Minimally Invasive Surgery Research Papers (original) (raw)

- by Andreea Roxana Luca
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- Computer Science, Artificial Intelligence, Oncology, Medical Informatics

Angesichts der zunehmenden strukturellen Verschaltung von Mensch und Maschine in der chirurgischen Praxis selbst genügt es nicht mehr, pathologische Veränderungen auf der Basis eines entsprechend theoriegeleiteten Bildwissensauf in medizinischen Visualisierung „lediglich“ zu erkennen. Bildkompetent müss ChirurgInnen inzwischen nicht mehr nur als DiagnostikerInnen sein, sondern Bilder gestalten zunehmend auch die Therapie. Visualisierungspraktiken lenken, steuern, führen und gestalten inwischen auch den Behandlungsprozess und etablieren ein verändertes Verhältnis zwischen ChirurgIn und PatientIn, zwischen Körper und Bild, zwischen Mensch und Maschine. Der Beitrag untersucht dieses Gefüge von Anschauung, Operativität und Bildlichkeit in der minimal-invasiven Chrirurgie anhand der medialen Produktionsbedingungen des roboter-assistierten Operationssystems Da Vinci. Dabei wird anhand konkreter Fallbeispiele der Architektur, Navigation und Steuerung des Systems gezeigt, dass dem Herstellerversprechen erhöhter medizinischer Effizienz und Präzision bildgeführter Operationssysteme eine praktische Kenntnis der Differenz zwischen Körper und Bild entgegenstehen muss, die nicht in Abrenzung zum Maschinellen verhandelt werden kann, sondern als Synthese von Chirurg und Operationssystem gedacht werden muss.

- by Moritz Queisner
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- Human Computer Interaction, Surgery, Media Studies, Human-machine Systems

In this study, we present our technique for performing video-assisted lobectomy. This is presented in clear, easy-to-follow, sequential steps, noting variations on the most established technique and the rationale for this divergence. We... more

- by Edward Caruana and +1
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- Cardiac and Thoracic Surgery, Lung Cancer, Thoracoscpic Surgery, Minimally Invasive Surgery
- by AGUSTIN ZERON
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- Preventive Health, Dental Caries, Minimally Invasive Surgery

Minimally invasive glaucoma surgery (MIGS) has become increasingly popular as a step in the management pathway of open angle glaucoma. Due to the relative novelty of these devices, there remains some paucity of evidence relating to their long-term efficacy and safety, and this can make comparison between these techniques somewhat complex. This review article aims to guide clinical decision making by providing the latest evidence on the comparative efficacy of current iterations of minimally invasive glaucoma surgery. A literature review was conducted to identify the most significant recent evidence to support the safety and efficacy of the various forms of minimally invasive glaucoma surgery. Included studies provided efficacy and safety data on a variety of minimally invasive glaucoma surgery methods. The PubMed database was searched and a total of 484 studies, published between 2015 and 2020 were identified, of which 27 were included. The studies indicate that most available forms of minimally invasive glaucoma surgery show statistically significant efficacy in terms of intraocular pressure reduction and improvement in medication burden, while maintaining an acceptable safety profile.

- by Mary Ma
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- Surgery, Minimally Invasive Surgery, Glaucoma Surgery, Trabeculectomy

This paper presents the design of a single module composing a modular soft variable stiffness manipulator for minimal access surgery. The module exploits flexible fluidic actuation for obtaining multi directional bending and elongation capabilities. A novel flexible crimped braided sheath is introduced in order to increase the performances of the flexible actuator. Granular jamming based stiffening mechanism is used to tune the stiffness of the module. The fabrication of the module is described and the performances in terms of bending, elongation and stiffening are reported. Keywords— Surgical manipulator; soft manipulator; variable stiffness; minimally invasive surgery; flexible fluidic actuator; granular jamming; crimped braided structure

Recent advancements in robotics technology have allowed more complex surgical procedures to be performed using minimally invasive approaches. In this article, we reviewed the role of robotic assistance in Otolaryngology and Head and Neck... more

- by Caio Oliveira
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- Minimally Invasive Surgery, Minimally Invasive

This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under... more

This paper presents the concept design, the fabrication and the experimental characterization of a unit of a modular manipulator for minimal access surgery. Traditional surgical manipulators are usually based on metallic steerable needles, tendon driven mechanisms or articulated motorized links. In this work the main idea is to combine flexible fluidic actuators enabling omnidirectional bending and elongation capability and the granular jamming phenomenon to implement a selective stiffness changing. The proposed manipulator is based on a series of identical modules, each one consisting of a silicone tube with pneumatic chambers for allowing 3D motion and one central channel for the implementation of the granular jamming phenomenon for stiffening. The silicone is covered by a novel bellows-shaped braided structure maximizing the bending still limiting lateral expansion. In this paper one single module is tested in terms of bending range, elongation capability, generated forces and stiffness changing.

- by Matteo Cianchetti and +2
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- Surgical Robotics, Soft Bodied Robotics, Minimally Invasive Surgery, Surgical Robots

INTRODUCTION Cameron lesions are linear ulcerations and erosions of the gastric mucosa from mechanical trauma in the setting of a hiatal hernia. Cameron lesions often present as chronic iron deficiency anemia and upper gastrointestinal bleeding. Medical management is the widely accepted treatment option for Cameron lesions, however the definitive treatment involves surgically correcting the underlying anatomic abnormality of the hiatal hernia itself.

