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1.
Anaesthesiol Intensive Ther ; 52(5): 366-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33327694

RESUMO

INTRODUCTION: COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from mechanical ventilation. Worldwide differences exist in terms of methods, operators, and settings, and questions remain regarding timing and indications. If tracheostomy is to be performed in COVID-19 patients, a safe environment is needed for optimal care. MATERIAL AND METHODS: We present a guidewire dilating forceps tracheostomy procedure in COVID-19 patients that was optimised including apnoea-moments, protective clothing, checklists, and clear protocols. We performed a retrospective analysis of the outcome after tracheostomy in COVID-19 patients between March 2020 and May 2020. RESULTS: The follow-up of the first 16 patients, median age 62 years, revealed a median intubation time until tracheostomy of 18 days and median cannulation time of 20 days. The overall perioperative complication rate and complication rate while cannulated was 19%, mainly superficial bleeding. None of the healthcare providers involved in performing the procedure developed any symptoms of the disease. CONCLUSIONS: This COVID-19-centred strategy based on flexibility, preparation, and cooperation between healthcare providers with different backgrounds facilitated percutaneous tracheostomy in COVID-19 patients without an increase in the overall complication rate or evidence of risk to healthcare providers. Our findings provide initial evidence that tracheostomy can be performed safely as a standard of care for COVID-19 patients requiring prolonged mechanical ventilation as was standard practice in ICU patients prior to the COVID-19 pandemic to promote ventilator weaning and patient recovery.


Assuntos
/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Traqueostomia/métodos , Idoso , Anestesia , Broncoscopia , Lista de Checagem , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Equipamento de Proteção Individual , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/terapia , Respiração Artificial , Estudos Retrospectivos , Instrumentos Cirúrgicos , Traqueostomia/instrumentação , Desmame do Respirador
2.
Am J Otolaryngol ; 41(6): 102664, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911391

RESUMO

PURPOSE: Abscess is still a formidable disease and requires adequate drainage. Moreover, drainage in the head and neck area needs cosmetic care, especially in the pediatric population. In this report, we introduce our method of percutaneous abscess drainage using an indwelling needle cannula. PATIENTS AND METHODS: Ten pediatric and five adult patients with cervical and/or facial abscess treated with this drainage method were retrospectively reviewed. Using an indwelling needle cannula (18-14 G Surflow®, Terumo, Tokyo, Japan), abscesses were penetrated under ultrasonic examination. Once purulent retention was identified, the inner metal needle was removed and the outer elastic needle was left and fixed. The outer needle was connected to the tube for continuous suction drainage for large abscess. RESULTS: The primary diseases of these abscesses were cervical abscess of dental origin (5), purulent lymphadenitis (3), pyriform sinus fistula (2) and subperiosteal abscess due to mastoiditis (2), circumorbital cellulitis (1), infection of Warthin's tumor (1), and unknown origin (1). The median (range) duration of drainage was 4 days (3-9 days). Abscesses were successfully treated, and no patients required additional incision for abscess drainage. No apparent scars after drainage were observed. CONCLUSION: This technique resembles the usual venous placement of an indwelling needle cannula and is thought to be familiar to physicians. Although simple and inexpensive, this drainage is safe, effective, and minimally invasive for the treatment of abscess.


Assuntos
Abscesso/cirurgia , Cateterismo/instrumentação , Cateteres de Demora , Drenagem/instrumentação , Face , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Pescoço , Idoso , Cateterismo/economia , Cateterismo/métodos , Cateteres de Demora/economia , Criança , Pré-Escolar , Drenagem/economia , Drenagem/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
3.
Am J Clin Oncol ; 43(11): 784-787, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32826390

