Low-Cost, Low-Fidelity, Self-Made Arthroscopic Surgical Simulators: A Systematic Review

Purpose: To systematically review the literature regarding low-cost, low-fidelity, self-made arthroscopic surgical simulators and provide an overview of their use in the teaching of arthroscopic surgical skills. Methods: Systematic review of the literature following PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. Results: A total of 10 studies met inclusion criteria. All studies utilized low-cost, low-fidelity, self-made arthroscopic simulators of varying designs. Five studies (50%) utilized low-cost, self-made arthroscopic cameras and three (30%) utilized commercial surgical arthroscopic cameras. One study (10%) demonstrated face validity, five (50%) demonstrated construct validity, and three (30%) demonstrated transfer validity. The assessed arthroscopic tasks varied, but generally consisted of a combination of triangulation, object grasping, and tissue manipulation. Seven (70%) studies evaluated total simulator construction costs, with six (60%) studies achieving total construction costs of < $80 US Dollars. Conclusions: A growing body of literature supports the use of low-cost, low-fidelity, self-made arthroscopic surgical simulators. The cost-effectiveness and practicality of these simulators remains a major benefit to their overall utility when compared to their commercially available and high-fidelity counterparts. Furthermore, studies utilizing low-fidelity arthroscopic simulators are beginning to place a large importance on the achievement of face, construct, and transfer validity. Evidence suggests that the true utility of low-cost, low-fidelity arthroscopic surgical simulators stem not from their ability to replicate operating room conditions, but rather from their ability to provide practical training in basic and essential arthroscopic skills that will then be further refined through possible additional simulation and future surgical training.

Imaging-Guided Bioreactor for De-Epithelialization and Long-Term Cultivation of Ex Vivo Rat Trachea

Recent synergistic advances in organ-on-chip and tissue engineering technologies offer opportunities to create in vitro-grown tissue or organ constructs that can faithfully recapitulate their in vivo counterparts. Such in vitro tissue or organ constructs can be utilized in multiple applications, including rapid drug screening, high-fidelity disease modeling, and precision medicine. Here, we report an imaging-guided bioreactor that allows in situ monitoring of the lumen of ex vivo airway tissues during controlled in vitro tissue manipulation and cultivation of isolated rat trachea. Using this platform, we demonstrated selective removal of the rat tracheal epithelium (i.e., de-epithelialization) without disrupting the underlying subepithelial cells and extracellular matrix. Through different tissue evaluation assays, such as immunofluorescent staining, DNA/protein quantification, and electron beam microscopy, we showed that the epithelium of the tracheal lumen can be effectively removed with negligible disruption in the underlying tissue layers, such as cartilage and blood vessel. Notably, using a custom-built micro-optical imaging device integrated with the bioreactor, the trachea lumen was visualized at the cellular level in real time, and removal of the endogenous epithelium and distribution of locally delivered exogenous cells were demonstrated in situ. Moreover, the de-epithelialized trachea supported on the bioreactor allowed attachment and growth of exogenous cells seeded topically on its denuded tissue surface. Collectively, the results suggest that our imaging-enabled rat trachea bioreactor and selective cell replacement method can facilitate creating of bioengineered in vitro airway tissue that can be used in different biomedical applications.

A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery

Background The THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy. Methods Prospective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days. Results 60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups. Conclusions Both energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation. ClinicalTrial.gov # NCT02628093.

FACIAL WOUND ASSESSMENT KIT

Facial wounds are a frequent reason for emergency room visits. The goals of laceration repair are to achieve hemostasis, avoid infection, restore function to the involved tissues, and achieve optimal cosmetic results with minimal scarring. Therefore, these cases are most appropriately managed by plastic surgeons who have a thorough knowledge of anatomy, aesthetic sense, and meticulous expertise in atraumatic tissue manipulation, combined with the surgical skill to repair any structure. You need to know what to do and what not to do : whether to suture or leave open. What local anesthesia to use and how. What equipment to use (and have it available beforehand). Whether to give antibiotic therapy and what kind. How to avoid aesthetic or functional after-effects. Which dressing to use depending on the state of the wound. This article will serve as an aid to wound management and review repair techniques for high-risk areas of the face.

Comparison between the Immediate Effects of Instrument Assisted Soft Tissue Mobilization and Active Release Technique in Individuals Wearing High Heels

Background: Wearing high heels regularly places muscle-tendon units (MTUs) in a shortened position. In this condition the length of the calf MTU (gastrocnemius-soleus) is reduced by the continuous ankle plantar flexion cause by the heel lift imposed by the high heels, which leads to concomitant inflexibility of these muscles. Tightness of these muscles inturns leads to formation of trigger points within the muscles. Instrument-assisted soft tissue mobilization (IASTM) is an approach to soft tissue manipulation that uses concave and convex stainless steel instruments to release scar tissue, break soft tissue adhesions, and remove fascial restrictions. Active Release Techniques, or ART, is a soft tissue treatment method that focuses on relieving tissue tension via the removal of fibrosis/adhesion that develops in tissue that is overloaded with repetitive use. Objective: To compare the immediate effect of Instrument Assisted Soft Tissue Mobilization and Active Release Technique for gastrosoleus muscle in individuals wearing high heels using VAS and active dorsiflexion using universal goniometer. Method: 30 subjects were selected as per inclusion and exclusion criteria and were randomly allocated into two groups of 15 each. Group A received Instrument Assisted soft tissue mobilization and Group B received Active Release Technique for Gastro-soleus muscle. Pre and Post intervention Dorsiflexion range of motion and VAS scores were analysed. Result: The statistical analyses showed that there is signification increase in dorsiflexion range of motion and significant reduction in pain in both the groups. (p<0.0001). However, inter group analysis showed that Group A is much more effective in improving the range of motion and reducing pain scores. Conclusion: The present study concluded that Instrument Assisted Soft Tissue Mobilization is a better intervention for the release of trigger points as it shows greater increase in ankle dorsiflexion range of motion and a significant pain reduction when compared to Active Release Technique. Key words: Instrument Assisted Soft Tissue Mobilization(IASTM), Active Release Technique(ART), Range of Motion, pain, High Heels, Calf Muscles.

