Assessment of the physical properties of laparoscopic myoma-fixation devices

Background The physical properties of three commercial 5-mm myoma-fixation devices available for clinical use (short-pitch corkscrew, long-pitch corkscrew, buttress-thread screw) and a standard wood screw were examined.Methods Fresh specimens of uterine leiomyoma masses were used to test the maximum traction force obtained from each device on 31 occasions. The myoma tissue at each traction site was evaluated histologically to determine its density. The maximal traction forces in each myoma density group were compared using a generalized estimating equations approach to linear regression based on repeated measures within each myoma. The bending strength also was determined for each device.Results A wide range of maximum traction forces with a mean of 130.8 ± 71.5 N (range, 21.6–341.6 N) over all devices and tissue densities was recorded. The mean maximum traction force provided by the short-pitch corkscrew (159.2 ± 12.2 N) was significantly higher (p < 0.01) than that of the other devices in medium-density myomas, and not significantly lower than that of other devices in low-density myomas. The mean maximum traction force provided by the buttress-thread screw was significantly lower than that of the short-pitch corkscrew only in medium density myomas, and did not differ significantly from that of the wood screw in any density group. The wood screw provided the highest bending strength (6.73 × 10⁴ N/m) (whereas the short- and long-pitch corkscrew provided the lowest (9.70 × 10² N/m and 1.95 × 10³ N/m, respectively) and the buttress-thread screw an intermediate (2.24 × 10⁴ N/m) strength (p < 0.0005 for all comparisons except for the two corkscrews).Conclusions Screw-type myoma-fixation devices can provide comparable traction force with high bending strength. A long-pitch corkscrew should not be used for laparoscopic myomectomy because of its low traction force and bending strength. When a commercial screw is not available, a standard wood screw can be used with acceptable traction force and very high strength for bending.     

The perforated intrauterine device: endoscopic retrieval.

BACKGROUND: Uterine perforation is the most serious complication associated with an intrauterine contraceptive device (IUD). Minimally invasive techniques, such as hysteroscopy and advanced laparoscopy, are ideally suited to the diagnosis and surgical management of the perforated IUD. CASE REPORTS: Three cases of uterine perforation caused by an IUD and treated with endoscopic surgery are presented. In all 3 cases, the IUD was located by using x-rays, ultrasonography, or pelvic magnetic resonance imaging. Diagnostic laparoscopy was performed to identify the specific location of the IUD and to remove it. All patients recovered without incident. CONCLUSION: The gynecologic surgeon should acquire familiarity with the complications of, and proficiency in managing, perforated and ectopic IUDs by using modern surgical techniques that permit the patient's rapid return to health.     

Slicer and tissue retrieval system for excisional endoscopic surgery

Extraction of large specimens risks detachment of malignant cells within the peritoneal cavity and contamination of the parieties with resultant seedling implantation at the access wounds. Therefore, extraction is best conducted through a rip-proof sleeve-retrieval system which creates a third space in which the specimen can be sliced under visual control. Slicing of tissue is preferable to morcellation or disintegration since it preserves the structural integrity of the tissue and thereby does not jeopardize histopathological examination and staging of excised tumors. Of the two types of tissue-slicing mechanisms investigated, the compression-moving blade system (CMB) was found to be superior to wire-cutting devices. A prototype CMB slicer has been developed which has been tested experimentally and is currently undergoing clinical evaluation.     

Controlled endoscopic retrieval of ectopic ureteral catheters using fluoroscopic guidance

The double-J ureteral catheter has been popularized as an ideal internal ureteral stent. Migration of the distal end of the catheter up the ureter, however, can complicate its safe removal. A safe, controlled method of stent extraction is described using a C-arm fluoroscopic unit.     

Assessment of physical fitness of female physical therapy students

This investigation was undertaken to assess the physical fitness status of physical therapy students. Fifty female students, enrolled as juniors in a physical therapy program of a private women's college, served as subjects. The students' body fat composition, low-backlhamstring flexibility, aerobic capacity (V02 ,. j, trunk muscular endurance, static and dynamic (isotonic) muscular strength were determined. All the tests were administered using standardized procedure. On the average, the subjects were 2 1.1 f 1.7 years old, 65.3 + 0.8 inches tall, weighed 60.1 + 0.9 kg, had 26.2 f 0.8% body fat, and had a predicted VOn, of 2.28 f 0.06 L . min-'. The low-backlhamstring flexibility and trunk muscular endurance were 36.8 + 1.1 cm and 26.4 f 0.9 repetitions, respectively. The static grip strength of the right hand was significantly (p c 0.05) greater than the left hand. The dynamic strength of the arm flexors and knee flexors on the ipsilateral side were not significantly different (p > 0.05). The knee flexors were weaker (p < 0.01) than the knee extensors. Results of the investigation revealed that the students' physical fitness compares well but is not superior to the norms reported previously for female physical therapy students and female college students of the same age. J Orthop Sports Phys Ther 1987;8(11):525-532.     