RESUMO

OBJECTIVES: The objective of this study was to compare the clinical effectiveness of uncovered stent and covered stent as percutaneous endoprosthesis for malignant biliary obstruction of the extrahepatic bile duct. MATERIALS AND METHODS: After completion of percutaneous internal and external tube placement for unresectable malignant biliary obstruction, 60 patients were registered and randomly assigned in a 1:1 ratio to an uncovered or covered stent group. Metallic stent placement was performed within 1 week after registration, and an external biliary drainage tube was removed >3 days after stent placement. The primary endpoint was the obstructive jaundice-free survival rate at 24 weeks after registration, and the secondary endpoints were the success rate of percutaneous tube removal and adverse events. RESULTS: The obstructive jaundice-free survival rate at 24 weeks after registration was 13/29 (44.8%, 95% confidence interval [CI]: 28.4%-62.5%) and 15/30 (50.0%, 95% CI: 33.2%-66.8%) in the uncovered and covered stent groups, respectively. The success rate of percutaneous tube removal was 28/29 (96.6%, 95% CI: 82.8%-99.4%) and 30/30 (100%, 95% CI: 90.5%-100%) in the uncovered and covered stent groups, respectively. There were no procedure-related deaths. Twenty-eight adverse events were observed in 21 patients (7 in the uncovered stent group and 14 in the covered stent group). CONCLUSIONS: There was no significant difference in the obstructive jaundice-free survival rate at 24 weeks between the 2 groups. Considering the technical difficulty and invasiveness of covered stent placement, the placement of covered stents may not be needed in patients with a short prognosis of <24 weeks.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Ductos Biliares Extra-Hepáticos/patologia , Ductos Biliares Extra-Hepáticos/cirurgia , Colestase/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Colestase/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Resultado do Tratamento
4.
Int J Comput Assist Radiol Surg ; 15(7): 1157-1165, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32506349

RESUMO

PURPOSE: Concentric tube robots are composed of multiple concentric, pre-curved, super-elastic, telescopic tubes that are compliant and have a small diameter suitable for interventions that must be minimally invasive like fetal surgery. Combinations of rotation and extension of the tubes can alter the robot's shape but the inverse kinematics are complex to model due to the challenge of incorporating friction and other tube interactions or manufacturing imperfections. We propose a model-free reinforcement learning approach to form the inverse kinematics solution and directly obtain a control policy. METHOD: Three exploration strategies are shown for deep deterministic policy gradient with hindsight experience replay for concentric tube robots in simulation environments. The aim is to overcome the joint to Cartesian sampling bias and be scalable with the number of robotic tubes. To compare strategies, evaluation of the trained policy network to selected Cartesian goals and associated errors are analyzed. The learned control policy is demonstrated with trajectory following tasks. RESULTS: Separation of extension and rotation joints for Gaussian exploration is required to overcome Cartesian sampling bias. Parameter noise and Ornstein-Uhlenbeck were found to be optimal strategies with less than 1 mm error in all simulation environments. Various trajectories can be followed with the optimal exploration strategy learned policy at high joint extension values. Our inverse kinematics solver in evaluation has 0.44 mm extension and [Formula: see text] rotation error. CONCLUSION: We demonstrate the feasibility of effective model-free control for concentric tube robots. Directly using the control policy, arbitrary trajectories can be followed and this is an important step towards overcoming the challenge of concentric tube robot control for clinical use in minimally invasive interventions.


Assuntos
Aprendizado Profundo , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Fenômenos Biomecânicos , Humanos
5.
Orthop Clin North Am ; 51(3): 339-343, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498952

RESUMO

Pediatric spine trauma presents unique management challenges. These injuries are often the result of high-energy mechanisms and are associated with other serious injuries that can complicate surgical and nonsurgical approaches. The pediatric population presents a host of challenges related to patient compliance, healing challenges, and patient tolerance of therapy. Percutaneous pedicle screw instrumentation, temporary fixation without fusion, continues to expand in its role of pediatric spine fracture treatment. Compared with open instrumentation and fusion, this technique addresses many of the previously mentioned challenges. Additional study is needed to evaluate the clinical utility of this approach in pediatric spinal fractures.


