Going Hands-Free: MagnetoSuture™ for Untethered Guided Needle Penetration of Human Tissue Ex Vivo

The application of force in surgical settings is typically accomplished via physical tethers to the surgical tool. While physical tethers are common and critical, some internal surgical procedures may benefit from a tetherless operation of needles, possibly reducing the number of ports in the patient or the amount of tissue damage caused by tools used to manipulate needles. Magnetic field gradients can dynamically apply kinetic forces to magnetizable objects free of such tethers, possibly enabling ultra-minimally invasive robotic surgical procedures. We demonstrate the untethered manipulation of a suture needle in vitro, exemplified by steering through narrow holes, as well as needle penetration through excised rat and human tissues. We present proof of principle manipulations for the fully untethered control of a minimally modified, standard stainless steel surgical suture needle.

Jacques-Louis Reverdin - pioneer of transplantology, a surgeon who opened the veil of functional importance of the thyroid gland

Jacques-Louis Reverdin is a famous Swiss surgeon, scientist, and entomologist of the nineteenth century. He made a considerable contribution to the development of transplantology — he was one of the first to publish work on allotransplantation, performing the so — called “skin grafting”, urology — he defended his thesis on urethrotomy, endocrinology- he performed surgical operations for the treatment of goiter, observed and described the symptoms of iatrogenic hypothyroidism, introduced the concept of postoperative myxedema. For thirty-four years, he led an active surgical practice, thanks to which he described a large number of operations (the most famous are operations on the thyroid gland), introduced a surgical suture and needle, which are still used today. During the Franco-Prussian war, he commanded a Swiss ambulance. He was a proponent of Lister’s method of asepsis and antiseptics, and introduced it in hospitals in Geneva. He was engaged in teaching and research, and was nominated for the Nobel prize three times. He received the Amuss prize of the Academy of Medicine, the prize of the Paris Academy of medicine for his work on urethrotomy, founded the Revue Medicale de la Suisse Romande, and was a co-founder and later President of the Association of physicians of Geneva. Honorary member of the entomological societies of Switzerland, France, England and Brazil.

Predictive Factors of Surgical Site Infection in Prosthetic Joint Surgery. A Prospective Study on 760 Arthroplasties.

Purpose: Surgical site infection (SSI) is a debilitating complication of total joint arthroplasty (TJA) with significant morbidity and increased costs. Aim of our study was to identify potential risk factors for SSIs in a population of patients undergoing TJA. Methods: TJA were prospectively recruited at Santa Maria Maddalena Hospital from February 2019 to April 2020. Age, sex, major comorbidities, American Society of Anesthesiologists (ASA) class, length of surgery, type of surgical suture, total hospital length of stay and clinical laboratory data were collected. The study population was then divided into two groups: Group A, normal post-operative course, and Group B, patients who developed SSI at follow-up (17-25 days).Results: 25/760 (3.3%) patients developed SSIs at follow-up. Clinical and demographic parameters were not different between the two groups. Total leucocyte and neutrophil values at discharge resulted to be significatively higher in Group B compared to Group A (p=0.025 and p=0.016, respectively). Values of 7860/mL for total leucocyte, and 5185/mL for neutrophil count at discharge significantly predicted the future development of SSI (AUC 0.623 and AUC 0.641, respectively; p<0.05) independently from confounding factors (total leukocytes: O.R.=3,69 [95% C.I. 1,63-8,32]; neutrophils: O.R.=3,98 [95% C.I. 1,76-8,97. Deep SSIs has been diagnosed significantly before superficial SSIs (p=0,008), with a median advance of 9 days. Conclusion: Total leukocytes and neutrophils at discharge seem useful to identify a population at risk for the development of SSIs following TJA. Further studies on larger populations are needed to develop a predictive SSIs risk score that should include those variables.

Automation of the wet disinfection process during the production of suture threads from natural collagen, catgut

Surgical sutures are the simplest yet most used medical devices in modern healthcare, they are the preferred type because of its biocompatibility and ability to be resorbed. Bovine intestinal fibers are converted into catgut that serves as the starting material of absorbable surgical suture threads. The mechanical and control subsystems of industrial equipment were designed to automate disinfection of bovine intestinal fibers to increase efficiency during the wet process stage of disinfection without altering its fiber quality. A turbulent regime of the water and disinfectant mix was designed, implemented and validated, this automatic aeration system in the disinfection thank increased the process efficiency by reducing the time used to handle a load of fibers by 50%, and the working time of the personnel involved in the process was reduced from 220 to 20 minutes. Tests on the final product showed that LAL levels comply with what is established by the American Pharmacopoeia: USP <85> Bacterial Endotoxin Test and USP <161> Medical Devices - Bacterial and Pyrogen Endotoxin Test. These results indicate that the disinfected catgut using the proposed automated system complies with all mechanical quality control tests.

ANALYSIS ON THE HALAL STATUS OF A MEDICAL DEVICE: A STUDY ON THE SURGICAL SUTURE

There is a recent demand for halal certification from another healthcare sector which is medical devices, which cover all types of medical equipment used in hospitals from simple equipment such as bandages to complex equipment such as ventilators. This matter has been raised by the industry as halal labelling is a requirement to penetrate the market of Islamic countries such as Saudi Arabia, Turkey, and Pakistan. Even it seems critical to proving halal status for the medical devices that incorporate animal tissues, in contact with or invasive to the body, and produce a reaction to the body, this does not deny the demand for other types of devices. This study will focus on the halal issues related to medical devices which are widely used to stitch and close the wounds of patients after surgery or injury, namely sutures. This study seeks to identify the status of suture usage from the perspective of Islamic ruling. To achieve this objective, a qualitative research method through library research, as well as field studies involving in-depth interviews with the industry players, both medical device and religious authorities, Islamic scholars, and medical practitioners. The interviews were recorded, transcribed, translated, coded, and reconciled with the aid of Atlas.ti software (version 7) to identify themes and subthemes for this study. The results show that with regard to the status of resources and processes, and the application of al-darurah (necessity) concept.

Applying basic principles of surgery may pave the way for more effective endoscopic bariatric techniques

Background and study aims In the last decade, gastroenterologists have been attempting to use endoscopy to reproduce the great success of traditional surgical suture techniques. Despite recent advances, we still lack a reliable method that results in a permanent suture with minimal incidence of suture failure. This was an experimental study in pigs with an innovative technique that applied basic surgical concepts to endoscopy to evaluate the effectiveness of a novel suture technique. Methods The procedures were performed on six live pigs under general anesthesia. Endoscopic mucosal resection (EMR) first was performed in the stomach, exposing the submucosal or muscularis propria layers. A novel device, a transparent chamber cap (DASE), was developed to aspirate the gastric wall, allowing the sutures to reach deep layers. The aspiration was performed with a standard gastroscope to which the novel cap was distally attached. Three sutures aligned were defined as a plication. Each pig received two or three plications and was placed on a liquid diet for 14 days after the procedure. The pigs were sacrificed at 4 and 8 weeks and the sutures were reviewed. Results The technique was feasible in all animals. Of 16 plications, only one failed. One perforation occurred after EMR. There were no other complications or adverse events. Permanent fusion of the gastric wall was confirmed by histology in all cases. Conclusions This study showed that basic principles of surgery can be applied endoscopically to ensure a permanent suture with reduced chances of failure. These findings can help to pave the way for more effective bariatric endoscopic techniques.