New approaches to pectus and other minimally invasive surgery in Argentina

This is a presentation about the development of pediatric minimally invasive surgery and other pediatric surgical practices in Argentina. For the last 15 years, based on a collaborative approach, many surgical and nonsurgical procedures have been used in the treatment of long gap esophageal atresia and thoracic wall deformities. These procedures are described and detailed in original algorithms that are currently being used to treat our patients.     

Human tactile perception as a standard for artificial tactile sensing--a review

In this paper, we examine the most important features of human skin tactile properties with special emphasis on the characteristics which are vital in the design of artificial systems. Contrary to the visual and auditory senses, the touch signal is not a well-defined quantity. As a result, the researchers of this field are still dealing with the basics of collecting the most relevant data. Following this, mimicking the sense of touch by producing artificial tactile skin is a challenging process. Although the sense of touch is widely distributed all over the human body, the tactile perception in the human hand is of great importance in terms of surgical and medical robotics applications. In this study, the role of various mechanoreceptors in the human hand, such as, RA, SA I, SA II, and PC units are discussed in relation to the stimuli like force, position, softness, and surface texture. Taking human hand as a suitable tactile model, the necessary engineering features of an artificial tactile sensor, such as, spatial and temporal resolutions, force sensitivity, and linearity, are being reviewed. In this work, we also report on the current and possible future applications of tactile sensors in various surgical procedures.     

后外侧入路小切口微创人工全髋关节置换术初步报告

[目的]探讨后外侧入路小切口微创（minimally invasive surgery，MIS）人工全髋关节置换的手术方法和初期临床治疗效果。[方法]采用后外侧入路MIS技术为68例72髋实施人工全髋关节置换术。股骨头坏死34例，其中双侧3例；股骨颈骨折25例；髋关节骨性关节炎9例，其中双侧1例。[结果]手术切口长7．5～11cm，平均9．28cm；术中出血量200～480ml，平均280ml；术后3个月时Harris评分平均为93分。在以往采用传统后外侧入路行人工全髋关节置换的病例中，选择病种、性别，年龄、术前Harris评分相近的患者68例72髋做为对照组，对两组进行对比：（1）切口MIS组明显短于传统组；（2）术中出血量少于传统组；（3）3个月时的Harris评分高于传统组（P〈0．001）。[结论]采用MIS人工全髋关节置换技术，手术切口短，创伤小，出血少，术后功能恢复快，较传统的全髋置换术有明显的优势，但应有严格的手术指征和熟练的操作技术。     

Development of actuated and sensor integrated forceps for minimally invasive robotic surger

In minimally invasive surgery (MIS) the patient's skin forms a spatial barrier between the operation area and the surgeon. This prevents direct access to the operation site which causes a lack of dexterity and limits the sensation of tissue manipulation forces, therefore complicating MIS procedures significantly. A telepresence approach can overcome these limitations: Additional degrees of freedom (DoF) inside the patient provide full manipulability and force torque sensors at the distal end of the instrument allow precise measurement of interaction forces. Using a suitable man-machine interface and free cartesian motion kinaesthetic feedback can be achieved, thus providing a virtual open surgery environment to the surgeon. This article focuses on the development and first results of actuated and sensor integrated instruments as part of the DLR minimally invasive robotic surgery (MIRS) setup. The instruments as a front-end part of the MIRS setup form one base of a telepresence working environment and are crucial for semi-autonomous functions, e.g. motion compensation.     

CT定位微创治疗高血压脑出血

目的总结118例高血压基底节区脑出血CT定位微创抽吸术的治疗体会。方法CT定位，YL-1型颅内血肿穿刺针抽吸引流。术后血肿腔内注入尿激酶，并用生理盐水反复冲洗。动态CT复查。结果定位准确率达90％；首次抽吸后血肿量减少1／3—1／2，临床症状好转98例，血肿量变化不大9例，血肿量增加11例。结论CT定位微创治疗高血压脑出血具有操作简单，效果确切，经济安全，病死率低的优点。     

小儿腹股沟疝微创小切口手术治疗体会

目的:总结112例小儿腹股沟疝微创小切口手术治疗的临床效果。方法:采用横形小切口行疝高位结扎术,对112例小儿腹股沟疝进行疗效观察,主要包括手术方法、术后恢复时间、术后并发症等。结果:横形小切口腹股沟疝高位结扎术有着微创、切口小、操作简便、术后恢复快、切口美观等优点,被广大患儿家属所接受。结论:小儿腹股沟疝微创切口行疝高位结扎手术值得各级医院推广应用。     

经Quadrant系统微创治疗峡部裂型腰椎滑脱症的临床研究

[目的]探讨借助Quadrant系统微创治疗峡部裂型腰椎滑脱症的临床疗效。[方法]本组共收治峡部裂型腰椎滑脱症33例,年龄32～68岁,平均47岁;男性20例,女性13例;L4、5滑脱21例、L5S1滑脱12例。根据Meyer-ding分级,其中Ⅰ度滑脱5例,Ⅱ度滑脱23例,Ⅲ度滑脱5例。均采用后路两侧旁中央肌间隙入路,在Quadrant可扩张管道系统下行减压、复位、植骨、融合、内固定术。采用腰椎JOA(29分法)功能评分对患者术前、术后1年的腰椎功能进行评估,并计算改善率。通过影像学测量术前、术后1年的滑脱率、滑脱角、椎间高度评估滑脱矫正情况。[结果]随访时间25～46个月,平均35个月。术前JOA评分为(14.24±1.39)分,术后1年JOA评分为(25.03±1.15)分。术前与术后1年比较有统计学差异(P<0.01)。所有患者滑脱均有一定程度的矫正,滑脱率由术前(34.00±11.25)%恢复到术后1年(6.30±2.77)%;滑脱角由术前(-1.33±3.91)°恢复到术后1年(5.92±1.96)°;椎间高度由术前(4.66±1.36)mm恢复到术后(9.66±1.45)mm。所有病例均无脑脊液漏、无神经根损伤,植骨均骨性融合、内固定位置良好。[结论]借助Quadrant系统微创治疗峡部裂型腰椎滑脱症临床效果好、切实可行。     

Two-incision technique for minimally invasive total hip arthroplasty

Recently, there has been considerable interest and debate over the application of minimally invasive surgical approaches to primary total hip arthroplasty. The 2-incision technique employs intermuscular and internervous planes to gain access to the hip joint while minimizing the disruption of muscles and tendons. Through the anterior incision, the femoral neck is osteotomized and the head removed, followed by preparation and cementless reconstruction of the acetabulum. The posterior incision permits femoral preparation and reconstruction with a cementless stem. The potential benefits of this technique include decreased perioperative blood loss and pain, more rapid recovery of hip function and return to normal activity, a reduced length of hospital stay, and cosmetically appealing small scars. Other essential considerations include appropriate patient selection, adherence to surgical principles, and familiarity with specialized instruments and implants.