- by Munazzah H Ross MD and +1
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- Minimally Invasive Surgery, Robotic-Assisted Surgery, Hiatal hernia

In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb and hip surgery was evaluated and results obtained were compared with those using hyperbaric bupivacaine. Methodology: Two hundred patients scheduled for lower limb and hip surgery were randomly divided into two groups of 100 patients each. These patients received a spinal injection of either 3ml (15mg) of 0.5% hyperbaric ropivacaine or 3ml (15mg) of 0.5% hyperbaric bupivacaine using 25G Quincke type spinal needle. The parameters studied were -onset and total duration of sensory block, onset and total duration of motor block, quality of intraoperative anaesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The mean onset of sensory block (6±1.3min vs. 3±1.1min; p value<0.05) and motor block (13±1.6min vs. 9±1.3min; p value< 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in ropivacaine group (160±12.9min) than in bupivacaine group (260±16.1min; p value <0.05). The mean duration of motor block was also shorter in ropivacaine group compared to bupivacaine group (126±9.2min vs. 174±12.6min; p value<0.05). Conclusion: The quality of anaesthesia was excellent in both the groups. In conclusion, a solution of ropivacaine (hyperbaric) can be used for spinal anaesthesia and is comparable with hyperbaric bupivacaine in terms of quality of block, but has shorter recovery profile.

This paper presents the concept design of a modular soft manipulator for minimally invasive surgery. Unlike traditional surgical manipulators based on metallic steerable needles, tendon-driven mechanisms, or articulated motorized links, we combine flexible fluidic actuators to obtain multidirectional bending and elongation with a variable stiffness mechanism based on granular jamming. The idea is to develop a manipulator based on a series of modules, each consisting of a silicone matrix with pneumatic chambers for 3-D motion, and one central channel for the integration of granular-jamming-based stiffening mechanism. A bellows-shaped braided structure is used to contain the lateral expansion of the flexible fluidic actuator and to increase its motion range. In this paper, the design and experimental characterization of a single module composed of such a manipulator is presented. Possible applications of the manipulator in the surgical field are discussed.

- by Tommaso Ranzani and +2
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- Medical Robotics, Surgical Robotics, Minimally Invasive Surgery, Soft Robotics
- by dehuji Dehuji
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- Health Sciences, Laparoscopic Surgery, Minimally Invasive Surgery, Sterilization

Electrosurgery is the most commonly used and misunderstood technology by all surgical and medical disciplines. A lack of basic knowledge or ignorance of principles of electrosurgery and equipment among obstetricians and gynecologists is reported. As a result, thermal injuries during laparoscopic electrosurgery occur, which frequently lead to significant morbidity and mortality and medicolegal actions. Surveys indicate that up to 90% of general surgeons and gynecologists use monopolar radiofrequency (RF) during laparoscopy, 18% have experienced visceral burns, and 13% admitted 1 or more ongoing cases of litigations associated with such burns. This article describes the basics of electrosurgery beginning with the generation of electrons and their physical characteristics and governing laws before their arrival in the operating room where they are fed to an electrosurgical unit (ESU) to boost their frequency with step-up transformers from 60 Hz to .500 000 Hz. This RF creates heat, resulting in dissection, desiccation, coagulation, and fulguration of tissues without neuromuscular stimulation, pain, or burn to the patient. The ESU delivers power (wattage 5 volts ! amps) in monopolar or bipolar (1 vs 2 high-density electrodes) configuration. Because of RF, monopolar electrosurgery compared with other energy sources is associated with unique characteristics, inherent risks, and complications caused by the requirement of a return/dispersive electrode, inadvertent direct and/or capacitive coupling, or insulation failure of instruments. These dangers become particularly important with the popular and frequent use of monopolar electrodes (hook, needle, and scissors) during cholecystectomy; robot-assisted surgeries; and the re-emergence of single-port laparoscopy, which requires close proximity and crossing of multiple intraabdominal instruments outside the surgeon's field of view. Presently, we identify all these potential risks and complications associated with the use of electrosurgery and provide suggestions and solutions to mitigate/minimize these risks based on good clinical practice and sound biophysical principles.

- by Chandrew Rajakumar and +1
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- Electrical Engineering, Medical Education, Technological Innovation, Laparoscopic Surgery

Since its inception within pediatric urology in early 2000, robotic assistance has become more
widely accepted due to its aid in reconstructive aspects. Numerous procedures have been
performed, from pyeloplasty to complex augmentation cystoplasty and Catherizable channels with
bladder neck procedures. After the initial period of learning curve and feasibility assessments,
quality outcomes and comparative studies have since been published, and these include some
prospective studies. The ongoing challenges of the cost effectiveness, wider availability, and
miniaturization of the instruments is a work in progress, and these will hopefully prove to be a
short-term issue.
This Research Topic is intended to highlight the evolution of robotic surgical technology and its
application in Pediatric Urology. In this collection of articles published on this subject, we have a
wide selection of studies that will contribute to the further progress of the field. This topic continues
to be of growing interest among the pediatric urology community and, in this Editorial, we have
reviewed 14 accepted and included papers.

The robotic arm used in minimally invasive surgery enters patient’s body through a port which constrains its end-effector translation along two axes. We aim to achieve the minimally-invasive operations using a general articulated robotic arm (GARA). The algorithm is applicable to articulated robotic arm independent of its design; given only end-link is constrained. Geometric transformations based on the constraints acting on the end-link coupled with kinematic-relations obtained using conventional techniques, were used to drive a simulated 6-DOF GARA for minimally-invasive operations. The method was verified by tracing predefined planar and 3D trajectories using this simulated arm. The mean deviation of the traced trajectories was of the order of 10-03 cm and the mean absolute error in maintaining remote center-of-motion (RCM) at the port was ~0 (< 10^-15 cm). The proposed method enabled a GARA to perform minimally-invasive operations without specialized design and with sufficient accuracy.