Positioning systems for endoscopic solo surgery

BACKGROUND: Endoscopic surgery has acquired undisputed importance in the field of both general and specialised surgery. The introduction of robotic technology in surgery has recently led to the development of new positioning systems for endoscopic surgery. These allow direct control of the endoscopic procedures by the surgeon, whose vision currently depends on the assistant in charge of positioning the optic camera in compliance with his wishes. METHODS: We experimented different positioning systems for optics and rigid endoscopic instruments for laparoscopy, some of which were our own design. Over 400 cholecystectomies were carried out by six different surgeons on phantoms containing animal organs. The experimental systems were AESOP (Computer Motion, USA), with both foot-pedal and voice control, ENDOASSIST (Armstrong Healthcare Co. UK), controlled by a device worn by the surgeon, FIPS Endoarm (Karlsruhe Research Centre, Germany), controlled by a joystick and voice, and the passive TISKA Endoarm system (Karlsruhe Research Centre, Germany). Combinations of two systems were compared, using one to position the optic and one to position the retractor instrument. RESULTS: Phantom tests, which are preferable owing to constant conditions, showed the feasibility of experiments in Solo Surgery conditions and highlighted the advantages and drawbacks of the various systems. In particular, the surgeons appreciated the intuitive use of the TISKA Endoarm system as a positioner for the retractor instrument and the optics, in spite of the fact that it was only a passive movement apparatus. Among the remote-control systems tested as an optics positioner, FIPS Endoarm controlled by a joystick was particularly intuitive and produced the best results in terms of time taken to complete the procedure. The time taken was even shorter than that in a large control group with human assistance. CONCLUSIONS: In our experience endoscopic Solo Surgery was found to be applicable to clinical practice. This will bring numerous advantages in terms of the precision of surgical procedures and savings in terms of time and human resources, with a consequent reduction of management costs. There is no doubt that this method represents a step forward in the application of technology to surgery.     

Assessment of material, structural, and functional properties of the human skeleton by pQCT systems

Peripheral quantitative computed tomography (pQCT) systems measure bone parameters noninvasively using low radiation doses. This limits image resolution but is practical for the diagnosis and quantitative monitoring of the properties of the peripheral human skeleton. pQCT determines volumetric bone mineral density separately in trabecular and cortical bone. It may combine densitometry determinations with geometric estimates and use strain-stress indexes, and it may be used to analyze muscle variables in some areas, allowing the study of regional fragility. Experimental and clinical ex vivo studies show that pQCT variables correlate with biomechanical predictors of fragility and/or fractures. Since pQCT was approved by the US Food and Drug Administration in 1997, new skeletal regions (human femur and mandible) have been considered in the development of the system. Basically, pQCT explores intraindividual and interindividual variations in greater detail and compares the impact of skeletal diseases, risk factors, and anabolic and catabolic treatments within a given bone cross section.     

Technique of radiological localisation and endoscopic retrieval of unusual foreign body from urinary bladder

Minimal invasive endoscopic retrieval of an unusual foreign body (Allen key) from urinary bladder in a young female patient is presented. The technique of radiological localisation using plain X-ray, often the only investigation available in small centres, is described.     

Assessment of the antimicrobial properties of maggots

Chronic bacterial colonisation or infection of wound is one of the major factors interfering proper wound healing, especially in diabetic foot ulcers. This study assesses the potential antimicrobial properties of maggots in vitro. This is a prospective randomised experimental study. Complete lysis of methicillin‐resistant Staphylococcus aureus, Pseudomonas aeruginosa, vancomycin‐resistant Enterococcus and Candida albicans cultures in the area of maggot application was observed 24 hours after application of live maggots in all culture plates and was confirmed by Gram staining. This lysis persisted for more than 5 days after the maggot application. Complete lysis of the bacterial or fungal cultures in the area of maggot application provides convincing evidence for the antimicrobial property of maggots. This effect has a significant implication in management of diabetic foot ulcers and vascular ulcers.     

Assessment of adventitial involvement of esophageal carcinoma by endoscopic ultrasonography

Summary The adventitial involvement (AI) of esophageal squamous cell carcinoma in 20 patients was analyzed by endoscopic ultrasonography (EUS) and computed tomography (CT). The findings were compared with the histologic evidence of tumor invasion in the resected specimens. AI was detected as an irregularity or interruption of the third layer of the esophageal wall on ultrasound examination. The overall accuracy in the assessment of depth of tumor invasion by EUS and CT scan was 80% and 68%, respectively. EUS diagnosed AI in 17 patients and detected direct tumor invasion of either the aorta, trachea or pericardium in 7 of them. In 4 patients who had severe stenotic lesions, EUS underestimated the depth of tumor invasion when compared to the histologic findings. Overall, these results, show that EUS when combined with CT scanning is a useful means of preoperatively evaluating tumor invasion in patients with esophageal carcinoma.     

老年前列腺癌患者身体状态评估的研究进展

在美国,前列腺癌(PCa)已成为第一位危害男性健康的肿瘤,在我国的发病率也逐年升高,但监测与治疗还是相对落后,很多患者在就诊时已是晚期或者年龄较大;治疗方案的选择尚无统一规范,患者状态的综合评估往往不够具体或者被忽略,这样进行的治疗可能会给患者带来过多的身体、心理和经济负担,甚至造成死亡;也有过于保守的,失去了最佳的治疗时机导致患者病情加重等。所以对于老年PCa患者治疗前的身体状态综合评估应该引起重视,选择最佳的治疗方案为患者带来最大益处。     

Robotic and systems technology for advanced endoscopic procedures

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in other fields of endoscopic surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. This consists of a system of devices for endoscopic surgery (HF, light source, etc...) with which the surgeon interacts directly, positioning systems for optic and instruments that the surgeon drives as the likes without assistance, and a chair to increase the comfort of the surgeon during surgery. The system of endoscopic devices named OREST (Dornier, München) designed already in 1992 opened the way to a number of systems available today that allow to the surgeon a direct control of the instrumentation. A considerable step ahead in endoscopic technology is the introduction of robotic technology to design assisting systems for solo-surgery and microsurgical instrument manipulators. Results of a number of experimental trials on combinations of different positioning devices are presented and commented. A further step in the employment of robotic technology is the design of "master-slave manipulators" to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system, named ARTEMIS, designed in cooperation with the Research Center in Karlsruhe, could be used in experimental applications. Clinical use of the system, however, will require further development of the arm mechanics and the control system. The combination with the implementation of telecommunication technology will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.