Remote-controlled cholangiography injection device: first clinical study in China

Background X-ray cholangiography is of great value in the imaging of biliary tract diseases; however, occupational radiation exposure is unavoidable. Moreover, clinicians must manually inject the contrast dye, which may result in a relatively high incidence of adverse reactions due to unstable injection pressure. Thus, there is a need to develop a novel remote-controlled cholangiography injection device. Methods Patients with external biliary drainage requiring cholangiography were included. A remote-controlled injection device was developed with three major components: an injection pump, a pressure sensor, and a wireless remote-control panel. Image quality, adverse reactions, and radiation dose were evaluated. Results Different kinds of X-ray cholangiography were successfully and smoothly performed using this remote-controlled injection device in all patients. The incidence of adverse reactions in the device group was significantly lower than that in the manual group (4.17% vs. 13.9%, P = 0.001), and increasing the injection pressure increased the incidence of adverse reactions. In addition, the device helped operators avoid ionizing radiation completely. Conclusions With good control of injection pressure (within 10 kPa), the remote-controlled cholangiography injection device could replace the need for the doctor to inject contrast agent with good security and effectivity. It is expected to be submitted for clinical application.

Restoration and Design of Ice Sculpture Structure following Multivision Sensor and Three-Dimensional Reconstruction Technology

The purpose of the study is to improve the structure restoration and design of ice sculptures. This study discusses the concept and artistic expression of ice sculpting based on the relevant theoretical knowledge of visual sensing technology and three-dimensional reconstruction technology. Based on this, the ice sculpture structure restoration and design model based on multivision sensors and three-dimensional reconstruction technology is constructed, and the model is compared with the manual test. The results show that the ice sculpture structure restoration and design model based on a multivision sensor and three-dimensional reconstruction technology is feasible and has high efficiency and stability compared with artificial ice sculpture restoration. In the experiment of structure reconstruction and restoration of an ice sculpture, the manual group 1 spends 237 minutes, the manual group 2 spends 252 minutes, and the time spent by the model group is very stable, which is about 139 minutes. Due to the difference in manual group personnel, their carving time is also different. As the carving continues, the possibility of errors made by the two manual groups increases. Therefore, ice sculpture structure restoration and design based on multivision sensors and three-dimensional reconstruction technology will provide a reference for the study in the field of ice sculpture structure restoration and design.

Lengths of Stay and Discharge Dispositions after Total Knee Arthroplasty: A Comparison of Robotic-Assisted and Manual Techniques

As evidence signifies that short-stay total knee arthroplasties (TKA) can be safe options, it is important to identify factors that contribute to early discharge. There is evidence that robotic-assisted TKAs may lead to shorter lengths of postoperative stays. However, this has not been evaluated as the primary outcome of interest in a large-scale population. The purpose of this study was to compare manual and robotic-assisted TKAs with regard to: (1) length of stay (LOS) and (2) discharge dispositions. TKAs performed between January 1, 2018, to March 31, 2019, were identified. After applying inclusion and exclusion criteria, a total of 10,296 patients were included: 5,993 in the manual and 4,303 in the robotic-assisted group. Length of stay, discharge dispositions, and Charlson comorbidity indices (CCIs) were recorded for all patients. The mean LOS was significantly lower in robotic-assisted (1.68 ± 0.86 days) compared with manual (1.86 ± 0.94 days) TKA procedures (p < 0.00001). In the robotic-assisted group, 2,049 (47.6%) were discharged in 1 day or less compared with 2,325 (38.8%) in the manual group (p < 0.0001). The proportion discharged home was significantly higher for patients who underwent robotic-assisted (91.3%) compared with manual (87.4%) TKAs (p < 0.00001). When comparing only patients who were discharged home and who did not have home health services, the rate was 51.8% in the robotic-assisted group compared with 44.0% in the manual group (p < 0.00001). The mean CCI was similar for patients who underwent robotic-assisted (2.9 ± 1.4 points) compared with manual (3.0 ± 1.5 points) TKAs. There was a trend toward shorter mean LOS for robotic-assisted versus manual TKA at 17 of the 24 included hospital sites (70.8%). Compared with manual, robotic-assisted TKAs demonstrated shorter lengths of postoperative stays and less need for skilled care after discharge. These results suggest the health care burden resulting from an upsurge of TKA procedures in our aging population might be addressed in part by increased utilization of robotic assistance.