- by Surbhi Gupta
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- Robotics, Control Systems, Surgical Robotics, Kinematics

This paper presents an enhanced haptic-enabled master-slave teleoperation system which can be used to provide force feedback to surgeons in minimally invasive surgery (MIS). One of the research goals was to develop a combined-control architecture framework that included both direct force reflection (DFR) and position-error-based (PEB) control strategies. To achieve this goal, it was essential to measure accurately the direct contact forces between deformable bodies and a robotic tool tip. To measure the forces at a surgical tool tip and enhance the performance of the teleoperation system, an optical force sensor was designed, prototyped, and added to a robot manipulator. The enhanced teleoperation architecture was formulated by developing mathematical models for the optical force sensor, the extended slave robot manipulator, and the combined-control strategy. Human factor studies were also conducted to (a) examine experimentally the performance of the enhanced teleoperation system w...

- by Mehrdad Zadeh
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- Robotics, Algorithms, Human Factors, Haptics

BACKGROUND:
The advent of laparoscopic cholecystectomy (LC) has created a dilemma for treating patients with known or suspected choledocholithiasis. With rapid technologic growth and experience in laparoscopic skills, many surgeons are now routinely performing laparoscopic common bile duct exploration (LCBDE) and questioning the wisdom of preoperative endoscopic retrograde cholangiography (ERC) with or without endoscopic sphincterotomy. The purpose of this article is to review the current literature on the subject of LCBDE and critically evaluate the clinical results of this emerging technology.
METHODS:
Medline and Science Citation Index databases were used to search English language articles published on LCBDE since 1989.
RESULTS:
Transcystic common bile duct exploration has a better clearance rate, and carries less morbidity and mortality compared with laparoscopic choledochotomy. Compared with two-stage ERCP and LC, one-stage LC and LCBDE seems to be associated with a shorter hospital stay, a quicker recovery, less expense, and less morbidity and mortality.
CONCLUSIONS:
LCBDE is a feasible, safe and effective procedure that carries a low morbidity and mortality and will decrease the need for unnecessary ERC in the future for suspected or proved choledocholithiasis.

- by Muhammed A Memon
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- Minimally Invasive Surgery, Gallstones

Obesity is a disease causing multiple comorbid health conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, back pain, and cancers. Weight loss improves overall health and quality of life. When diets, exercise, and behavioral changes are not enough, weight loss operations can help patients lose 100 pounds or more, reverse associated health problems, and increase longevity.

- by Mary Ma
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- Bariatric Surgery, Obesity, Minimally Invasive Surgery

Minimally-invasive conventional up-to-down laparoscopic approach is a widespread alternative for rectal cancer resection. Its potential benefits towards open surgery have been shown to rely, however, at secondary clinical outcomes, and its oncological non-inferiority compared with the traditional open approach has not been demonstrated yet. In this scenario, robotic-assisted minimally-invasive rectal resection has gained increasing popularity and promising expectancies. This narrative review aims to assemble the most updated evidence available and to discuss the future perspectives and challenges for this emergent surgical tool. The main benefit over conventional laparoscopy appears to be a reduction of conversion rates to open surgery, whereas the oncologic and functional outcomes seem similar than the other alternatives. Increased costs are the main limitation of the widespread of robotic technology. Low quality of the current evidence is remarkable.

- by Mini-invasive Surgery Journal and +5
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- Robotic Surgery, Minimally Invasive Surgery, Total Mesorectal Excision, Rectal Cancer

We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months), and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

- by Giuseppe Bosco and +1
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- Minimally Invasive Surgery

This chapter is devoted towards analyzing the progress and barriers to the development of artificial intelligence (AI) and medical robotics in minimally-invasive surgery. The less invasive the surgical intervention and the further the surgeon is from the operating table, the greater the roles of decision support systems (AI) and performance of specific tasks (by medical robots).

RESUMEN: La obesidad es el resultado de un desbalance entre la ingesta calórica y el gasto energético. La obesidad mórbida incluye pacientes con índice de masa corporal mayor a 35 con co-morbilidades asociadas o con índices mayores de 40 sin co-morbilidades. Estos pacientes no logran pérdidas del exceso de peso sostenido cuando lo intentan a través de tratamiento médico, por ello el tratamiento quirúrgico es la única opción que permite la pérdida de peso efectiva a largo plazo. La gastrectomía en manga permite resecar la porción donde predomina la producción de grelina: hormona orexígena involucrada en la regulación del apetito, proporcionando un efecto adicional al restrictivo derivado de la disminución del volumen gástrico. Se incluyeron 11 pacientes en el trabajo 36 % hombres y 64 % mujeres. El IMC promedio fue de 42 kg/m 2 , las morbilidades la padecían el 54 % de los pacientes y las más frecuentes fueron dislipidemia e hipertensión, tiempo operatorio promedio fue de 90 min, hubo una sola complicación mayor que ameritó conversión y la evolución posoperatoria fue estupenda con pérdidas del exceso de peso de 66 % y disminución del IMC de 25 % en promedio a los seis meses, con mejoría del 100 % de las morbilidades. La gastrectomía en manga es un procedimiento efectivo, sencillo, reproducible, con escasa morbilidad que mantiene la fisiología del vaciamiento gástrico con la adición de la influencia hormonal a través de la disminución de la producción de grelina y otros mecanismos hormonales que participan en la regulación del apetito y la saciedad. ABSTRACT: The obesity is the result of a trouble between the caloric ingestion and the energetic expense. The morbid obesity includes patients with index of corporal bigger mass than 35 with associate co-morbidities or with major indexes of 40 without co-morbidities. These patients do not achieve losses of the supported overweight when they try it across medical treatment, for it the surgical treatment is the unique option that allows the effective long-term loss of weight. The gastrectomía in sleeve allows to resect the portion where it predominates over the production of ghrelina: orexígen hormone involved in the regulation of the appetite, providing an additional effect to the restrictive derivative of the decrease of the gastric volume. 11 patients included in the clinical trial 36 % men and 64 % women. The average IMC was of 42 kg/m 2 , the morbidities were suffering 54 % of the patients and the most frequent were dislipidemia and hypertension, operative average time was 90 minutes, there was an alone major complication that deserved conversion and the evolution post operative was marvellous with losses of the overweight of 66 % and decrease of the IMC of 25 % in average to six months, with improvement of 100 % of the morbidities. The gastrectomía in sleeve is an effective, simple, reproducible procedure, with scanty morbidity that supports the physiology of the gastric voidance with the addition of the hormonal influence across the decrease of the production of grelina and other hormonal mechanisms that take part in the regulation of the appetite and the satiety.

