Sample records for surgical assistance systems

  1. Interfaces for Modular Surgical Planning and Assistance Systems


    Gessat, Michael


    Modern surgery of the 21st century relies in many aspects on computers or, in a wider sense, digital data processing. Department administration, OR scheduling, billing, and - with increasing pervasion - patient data management are performed with the aid of so called Surgical Information Systems (SIS) or, more general, Hospital Information Systems (HIS). Computer Assisted Surgery (CAS) summarizes techniques which assist a surgeon in the preparation and conduction of surgical interventions...

  2. Surgical data processing for smart intraoperative assistance systems

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    Stauder Ralf


    Full Text Available Different components of the newly defined field of surgical data science have been under research at our groups for more than a decade now. In this paper, we describe our sensor-driven approaches to workflow recognition without the need for explicit models, and our current aim is to apply this knowledge to enable context-aware surgical assistance systems, such as a unified surgical display and robotic assistance systems. The methods we evaluated over time include dynamic time warping, hidden Markov models, random forests, and recently deep neural networks, specifically convolutional neural networks.

  3. Robot-Assisted Fracture Surgery: Surgical Requirements and System Design. (United States)

    Georgilas, Ioannis; Dagnino, Giulio; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja


    The design of medical devices is a complex and crucial process to ensure patient safety. It has been shown that improperly designed devices lead to errors and associated accidents and costs. A key element for a successful design is incorporating the views of the primary and secondary stakeholders early in the development process. They provide insights into current practice and point out specific issues with the current processes and equipment in use. This work presents how information from a user-study conducted in the early stages of the RAFS (Robot Assisted Fracture Surgery) project informed the subsequent development and testing of the system. The user needs were captured using qualitative methods and converted to operational, functional, and non-functional requirements based on the methods derived from product design and development. This work presents how the requirements inform a new workflow for intra-articular joint fracture reduction using a robotic system. It is also shown how the various elements of the system are developed to explicitly address one or more of the requirements identified, and how intermediate verification tests are conducted to ensure conformity. Finally, a validation test in the form of a cadaveric trial confirms the ability of the designed system to satisfy the aims set by the original research question and the needs of the users.

  4. Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system. (United States)

    Schuler, Patrick J; Hoffmann, Thomas K; Veit, Johannes A; Rotter, Nicole; Friedrich, Daniel T; Greve, Jens; Scheithauer, Marc O


    Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Robot-assisted cardiac surgery using the da vinci surgical system: a single center experience. (United States)

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun


    We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.

  6. DaVinci canvas: a telerobotic surgical system with integrated, robot-assisted, laparoscopic ultrasound capability. (United States)

    Leven, Joshua; Burschka, Darius; Kumar, Rajesh; Zhang, Gary; Blumenkranz, Steve; Dai, Xiangtian Donald; Awad, Mike; Hager, Gregory D; Marohn, Mike; Choti, Mike; Hasser, Chris; Taylor, Russell H


    We present daVinci Canvas: a telerobotic surgical system with integrated robot-assisted laparoscopic ultrasound capability. DaVinci Canvas consists of the integration of a rigid laparoscopic ultrasound probe with the daVinci robot, video tracking of ultrasound probe motions, endoscope and ultrasound calibration and registration, autonomous robot motions, and the display of registered 2D and 3D ultrasound images. Although we used laparoscopic liver cancer surgery as a focusing application, our broader aim was the development of a versatile system that would be useful for many procedures.

  7. A development of assistant surgical robot system based on surgical-operation-by-wire and hands-on-throttle-and-stick. (United States)

    Kim, Myungjoon; Lee, Chiwon; Park, Woo Jung; Suh, Yun Suhk; Yang, Han Kwang; Kim, H Jin; Kim, Sungwan


