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.

[Design and Feasibility Study of Tracheal Intubation Device Based on Magnetic Navigation Technology].

OBJECTIVE: In the context of coronavirus disease 2019 (COVID-19) pandemic, the subject was designed to develop a new tracheal intubation device based on magnetic navigation technology to improve the success rate of tracheal intubation and reduce the risk of occupational exposure of medical staff. METHODS: The new tracheal intubation device was designed with the uniqueness of the magnetic field environment and magnetic steering of magnetic navigation technology. And preliminary magnetic navigation tracheal intubation experiments were performed on the tracheal intubation simulator. RESULTS: Magnetic navigation tracheal intubation can successfully implement tracheal intubation, and the time required is lower than that of traditional laryngoscopy. CONCLUSIONS: The tracheal intubation based on magnetic navigation technology is feasible, with high efficiency and easy operation. That is expected to be widely used for tracheal intubation during treatment of patients outside the hospital in the future. At the same time, magnetic navigation endotracheal intubation technology will be the key technology for the development of endotracheal intubation robots.

Magnetic Spiderman, a New Surgical Training Device: Study of Safety and Educational Value in a Liver Transplantation Surgical Training Program.

INTRODUCTION: Difficulties with liver transplantation (LT)-related surgical techniques are great challenges for young surgeons. Thus, young surgeons need to undergo systematic preclinical training. However, an optimal training system for LT is still lacking. This study aims to evaluate the safety and educational value of the Magnetic Spiderman (MS) during LT-related surgical techniques training, particularly during training for the preparation of the donor's liver and vascular reconstruction. METHODS: For the donor liver preparation training, the pulling force of the MS was measured using 16 porcine livers. Another 40 porcine livers were divided into two groups: MS group (used MS in the preparation of the liver) (n = 25) and manual group (took manual assistance in the preparation of the liver) (MA group, n = 15). In vascular reconstruction training, 25 pairs of porcine iliac veins were used to practice reconstruction. Five LT experts evaluated the MS for its use in LT-related surgical techniques training. RESULTS: During the donor liver preparation training, the number of assistants required in the MS group was significantly less than the number required in the MA group (0 vs. 1.8 ± 0.1; P < 0.001). However, the number of vasculature leaking points was similar between the two groups (0.2 ± 0.1 vs. 0.4 ± 0.2; P = 0.51). In vascular reconstruction training, the trainee alone could complete the vascular reconstruction training, with a reconstruction success rate of 80% (20/25). All five experts considered the MS a viable alternative to assistants, with the ability to facilitate single surgeon training for LT. Four out of five (80%) experts considered MS quite safe for surgery and effective at keeping the surgical field clear. CONCLUSION: MS can reduce the number of assistants to zero in LT-related techniques training without increasing the risk of the operation, thus facilitating training for LT.

10-mm Laparo-Endoscopic Single-Site Cholecystectomy Using Multiple Magnetically Anchored and Controlled Instruments.

BACKGROUND: To study the feasibility of laparo-endoscopic single-site (LESS) cholecystectomy through a 10-mm incision using a miniature magnetically anchored and controlled laparoscopy system and a grasper system. METHODS: The miniature magnetically anchored and controlled laparoscopy system consisted of a miniature magnetically anchored camera (MMAC), an external magnetic anchoring unit, and a vision output device. The camera weighed 9.8 g and measured Φ10 mm × 50 mm. The magnetically anchored and controlled grasper system consisted of a magnetically anchored grasper (MAG), an external magnetic anchoring unit, and a push-pull device. The MAG had a titanium alloy clip head and a magnetic tail. The laparoscopy system and grasper system were used simultaneously to perform LESS cholecystectomy through a single 10-mm incision in model canines. RESULTS: LESS cholecystectomy through a 10-mm incision using the MMAC and MAG was attempted in six dogs. The mean operative time was 85.75 ± 7.14 min. The operation was completed successfully in four cases, with failure occurring in one case due to gallbladder rupture and in another due to bile duct injury. The MMAC provided clear imaging, and the MAG provided sufficient exposure to perform the cholecystectomy. The use of multiple magnetically anchored and controlled instruments did not result in notable collisions. CONCLUSIONS: The designed MMAC and MAG system could be easily maneuvered. LESS cholecystectomy may be feasible through a single 10-mm incision with the simultaneous use of multiple magnetically anchored and controlled instruments.