- by Joanne L Salas Rodríguez
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- Obesity, Minimally Invasive Surgery, Obesity Surgery

Lower lumbar disc disorders pose a significant problem in an aging society with substantial socioeconomic consequences.
Both inner tissue (nucleus pulposus) and outer tissue (annulus fibrosus) of the intervertebral disc are affected by such
debilitating disorders and can lead to disc herniation and lower back pain. In this study, we developed an alginate–collagen
composite porous scaffold with shape-memory properties to fill defects occurring in annulus fibrosus tissue of degenerated
intervertebral discs, which has the potential to be administered using minimal invasive surgery. In the first part of
this work, we assessed how collagen incorporation on preformed alginate scaffolds influences the physical properties
of the final composite scaffold.We also evaluated the ability of annulus fibrosus cells to attach, migrate, and proliferate on
the composite alginate–collagen scaffolds compared to control scaffolds (alginate only). In vitro experiments, performed
in intervertebral disc-like microenvironmental conditions (low glucose and low oxygen concentrations), revealed that for
alginate only scaffolds, annulus fibrosus cells agglomerated in clusters with limited infiltration and migration capacity.
In comparison, for alginate–collagen scaffolds, annulus fibrosus cells readily attached and colonized constructs, while
preserving their typical fibroblastic-like cell morphology with spreading behavior and intense cytoskeleton expression.
In a second part of this study, we investigated the effects of alginate–collagen scaffold when seeded with bone marrow
derived mesenchymal stem cells. In vitro, we observed that alginate–collagen porous scaffolds supported cell proliferation
and extracellular matrix deposition (collagen type I), with secretion amplified by the local release of transforming
growth factor-b3. In addition, when cultured in ex vivo organ defect model, alginate–collagen scaffolds maintained
viability of transplanted mesenchymal stem cells for up to 5 weeks. Taken together, these findings illustrate the advantages
of incorporating collagen as a means to enhance cell migration and proliferation in porous scaffolds which could be
used to augment tissue repair strategies.

Chest wall invasion is seen in 5% to 8% of patients presenting with lung cancer. We report a case of complete resection of a 14 cm × 9 cm pT3N0M0 squamous cell carcinoma arising from the right lower lobe and invading the lower chest wall posteriorly, in a 75 years old male, via a hybrid thoracoscopic [video assisted thoracoscopic surgery (VATS)] approach. Following conventional VATS lobectomy, a targeted 10 cm
incision was performed to allow wide resection of the 7th to 10th ribs and 6th to 9th transverse processes, with the defect being subsequently reconstructed with a composite rigid prosthesis. The patient made an
uneventful recovery, and was discharged on the 3rd postoperative day; with later adjuvant chemotherapy. Thoracoscopic surgery is not currently widely adopted in patients with chest wall invasion, likely due to the technical difficulties. We briefly review the various techniques described in the current literature, whilst emphasising a role for such an approach in highly selected cases.

Objectives: To look at the early results of total knee replacement in King Abdulla University Hospital (KAUH), and decide whether we should continue offering this service or not? Methods: We retrieved the files of all patients who underwent total knee joint replacement in KAUH since its commissioning on 2002. We looked at certain epidemiological factors such as age, sex, weight and risk factors. We explained our preoperative plan, surgical techniques, types of prosthesis inserted, and the complications encountered. Results: The number of patients was 210, while the number of knees replaced were 267 joints. 80% of our patients were females, right and left side knees were replaced equally. The mean age of patients was 63.3 years, while the mean weight was 84.6 kgms. Only thirty patients were free of any co-morbidity, and the rest of them had at least one symptom of co-morbidity. The vast majority of patients have advanced primary osteoarthritis. Mobile bearing prosthesis were mostly used. The complications rate was 20%, most of which were in the form of superficial wound infection. Conclusions: Total knee replacement is a thriving surgery in Jordan, to keep going we must stick to the sound principles. Such a major surgery should be done in specialized centers. So far, we think that our results are satisfying and we will continue doing this type of surgery.

