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Augmenting Haptic Perception in Surgical Tools
Published in Terry M. Peters, Cristian A. Linte, Ziv Yaniv, Jacqueline Williams, Mixed and Augmented Reality in Medicine, 2018
Randy Lee, Roberta L. Klatzky, George D. Stetten
Microsurgery refers to the set of surgical techniques that are performed beyond the limits of unassisted human eyesight (Yap and Butler 2007). As opposed to MIS, clinicians still make incisions to directly access tissues of interest, but in general they operate on relatively small structures, such as nerves, vessels, and thin membranes, and employ correspondingly smaller forces (Patkin 1977; Tsai et al. 2013). For example, Jagtap and Riviere (2004) measured average axial forces during in vivo microvascular puncture tasks to be as low as 75 mN. Furthermore, movements in microsurgery are performed on such a small scale that kinesthetic afferent signals are generally not differentiable (Jones 2000), and tremor becomes a significant additional component to the intended movement.
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Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
Corrective surgical procedures were employed by infertility surgeons for many years. The aim of corrective surgery in mechanical infertility is the restoration of the anatomical and functional capacity of the reproductive organs to participate in the process of conception. For that purpose, various procedures are used, including resection of adhesions surrounding the tubes, ovaries, uterus, and bowel, salpingostomy for the restoration of tubal patency in cases of distal occlusion of the tubes, and tubal implantation or tubal anastomosis in cases with a proximal occlusion. In the past, most of the corrective infertility surgery was performed with conventional surgical methods. In the last 10 years, there has been a change in attitude with the introduction of microsurgical techniques that led to the concept that conventional surgery for delicate organs such as the fallopian tubes is a traumatic procedure. It results in tissue damage due to the cumbersome crushing instruments and rough suture material used. Tissue irrigation was used infrequently and the lack of magnification allowed only imprecise manipulations. In comparison, microsurgery employs fine instrument, very fine sutures, intense light and magnification, very gentle tissue handling, careful dissection and anastomosis, and accurate approximation of tissues, thus significantly reducing trauma to the tissue. A wide range of pregnancy rates following corrective infertility surgery was reported. After resection of adhesions by conventional surgery, the pregnancy rate reported was 20 to 57%, very similar to the 25 to 57% pregnancy rate reported by the microsurgeons. Also for salpingostomy, a wide range of success rates (14 to 41%) was reported by the conventional surgeons compared to 10 to 49% by the microsurgeons. For proximal tubal occlusion, tubocorneal implantation was usually used by the conventional surgeons with a success rate of 11 to 34%. The microsurgical approach to proximal occlusion is tubocorneal anastomosis with a pregnancy rate of 53 to 68%, and when tubotubal anastomosis was performed, a success rate of 37 to 80% was achieved.
Devices for minimally-invasive microdiscectomy: current status and future prospects
Published in Expert Review of Medical Devices, 2020
As previously mentioned, the need for a technical fusion between tubular microsurgery and endoscopic spine surgery is ever increasing. Technological development should meet the needs of the current spine treatment market and can be accomplished in several ways. First, technical evolution in the optics will be remarkable. Three-dimensional endoscopic visualization with a flexible control may guarantee a more relevant outcome. Second, various forms of a tube or working channel needs to be improved. Eventually, trauma to healthy neuromuscular tissues can be minimized. Third, useful surgical instruments or supplementary devices such as navigable forceps, articulating burrs, laser scalpels, and radiofrequency should be improved. Finally, an advanced surgical technique and postoperative care protocol will make an outpatient surgery or same-day surgery feasible.
Influence of needling conditions on the corneal insertion force
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Corneal graft surgery is a high-precision microsurgery based on the scale of the tissues concerned and the control levels of the operating forces. One of the critical steps of the surgery is corneal suturing (Lee and Mannis 2007). Previous studies have investigated the effects of corneal suturing techniques on the wound healing (Melles and Binder 1990), visual outcome (Assil et al. 1992), and postkeratoplasty astigmatism (Javadi et al. 2006). However, the mechanics of needle insertion into the cornea and influence of this within the surgical process has received less attention. Current practices are largely based on the relative tactile perception of the surgeons, who are subjectively judging tissue distortion and required accommodation to the needle. Hence, it is necessary to explore the effects of insertion conditions on the cornea, thereby optimizing the overall design practices and benefits.
Is there a role for ultrasonic surgery in transoral laryngeal cancer resections?
Published in Expert Review of Medical Devices, 2019
Giancarlo Tirelli, Nicoletta Gardenal, Annalisa Gatto, Pierluigi Bonini, Margherita Tofanelli, Mario Marcos Fernández-Fernández
Transoral laser microsurgery is the preferred transoral conservative technique but has some technical limitations (narrow working field and poor hemostatic ability of CO2 laser)Transoral robotic surgery overcomes some limitations of TLM but has unsustainable costs for many centers.Transoral ultrasonic surgery is an endoscopic technique combining a video-endoscope for the vision and the ultrasonic scalpel for the cut.The advantages of TOUSS over TLM are the wide exposure of the operative field, the possibility of NBI illumination whenever required, the direct tissue manipulation, and the freedom of working ‘from the inside’ using different angulations for both vision and cutting.Ultrasonic scalpel produces more thermal and mechanical damage than CO2 laser, so the latter is preferable to perform very-narrow margin surgery.For the time being, US use is indicated only for tumors limited to the ‘suprahyoid’ larynx or spreading up to the glossoepiglottic valleculae and base of tongue and with a reasonable margin of healthy tissue where to cut.