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A Knee Arthroscopy Training Tool Using Virtual Reality Techniques
Published in J. Middleton, M. L. Jones, G. N. Pande, Computer Methods in Biomechanics & Biomedical Engineering – 2, 2020
Training for arthroscopic surgery involves a number of techniques. The skill of triangulation, where the instruments are manipulated to bring them into view of the camera, is often taught using simple ‘black-box’ models.1 Cadavers can be used for training; however, their use is limited due to ethical restrictions, the associated costs of cadavers, and because the joints are altered by the preservation process. Therefore, simple physical models of the internal structures of the joint tend to be used. Although these models provide a greater sense of realism than the abstract ‘black-box’ models, they reproduce only some of the key internal structures and are less challenging of technique than a real joint. In addition, practising destructive surgical procedures will damage the physical model, requiring the insertion of replacement parts and making them expensive in both components and time. Hence, much of a surgeon’s training takes the form of supervised surgery on patients.
Telescopes for Inner Space: Fiber Optics and Endoscopes
Published in Suzanne Amador Kane, Boris A. Gelman, Introduction to Physics in Modern Medicine, 2020
Suzanne Amador Kane, Boris A. Gelman
Many areas of medicine now make use of fiber optic scopes for both surgery and examination; the tiniest can go virtually anywhere a needle can. The laparoscope (named after the Greek word for flank) can be used for surgery in the abdomen, including gynecological procedures, as well as gallbladder removals, hernia repairs, and stomach surgery. Surgeons often can achieve equally good success rates and lower complication rates compared to conventional, or open surgery, which requires large incisions in the abdomen. Similarly, arthroscopes are widely used for operations on the knee, ankle, shoulder, and other joints (Figure 2.2). Patients who have undergone laparoscopic and arthroscopic surgery generally require much shorter hospital stays and fewer days of recovery time. In fact, after undergoing arthroscopic surgery a person can usually leave the hospital the same day. This is in part because the surgery is performed through tiny keyhole-sized incisions that leave equally small scars.
Endoscopic Surgery
Published in John G Webster, Minimally Invasive Medical Technology, 2016
Applying lasers for cutting and coagulating tissue in arthroscopic surgery becomes more and more common. To limit the damage to surrounding tissue, the type and energy settings of the laser device must be carefully determined according to tissue type, arthroscopic medium and technique of the surgeon. The first laser used in arthroscopy was a CO2 laser. CO2 is easily absorbed by water so it requires a gaseous medium to perform the surgery, which is hard to achieve in many arthroscopic surgery procedures. And it cannot be transmitted by fiber-optic cables and requires awkward hand-pieces. The most widely used type today is the 2.1 μm holmium:YAG laser. It is used in an aqueous medium; and it can be transmitted by fiber-optic cables; it is precise and minimizes surrounding tissue damage.
Uniportal versus biportal endoscopic spine surgery: a comprehensive review
Published in Expert Review of Medical Devices, 2023
Many researchers have developed a biportal endoscopic approach borrowed from arthroscopic surgery for various joint diseases in orthopedic surgery to improve the learning curve and clinical availability [19–22]. This surgical approach can provide a more apparent surgical field and better access to the lesion using two access channels. Moreover, surgeons can use standard surgical devices for open surgeries. The biportal endoscopic spine surgery technique has recently emerged as an alternative in the minimally invasive spine surgery society. Many surgeons believe that this novel technique compensates for the shortcomings of conventional full-endoscopic spine surgery. However, there is a lack of comparison between these two surgical approaches regarding clinical effectiveness and practicability.
Modeling algorithm for dynamic generalized body cavity
Published in Cogent Engineering, 2018
Jianqing Mo, Hanwu He, Jinfang Li, Heen Chen
As shown in Figure 4, the articular cavity of the knee joint is enclosed by femur, tibia plateau, ligaments, meniscus and muscles. It is very difficult for surgical instruments to reach the lesion due to the knee joint cavity is very narrow and complex. During knee arthroscopic surgery, surgeons need to constantly adjust the patient’s lower limb to obtain necessary operating space. Therefore, only the experienced doctor can be qualified for this job.
Influence of limb positioning during image acquisition on femoral torsion measurements: implications for surgical planning
Published in Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 2023
Martina Guidetti, Floor M. Lambers, Michael Kohnen, Philip Malloy, Richard C. Mather, James W. Genuario, Shane J. Nho
Measures of femoral torsion play an important role in the management of clinical hip conditions, such as FAIS and hip instability (Kudrna 2005; Sankar et al. 2018; Scorcelletti et al. 2020; Wang et al. 2021). Excessive femoral ante-torsion is associated with conditions of hip instability, whereas excessive femoral retro-torsion is linked to conditions of FAIS (Westermann and Willey 2021; Arshad et al. 2021) (Figure 2). Lerch and colleagues found that 1 in 10 patients with FAIS also demonstrate severe abnormality in femoral torsion (Lerch et al. 2018). Patients with excessive femoral ante-torsion have significantly greater range of motion for internal rotation and smaller range of motion for external rotation, when compared to people with retro-torsion or normal femoral torsion values (Hartigan et al. 2017; Kraeutler et al. 2018; Sankar et al. 2018). Therefore, dynamic mechanical impingement could be reduced by femoral ante-torsion and femoral retro-torsion may exacerbate this dynamic mechanical impingement. Although arthroscopic surgery for FAIS addresses the local causes of bony impingement associated with cam and/or pincer pathomorphology, these arthroscopic surgical procedures do not address femoral torsion abnormality leading to persistent pain and symptoms. Some studies have shown that accounting for femoral retro-torsion abnormality during surgical planning improves clinical outcome scores following hip arthroscopy (Hartigan et al. 2017; Kraeutler et al. 2018; Sankar et al. 2018). For this reason, accurate femoral torsion measures are important to include in the diagnostic workup of FAIS. However, the image based evaluation of femoral torsion also demonstrates some ambiguity in the most accurate measurement technique, and is known to be influenced by patient positioning, therefore, is an area that warrants further research using more sophisticated three-dimensional (3D) imaging-based methods (Banerjee et al. 2014; Schmaranzer et al. 2020).