A Novel Remote-Controlled Injection Device for T-Tube Cholangiography: A Feasibility Study in Canines.

BACKGROUND The purpose of this study was to develop a remote-controlled injection device for T-tube cholangiography to avoid occupational exposure. MATERIAL AND METHODS The remote-controlled injection device has 3 major components: an injection pump, a pressure sensor, and a wireless remote-control panel. The feasibility and effectiveness of this device for T-tube cholangiography was evaluated in ex vivo porcine livers using a laparoscopic training platform and in in vivo canine experiments. RESULTS The contrast dye was successfully injected into the biliary tracts of the ex vivo porcine liver and canines by the designed device. The X-ray images clearly showed the anatomical structure of the bile ducts. No obvious adverse reaction was observed in the dogs during or after the procedure. All steps were controlled remotely, avoiding ionizing radiation exposure to the surgeons. CONCLUSIONS This novel remote-controlled injection device for T-tube cholangiography can assist operators in completing cholangiography remotely and protecting them from occupational exposure.

Effects of Different 980-nm Diode Laser Parameters in Hepatectomy.

BACKGROUND AND OBJECTIVE: Despite the successful application of laser in animal experiments and clinics, the adjustment of laser parameters during surgery is still unclear. This study aimed to investigate the effect of different 980-nm diode laser parameters in hepatectomy. This could provide a clear protocol for using 980-nm diode laser in hepatectomy. STUDY DESIGN/MATERIALS AND METHODS: In total, 48 Sprague-Dawley rats were used to explore the effects of different 980-nm diode laser parameters in hepatectomy, by setting different parameter combinations. The rats were randomly divided into eight groups, including the continuous wave group and quasi-continuous wave group. The effects were assessed in terms of liver resection speed, extent of intraoperative bleeding, and thermal damage. RESULTS: In the quasi-continuous wave group, there was a significant difference in resection speed at the different laser parameters (P < 0.001); however, there was no significant difference in intraoperative bleeding and thermal damage. In the continuous wave group, there was a significant difference in resection speed, intraoperative bleeding, and thermal damage at different parameters. CONCLUSION: The study showed that the average power determined hemostasis efficiency and thermal damage, and peak power determined the liver resection speed, whereas the pulse width and repetition frequency are not independent factors. When using 980-nm diode laser in hepatectomy, the average power should be decreased to prove hemostasis efficiency in delicate operations, and the peak power should be decreased to accelerate the procedure without worsening thermal damage. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

[Development of Motion Unit of Simulated Intelligent Endotracheal Suctioning Robot].

A motion unit for sucking robot with a stable motion, convenient operation and process simulation is introduced. The key parameters and process data of the sucking operation were obtained from the clinical work, which provided the basis for the design of the sucking robot motion unit. According to the points of sucking action, robotic thumb, forefinger and metacarpophalangeal joints were used to grip the suction tube, and the servo and arm structure were used to simulate the motion of the wrist and elbow to complete the rotation and push of the sputum suction tube. The feasibility is verified through the advanced sputum suction training model. The movement unit is stable in movement, and can smoothly complete the clamping, feeding, back off protection and rotating tube removal of the sputum suction tube, so as to achieve effective sputum suction.

[Development of Biliary Contrast Agents Remote Pushing Device].

A biliary contrast agents pushing device, including a syringe pushing system and a remote controller is introduced. The syringe pushing system comprises an injector card slot, a support platform and an injection bolus fader. A 20 mL syringe can be fitted on the syringe pushing system and kept with the ground about 30 degree. This system can perform air bubble pumping back and contrast agents bolus injection as well as speed adjustment. Remote controller is an infrared remote control which can start and stop the syringe pushing system. With this device, the remote controlled cholangiography technology can be achieved, which can not only protect doctors from X-ray radiation but also improve the traditional T-tube cholangiography and the contrast effect, reduce postoperative complications in patients as well. The application of this device will improve the current diagnosis and treatment system, the device will benefit the majority of doctors and patients.

A novel magnetic device for laparoscopic cholangiojejunostomy.