Assuntos
Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Parafusos Pediculares , Resultado do Tratamento
6.
Ann Thorac Surg ; 110(5): 1746-1750, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32599035

RESUMO

PURPOSE: We developed a heart positioner, the Tentacles NEO, specifically designed for minimally invasive coronary artery bypass grafting (MICS-CABG). DESCRIPTION: The device has 3 flexible suction tubes, with a suction cup at the tip of each tube. The suction tubes can be detached from the device body, allowing them to be manipulated in any direction through a small incision around the small thoracotomy. When the device displaces the heart, the suction cup moves behind the chest wall and does not crowd the operative field. EVALUATION: Although the sideways suction force of the new device was as strong as that of the original device, Tentacles, the longitudinal and perpendicular force exerted was approximately 80% of the original device. Nevertheless, the new device could safely and favorably displace the heart in a pig model and even during off-pump CABG via sternotomy. During MICS-CABG, the device was able to displace the heart without crowding the operative field. CONCLUSIONS: The new heart positioner, Tentacles NEO, is a useful and practical heart positioner suitable for MICS-CABG.


Assuntos
Ponte de Artéria Coronária/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Animais , Ponte de Artéria Coronária/métodos , Desenho de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sucção , Suínos
7.
Spine (Phila Pa 1976) ; 45(19): E1279-E1285, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32472823

RESUMO

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To determine the risk factors of cage subsidence in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and its correlation with patient-reported outcomes. SUMMARY OF BACKGROUND DATA: Cage subsidence is among the cage-related complications after TLIF and may lead to poor outcomes. Few studies have addressed the incidence of cage subsidence in MI-TLIF. METHODS: This retrospective study of a prospectively collected database was conducted from October 2015 to October 2017. All patients received MI-TLIF with a minimum of 2-year follow-up. All levels were separated into the cage subsidence (CS group) and no cage subsidence (non-CS group) groups. Cage subsidence was evaluated using lateral radiographs and defined as more than 2 mm migration of the cage into the endplate of adjacent vertebral body. Patient demographics, perioperative details, and radiographic parameters were recorded. Cage-related parameters were cage height, cage insertion level, and cage position. Cage position was recorded using central point ration (CPR). Patient-reported outcome was analyzed using the Oswestry Disability Index (ODI) questionnaire and Visual Analog Scale (VAS) preoperatively and at 2 years postoperatively. RESULTS: Ninety-three patients (126 levels) were included. Mean age was 66.5 years with an average follow-up of 36.9 months. Overall incidence of cage subsidence was 34.1%. The CS group had significantly higher body mass index, less bone mineral density (BMD), shorter disc height, and higher CPR than the non-CS group. BMD, disc height, and CPR were significantly negatively correlated with depth of cage subsidence. ODI improvement was significantly lesser in the CS group than in the non-CS group. Fusion rate and complications were unrelated to cage subsidence. CONCLUSION: The BMD, disc height, and cage position were the most significant risk factors that were negatively correlated with depth of cage subsidence. Placing a TLIF cage anteriorly if possible may reduce the risk of cage subsidence. LEVEL OF EVIDENCE: 3.


Assuntos
Densidade Óssea/fisiologia , Fixadores Internos , Vértebras Lombares/fisiologia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Medição da Dor/métodos , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Resultado do Tratamento
8.
Eur J Surg Oncol ; 46(7): 1225-1232, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360066

RESUMO

BACKGROUND: Minimally invasive surgery has achieved great success in the surgical treatment of many kinds of cancer. This study aimed to systematically review the available evidence evaluating the effects of the use of uterine manipulators in minimally hysterectomies for endometrial cancer patients. METHODS: We searched the CENTRAL, MEDLINE, PubMed, EMBASE and ClinicalTrials.gov databases to Sep. 12, 2019 to identify relevant prospective or retrospective studies, using the intersection of "endometrial neoplasms", "endometrial carcinoma", "endometrial cancer"; "uterine manipulator", and "intrauterine manipulator". The initial search identified 251 items in total. The main outcomes of interest were the presence of LVSI (lymphovascular space invasion), the incidence of positive peritoneal cytology, and the presence of recurrence during follow-up. RESULTS: After screening for eligibility, 11 studies were included in the meta-analysis finally. The timing of uterine manipulators insertion during MIS for endometrial cancer was not associated with an increased risk of positive peritoneal cytology (RR: 1.21, 95% CI, 0.68 to 2.16). Moreover, there was no significant difference for the rate of positive peritoneal cytology (RR: 1.53, 95% CI, 0.85 to 2.77), LVSI (RR: 1.18, 95% CI, 0.66 to 2.11) or the rate of recurrence (RR: 1.25, 95% CI, 0.89 to 1.74) regarding the use of uterine manipulators for laparoscopic surgery in the treatment of endometrial cancer patients. CONCLUSION: We found that the use of uterine manipulators is not associated with an increased incidence of positive peritoneal cytology, LVSI, or recurrence among patients with endometrial cancer. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020147111.


