Instrumental in Surgery: A Narrative Review on Energy-based Surgical Cutting Devices and Surgical Smoke.

OBJECTIVE: To provide an informed understanding of existing energy-based surgical cutting technologies and aerosol-generating surgical procedures. We provide a perspective on the future innovation and research potential in this space for the benefit of surgeons, physicians, engineers, and researchers alike. BACKGROUND: Surgery is a treatment for many medical conditions, the success of which depends on surgical cutting instruments that enable surgeons to conduct surgical procedures for tissue cutting and manipulation. Energy-based surgical cutting tools improve accuracy and limit unnecessary destruction of healthy tissues and cells, but can generate surgical smoke and aerosols, which can be handled using surgical smoke evacuation technology. METHODS: A narrative review was conducted to explore existing literature describing the history and development of energy-based surgical instruments, their mechanisms of action, aerosol-generating medical procedures, surgical smoke and aerosols from aerosol-generating medical procedures, and the recommended mitigation strategies, as well as research on rapid biological tissue analyzing devices to date. CONCLUSIONS: Smoke evacuation technology may provide diagnostic information regarding tissue pathology, which could eliminate health concerns and revolutionize surgical accuracy. However, further research into surgical smoke is required to quantify the measurable risk to health it poses, the cutting conditions, under which it is generated and to develop advanced diagnostic approaches using this information.

Comparison of Surgical Smoke Generated During Electrosurgery with Aerosolized Particulates from Ultrasonic and High-Speed Cutting.

"Surgical smoke" is an airborne by-product of electrosurgery comprised of vapour and suspended particles. Although concerns exist that exposure may be harmful, there is a poor understanding of the smoke in terms of particle size, morphology, composition and biological viability. Notably, it is not known how the biological tissue source and cutting method influence the smoke. The objective of this study was to develop a collection method for airborne by-product from surgical cutting. This would enable comprehensive analyses of the particulate burden, composition and biological viability. The method was applied to compare the electrosurgical smoke generated (in the absence of any evacuation mechanism) with the aerosolized/airborne by-products generated by ultrasonic and high-speed cutting, from bone and liver tissue cutting. We report a wide range of particle sizes (0.93-806.31 µm for bone, 0.05-1040.43 µm for liver) with 50% of the particles being <2.72 µm (~PM2.5) and 90% being <10 µm (PM10). EDX and biochemical analysis reveal components of biological cells and cellular metabolic activity in particulate from liver tissue cut by electrosurgery and ultrasonic cutting. We show for the first time however that bone saws and ultrasonic cutting do not liberate viable cells from bone.

Circumferential tissue compression at the lower limb during walking, and its effect on discomfort, pain and tissue oxygenation: Application to soft exoskeleton design.

Soft exoskeletons apply compressive forces at the limbs via connection cuffs to actuate movement or stabilise joints. To avoid excessive mechanical loading, the interface with the wearer's body needs to be carefully designed. The purpose of this study was to establish the magnitude of circumferential compression at the lower limb during walking that causes discomfort/pain. It was hypothesized that the thresholds differ from those during standing. A cohort of 21 healthy participants were tested using two sizes of pneumatic cuffs, inflated at the thigh and calf in a tonic or phasic manner. The results showed lower inflation pressures triggering discomfort/pain at the thigh, with tonic compression, and wider pneumatic cuffs. The thresholds were lower during walking than standing still. Deep tissue oxygenation increased during phasic compression and decreased during tonic compression. According to the findings, circumferential compression by soft exoskeletons is preferably applied at anatomical sites with smaller volumes of soft tissue, using narrow connection cuffs and inflation pressures below 14 kPa.

The need for a standard approach to assessing the functionality of rural community water supplies.

The Sustainable Development Goals have set an agenda for transformational change in water access, aiming for secure household connections globally. Despite this goal, communal groundwater supplies are likely to remain the main source of improved water supplies for many rural areas in Africa and South Asia for decades to come. Understanding the poor functionality of existing communal supplies remains, therefore, a priority. A critical first step is to establish a sector-wide definition of borehole supply functionality and a standard method of its assessment.