    Robot-assisted laparoscopic surgery offers several advantages compared with open surgery and conventional minimally invasive surgery. However, one issue that needs to be resolved is a collision between the robot arm and the assistant instrument. This is mostly caused by miscommunication between the surgeon and the assistant. To resolve this limitation, an assistant surgical robot system that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. The system comprises two novel master interfaces (NMIs), a surgical instrument with a gripper actuated by a micromotor, and 6-axis robot arm. Two NMIs are attached to master tool manipulators of da Vinci research kit (dVRK) to control the proposed system simultaneously with patient side manipulators of dVRK. The developments of the surgical instrument and NMI are based on surgical-operation-by-wire concept and hands-on-throttle-and-stick concept from the earlier research, respectively. Tests for checking the accuracy, latency, and power consumption of the NMI are performed. The gripping force, reaction time, and durability are assessed to validate the surgical instrument. The workspace is calculated for estimating the clinical applicability. A simple peg task using the fundamentals of laparoscopic surgery board and an in vitro test are executed with three novice volunteers. The NMI was operated for 185 min and reflected the surgeon's decision successfully with a mean latency of 132 ms. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1000 times of gripping motion. The reaction time was 0.4 s. The workspace was calculated to be 8397.4 cm(3). Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test without any collision. Various experiments were conducted and it is verified that the proposed assistant

  8. Access to surgical assistance: challenges and perspectives

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    Maria Fernanda do Prado Tostes


    Full Text Available Objective to characterize the access to surgical assistance in Brazil. Method documentary study, with a quantitative approach, developed from information of the Caixa Preta da Saúde [Health Black Box] database, of the Brazilian Medical Association. Results in the one-year period 3773 cases related to health care in Brazil were recorded. There were 458 (12.3% records on surgical assistance. Of these, most, 339 (74.1%, involved the lack of access in all regions of Brazil. The main access constraint was the prolonged waiting time for surgery. Other constraints were the excessive waiting for medical appointment with experts, doing examinations and cancellation of surgeries. Conclusion the access to surgical assistance, by users of the Brazilian health system, is not widely guaranteed, reinforcing the need for integrated governmental actions, organization of the health care network, management of health care and human resources to overcome the challenges imposed to achieve the Universal Access to Health and Universal Health Coverage.

  9. Surgical Residents are Excluded From Robot-assisted Surgery

    DEFF Research Database (Denmark)

    Broholm, Malene; Rosenberg, Jacob


    PURPOSE: Implementation of a robotic system may influence surgical training. The aim was to report the charge of the operating surgeon and the bedside assistant at robot-assisted procedures in urology, gynecology, and colorectal surgery. MATERIALS AND METHODS: A review of hospital charts from sur...

  10. The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts. (United States)

    Saziye, Karaca; Afksendiyos, Kalangos


    In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5-10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement. © The Author(s) 2014 Reprints and permissions:

  11. A Comparative Study of Da Vinci Robot System with Video-assisted Thoracoscopy in the Surgical Treatment of Mediastinal Lesions

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    Renquan DING


    Full Text Available Background and objective In recent years, Da Vinci robot system applied in the treatment of intrathoracic surgery mediastinal diseases become more mature. The aim of this study is to summarize the clinical data about mediastinal lesions of General Hospital of Shenyang Military Region in the past 4 years, then to analyze the treatment effect and promising applications of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods 203 cases of mediastinal lesions were collected from General Hospital of Shenyang Military Region between 2010 and 2013. These patients were divided into two groups da Vinci and video-assisted thoracoscopic surgery (VATS according to the selection of the treatments. The time in surgery, intraoperative blood loss, postoperative drainage amount within three days after surgery, the period of bearing drainage tubes, hospital stays and hospitalization expense were then compared. Results All patients were successfully operated, the postoperative recovery is good and there is no perioperative death. The different of the time in surgery between two groups is Robots group 82 (20-320 min and thoracoscopic group 89 (35-360 min (P>0.05. The intraoperative blood loss between two groups is robot group 10 (1-100 mL and thoracoscopic group 50 (3-1,500 mL. The postoperative drainage amount within three days after surgery between two groups is robot group 215 (0-2,220 mL and thoracoscopic group 350 (50-1,810 mL. The period of bearing drainage tubes after surgery between two groups is robot group 3 (0-10 d and thoracoscopic group: 5 (1-18 d. The difference of hospital stays between two groups is robot group 7 (2-15 d and thoracoscopic group 9 (2-50 d. The hospitalization expense between two groups is robot group (18,983.6±4,461.2 RMB and thoracoscopic group (9,351.9±2,076.3 RMB (All P<0.001. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted

