been developed and applied during minimally invasive operation procedure. Preliminary measurements with two aforementioned channels have been performed at specified excitation wavelengths. The possibility of obtaining fluorescence spectra and laser Doppler flowmetry signals in vivo during minimally invasive interventions was shown. Obtained data show perspectives of further research on technical and methodological development of optical diagnostic methods for minimally invasive surgery. The obtained results can be used to provide a deeper understanding of pathological processes influence on optical properties of abdominal organs tissues, which will ultimately help surgeons to determine the state of vitality in tissues and mucous membranes directly during the process of surgical intervention.

Laparoscopic sleeve gastrectomy in a superobese patient with restenosis of the trachea

Introduction. Super obese group of patients with body mass index (BMI) ? 50kg/m2 have higher technical intraoperative problems, higher morbidity and mortality. Indications for the metabolic procedure are widening and minimally invasive operation dictate both patients and surgeons to face with previously assumed ?general contraindication? for surgical bariatric/metabolic procedure. Case outline. We present a super obese patient with restenosis of the trachea, chronic obstructive pulmonary disease, sleep apnea and cardiomyopathy with panniculus grade IV, in whom as a multidisciplinary team we did simultaneously permanent tracheostomy, laparoscopic sleeve gastrectomy and panniculectomy. Conclusion. Quality of life after the bariatric operation is a factor which must be leading in concern how to approach a difficult patient, with operation adaptable to fit all demands.