Les objectifs du développement durable ont mis en place un programme de changement transformationnel de l'accès à l'eau, visant à assurer des connexions sûres des ménages à l'échelle mondiale. Malgré cet objectif, les approvisionnements en eaux souterraines à l'échelle communale sont susceptibles de demeurer le sujet principal à améliorer pour de nombreuses régions rurales d'Afrique et d'Asie du Sud pour les décennies à venir. La compréhension de la piètre fonctionnalité des approvisionnements existants à l'échelle communale reste donc une priorité. Une première étape cruciale consiste à établir une définition sectorielle de la fonctionnalité de l'approvisionnement par forage et une méthode normalisée de son évaluation.

Los objetivos de desarrollo sostenible han establecido una agenda para un cambio transformacional en el acceso al agua, con la finalidad de establecer conexiones domiciliarias seguras a nivel mundial. A pesar de este objetivo, es probable que los suministros comunales de agua subterránea sigan siendo la principal fuente de mejoras en el abastecimiento de agua para muchas áreas rurales en África y el sur de Asia en las próximas décadas. Entender la funcionalidad deficiente de los suministros comunales existentes sigue siendo, por lo tanto, una prioridad. Un primer paso crítico es establecer una definición sectorial de la funcionalidad del suministro de los pozos y un método estándar para su evaluación.

Os Objetivos de Desenvolvimento Sustentável estabeleceram uma agenda para mudanças de paradigmas no acesso à água, visando abastecimento doméstico em escala global. Apesar desse objetivo, os suprimentos comunitários de águas subterrâneas provavelmente continuarão a ser a principal fonte de abastecimento de água potável para muitas áreas rurais da África e do sul da Ásia por décadas. Compreender a baixa funcionalidade desses atuais suprimentos comunitários torna-se, portanto, prioritária. Um primeiro passo crítico é estabelecer uma definição setorial de funcionalidade de fornecimento de poços e um método padrão de avaliação.

An Objective Measure of Noseband Tightness and Its Measurement Using a Novel Digital Tightness Gauge.

Noseband tightness is difficult to assess in horses participating in equestrian sports such as dressage, show jumping and three-day-eventing. There is growing concern that nosebands are commonly tightened to such an extent as to restrict normal equine behaviour and possibly cause injury. In the absence of a clear agreed definition of noseband tightness, a simple model of the equine nose-noseband interface environment was developed in order to guide further studies in this area. The normal force component of the noseband tensile force was identified as the key contributor to sub-noseband tissue compression. The model was used to inform the design of a digital tightness gauge which could reliably measure the normal force component of the noseband tensile force. A digital tightness gauge was developed to measure this parameter under nosebands fitted to bridled horses. Results are presented for field tests using two prototype designs. Prototype version three was used in field trial 1 (n = 15, frontal nasal plane sub-noseband site). Results of this trial were used to develop an ergonomically designed prototype, version 4, which was tested in a second field trial (n = 12, frontal nasal plane and lateral sub-noseband site). Nosebands were set to three tightness settings in each trial as judged by a single rater using an International Society for Equitation Science (ISES) taper gauge. Normal forces in the range 7-95 N were recorded at the frontal nasal plane while a lower range 1-28 N was found at the lateral site for the taper gauge range used in the trials. The digital tightness gauge was found to be simple to use, reliable, and safe and its use did not agitate the animals in any discernable way. A simple six point tightness scale is suggested to aid regulation implementation and the control of noseband tightness using normal force measurement as the objective tightness discriminant.

Noseband Use in Equestrian Sports - An International Study.

Nosebands are used by riders to prevent the horse from opening its mouth, to increase control and, in some cases, to comply with the competition rules. While equestrian texts traditionally recommend that two adult human fingers should be able to fit under a fastened noseband, noseband tightness levels are not, in general, regulated in competition. Possible detrimental consequences for the horse, of excessively tight nosebands, include discomfort, pain or tissue damage. The current study investigated noseband usage in equestrian competition. Data regarding noseband type, position, width and tightness were collected from 750 horses in eventing (n = 354), dressage (n = 334) and performance hunter (n = 62) competitions in Ireland, England and Belgium. Data were collected immediately before or after the performance. Using the ISES taper gauge as a guide, results were classified according to the number of 'fingers' that could fit under the noseband at the nasal planum, and assigned to six groups: greater than 2 fingers; 2 fingers; 1.5 fingers; 1 finger; 0.5 fingers; zero fingers. A calliper was used to measure noseband width and position relative to the facial crest. The data were not normally distributed so Kruskall-Wallis and Mann-Whitney tests were used. In all, 44% of horses fell into the zero fingers classification while only 7% were in the two fingers classification. Significant differences emerged between disciplines (p<0.001), with the highest levels of noseband tightness measured among eventers followed by dressage horses with lowest levels among performance hunters. Noseband tightness did not differ significantly with horse age (p>0.05), which ranged from 4 to 19 years. The flash noseband was the most commonly used noseband (n = 326) and was significantly tighter than the cavesson (p < 0.001), drop noseband (p < 0.001) and the Micklem (p < 0.005). Noseband width ranged from 10 to 50 mm. Noseband position varied widely with the distance between the facial crest and upper noseband margin ranging from 0 to 70 mm. The high proportion of very tight nosebands found in this study raises concerns regarding the short and long term behavioural and physiological consequences of such tight nosebands are for the horse. Although these data are currently lacking, the findings are of concern.