  12. [Simulation-based robot-assisted surgical training]. (United States)

    Kolontarev, K B; Govorov, A V; Rasner, P I; Sheptunov, S A; Prilepskaya, E A; Maltsev, E G; Pushkar, D Yu


    Since the first use of robotic surgical system in 2000, the robot-assisted technology has gained wide popularity throughout the world. Robot-assisted surgical training is a complex issue that requires significant efforts from students and teacher. During the last two decades, simulation-based training had received active development due to wide-spread occurrence and popularization of laparoscopic and robot-assisted surgical techniques. We performed a systematic review to identify the currently available simulators for robot-assisted surgery. We searched the Medline and Pubmed, English sources of literature data, using the following key words and phrases: "robotics", "robotic surgery", "computer assisted surgery", "simulation", "computer simulation", "virtual reality", "surgical training", and "surgical education". There were identified 565 publications, which meet the key words and phrases; 19 publications were selected for the final analysis. It was established that simulation-based training is the most promising teaching tool that can be used in the training of the next generation robotic surgeons. Today the use of simulators to train surgeons is validated. Price of devices is an obvious barrier for inclusion in the program for training of robotic surgeons, but the lack of this tool will result in a sharp increase in the duration of specialists training.

  13. Surgically assisted rapid maxillary expansion in adults. (United States)

    Pogrel, M A; Kaban, L B; Vargervik, K; Baumrind, S


    Twelve adults with maxillary width discrepancy of greater than 5 mm were treated by surgically assisted rapid maxillary expansion. The procedure consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a tooth-borne orthopedic device postoperatively. Mean palatal expansion of 7.5 mm (range of 6 to 13 mm), measured in the first molar region, was achieved within 3 weeks in all patients. Expansion remained stable during the 12-month study period, with a mean relapse for the entire group of 0.88 +/- 0.48 mm. Morbidity was limited to mild postoperative discomfort. The results of this preliminary study indicated that surgically assisted rapid maxillary expansion is a safe, simple, and reliable procedure for achieving a permanent increase in skeletal maxillary width in adults. Further study is necessary to document the three-dimensional movements of the maxillary segments and long-term stability of the skeletal and dental changes.

  14. Maxillary protraction after surgically assisted maxillary expansion

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    Laurindo Zanco Furquim


    Full Text Available This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME followed by orthopedic protraction (Sky Hook and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion.

  15. Chronic ventricular assist device support: surgical innovation. (United States)

    Rojas, Sebastian V; Hanke, Jasmin S; Haverich, Axel; Schmitto, Jan D


    Ventricular assist device (VAD) therapy is currently one of the fastest-developing fields in cardiac surgery. Consistently improved technology, research, and gain of clinical experience have established VADs as an important option for the treatment of congestive heart failure. During the past year, novel devices and less invasive surgical procedures have been revolutionizing this field. The purpose of this manuscript is to review these innovations with special emphasis on device-related surgery. Device miniaturization has enabled less invasive VAD surgery, excluding the need for full sternotomy. Recent data show that intrahospital survival rates following less invasive VAD implantation are surpassing 90%. Secondly, two new devices, Heartmate 3 and MVAD, are being applied and tested for clinical application. In this context, the Heartmate 3 CE mark study recently concluded with excellent outcomes and without any pump thrombosis or device malfunctions. The first clinical results of the newest generation of VADs are very promising compared with old-generation devices. Furthermore, less invasive surgery is becoming a standard for the implantation, exchange, or explantation of left VADs. The joint venture of improved technology and innovative surgical techniques will push this field forward to even better outcomes and reduced complication rates.