Combined Corneal Cross-Linking and Myoring Implantation in Advanced Keratoconus: Femtosecond Laser versus Manual Dissection

Background. Intrastromal corneal ring segments are widely adopted for keratoconus management. However, the complete ring (Myoring) was proposed to be superior in advanced cases. Myoring can be implanted either via femtoassisted or manual dissection techniques. A comparison between both techniques can delineate any differences in the outcomes. Methods. This was a prospective interventional case series study. Sixty-four eyes with progressive advanced keratoconus were enrolled: 36 and 28 had femtoassisted or manual Myoring, respectively. Uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), maximal keratometry (Kmax), spherical equivalent (SE) and corneal thinnest location were measured in all eyes preoperatively and at one, six, and 12 months postoperatively. Epi-off corneal cross-linking (CXL) was performed eight weeks after Myoring implantation for all cases. Results. Femtoassisted Myoring dissection significantly improved UCVA and CDVA from 0.1 ± 0.06 and 0.18 ± 0.1 preoperatively to 0.29 ± 0.08 and 0.43 ± 0.1 at 12 months. Also, manual technique similarly enhanced UCVA and CDVA from 0.11 ± 0.05 and 0.2 ± 0.1 preoperatively to 0.27 ± 0.2 and 0.4 ± 0.2 at 12 months. In terms of safety, while no cases of ring extrusion were encountered with the femtoassisted technique, six (21.4%) cases of extrusion were encountered in the manual group. Conclusion. Femtoassisted or manual Myoring technique followed by CXL is an effective choice for advanced progressive keratoconus. Although it did not reach a statistical significance, the high extrusion rate with manual dissection is a red flag to be considered.

Accuracy of half-guided implant placement with machine-driven or manual insertion: a prospective, randomized clinical study

Objectives To compare the accuracy of implant placement performed with either a surgical motor or a torque wrench as part of a half-guided surgical protocol. Materials and methods Implant insertion with half-guided surgical protocol was utilized by surgical motor (machine-driven group) or torque wrench (manual group) in the posterior maxilla. After the healing period, accuracy comparison between planned and actual implant positions was performed based on preoperative cone beam computed tomography and postoperative digital intraoral scans. Coronal, apical, and angular deviations, insertion time, and insertion torque were evaluated. Results Forty patients were treated with 1 implant each; 20 implants were inserted with a surgical motor and 20 implants with a torque wrench. Global coronal and apical deviations were 1.20 ± 0.46 mm and 1.45 ± 0.79 mm in the machine-driven group, and 1.13 ± 0.38 mm and 1.18 ± 0.28 mm in the manual group (respectively). The mean angular deviation was 4.82 ± 2.07° in the machine-driven group and 4.11 ± 1.63° in the manual group. Mean insertion torque was 21.75 ± 9.75 Ncm in the machine-driven group, compared to 18.75 ± 7.05 Ncm in the manual group. Implant placement duration was 9.25 ± 1.86 s in the machine-driven group at a speed of 50 rpm, and 36.40 ± 8.15 s in the manual group. Conclusion No significant difference was found between the two groups in terms of accuracy and mean insertion torque, while machine-driven implant placement was significantly less time-consuming. Clinical relevance Optimal implant placement accuracy utilized by half-guided surgical protocol can be achieved with both machine-driven and torque wrench insertion. Trial registration ID: NCT04854239

Abstract 12985: Efficacy and Safety of Mechanical versus Manual Compression in Cardiac Arrest and Cardiogenic Shock Patients

Introduction: Mechanical chest compression (MCC) provides consistent pressure and timing of each chest compression in line with latest evidenced-based practice. However, there has been no evidence from large randomized trials about the effectiveness of the mechanical device compared with manual chest compression. Furthermore, few studies focused on cardiogenic shock and cardiac arrest related to heart disease. Hypothesis: The aim is to assess the effectiveness and safety of mechanical chest compressions versus manual chest compressions in patients with out of hospital cardiogenic shock and cardiac arrest due to heart disease. Methods: We conducted a retrospective observational study of comparing the outcomes of mechanical and manual chest compressions. A total of 69 consecutive patients with out of hospital cardiogenic shock and cardiac arrest were enrolled between April 2014 and May 2018. 39 patients of them received only manual cardiopulmonary resuscitation (CPR) and 30 utilized a mechanical CPR device. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual (manual group) and mechanical compressions (MCC group). Results: There was no significant difference in age, gender, the rate of bystander CPR and arterial blood gases at baseline. No differences were found for the rate of ROSC and 30-day survival between two groups. However, MCC group had significantly higher rate of bleeding events than manual group. In addition, fifty-four patients of them were treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among patients underwent VA-ECMO, the rate of 30-day survival was significantly lower in MCC group. (Figure 1). Conclusions: This study showed that mechanical chest compression increased bleeding events than manual chest compression. Furthermore, in the patients underwent ECMO, the use of mechanical chest compression might be associated with higher mortality.