Assuntos
Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Histerectomia/instrumentação , Recidiva Local de Neoplasia , Inoculação de Neoplasia , Peritônio/patologia , Vasos Sanguíneos/patologia , Feminino , Humanos , Histerectomia/métodos , Vasos Linfáticos/patologia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia
9.
J Med Eng Technol ; 44(3): 108-113, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32367762

RESUMO

Background: The aim of this study was to address the vision of wireless theranostic devices distributed along the gastrointestinal (GI) tract by defining design requirements, developing prototype mock-ups, and establishing a minimally invasive surgical approach for the implantation process.Methods: Questionnaires for contextual analysis and use case scenarios addressing the technical issues of an implantable GI device, a possible scenario for implantation, preparation and calibration of a device, and therapeutic usage by professionals and patients were completed and discussed by an interdisciplinary team of surgeons, engineers, and product designers. Two acute porcine experiments were conducted with a robotic surgical system under general anaesthesia.Results: A variety of requirements for the design and implantation of implantable devices for modulating GI motility were defined. Five prototype implant mock-ups were three-dimensional (3D)-printed from black polymer material (width 22.32 mm, height 7.66 mm) and successfully implanted on the stomach, duodenum, jejunum, ileum, and colon using the robotic surgical system, without any complications.Conclusions: Our study shows the development and successful pre-clinical evaluation of a reliable device design with a minimally invasive implantation approach. Several stages of device development, including pre-clinical tests, characterisation of clinical requirements, regulatory affairs, and marketing issues should be managed side by side.


Assuntos
Trato Gastrointestinal , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Animais , Desenho de Equipamento , Plásticos , Impressão Tridimensional , Próteses e Implantes , Suínos , Pesquisa Médica Translacional
10.
J Laparoendosc Adv Surg Tech A ; 30(7): 810-814, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32392445

RESUMO

Background: The Chinese minimally invasive surgical robot system "Micro Hand S" was developed in 2013. However, there was no bariatric surgery performed with the "Micro Hand S" surgical robot. We first aim to report our experience with the "Micro Hand S" robotic-assisted sleeve gastrectomy and evaluate the safety and feasibility of the "Micro Hand S" surgical robot. Methods: Between March 2018 and November 2019, sleeve gastrectomies were performed with the "Micro Hand S" robotic system on 7 consecutive patients by a trained surgeon-assistant team. Preoperative, intraoperative, and postoperative clinical data were collected. A questionnaire was used to investigate surgeons' satisfaction with the "Micro Hand S" robot platform. Results: All the patients underwent successful operations. There were no cases of perioperative mortality and complications. The intraoperative blood loss was 20.8 ± 3.6 mL. The average overall operating time was 166.4 ± 16.1 minutes. The weight, body mass index, waist circumference, and hip circumference decreased significantly at 3 months (all P < .01) and 6 months (all P < .01) postoperatively. The percentage excess weight loss was 62.6% ± 10.3% and 85.9% ± 13.3% at 3 and 6 months postoperatively. Surgeons were satisfied with the "Micro Hand S" surgical robot performance in sleeve gastrectomy. Eighty percent of surgeons would incline to use it again. Conclusions: The first use of the "Micro Hand S" robotic surgical platform in sleeve gastrectomy was carried out successfully. The perioperative outcomes are satisfying. Further comparative and large-sample studies are warranted to verify our preliminary outcomes.