  16. Ergonomic analysis of primary and assistant surgical roles. (United States)

    Zihni, Ahmed M; Cavallo, Jaime A; Ray, Shuddhadeb; Ohu, Ikechukwu; Cho, Sohyung; Awad, Michael M


    Laparoscopic surgery is associated with a high degree of ergonomic stress. However, the stress associated with surgical assisting is not known. In this study, we compare the ergonomic stress associated with primary and assistant surgical roles during laparoscopic surgery. We hypothesize that higher ergonomic stress will be detected in the primary operating surgeon when compared with the surgical assistant. One right-hand dominant attending surgeon performed 698 min of laparoscopic surgery over 13 procedures (222 min primary and 476 min assisting), whereas electromyography data were collected from bilateral biceps, triceps, deltoids, and trapezius muscles. Data were analyzed in 1-min segments. Average muscle activation as quantified by maximal voluntary contraction (%MVC) was calculated for each muscle group during primary surgery and assisting. We compared mean %MVC values with unpaired t-tests. Activation of right (R) biceps and triceps muscle groups is significantly elevated while operating when compared with assisting (R biceps primary: 5.47 ± 0.21 %MVC, assistant: 3.93 ± 0.11, P ergonomic differences between operating and assisting. Surgical assisting was associated with similar and occasionally higher levels of muscle activation compared with primary operating. These findings suggest that surgical assistants face significant ergonomic stress, just as operating surgeons do. Steps must be taken to recognize and mitigate this stress in both operating surgeons and assistants. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Histological underestimation of a 9-gauge stereotactic vacuum-assisted breast biopsy system compared with surgical excision at a tertiary hospital in South Africa

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    Michael Pieters


    Full Text Available Background: Breast cancer is a major cause of morbidity and mortality worldwide. Certain lesions encountered on mammography require histological assessment of biopsy samples to identify benign versus malignant disease. Stereotactic vacuum-assisted breast biopsy (SVAB is a useful technique, especially for non-palpable microcalcific lesions, and was introduced at our institution in 2011.Objectives: To determine whether the histological underestimation from 9-gauge SVABs performed at our institution is within acceptable limits.Method: In this cross-sectional study, 9-gauge stereotactic biopsy histology results and breast imaging and reporting data system (BI-RADS findings of 158 lesions (from 153 patients were analysed and the histological findings compared with surgical excision histology results (54 lesions to determine histological underestimation (upgrade rates.Results: One out of eight cases of ductal carcinoma in situ (DCIS was underestimated, yielding a DCIS underestimation rate of 12.5%.Conclusion: The DCIS underestimation obtained from the present study in our institution was on a par with other authors’ findings and was therefore within acceptable limits. Atypical ductal hyperplasia underestimation could not be reliably obtained with the small study population.Keywords: Stereotactic vacuum assisted breast biopsy; histological underestimation; histological upgrade

  18. Gastrointestinal stromal tumours of stomach: Robot-assisted excision with the da Vinci Surgical System regardless of size and location site. (United States)

    Furbetta, Niccolo; Palmeri, Matteo; Guadagni, Simone; Di Franco, Gregorio; Gianardi, Desirée; Latteri, Saverio; Marciano, Emanuele; Moglia, Andrea; Cuschieri, Alfred; Di Candio, Giulio; Mosca, Franco; Morelli, Luca


    The role of minimally invasive surgery of gastrointestinal stromal tumours (GISTs) of the stomach remains uncertain especially for large and/or difficult located tumours. We are hereby presenting a single-centre series of robot-assisted resections using the da Vinci Surgical System (Si or Xi). Data of patients undergoing robot-assisted treatment of gastric GIST were retrieved from the prospectively collected institutional database and a retrospective analysis was performed. Patients were stratified according to size and location of the tumour. Difficult cases (DCs) were considered for size if tumour was> 50 mm and/or for location if the tumour was Type II, III or IV sec. Privette/Al-Thani classification. Between May 2010 and February 2017, 12 consecutive patients underwent robot-assisted treatment of GIST at our institution. DCs were 10/12 cases (83.3%), of which 6/10 (50%) for location, 2/10 (25%) for size and 2/10 (25%) for both. The da Vinci Si was used in 8 patients, of which 6 (75%) were DC, and the da Vinci Xi in 4, all of which (100%) were DC. In all patients, excision was by wedge resection. All lesions had microscopically negative resection margins. There was no conversion to open surgery, no tumour ruptures or spillage and no intraoperative complications. Our experience suggests a positive role of the robot da Vinci in getting gastric GIST removal with a conservative approach, regardless of size and location site. Comparative studies with a greater number of patients are necessary for a more robust assessment.