Evaluation of Cognitive Skill Degradation in Flight Planning

This work aimed to identify cognitive skills associated with flight planning, suggest which skills might be susceptible to skill degradation, and investigate the effects of cognitive skill degradation over time. Information automation systems offload cognitive tasks to reduce workload and error. However, the same phenomena seen with physical skill degradation in highly automated aircrafts may also occur when automating cognitive tasks. Two studies were conducted. An applied cognitive task analysis identified cognitive skills in flight planning. An empirical evaluation examined whether some of those skills were susceptible to cognitive skill degradation over time when using automation. Participants were placed into three groups. After conducting a flight planning task manually, groups differed in the next three practice trials: manual, alternating between manual and automation, or only with automation. Finally, all groups conducted the task manually again. Trials were separated by 2 weeks. The automation group showed the most performance degradation and highest workload, while the manual group showed the least performance degradation and least workload. Automation use did not provide the practice needed to mitigate cognitive skill degradation. Analysis of the impacts of information automation on cognitive performance is a first step in understanding the root causes of errors and developing mitigations.

Comparable surgery time for robotic assisted total knee arthroplasty after initial learning curve

Aims and Objectives: In the past years, further development in knee replacement still continues. Computer-assisted surgery techniques in total knee arthroplasty (TKA) are on the rise. One point of criticism is the prolonged time of surgery and associated cost as known from old techniques like navigation. The primary objective of this study was to determine the learning curve for the time of surgery and accuracy in implant positioning for an imageless robotic system for TKA. Materials and Methods: In this prospective study, the first 30 robotic-assisted TKA from a single senior surgeon were analyzed with regard to time of surgery and accuracy of implant position on the basis of the intraoperative plan and the postoperative x-rays. This data was compared to the last 30 manual TKAs of the same surgeon with the same prosthesis. Evaluation of the learning curve was performed with CUSUM analysis. The time of surgery after finishing the learning curve in the robotic group was compared to the manual group. Results: The learning curve in the robotic group for surgery time was finished after 11 cases. The robotic experience did not affect the accuracy of implant positioning, such as limb alignment and restoration of the joint line. The mean absolute deviation of the postoperative limb alignment to the intraoperative plan was 2° (+/- 1,1). The mean absolute deviation of the medial proximal tibial (mPTA) and distal lateral femoral angle (dLFA) was 1° (+/- 0,9) for both. The mean surgery time in the robotic group after finishing the learning curve was 66 minutes (+/- 4,2) and in the total manual group 67 minutes (+/- 3,5) (n.s.). Conclusion: After finishing the initial learning curve of 11 cases for robotic-assisted TKA the time of surgery is equal to the manual conventional technique. However, there is no learning curve for implant positioning with the imageless robotic system. The implementation of the intraoperative plan is accurate to 1° with the robotic system.

Impact of Surgeon Handedness in Manual and Robot-assisted Total Hip Arthroplasty

Background: The purpose of this study was to examine whether surgeon handedness could affect cup positioning in manual total hip arthroplasty (THA), and whether robot could diminish or eliminate the impact of surgeon handedness on cup positioning in robot-assisted THA.Methods: Fifty-three patients who underwent bilateral robot-assisted THA and sixty-two patients who underwent bilateral manual THA between August 2018 and July 2019 in our institute were respectively analyzed in this study. When the difference between the bilateral anteversion or inclination was greater than 5°, the patient was regarded as having different cup positioning between bilateral THA. Their demographics, orientation of acetabular cup and postoperative 3 month Harris hip score (HHS) were recorded for analysis. Results: There were no significant difference in the gender, age, BMI, diagnosis’s composition, preoperative and postoperative HHS between the robotic and manual group. Two left hips dislocated in the manual group. The anteversion of left hip was significantly larger than that of right hip (24.77±10.44 vs 22.44±8.67, p=0.043) in the manual group. There were no significant difference of cup positioning between bilateral robot-assisted THA. The patients in manual group were significantly more likely to have different cup positioning between bilateral hips than those in robotic group (77% vs 45%, p=0.000). More manual THA were located out of the target zone than robot-assisted THA (70% vs 48%, p=0.001). Conclusions: Surgeon’s handedness showed a trend towards an impact on cup positioning in manual THA and robot might help surgeon eliminate the adverse impact. However, the impact of handedness on the clinical outcomes still needs further observation.