Assuntos
Gastrectomia/instrumentação , Laparoscopia/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Obesidade Mórbida/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Adulto , Cirurgia Bariátrica , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Desenho de Equipamento , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Segurança do Paciente , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgiões , Adulto Jovem
11.
World Neurosurg ; 140: 664-673, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32445895

RESUMO

BACKGROUND: The desire to improve accuracy and safety and to favor minimally invasive techniques has given rise to spinal robotic surgery, which has seen a steady increase in utilization in the past 2 decades. However, spinal surgery encompasses a large spectrum of operative techniques, and robotic surgery currently remains confined to assistance with the trajectory of pedicle screw insertion, which has been shown to be accurate and safe based on class II and III evidence. The role of robotics in improving surgical outcomes in spinal pathologies is less clear, however. METHODS: This comprehensive review of the literature addresses the role of robotics in surgical outcomes in spinal pathologies with a focus on the various meta-analysis and prospective randomized trials published within the past 10 years in the field. RESULTS: It appears that robotic spinal surgery might be useful for increasing accuracy and safety in spinal instrumentation and allows for a reduction in surgical time and radiation exposure for the patient, medical staff, and operator. CONCLUSION: Robotic assisted surgery may thus open the door to minimally invasive surgery with greater security and confidence. In addition, the use of robotics facilitates tireless repeated movements with higher precision compared with humans. Nevertheless, it is clear that further studies are now necessary to demonstrate the role of this modern tool in cost-effectiveness and in improving clinical outcomes, such as reoperation rates for screw malpositioning.


Assuntos
Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/tendências , Doenças da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/tendências , Fluoroscopia/instrumentação , Fluoroscopia/tendências , Humanos , Monitorização Neurofisiológica Intraoperatória/instrumentação , Monitorização Neurofisiológica Intraoperatória/tendências , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
12.
J Urol ; 204(5): 1019-1026, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32396049

RESUMO

PURPOSE: The surgical reintervention rate after prostatic urethral lift is not well characterized but has been estimated at 2% to 3% per year. We performed a systematic review and meta-analysis to determine the surgical reintervention rate after prostatic urethral lift. MATERIALS AND METHODS: We systematically searched MEDLINE®, Embase® and the Cochrane Central Register of Controlled Trials for studies of men treated with prostatic urethral lift reporting at least 1 year of maximum followup data. We performed a random effects meta-analysis to estimate the annual rate of surgical reintervention after prostatic urethral lift, including those performed for lower urinary tract symptoms or involving device explant, additions or replacement. The robustness of the meta-analysis conclusions was evaluated in a one-study removed analysis and heterogeneity was investigated with a subgroup analysis. RESULTS: In 11 studies (2,016 patients) 153 surgical reinterventions were performed, among which transurethral resection of the prostate/laser (51.0%), repeat prostatic urethral lift (32.7%) and device explant (19.6%) were most common. The annual rate of surgical reintervention was 6.0% per year (95% CI 3.0-8.9). These results were not significantly influenced by any single study. The annual rate of surgical intervention was significantly influenced by the mean duration of patient followup. Surgical reintervention rates were 4.3% per year in studies with 1 year or less mean followup, 10.7% per year in studies with more than 1 year to 3 years mean followup and 5.8% per year in a single study with more than 3 years mean followup (p=0.04). CONCLUSIONS: The surgical reintervention rate with prostatic urethral lift is 6.0% per year and is higher in studies with longer followup durations.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Prostatismo/cirurgia , Falha de Prótese , Reoperação/estatística & dados numéricos , Remoção de Dispositivo/estatística & dados numéricos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Prostatismo/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressecção Transuretral da Próstata/estatística & dados numéricos , Resultado do Tratamento
15.
PLoS One ; 15(5): e0232952, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407397

RESUMO

In minimally invasive surgery, maneuverability is usually limited and a large number of degrees of freedom (DOF) is highly demanded. However, increasing the DOF usually means increasing the complexity of the surgical instrument leading to long fabrication and assembly times. In this work, we propose the first fully 3D printed handheld, multi-steerable device. The proposed device is mechanically actuated, and possesses five serially controlled segments. We designed a new compliant segment providing high torsion and axial stiffness as well as a low bending stiffness by merging the functions of four helicoids and a continuum backbone. Compliant segments were combined to form the compliant shaft of the new device. In order to control this compliant shaft, a control handle was designed that mimics the shaft structure. A prototype called the HelicoFlex was built using only three 3D printed parts. HelicoFlex, with its 10 degrees of freedom, showed a fluid motion in performing single and multi-curved paths. The multi-steerable instrument was 3D printed without any support material in the compliant shaft itself. This work contributes to enlarge the body of knowledge regarding how additive manufacturing could be used in the production of multi-steerable surgical instruments for personalized medicine.