BACKGROUND: Laparoscopic cholangiojejunostomy (LCJ) with hand-sewn technique is technically difficult and requires a long time to master. The purpose of this study was to assess the feasibility of LCJ using a novel magnetic compression device (MCD) in dogs. METHODS: The concept of the purse-string technique of the circular stapler was used to design a novel MCD for LCJ. To test the feasibility of this MCD in a more clinically relevant situation, four dogs were subjected to bile duct ligation. When the diameter of their bile ducts reached 10 mm, LCJ using MCD was performed. The anastomotic time and expelling time of the magnets were assessed. RESULTS: In the clinically relevant model of bile duct obstruction in dogs, LCJ created with this MCD yielded patent anastomoses. The LCJ procedure using this novel MCD was simple, and the mean anastomotic time was 12.9 ± 1.73 min. All animals recovered smoothly after the operation without complications. All magnets spontaneously passed through the rectum in 14.5 ± 2.08 d after LCJ. CONCLUSIONS: LCJ in dogs using this novel MCD is feasible.

Mass Continuous Suture versus Layered Interrupted Suture in Transverse Abdominal Incision Closure after Liver Resection.

BACKGROUND: Abdominal incision closure technique seriously influences patient prognosis. Most studies have focused on the different suture techniques and materials on midline incision, while little data are available in wide transverse or oblique incisions after liver resection (LR). The aim of the present study is to compare the two major incision suture methods after LR in our institute: Mass continuous suture (group P) and layered interrupted suture (group S). STUDY DESIGN: 258 patients undergoing LR with abdominal transverse or oblique incisions were prospectively enrolled. They were divided into two groups according to different abdominal incision suture methods and compared with the preoperative, intraoperative parameters, and postoperative wound complications. RESULTS: There were 118 patients in group P and 140 patients in group S, which was similar in general condition, primary disease, liver, and renal function. Incision length, total operation time, intraoperative blood loss, or perioperative antibiotics use were not different between the two groups. However, abdominal incision closure time and interval time for stitches removing after operation was significantly shorter in group P than group S (both p < 0.001). After a median follow-up of 16 months, the incidence of wound infection and fat liquefaction was more than two times higher in group S than group P, which, however, was not statistically different. Moreover, there was no difference in wound disruption or incisional hernia between the two groups. CONCLUSIONS: Although similar in occurrence of postoperative wound complications, mass continuous suture with polydioxanone seemed to be more timesaving in incision closure and motivated in wound healing.

Splenorenal shunt via magnetic compression technique: a feasibility study in canine and cadaver.

INTRODUCTION: The concept of magnetic compression technique (MCT) has been accepted by surgeons to solve a variety of surgical problems. In this study, we attempted to explore the feasibility of a splenorenal shunt using MCT in canine and cadaver. MATERIAL AND METHODS: The diameters of the splenic vein (SV), the left renal vein (LRV), and the vertical interval between them, were measured in computer tomography (CT) images obtained from 30 patients with portal hypertension and in 20 adult cadavers. The magnetic devices used for the splenorenal shunt were then manufactured based on the anatomic parameters measured above. The observation of the anatomical structure showed there were no special structural tissues or any important organs between SV and LRV. Then the magnetic compression splenorenal shunt procedure was performed in three dogs and five cadavers. Seven days later, the necrotic tissue between the two magnets was shed and the magnets were removed with the anchor wire. RESULTS: The feasibility of splenorenal shunt via MCT was successfully shown in both canine and cadaver, thus providing a theoretical support for future clinical application.

[The Development of the Supermicroinvasive Magnetic Anchoring Laparoscopic System].

A magnetic anchoring supermicroinvasive laparoscopic system, including in vitro magnetic navigation handle and in vivo magnetic anchor laparoscopy is introduced. The magnetic anchor laparoscopic comprises an outer cannula, two data lines, a camera, a high color temperature LED light and two inner magnets. It is tiny enough to enter the abdominal cavity through conventional laparoscopic trocar and achieve orientation, navigation as wel as adjustment thefi eld of view within the abdominal cavity by attracting with the in vitro magnetic handle, thus it does not take up space of the laparoscopic trocar in working state. The system which can not only apply in single-port laparoscopic surgery based on a single traditional laparoscopic trocar but also apply in traditional laparoscopic surgery with less trocar, wil enhance the extent of minimaly invasive surgery and reduce the operation diffi culty at the same time. The clinical application of the system wil optimize the minimaly invasive techniques and benefi t the patients.

[The Current Status and Prospects of Single-Port Laparoscopic Flexible Instrument in Surgery].