- by Ziad Audat
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- Orthopedic Surgery, Spine Biomechanics, Spine Surgery, Minimally Invasive Surgery

Introduction: The aim of this research is to assess the learning curve of flexible ureteroscopic stone extraction skill using the UroMentorTM simulator and transfer of this skill to the operating theatre. Methods: After obtaining ethics approval, urology Post-Graduate Trainees (PGTs) from Post-Graduate Years (PGY) 1-4 participated in the study. The study was conducted in two phases. During phase I, participants completed three weekly one-hour training sessions on the UroMentorTM simulator practicing task 10. In this task, two stones from the left proximal ureter and renal pelvis were extracted using a basket under fluoroscopic guide. Objective assessments by the simulator and subjective assessments using the validated Ureteroscopy-Global Rating Scale (URS-GRS) were used to establish the learning curve. During phase II, the URS-GRS tool was used to assess performance of participants in the operating theatre. Results: In phase I, ten urology PGTs (PGY1-4) with mean age of 27.6±1.9 (25-31) years participated in the study. PGTs practiced a total of 62 times, with a mean operative time of 13.8±7.3 minutes and a mean fluoroscopy time of 9.7±16.4 seconds. Competency in task 10 was achieved after seven trials on the UroMentorTM simulator. In phase II, seven PGTs were assessed during 60 consecutive flexible ureteroscopic stone extraction procedures in the operating theatre. The mean operative time was 55.6±14.6 minutes and the mean fluoroscopy time was 28.6±6.4 seconds. There was a significant positive correlation between URS-GRS scores obtained on the simulator and in the operating theatre (r=0.76, p=0.044), thus establishing predictive validity of performance on the UroMentorTM simulator. Moreover, URS-GRS scores of all participants increased both on the simulator and in the operating theatre (p<0.05). Conclusion: In conclusion, competency in flexible ureteroscopic stone-extraction (task 10) on the UroMentorTM simulator was achieved after seven trials. Since there was a strong positive correlation between URS-GRS scores on the simulator and in the operating theatre, the skill obtained on the simulator could be transferred to the operating theatre.

The past several decades have seen remarkable advancements in percutaneous interventions for treatment of congenital heart disease (CHD). These advancements have been significantly aided by improvements in noninvasive diagnostic imaging. The use of three-dimensional (3D) printed models for planning and simulation of catheter-based procedures has been demonstrated for numerous cardiac defects and has been shown to reduce complications, procedure times, and limit radiation exposure. This paper reviews the process by which patient-specific 3D cardiac models are produced, as well as numerous applications of these models for use in percutaneous interventions in CHD.

- by Mary Ma
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- 3D printing, Minimally Invasive Surgery, Three Dimensional, Congenital Heart Disease

Objectives: We report an early, single-institution experience of Robot-Assisted Minimally Invasive McKeown Esophagectomy (RAMIME) using a four-arm platform. The technique details, rationale, complications, and pitfalls during procedure development are discussed.
Methods: This was a retrospective observational study.
Results: Nine of the 11 patients (median age: 57 years [range: 45-83]) had a complete (R0) resection; 10 were given induction treatment combined with chemoradiation. The median operative time was 795 min (range: 635-975). The median thoracoscopic console time was 270 min (range: 135-330). The median laparoscopic console time was 160 min (range: 150-260 min). The median blood loss was 300 cm3 (range: 100-650), and the median length of hospital stay was 18 days (range: 14-36). The median number of lymph nodes harvested was 28 (range: 9-39). No patients were converted to open procedures. Four patients had major complications; one died of liver failure on postoperative day 16; and none had clinically significant anastomotic leaks.
Conclusions: RAMIME is feasible. With good understanding of the robotic concepts and a good robotic team, RAMIME is worth trying. In addition to its well-known benefits, RAMIME permits replacing one human assistant.

Based on case studies in minimally invasive surgery, the paper investigates how head-mounted displays (HMDs) transform action and perception in the operating theater. In particular, it discusses the methods and addresses the obstacles that are linked to the attempt to eliminate the divide between vision and visualization by augmenting the surgeon’s field of view with images. Firstly, it analyzes how HMDs change the way images are integrated into the surgical workflow by looking at the modalities of image production, transmission, and reception of HMDs. Secondly, it examines how HMDs change where and in which situations images are used by looking at screen architectures in minimally invasive surgery. Thirdly, it discusses the impact of HMD-based practice on action, perception, and decision-making, by examining how HMDs challenge the existing techniques and routines of surgical practice and, therefore, call for a new type of image and application-based expertise.

- by Moritz Queisner
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- Human Computer Interaction, Surgery, Computer Vision, Medical Imaging

In minimally invasive robotic surgery (MIRS), a surgeon teleoperates a robotic arm from a
master console. This arm operates inside the patient's body through a small orifice which constrains
the end-effector's translation along two axes. The workspace of such a robotic arm depends on its
design as well as orifice location. Conventionally, the design of such an arm is optimized for large
workspace and high dexterity. However, this large workspace might be reachable through only a few
orifices, thus making the workspace volume and operation quite sensitive to the orifice location. To
overcome this problem, we optimized the design of a 3 degrees of freedom serial robotic arm to attain
multiple adjacent (desired number of) possible orifice locations, through which a planar workspace of
pre-specified geometry can be traced. To achieve this goal, an algorithm was developed to relate the
design of such an MIRS arm to the possible orifice positions. The optimization problem was solved
using several metaheuristics such as simulated annealing, Tabu search, artificial bee colonization and
genetic algorithm, and their performance was compared.

- by Livjot Sachdeva
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- Otolaryngology, Pediatrics, Biofilms, Tissue Engineering

OBJECTIVES: The decision to proceed with surgical treatment for pectus excavatum (PE) is rarely clear-cut. Patients interested in treatment are referred for evaluation by numerous different specialists, but psychosocial counselling is currently not included in this process. Our objective was to assess whether PE patients would be interested in formal assistance with the decision-making process surrounding PE surgery using narrative therapy principles. METHODS: Ninety-seven untreated PE patients at 5 different institutions in 4 countries completed a questionnaire consisting of 13 questions , with 3 questions specifically evaluating interest in narrative therapy. RESULTS: Eighty-two percent of participants were interested in narrative therapy to assist with the decision-making process surrounding PE surgery. Individuals most interested in narrative therapy tend to be more interested in correction (P < 0.05) to improve the way they feel about their body (P < 0.05). CONCLUSIONS: The majority of PE patients are interested in narrative therapy to aid the decision-making process about treatment. We propose that narrative therapy should be offered to PE patients during the treatment evaluation process to address the psychosocial difficulties associated with PE and the surgical decision-making process overall. Future studies should assess the effectiveness of this interdisci-plinary model.