Assuntos
Tecnologia Biomédica/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Impressão Tridimensional/instrumentação , Elasticidade , Desenho de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Instrumentos Cirúrgicos
16.
Ann Biomed Eng ; 48(6): 1837-1849, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32232695

RESUMO

In flexible endoscopy, the endoscope needs to be sufficiently flexible to go through the tortuous paths inside the human body and meanwhile be stiff enough to withstand external payloads without unwanted tip bending during operation. Thus, an endoscope whose stiffness can be adjusted on command is needed. This paper presents a novel variable-stiffness manipulator. The manipulator (Ø15 mm) has embedded thermoplastic tubes whose stiffness is tunable through temperature. Temperature is adjusted through joule heat generated by the electrical current supplied to the stainless steel coils and an active air-cooling mechanism. Tests and modeling were conducted to characterize the performance of the design. The manipulator has a high stiffness-changing ratio (22) between rigid and flexible states while that of its commercial Olympus counterpart is only 1.59. The active cooling time is 11.9 s while that of passive ambient cooling is 100.3 s. The thermal insulation layer (Aerogel) keeps the temperature of the outer surface within the safe range (below 41 °C). The models can describe the heating and cooling processes with root mean square errors ranging from 0.6 to 1.3 °C. The results confirm the feasibility of a variable-stiffness endoscopic manipulator with high stiffness-changing ratio, fast mode-switching, and safe thermal insulation.


Assuntos
Endoscopia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Desenho de Equipamento , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Temperatura
17.
Acta Cir Bras ; 35(2): e202000206, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348403

RESUMO

Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.


Assuntos
Endoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Animais , Endoscópios/classificação , Ressecção Endoscópica de Mucosa/instrumentação , Ressecção Endoscópica de Mucosa/métodos , Desenho de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Modelos Animais , Procedimentos Cirúrgicos Robóticos/instrumentação , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos
18.
J Cardiothorac Surg ; 15(1): 65, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32316997

RESUMO

BACKGROUND: Pectus bar removal after Nuss repair is associated with the risk of major complications that are underreported. Of these, surgical bleeding is the main concern. Old age and placement of more than one bar are reported risk factors for pectus bar removal. In this study, we presented our experience regarding the modified skills required to minimize complications during bar removal, especially in adult patients. METHODS: Consecutive patients who underwent pectus bar removal as the final stage of Nuss repair between August 2014 and December 2018 were included. The patients were positioned in the supine position. The bar(s) was (were) removed from the left side via the bilateral approach using the previous surgical scars after full dissection of the ends of the bar lateral to the hinge point and after straightening the right end of the bar. Bleeding was carefully checked after removal. An elastic bandage was wrapped around the chest after wound closure to prevent wound hematoma/seroma formation. RESULTS: A total of 283 patients (260 male and 23 female), with a mean age of 22.8 ± 6.6 years at the time of the Nuss repair were included. The mean duration of pectus bar maintenance interval was 4.3 years (range: 1.9 to 9.8 years). A total of 200 patients (71%) had two bars. The mean estimated blood loss was 11.7 mL (range: 10 mL to 100 mL). Nine patients (3.1%) experienced complications, six had pneumothorax and three had wound hematoma. No major bleeding occurred. Adults and the use of more than one bar were not associated with a significantly higher rate of complications (P = 0.400 and P = 0.260, respectively). CONCLUSIONS: Adult patients and removal of multiple bars were not risk factors for complications in our cohort. Skill in preventing intraoperative mediastinal traction, carefully controlling bleeding, and reducing the effect of dead space around the wounds could minimize the risk of bleeding complications. A multicentric study or case accumulation is needed to further evaluate the risk factors of removal pectus bar(s).