In recent years, the emergence of single-port laparoscopic technology promoted the development of the technology of laparoscopy, but deficiencies like equipment conflict or lack of triangulation severely hampered the clinical application of this technology. The appearance of single-port laparoscopic flexible instruments makes up for those deficiencies to a great extent. The element is to add a wrist joint to the tip of the instrument to form triangulation and reduce equipment conflict. But this technique is still in an early stage of development. The purpose of this article is to summarize the characteristics and problems of existing flexible single-port laparoscopic instruments, and to provide information for the further improvement, finally the future development was expected.

[The Application of Machine Perfusion on Clinical Liver Transplantation].

Liver transplantation is the only way to treat end-stage liver disease. In order to overcome the shortage of donor, marginal donors have been used widely, which bring about a series of problems. Machine perfusion can stimulate the circulation in vivo and is beneficial for the protection of liver. It could also improve the graft function and reduce postoperative complications, which makes it a hot spot in recent years. The aim of this study is to summarize the current status and prospects of application of machine perfusion on clinical liver transplantation.

Challenges in clinical practice, biological mechanism and prospects of physical ablation therapy for COPD.

Chronic obstructive pulmonary disease (COPD) is projected to become the third leading cause of death globally by 2030. Despite the limited treatment options available for advanced COPD, which are mostly restricted to costly lung transplants, physical ablation therapy offers promising alternatives. This technique focuses on ablating lesioned airway epithelium, reducing secretions and obstructions, and promoting normal epithelial regeneration, demonstrating significant therapeutic potential. Physical ablation therapy primarily involves thermal steam ablation, cryoablation, targeted lung denervation, and high-voltage pulsed electric field ablation. These methods help transform the hypersecretory phenotype, alleviate airway inflammation, and decrease the volume of emphysematous lung segments by targeting goblet cells and damaged lung areas. Compared to traditional treatments, endoscopic physical ablation offers fewer injuries, quicker recovery, and enhanced safety. However, its application in COPD remains limited due to inconsistent clinical outcomes, a lack of well-understood mechanisms, and the absence of standardized guidelines. This review begins by exploring the development of these ablation techniques and their current clinical uses in COPD treatment. It then delves into the therapeutic effects reported in recent clinical studies and discusses the underlying mechanisms. Finally, the review assesses the future prospects and challenges of employing ablation technology in COPD clinical practice, aiming to provide a practical reference and a theoretical basis for its use and inspire further research.

Advantages of pulsed electric field ablation for COPD: Excellent killing effect on goblet cells.

Mucus hypersecretion resulting from excessive proliferation and metaplasia of goblet cells in the airways is the pathological foundation for Chronic obstructive pulmonary disease (COPD). Clinical trials have confirmed the clinical efficacy of pulsed electric field ablation (PFA) for COPD, but its underlying mechanisms is poorly understood. Cellular and animal models of COPD (rich in goblet cells) were established in this study to detect goblet cells' sensitivity to PFA. Schwan's equation was adopted to calculate the cells' transmembrane potential and the electroporation areas in the cell membrane. We found that goblet cells are more sensitive to low-intensity PFA (250 V/cm-500 V/cm) than BEAS-2B cells. It is attributed to the larger size of goblet cells, which allows a stronger transmembrane potential formation under the same electric field strength. Additionally, the transmembrane potential of larger-sized cells can reach the cell membrane electroporation threshold in more areas. Trypan blue staining confirmed that the cells underwent IRE rate was higher in goblet cells than in BEAS-2B cells. Animal experiments also confirmed that the airway epithelium of COPD is more sensitive to PFA. We conclude that lower-intensity PFA can selectively kill goblet cells in the COPD airway epithelium, ultimately achieving the therapeutic effect of treating COPD.

Fedora-type magnetic compression anastomosis device for intestinal anastomosis.

BACKGROUND: Although previous studies have confirmed the feasibility of magnetic compression anastomosis (MCA), there is still a risk of long-term anastomotic stenosis. For traditional MCA devices, a large device is associated with great pressure, and eventually increased leakage. AIM: To develop a novel MCA device to simultaneously meet the requirements of pressure and size. METHODS: Traditional nummular MCA devices of all possible sizes were used to conduct ileac anastomosis in rats. The mean (± SD) circumference of the ileum was 13.34 ± 0.12 mm. Based on short- and long-term follow-up results, we determined the appropriate pressure range and minimum size. Thereafter, we introduced a novel "fedora-type" MCA device, which entailed the use of a nummular magnet with a larger sheet metal. RESULTS: With traditional MCA devices, the anastomoses experienced stenosis and even closure during the long-term follow-up when the anastomat was smaller than Φ5 mm. However, the risk of leakage increased when it was larger than Φ4 mm. On comparison of the different designs, it was found that the "fedora-type" MCA device should be composed of a Φ4-mm nummular magnet with a Φ6-mm sheet metal. CONCLUSION: The diameter of the MCA device should be greater than 120% of the enteric diameter. The novel "fedora-type" MCA device controls the pressure and optimizes the size.

