Comparison of the FreeHand® robotic camera holder with human assistants during endoscopic extraperitoneal radical prostatectomy

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The use of robotic arms for instrument and camera manipulation has been proposed for more than a decade. The current study provides a direct comparison of robotic camera movement to the conventional human camera holding assistance in real operative room setting.

OBJECTIVE

? To assess, in a prospective randomized study, the efficiency of the FreeHand® (Prosurgics Ltd, Bracknell, UK) compared to manual camera control during the performance of endoscopic extraperitoneal radical prostatectomy (EERPE).

PATIENTS AND METHODS

? Three surgeons performed 50 EERPE for localized prostate cancer. In group A (n= 25), procedures were performed with manual control of the camera by the assistant, whereas group B (n= 25) patients were treated with the assistance of the FreeHand® robotic device. ? The EERPE procedure was divided into several steps. ? Total operation duration, time for each surgical step, number of camera movements, number of movement errors, number of times the lens was cleaned, blood loss and margin status were compared.

RESULTS

? No statistically significant difference was observed in terms of patient age, preoperative prostate‐specific antigen level, Gleason score, positive cores and prostate volume. ? The average operation duration required for the performance of each step did not differ significantly between the two groups. ? Significant differences in favour of the FreeHand® camera holder were observed in case of horizontal and zooming camera movement, camera cleaning and camera errors. ? Vertical camera movements were performed significantly faster by the human assistant compared to the robotic camera holder. ? The average total operation duration was similar for both groups. ? Positive surgical margins were detected in one patient in each group (4% of the patients).

CONCLUSIONS

? A comparison of the FreeHand® robotic camera holder with human camera control during EERPE showed a similar time requirement for the performance of each step of the procedure. ? The robotic system provided accurate and fast movements of the camera without compromising the outcome of the procedure.     

基于彩色多普勒速度能量图评价肌瘤内消丸治疗子宫肌瘤的临床疗效

目的:运用彩色多普勒速度能量图技术,探讨益气祛瘀、活血散结类中药配伍之肌瘤内消丸,对子宫肌瘤的作用机制及临床疗效。方法:运用彩色多普勒速度能量图将子宫肌瘤患者瘤体血流分为0级、I级、Ⅱ级和III级。将62例患者随机分为治疗组32例和对照组30例,治疗组采用名老中医肖承悰教授之经验方肌瘤内消丸治疗;对照组口服中成药桂枝茯苓胶囊治疗,两组均连续服用3个月,治疗前、后24 h内均进行彩色多普勒速度能量图检查并存储图像,观察子宫肌瘤患者瘤体血流频谱变化及评价肌瘤内消丸疗效。结果:治疗组在肌瘤血流减少程度,肌瘤大小与子宫体积减小程度,疗效方面均优于对照组,差异有统计学意义(P0.05)。结论:肌瘤内消丸治疗子宫肌瘤,具有良好的消融疗效,值得临床推广。     

Biodistribution of liposomal I-VIP in rat using gamma camera

Vasoactive intestinal peptide (VIP), a 28 amino-acid peptide was labeled with ¹³¹I and encapsulated into liposomes. ¹³¹I-VIP or liposomal ¹³¹I -VIP was administered intravenously into the rats. The distribution was studied by a gamma camera and established by counting the radioactivity in the removed organs. The elimination half-life for the liposomal ¹³¹I-VIP in both blood and lungs was significantly longer (5.29 and 9.28 min, respectively) than that obtained after the administration of ¹³¹I-VIP (0.62 and 3.18 min, respectively). Dynamic scans using a gamma camera after the administration of liposomal ¹³¹I-VIP showed a higher uptake of the liposomal form into the lungs compared with ¹³¹I-VIP. The lack of VIP in asthmatics has been shown in previous studies. However, the clinical investigations using VIP were disappointing most probably due to the rapid degradation of the peptide in the bronchial tract. This in fact is supported by our previous study, in which we demonstrated that VIP had a half-life of 0.45 min in blood. We conclude that the encapsulation of VIP in liposomes prolongs its elimination half-life in plasma and enhances its uptake in lungs. This observation may increase the clinical use of VIP in both diagnostic and therapy.     

The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: Visual spatial ability as a predictor for improved surgical performance: a randomized trial

Introduction:Due to the current COVID-19 pandemic, surgical training has become increasingly challenging due to required social distancing. Therefore, the use of virtual reality (VR)-simulation could be a helpful tool for imparting surgical skills, especially in minimally invasive environments. Visual spatial ability (VSA) might influence the learning curve for laparoscopic surgical skills. However, little is known about the influence of VSA for surgical novices on VR-simulator training regarding the complexity of different tasks over a long-term training period. Our study evaluated prior VSA and VSA development in surgical trainees during VR-simulator training, and its influence on surgical performance in simulator training.Methods:In our single-center prospective two-arm randomized trial, VSA was measured with a tube figure test before curriculum training. After 1:1 randomization, the training group (TG) participated in the entire curriculum training consisting of 48 different VR-simulator tasks with varying difficulty over a continuous nine-day training session. The control group (CG) performed two of these tasks on day 1 and 9. Correlation and regression analyses were used to assess the influence of VSA on VR-related surgical skills and to measure procedural abilities.Results:Sixty students (33 women) were included. Significant improvements in the TG in surgical performance and faster completion times were observed from days 1 to 9 for the scope orientation 30° right-handed (SOR), and cholecystectomy dissection tasks after the structured 9-day training program. After training, the TG with pre-existing low VSA scores achieved performance levels similar to those with pre-existing high VSA scores for the two VR simulator tasks. Significant correlations between VSA and surgical performance on complex laparoscopic camera navigation SOR tasks were found before training.Conclusions:Our study revealed that that all trainees improved their surgical skills irrespective of previous VSA during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more distinct in complex simulator tasks. Further, we demonstrated a positive relationship between VSA and surgical performance of the TG, especially at the beginning of training. Our results identified pre-existing levels of VSA as a predictor of surgical performance.     

Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries

Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.     

慢性压迫背根神经节对TRPV1功能作用的研究进展

辣椒素受体（TRPV1）是瞬态感受器电位非选择性阳离子通道,在介导炎性痛、内脏痛等多种痛觉方面均起重要作用,是目前研究疼痛机制与研发镇痛药物的一大热点。慢性腰背痛是临床上常见的疾病,椎间盘突出是常见病因之一。现阶段研究表明,TRPV1在介导神经病理性疼痛和热痛觉过敏中起着关键性作用,同时TRPV1阳性神经元介导了慢性神经痛的发生。     

利用数码相机测定面部皮肤颜色的初步研究

目的:利用数码相机进行面部皮肤颜色测定的可行性与合理性的研究.方法:在进行颜色采集之前,首先测定实验光源的稳定性.使用Canon EOS 20D单反数码相机,在实验光源稳定的时间内,以相同的拍摄参数(快门1/25 s,光圈4.5 自定义白平衡,ISO 800)采集122 例22～32 岁受试人群颌面部的皮肤颜色,拍摄文档保存为Jpeg格式.图像经Adobe photoshop7.0统一校色后,拾取皮肤CIE L*a*b*色度学空间颜色数据,利用SPSS 10.0做统计描述.结果:实验光源在21～70 min内是稳定的,可以达到比色要求.实验测得皮肤的L*a*b*色度学参数范围为:L* 49～66,a* 7～18,b* 5～22.结论:面部皮肤色度参数与测色手段和方式密切相关,数码相机作为面部赝复体的比色方法,在面部皮肤色彩信息全面采集、色彩信息准确传递方面,具有独特优势.