Assuntos
Remoção de Dispositivo/efeitos adversos , Tórax em Funil/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Próteses e Implantes , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hematoma/etiologia , Hematoma/prevenção & controle , Humanos , Masculino , Mediastino/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
World Neurosurg ; 138: 360-362, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32200012

RESUMO

BACKGROUND: Retained old cerebrospinal fluid diversion shunt catheters in the neck, chest, or abdominal walls are frequently encountered in patients with lifelong shunt-dependent hydrocephalus who have undergone multiple shunt revisions. Particularly in cases where years and decades go between shunt revisions, the distal catheter portion can get calcified and nearly impossible to remove. Most patients tolerate a retained shunt catheter without problems. In some patients, however, retained catheters can cause pain and discomfort, particularly over the clavicle with head movements. Albeit trivial, we are unaware of innovative solutions to this problem. Here, we describe the use of an endoscopic vein harvest device used in cardiothoracic surgery to completely remove an old, calcified shunt catheter. METHODS: Removal of a calcified ventriculoperitoneal shunt catheter using an endoscopic vein harvesting system was performed in a 32-year-old man with shunt-dependent hydrocephalus from premature birth. At 14 years of age, the patient had his only shunt revision consisting of a new distal catheter being placed adjacent to the old catheter. The patient presented with significant discomfort from the retained original shunt catheter. RESULTS: Using the endoscopic vein harvesting system, the shunt catheter was removed minimally invasively and the patient had complete resolution of his symptomatology. CONCLUSIONS: The endoscopic vein harvesting system used in cardiothoracic surgery is a suitable instrument to remove long segments of a retained ventriculoperitoneal shunt catheter minimally invasively through a small skin incision. To our knowledge, this is the first report of minimally invasive removal of a retained ventriculoperitoneal catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Humanos , Masculino
20.
BMC Musculoskelet Disord ; 21(1): 70, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019514

RESUMO

BACKGROUND: Simple bone cysts (SBCs) are common benign lytic bone lesions in children. This study focused on exploring a clinical treatment method, minimally invasive intramedullary decompression and drainage with elastic stable intramedullary nailing (ESIN) combined with intralesional injections of steroids, and evaluated its effectiveness, complications and morbidity through functional and radiographic outcomes. METHODS: The postoperative recovery of 18 children who suffered from SBCs of humerus was evaluated (mean follow-up, 40 months) from January 2009 to December 2016. These patients (11 males, 7 females; 8 in the left, 10 in the right; mean age, 10.9 years old) were treated with minimally invasive intramedullary decompression and drainage with ESIN combined with intralesional injections of steroids. The diagnosis was based on not only pre-operative typical medical images (X-rays/CT/MRI) but also surgical findings and pathological diagnosis. Radiological and functional outcomes were evaluated according to Capanna and Musculoskeletal Tumor Society (MSTS) score. The interclass differences were analyzed by t-test. RESULTS: According to Capanna and MSTS criteria, after treatment, 14 patients made full recoveries which was presented by all the cysts filled with bone tissue, and 4 patients made partially recoveries, which were presented by cystic spaces partially filled with low density bone. All the cysts responded to treatment method, and there was no cyst recurrence. All except 2 patients had good functional results. One of the two patients had irritation of the end of the nail and one patient had a valgus deformity. CONCLUSIONS: Treatment for SBCs of humerus by minimally invasive intramedullary decompression and drainage with ESIN combined with intralesional injections of steroids is safe, effective and convenient. The clinical effect is satisfactory and worth popularizing.


Assuntos
Cistos Ósseos/terapia , Descompressão Cirúrgica/instrumentação , Drenagem/instrumentação , Glucocorticoides/administração & dosagem , Úmero/patologia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Adolescente , Cistos Ósseos/diagnóstico , Cistos Ósseos/patologia , Pinos Ortopédicos/efeitos adversos , Criança , Terapia Combinada/efeitos adversos , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Seguimentos , Humanos , Úmero/diagnóstico por imagem , Úmero/efeitos dos fármacos , Úmero/cirurgia , Injeções Intralesionais , Imagem por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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