- by Davide Ticchi
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- Gender Studies, Narrative Methods, Masculinities, Narrative Theory

Objective. The aim of the study is to evaluate adenomyosis in patients undergoing surgery for different type of endometriosis. It is an observational study including women with preoperative ultrasound diagnosis of adenomyosis. Demographic data and symptoms were recorded (age, body mass index, parity, history of previous surgery, dysmenorrhea, dyspareunia, dyschezia, dysuria, and abnormal uterine bleeding). Moreover a particular endometrial shape "question mark sign" linked to the presence of adenomyosis was assessed. Results. From 217 patients with ultrasound diagnosis of adenomyosis, we found 73 with ovarian histological confirmation of endometriosis, 92 with deep infiltrating endometriosis, and 52 patients who underwent surgery for infertility. Women with adenomyosis alone represented the oldest group of patients (37.8 ± 5.18 years, P = 0.02). Deep endometriosis patients were nulliparous more frequently (P < 0.0001), had history of previous surgery (P = 0.004), and co...

- by Renato Seracchioli
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- Minimally Invasive Surgery

Background. Relaparoscopic treatment of inguinal hernia recurrences has become a relatively new concept with favourable results. The purpose of this study was to examine a series of relaparoscopic repair, present technical experiences, and the clinical outcomes in this subset of patients. Patients and Methods. The medical records of five patients who underwent relaparoscopic repair (TAPP or TEP) for a recurrence between March 2005 and September 2012 were retrospectively reviewed. Results. All the patients were male with a mean age of 45 years. Technical failures in the previous repairs were the main factors contributing to recurrences. In two re-TEP cases with no previous mesh fixation, the old mesh remained on the peritoneal side during preperitoneal dissection and this greatly facilitated surgical manipulation. The mean operative time was 93 min (range, 45-120 min). There were no conversions, no intraoperative complications, and no morbidity or rerecurrence after a mean follow-up period of 17 months (range, 7-24 months). Conclusion. Relaparoscopic repair appears to be safe and effective in the treatment of recurrent inguinal hernia and repeated TEP could be a simpler approach than expected in the presence of no prior mesh fixation.

- by Metin Ertem and +1
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- Minimally Invasive Surgery

Rationale and Objectives: Accurate diagnosis and staging of cervical precancers is essential for practical medicine in determining the extent of the lesion extension and determines the most correct and effective therapeutic approach. For accurate diagnosis and staging of cervical precancers, we aim to create a diagnostic method optimized by artificial intelligence (AI) algorithms and validated by achieving accurate and favorable results by conducting a clinical trial, during which we will use the diagnostic method optimized by artificial intelligence (AI) algorithms, to avoid errors, to increase the understanding on interpretation of colposcopy images and improve therapeutic planning. Materials and Methods: The optimization of the method will consist in the development and formation of artificial intelligence models, using complicated convolutional neural networks (CNN) to identify precancers and cancers on colposcopic images. We will use topologies that have performed well in similar image recognition projects, such as Visual Geometry Group Network (VGG16), Inception deep neural network with an architectural design that consists of repeating components referred to as Inception modules (Inception), deeply separable convolutions that significantly reduce the number of parameters (MobileNet) that is a class of Convolutional Neural Network (CNN), Return of investment for machine Learning (ROI), Fully Convolutional Network (U-Net) and Overcomplete Convolutional Network Kite-Net (KiU-Net). Validation of the diagnostic method, optimized by algorithm of artificial intelligence will consist of achieving accurate results on diagnosis and staging of cervical precancers by conducting a randomized, controlled clinical trial, for a period of 17 months. Results: We will validate the computer assisted diagnostic (CAD) method through a clinical study and, secondly, we use various network topologies specified above, which have produced promising results in the tasks of image model recognition and by using this mixture. By using this method in medical practice, we aim to avoid errors, provide precision in diagnosing, staging and establishing the therapeutic plan in cervical precancers using AI. Conclusion: This diagnostic method, optimized by artificial intelligence algorithms and validated by the clinical trial, which we consider “second opinion”, improves the quality standard in diagnosing, staging and establishing therapeutic conduct in cervical precancer.

- by Andreea Roxana Luca and +1
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- Artificial Intelligence, Oncology, Medical Informatics, Medical Device Design

Traditional open surgical technique for rectal cancer is associated with significant morbidity and impact on quality of life. Multiple structures are at risk during total mesorectal excision, which may have profound impact on sexual function, and urinary and fecal continence. In addition, having a temporary or permanent ostomy can have a significant effect on overall well-being. Patients have reported post-operative problems such as chronic wounds, poor body image, inhibited work and social function. Minimally invasive surgery (MIS) is an evolving component of colon and rectal cancer treatment that may have benefits over open surgery. The increasing role of laparoscopy for colon and rectal cancer has been associated with decreased morbidity, improved pain control, and reduced length of stay. However, laparoscopic surgery in rectal cancer remains technically difficult due to the inherent limitations of operating in the pelvis. Robotic surgery is a newer method for treating rectal cancer developed to overcome these limitations. Transanal endoscopic microsurgery and transanal MIS are techniques to achieve local excision, avoiding proctectomy in select patients, potentially improving functional outcomes. Transanal total mesorectal excision is an even newer technique to facilitate dissection of low rectal cancers. Controversy remains about equivalence in oncologic outcomes when these MIS approaches are used for rectal cancer. Even more unclear is the effect of MIS approaches on quality of life and how they compare to open surgery. This review discusses the most current evidence on the impact of various MIS techniques on quality of life after rectal cancer surgery.

