Specialised Surgical Instruments for Endoscopic and Endoscope-Assisted Neurosurgery: A Systematic Review of Safety, Efficacy and Usability.

While there have been great strides in endoscopic and endoscope-assisted neurosurgical approaches, particularly in the treatment of deep-sited brain and skull base tumours, the greatest technical barrier to their adoption has been the availability of suitable surgical instruments. This systematic review seeks to identify specialised instruments for these approaches and evaluate their safety, efficacy and usability. Conducted in accordance with the PRISMA guidelines, Medline, Embase, CENTRAL, SCOPUS and Web of Science were searched. Original research studies that reported the use of specialised mechanical instruments that manipulate tissue in human patients, cadavers or surgical models were included. The results identified 50 specialised instruments over 62 studies. Objective measures of safety were reported in 32 out of 62 studies, and 20 reported objective measures of efficacy. Instruments were broadly safe and effective with one instrument malfunction noted. Measures of usability were reported in 15 studies, with seven reporting on ergonomics and eight on the instruments learning curve. Instruments with reports on usability were generally considered to be ergonomic, though learning curve was often considered a disadvantage. Comparisons to standard instruments were made in eight studies and were generally favourable. While there are many specialised instruments for endoscopic and endoscope-assisted neurosurgery available, the evidence for their safety, efficacy and usability is limited with non-standardised reporting and few comparative studies to standard instruments. Future innovation should be tailored to unmet clinical needs, and evaluation guided by structured development processes.

Robotic Handle Prototypes for Endoscopic Endonasal Skull Base Surgery: Pre-clinical Randomised Controlled Trial of Performance and Ergonomics.

Endoscopic endonasal skull base surgery is a promising alternative to transcranial approaches. However, standard instruments lack articulation, and thus, could benefit from robotic technologies. The aim of this study was to develop an ergonomic handle for a handheld robotic instrument intended to enhance this procedure. Two different prototypes were developed based on ergonomic guidelines within the literature. The first is a forearm-mounted handle that maps the surgeon's wrist degrees-of-freedom to that of the robotic end-effector; the second is a joystick-and-trigger handle with a rotating body that places the joystick to the position most comfortable for the surgeon. These handles were incorporated into a custom-designed surgical virtual simulator and were assessed for their performance and ergonomics when compared with a standard neurosurgical grasper. The virtual task was performed by nine novices with all three devices as part of a randomised crossover user-study. Their performance and ergonomics were evaluated both subjectively by themselves and objectively by a validated observational checklist. Both handles outperformed the standard instrument with the rotating joystick-body handle offering the most substantial improvement in terms of balance between performance and ergonomics. Thus, it is deemed the more suitable device to drive instrumentation for endoscopic endonasal skull base surgery.

An intuitive surgical handle design for robotic neurosurgery.

PURPOSE: The expanded endoscopic endonasal approach, a representative example of keyhole brain surgery, allows access to the pituitary gland and surrounding areas through the nasal and sphenoid cavities. Manipulating rigid instruments through these constrained spaces makes this approach technically challenging, and thus, a handheld robotic instrument could expand the surgeon's capabilities. In this study, we present an intuitive handle prototype for such a robotic instrument. METHODS: We have designed and fabricated a surgical instrument handle prototype that maps the surgeon's wrist directly to the robot joints. To alleviate the surgeon's wrist of any excessive strain and fatigue, the tool is mounted on the surgeon's forearm, making it parallel with the instrument's shaft. To evaluate the handle's performance and limitations, we constructed a surgical task simulator and compared our novel handle with a standard neurosurgical tool, with the tasks being performed by a consultant neurosurgeon. RESULTS: While using the proposed handle, the surgeon's average success rate was [Formula: see text], compared to [Formula: see text] when using a conventional tool. Additionally, the surgeon's body posture while using the suggested prototype was deemed acceptable by the Rapid Upper Limb Assessment ergonomic survey, while early results indicate the absence of a learning curve. CONCLUSIONS: Based on these preliminary results, the proposed handle prototype could offer an improvement over current neurosurgical tools and procedural ergonomics. By redirecting forces applied during the procedure to the forearm of the surgeon, and allowing for intuitive surgeon wrist to robot-joints movement mapping without compromising the robotic end effector's expanded workspace, we believe that this handle could prove a substantial step toward improved neurosurgical instrumentation.

Determination of heavy metals and halogens in plastics from electric and electronic waste.

The presence of hazardous substances and preparations in small waste electrical and electronic equipment (sWEEE) found in the residual household waste stream of the city of Dresden, Germany has been investigated. The content of sWEEE plastics in heavy metals and halogens is determined using handheld X-ray fluorescence analysis (HXRF), elemental analysis by means of atomic absorption spectrometry (AAS) and ion exchange chromatography (IEC). Mean value of results for heavy metals in samples (n=51) by AAS are 17.4 mg/kg for Pb, 5.7 mg/kg for Cd, 8.4 mg/kg for Cr. The mass fraction of an additive as shown by HXRF (n=161) can vary over a wide range. Precise deductions as regards sWEEE plastics content in hazardous substances and preparations cannot be made. Additional research would be expedient regarding the influence of hazardous substances to recycling processes, in particular regarding the contamination of clean fractions in the exit streams of a WEEE treatment plant. Suitable standards for calibrating HXRF for use on EEE plastics or complex electr(on)ic components do not exist and should be developed.

Small WEEE: determining recyclables and hazardous substances in plastics.

An examination regarding the determination of recyclables and hazardous substances in small waste electrical and electronic equipment (WEEE) found in the residual household waste stream of the city of Dresden, Germany, is described. Firstly, attitudes towards the disposal of small WEEE in the latter are assessed, and product types and categories which mostly contribute to its composition are identified. Physical parameters which could be used as mechanical sorting criteria are measured, and the material composition of the small WEEE found is determined. The hazardous substances' "base" charge in the residual waste is established by means of atomic absorption spectrometry and ionic chromatography, as a first step in estimating the contribution of small WEEE to its pollutant load. Consequently, the content of small WEEE plastics in key heavy metals and halogens is determined. Key conclusions are drawn concerning the future strategic development and practical implementation of the 2002/96/EC Directive, in relation to small WEEE management and recycling.

Solid-phase microextraction-capillary gas chromatography combined with microwave-induced plasma atomic-emission spectrometry for selenite determination.

The use of solid-phase microextraction (SPME) with gas chromatography coupled to microwave-induced plasma atomic-emission detection (GC-MIP-AED) is described for selenite [Se(IV)] speciation. Aqueous standards were derivatised with sodium tetraethyl- or tetrapropylborate and extracted by SPME. Headspace extraction of the ethyl and propyl derivatives was studied. Relevant experimental conditions were optimised, including conditions for derivatisation and extraction and those of gas chromatographic analysis. The limits of detection achieved for headspace sampling of derivatised Se(IV) were in the low ng mL(-1) range for both ethylation and propylation. When the method was applied to analysis of selenite in selenised yeast reference material results were in good agreement with the indicated values.