Characterization of the PM2.5 concentration in surgical smoke in different tissues during hemihepatectomy and protective measures.

The characteristics of the PM2.5 concentration in surgical smoke produced by operating on different human tissues during hemihepatectomy were explored to provide a reference for protective measures. Our results showed that the highest concentration of PM2.5 produced by the electrosurgical knife was the liver tissue, followed by muscle, adipose, and vascular tissue. When the single-layer disposable medical mask, double-layer disposable medical mask, and surgical particulate respirator were used to cover the sampling port of the detector, the PM2.5 concentration for all tissue types could be reduced by approximately 40%, 55% and 75%, respectively. In the liver, the average concentration of PM2.5 produced by the ultrasonic scalpel was approximately twice that produced by the electrosurgical knife, suggesting that the air pollution around the chief surgeon caused by the ultrasonic scalpel is more serious than that caused by the electrosurgical knife. Much more protective work should be given for the liver-related surgery.

Pathophysiologic Characterization of a Novel Rabbit Model of Biliary Tract Infection-Derived Sepsis.

Biliary tract infection (BTI)-derived sepsis remains a serious problem with significant morbidity and mortality in the modern era of critical care management. Current animal models of BTI have relied mostly on injecting purified bacteria or their toxins into the biliary tract. These models do not fully reflect pathophysiology or disease processes of clinical cholangitis or cholecystitis. In the current study, we developed a novel model of BTI by performing cholecystocolonic anastomosis (CCA) in rabbits and characterized pathophysiologic changes in this model. This model is intended to mimic the clinical process of cholecystocolonic fistula with reflux cholangitis, a severe form of BTI. Adult male rabbits were subjected to BTI-derived sepsis through an anastomosis of the gall bladder to the colon (i.e., CCA). The animals were monitored for 7 days to record survival. In additional groups of animals, various bacterial, hemodynamic, histological and biochemical parameters were measured at 12, 24, 48 and 72 h after CCA. The anastomosis between the gallbladder and the colon required about 5-8 min to finish. The median survival time for rabbits after CCA was 96 h. The positive rates of bacterial culture at 72 h after CCA were 83.3% and 100% in the blood and liver, respectively. The most common microorganism was Escherichia coli followed by Enterococcus. Plasma Tumor Necrosis Factor-α (TNF-α), Lnterleukin-10 (IL-10), Lnterleukin-6 (IL-6), and High-mobility group box 1 protein (HMGB-1) levels were greatly elevated after CCA. The cardiac index and heart rate increased slightly at 12 h after CCA and then continued to decrease. Systemic hypotension developed 48 h after CCA. Histological studies showed reflux cholangitis with acute lung and kidney injury. Cholecystocolonic anastomosis produces polymicrobial sepsis in rabbits, which mimics many aspects of human BTI-derived sepsis. It is reproducible and easy to perform and may serve as an excellent model for future sepsis research.

Adopting data interpretation on mining fine-grained near-repeat patterns in crimes.

The near-repeat effect is a well-known phenomenon in crime analysis. The classic research methods focus on two aspects. One is the geographical factor, which indicates the influence of a certain crime risk on other similar crime incidents in nearby places. The other is the social network, which demonstrates the contacts of the offenders and explain "near" as degrees instead of geographic distances. In our work, these coarse-grained patterns discovering methods are summarized as bundled-clues techniques. In this paper, we propose a knotted-clues method. Adopting a data science perspective, we make use of a data interpretative technology and discover that the near-repeat effect is not always so near in geographic or network structure. With this approach, we analyze the near-repeat patterns in all districts of the dataset, as well as in different crime types. Using open source data from Crimes in Chicago provided by Chicago Police Department, we find interesting relationships and patterns with our mining method, which have a positive effect on police deployment and decision making.