This paper describes the design, fabrication and testing of a shape memory alloy based actuator system to provide three degrees of freedom bending with high flexibility and repeated use capability without any performance loss for minimally invasive surgery. The flexibility, long-term endurance and thermal characteristics of this system were studied. The system consisted of 3 segments, front, middle and back. Thermal simulations showed an increase in temperature of 1–2 °C at the segment nearest to the activated segment and a temperature increase of 1 °C at the segment furthest from the activated segment. Transformation strain simulations showed that the 8 mm width design has the lowest strain (2 %). The average maximum bending angle was above 30° across most actuator segments but a reformation angle of only 50 % of the maximum angle. The endurance test showed that all actuators can operate for 7,000 actuation cycles with a standard deviation of 0.6154, 0.8293 and 0.0364 mm for sections A, B and C, respectively. The system was capable of high angle of bending across all segments and capable of continuous long-term use with little performance deviation. The system will allow surgeons to have more flexibility during surgery and thus enable reaching difficult regions in minimally invasive surgery.

- by Marwan Nafea
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- Endoscopy, Shape Memory Alloys, Actuators, Minimally Invasive Surgery
- by Tudor Florin Ursuleanu and +1
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- Computer Science, Artificial Intelligence, Oncology, Medical Informatics

Inguinal hernia repair is one of the most commonly performed general surgery operations. Throughout the years there have been many variations and advancements, including open and laparoscopic techniques, to accomplish the same task of reducing herniated contents and preventing groin hernia recurrence. An array of factors contributes to deciding which operative technique is the best approach to managing a patient presenting with an inguinal hernia. Published data vary due to the heterogeneity of techniques compared, patient presentations, and surgeon expertise. In experienced hands, laparoscopic repair results in a quicker return to work and reduced postoperative pain. Patients with bilateral groin hernias, female patients with groin hernias, and patients with recurrent hernias after prior anterior mesh repair should be offered a laparoscopic preperitoneal mesh approach, when surgeons have the appropriate skill set and experience. We find that open and laparoscopic techniques of inguinal hernias can both achieve exceptional outcomes when applied to the right patient population. To know one's own capabilities, it is beneficial for surgeons to have baseline familiarity of the multitude of methods of repair, become proficient in both mesh and mesh-free techniques as well as open and laparoscopic techniques to best tailor the surgery to the patient and the clinical circumstances, and follow personal outcomes to evaluate individual results.

- by Mary Ma
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- Herniorrhaphy, Minimally Invasive Surgery, Inguinal Hernia, Laparoscopy

Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90⋅2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72⋅3 per cent. Globally, 81⋅7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37⋅7 per cent of cancer operations (2 324 070 of 6 162 311) and 25⋅4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely. * Members of the COVIDSurg Collaborative are co-authors of this study and are listed in Appendix S1 (supporting information)

- by Jibril O Bello
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- Orthopedic Surgery, Surgery, Bariatric Surgery, Cardiothoracic Surgery

Robotics systems designed for surgical applications such as Neurosurgery, likely may need to implement synchronous communication in real time and asynchronous learning. It will likely primarily be oriented towards spatial imaging and 3D virtualization, various communication protocols, and calibration settings in order to perform optimal results. In regards to computation, it needs to be heavily fault tolerant in operation. It also needs to be aware of false positives. Likely a complex deep brain surgical robotics system would implement variations of brain mapping technology and may utilize topological neuroanatomy. Various technologies in regards to the mapping of the brain, visualization, robotics and mechatronics systems would need to be in place. This paper is to look at the sciences through a theoretical and conceptual process. This isn't FDA reviewed for medical accuracy and is meant to warrant a theoretical paper where information is "as-is". This will hopefully provide a blueprint for continuing research later on.

This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

- by Guaracilei Vidigal and +1
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- Dentistry, Bone Regeneration, Minimally Invasive Surgery, postextracion alveolar bone regeneration

Internal snapping hip is a recognized cause of hip pain caused by recurrent subluxation of the iliopsoas tendon. When conservative treatment fails, surgical release of the iliopsoas tendon may be indicated using an arthroscopic or open hip approach. Results have been better with arthroscopic release. We report a case of a 32-year-old active female with a painful internal snapping hip. The right hip extension from a flexed position produced a strong and audible snap. A tenotomy of the iliopsoas in combination with a resection of the lesser trochanter was performed, using a limited medial hip approach different than the one described by Ludloff and Ferguson. The pain and snapping phenomenon were solved; however, a slight heterotopic ossification, as well as a weakness in the flexion of the hip was noted after the procedure, with no functional limitation. The minimally invasive medial hip approach appears to be a simple, reproducible and successful operation for the treatment of an internal snapping hip caused by the iliopsoas tendon, namely in orthopaedics departments with limited experience in hip arthroscopic approach, but it is not superior to arthroscopic release.

We describe a percutaneous or minimally invasive approach to apply an augmentation of pedicle fenestrated screws by injection of the PMMA bone cement through the implant and determine the safety and efficiency of this technique in a clinical series of 15 elderly osteoporotic patients. Clinical outcome and the function were assessed using respectively the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI). Peri- and post-operative complications were monitored during a minimum of 2 years of follow-up. Radiographic follow-up was based on plain fluoroscopic control at 3, 6 and 12 months and every year. In this approach, four steps were considered with care: optimal positioning of the screws, correct alignment of the screw heads, waiting time before the injection of cement, fluoroscopic control of the cement injection. Using these precautions, only 2 minor complications occurred. VAS scores and ODI questionnaires showed a statistically significant improvement up to...