Manual scar therapy on the example of a caesarean section scar

Surgical procedures (including cesarean section) or accidental cuts, may leave marks on the skin in the form of scars and accompanying ailments. There are many methods of scar treatment, including physiotherapeutic techniques. The aim of the study was to present the issues of manual work with a scar on the example of a scar after a caesarean section. Soft tissue manipulation techniques allow physiotherapists to be effective in removing the negative effects of poor wound healing, including restoring the aesthetics of visible tissues.

A call for research on soft tissue manipulation (STM) as a bone anabolic therapy

Individuals with osteoporosis, i.e., low bone mass, are at enhanced risk for fracture, disability, and death. Hospitalizations for osteoporotic fractures exceed those for heart attack, stroke, and breast cancer. Osteoporosis rates are predicted to increase due to an aging global population yet there are limited pharmacological treatment options for osteoporosis, particularly for long-term management of this chronic condition. Moreover, the drug development pipeline is relatively bereft of new strategies and drug candidates, creating an urgent need for developing new therapeutic strategies for treating osteoporosis. In this mini-review, we speculate about the potential for non-invasive soft tissue manipulation (STM) to exert anabolic effects on the skeleton that may provide therapeutic benefit for individuals with low bone mass. Our rationale is premised on work by us and others showing that STM leads to decreased levels of chemokines and pro-inflammatory cytokines (such as Interleukin (IL)-3, IL-6, and IL-8) known to restrict the differentiation and/or activity of bone-forming osteoblasts. However, there are no published studies examining whether STM impacts bone mass, potentially limiting the widespread use of this non-invasive and non-pharmacological intervention in the worldwide treatment of patients with osteoporosis, individuals with low bone mass due to being bed-ridden or otherwise mobility-limited, and persons subjected to spaceflight-related bone loss.

Efficacy of Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so as to reduce the dependence on drugs for alleviating the symptoms. The aim was to find out the effectiveness of some physiotherapy techniques in the treatment of PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were “dysmenorrhea”, “physical the-rapy”, “physiotherapy”, and “manual therapy”. The search was performed in five databases: Scopus, PubMed, PEDro, Web of Science, and Medline, in February 2021. The inclusion criteria were randomized controlled trials over the last six years. Articles not related to the treatment of PD or using pharmacology as the main treatment were excluded. Nine articles met the objectives and criteria, with a total of 692 participants. The most used scale to measure pain was the VAS (visual analogue scale). The main techniques were isometric exercises, massage therapy, yoga, electrotherapy, connective tissue manipulation, stretching, kinesio tape, progressive relaxation exercises and aerobic dance. Meta-analysis shows benefits of physiotherapy treatment for pain relief compared with no intervention or placebo (MD: −1.13, 95% CI: −1.61 to −0.64, I2: 88%). The current low-quality evidence suggests that physiotherapy may provide a clinically significant reduction in menstrual pain intensity. Given the overall health benefits of physiotherapy and the low risk of side effects reported, women may consider using it, either alone or in conjunction with other therapeutic modalities.

A Technique for Mimicking Soft Tissue Manipulation from Experimental Data to a Wave Equation Model for a New Laparoscopic Virtual Reality Training System

Background: The difficulty of laparoscopic procedures and the specific psychomotor skills required support the need for a training system for intensive and repetitive practice to acquire the specific skills. The present VR training systems have some limitations with respect to the soft tissue models in the training system. This is associated with the need for a real-time simulation, which requires a balance between computational cost and accuracy. Objective: The primary objective of the study is to develop a two dimensional wave equation model that closely mimics the soft tissue manipulation in a laparoscopic procedure for a VR training system. Methods: A novel mathematical model based on the wave equation is prepared to represent the interaction between the laparoscopic tool and the soft tissue. The parameters within the model are determined through experimental analysis of a soft tissue phantom. The experimental setup involves a linear actuator applying force to the soft tissue phantom to generate deformation. Data acquisition is conducted through a camera and a robotic force acquisition system which measures force, displacement of the linear actuator and records a video. Through image processing, the displacements of the markers on the phantom’s x-y plane during its deformation are determined and these parameters are used to develop the model, which finally is validated through a comparative analysis. Results: The results from the developed model are observed and compared statistically as well as graphically with the finite element model based on deformation data. The results show that the deformation data between the developed model and the available model is significantly similar. Conclusion: This study demonstrates the adaptability of the wave equation to meet the needs of the specific surgical procedure through modification of the model based on the experimental data. Moreover, the comparative analysis further corroborates the relevance and validity of the model for the surgical training system.