A Study of Healthy Adults' Oro-lingual Effort During Swallowing Using OroPress, A New Portable Wireless Measurement Tool.

OroPress is a new, low profile, portable, wireless tool that enables stable measurement of tongue pressure during isometric ('pushing') tasks and, more importantly, during swallowing. Using this tool, a pressure-time product, the OroPress Absolute (OPA) parameter, has been developed as a representative measure of lingual effort during swallowing. In a sample of 57 adults aged 20-80+ years, of both sexes and without dysphagia, tongue-palate contact pressures generated while swallowing 5 ml, 10 ml of water and 5 ml custard, were recorded using OroPress. Data were examined for effects of gender, age and bolus condition (consistency, volume). OPA was tested for stability of measure and then correlated with the criterion standard, peak pressure recorded when swallowing (PMax(SW)). Swallowing pressures (PMax(SW), OPA) were positively correlated with bolus viscosity. No significant age and gender differences were found. Excellent stability of measure (test, re-test reliability) was demonstrated and OPA was positively correlated with PMax(SW). OroPress produces valid, reliable and reproducible measurements and improved accuracy of oro-lingual pressure measurement during swallowing. With such a tool, interventions/therapy can be proactive and principled as outcomes are better validated. To enhance specificity of intervention, measurement parameters need to reflect the pressure and temporal qualities of swallow function. OPA has the potential to describe differences in effort made, and ability to sustain pressures, in adults without dysphagia. The results of these studies will enable more accurate examination of the oral phase of swallowing as we establish this highly accurate sensor as a criterion standard for oro-lingual pressure measurement in clinical populations.

OroPress a new wireless tool for measuring oro-lingual pressures: a pilot study in healthy adults.

BACKGROUND: Commercially available tools for measuring oro-lingual pressures during swallowing or isometric (tongue 'pushing') tasks have either poor, or unknown, psychometric properties (stability, reliability) which means their validity in a clinical setting is unknown. A new wireless tool, OroPress, has been designed to address the shortcomings of existing devices. In this pilot cohort study of normal adults (i.e., people without dysphagia), the face validity of OroPress was examined when it was used to measure oro-lingual pressures during (i) isometric tongue strength (ITS) tasks and (ii) isometric tongue endurance (ITE) tasks. The effects of gender on isometric oro-lingual data, captured using OroPress, were compared to published oro-lingual pressure data recorded using either the Kay Swallowing Workstation or the Iowa Oral Performance Instrument (aka commercial tools). METHODS: Thirty five adults (17 males, 18 females), were purposefully recruited at the University of Limerick (UL), Ireland. They attended one session at the university-based clinic where their oro-lingual pressures were recorded while undertaking two isometric tasks by speech and language therapy student clinicians. OroPress was used to capture tongue strength and tongue endurance pressures during two trials of each condition and data were downloaded and analysed post-hoc. An independent-samples t-test and an ANOVA were used to examine the effect of gender on ITS pressures (as data were normally distributed) and an independent-samples t-test was used for the effect of gender on ITE pressures (where data were not normally distributed). RESULTS: OroPress is a portable tool that was reported as being 'easy to use' by student SLT clinicians. The intra-oral sensor was reportedly comfortable and 'felt non-invasive' for participants. Data from 34 participants (16 males, 18 females) are reported. Males did not demonstrate significantly higher mean ITS pressures than females (P = 0.057), although this approached significance, and there was no gender effect for ITE oro-lingual pressure. These results were consistent with published data from studies where other tools have been used to measure ITS pressures. CONCLUSIONS: Preliminary face validity of OroPress as a tool for recording isometric oro-lingual pressures was supported. This new wireless tool shows promise for being a criterion standard for recording oro-lingual pressures during isometric tasks.