- by Michal Rynkowski
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- Minimally Invasive Surgery

Purpose: Defining the effectiveness of the embolization of the splenic artery (ESA) in the treatment of patients with liver cirrhosis. Materials and Methods: We have analyzed the results of treatment 318 patients with cirrhosis who were hospitalized in the 2-clinic of the Tashkent Medical Academy in 2007-2014. Most of the patients (201) were males, mean age was 35.1±17.7 years. For the purpose of monitoring performed comprehensive study, including clinical, laboratory and special instrumental methods of research. To assess the severity of the Hepatic Failure (HF) used classification of Child-Turcotte-Pugh (CTP). Bleeding from the esophagus and stomach varices history was noted in 207 (65.1%) patients, in 151 (47.5%) of them had been made endoscopic ligation varices of esophagus and stomach and 56 (17,6%) patients was successfully performed percutaneous transhepatic embolization coronary vein and short gastric vein using the technique described by Lunderquist et al. Pronounced hemodynamic disorder on the background of anemia accompanied by deteriorated metabolic and functional status of the liver and other organs. Therefore, 32.0% detected HF class-A by CTP, at 45.6%-Class-B and 22.4%-Class C. The indications for ESA are splenomegaly with Original Research Article Karimov et al.; BJMMR, 13(5): 1-10, 2016; Article no.BJMMR.23484 2 hypersplenism, and without it, varices of esophagus and stomach, high portal pressure (PP). Contraindications were severe general condition of the patient, the high activity of cirrhotic process, which was estimated at the level of bilirubin and ALT, AST. Results: The effectiveness of endovascular interventions we evaluated on the following criteria: changes in general clinical and biochemical parameters of blood, portal blood flow dynamics and the state of varices of esophagus and stomach, the incidence of bleeding, the overall mortality rate and life expectancy. Laboratory analysis was carried out after stabilization of the patients in terms from 1 to 3 months, revealed an increase in cellular composition and the level of hemoglobin. The number of leukocytes increased to 6.8±0.24×109/L, platelet – to176.3±15.8×109/L,34 the hemoglobin level was 94.7±12.4 g/l. The increase in arterial blood supply of the liver caused by the redistribution of blood flow after ESA, accompanied by an improvement of the functional state of the liver, which evaluated by a number of clinical and laboratory parameters in 37 the at 1 month, 3 months, 6 months and 12 months. Results of the study of the portal system show that in the period of 3 months after the ESA with a decrease of PP428,7±10,2 to 342,3±12,6 mm of water. Conclusion: Splenic artery embolization after endoscopic band ligation varices of esophagus and stomach or transhepatic embolization coronary vein and short gastric vein reduces the risk of rebleeding and maybe use as method for improve liver function and decrease of portal hypertension.

- by Bekhzod Abdullaev
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- Liver Cirrhosis, Minimally Invasive Surgery, Abdominal Surgery

Purpose: Nonsurgical glaucoma therapy reduces intraocular pressure (IOP) by a percentage that is similar for most patients. Recently introduced microincisional glaucoma surgeries are different because they remove the trabecular meshwork that constitutes the primary resistance to outflow. We hypothesized that because of this, the resulting postoperative IOP, rather than the relative reduction, had to be independent of glaucoma severity. We applied a glaucoma index (GI) to analyze outcomes of trabectome surgery combined with phacoemulsification (PT) by glaucoma severity. Methods: Only PT with 12 month follow up and no other surgeries were included. GI incorporated preoperative IOP, medications (meds) and visual field (VF). Baseline IOP was divided into 4 groups, <20 mmHg, 20-29 mmHg, 30-39 mmHg, and above 40 and assigned with 1 to 4 points. Meds was divided into 4 groups: ≤1, 2, 3, or ≥4, and assigned values of 1 to 4. VF was separated into 4 groups with points from 1 to 4: mild, moderate, advanced and end stage. GI was then defined as VF*meds*IOP and separated into GI1: <3, GI2: 3-5, GI3: 6-11 and GI4 ≥12. We tested for an association between GI group and IOP reduction at one year as well as age, gender, race, diagnosis, cup to disc (C/D) ratio, and Shaffer grade, using linear regression. Results: Phaco-AIT was analyzed in 498 cases. These patients had a mixed indication of a visually significant cataract and the need to lower IOP or an interest in lowering the number of glaucoma medications. Mean IOP reduction after one year was 2.9±4.4, 3.6±5.0, 3.9±5.3, and 9.2±7.6 mmHg for GI groups 1 to 4, respectively. Linear regression showed that IOP reduction was associated with GI group after adjusting for age, diagnosis, and visual acuity (logMAR). For patients that differ in GI group by 1, patients in a higher GI group had an IOP reduction greater by 1.7±0.2 mmHg than patients in a lower GI group. Survival rate at 12 months was 98%, 93%, 96% and 88% for GI groups 1 to 4. Log-rank test suggested a statistically significant difference in survival distributions between GI groups. Conclusion: Despite a less absolute indication to lower IOP compared to patients undergoing trabectome surgery as a stand-alone procedure, a substantial IOP reduction was seen that was larger in subjects with more advanced glaucoma. This matches the concept that the trabecular meshwork is the primary impediment to outflow and its ablation benefits those eyes relatively more than in mild glaucoma. Higher GI groups are expected to have a greater reduction of IOP and appear to be similarly suited to trabectome surgery as a first step towards pressure control.

- by Nils Loewen and +3
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- Glaucoma, Minimally Invasive Surgery, Glaucoma Surgery, Glaucoma Microsurgery