  19. Surgical Resection of Idiopathic Distal Anterior Choroidal Artery Aneurysm Assisted by Frameless Stereotactic System Guidance: Case Report and Literature Review. (United States)

    Ye, Feng; Tao, Chuanyuan; Xiong, Shenghua; You, Chao


    Idiopathic distal anterior choroidal artery (AChoA) aneurysms are particularly rare. Their diagnosis and treatment are difficult because of the particular characteristic of pathological anatomy. Our case mainly presented with intraventricular hemorrhage. His idiopathic aneurysm was located in the trigone of the undilated ventricle. Computed tomographic angiography demonstrated both the precise aneurysm and parent artery even when there was no dilated parent artery for the first time. It is also the first time this tiny aneurysm was resected assisted by frameless stereotactic guidance during operation after absorption of intraventricular blood. Computed tomographic angiography and frameless stereotactic guidance benefit the diagnosis and treatment of this kind of aneurysm. Sacrificing plexual AChoA did not cause any neurologic deficit.

  20. Computer-Assisted Technique for Surgical Tooth Extraction

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    Hosamuddin Hamza


    Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  1. Peer-assisted teaching of basic surgical skills. (United States)

    Preece, Ryan; Dickinson, Emily Clare; Sherif, Mohamed; Ibrahim, Yousef; Ninan, Ann Susan; Aildasani, Laxmi; Ahmed, Sartaj; Smith, Philip


    Basic surgical skills training is rarely emphasised in undergraduate medical curricula. However, the provision of skills tutorials requires significant commitment from time-constrained surgical faculty. We aimed to determine how a peer-assisted suturing workshop could enhance surgical skills competency among medical students and enthuse them towards a career in surgery. Senior student tutors delivered two suturing workshops to second- and third- year medical students. Suturing performance was assessed before and after teaching in a 10-min suturing exercise (variables measured included number of sutures completed, suture tension, and inter-suture distance). Following the workshop, students completed a questionnaire assessing the effect of the workshop on their suturing technique and their intention to pursue a surgical career. Thirty-five students attended. Eighty-one percent believed their medical school course provided insufficient basic surgical skills training. The mean number of sutures completed post-teaching increased significantly (p teaching, to ± 2.6 mm post-teaching. All students found the teaching environment to be relaxed, and all felt the workshop helped to improve their suturing technique and confidence; 87% found the peer-taught workshop had increased their desire to undertake a career in surgery. Peer-assisted learning suturing workshops can enhance medical students' competence with surgical skills and inspire them towards a career in surgery. With very little staff faculty contribution, it is a cheap and sustainable way to ensure ongoing undergraduate surgical skills exposure.

  2. Video-assisted thoracic surgery: a renaissance in surgical therapy. (United States)

    Yim, A P; Izzat, M B; Lee, T W; Wan, S


    Within a few years, video-assisted thoracic surgery (VATS) has become the accepted or preferred approach over a wide range of thoracic procedures. The authors review the development of this technique, the basic operative strategies and the current surgical indications. Technical pitfalls and future developments are also discussed.

  3. Effects of Surgical Assistant's Level of Resident Training on Surgical Treatment of Intermittent Exotropia: Operation Time and Surgical Outcomes. (United States)

    Kim, Moo Hyun; Chung, Hyunuk; Kim, Won Jae; Kim, Myung Mi


    To evaluate the effects of the surgical assistant's level of resident training on operation time and surgical outcome in the surgical treatment of intermittent exotropia. This study included 456 patients with intermittent exotropia who underwent lateral rectus recession and medial rectus resection and were followed up for 24 months after surgery. The patients were divided into two groups according to the surgical assistant's level of resident training: group F (surgery assisted by a first-year resident [n = 198]) and group S (surgery assisted by a second-, third-, or fourth-year resident [n = 258]). The operation time and surgical outcomes (postoperative exodeviation and the number of patients who underwent a second operation) were compared between the two groups. The average operation times in groups F and S were 36.54 ± 7.4 and 37.34 ± 9.94 minutes, respectively (p = 0.33). Immediate postoperative exodeviation was higher in group F (0.79 ± 3.82 prism diopters) than in group S (0.38 ± 3.75 prism diopters). However, repeated-measures analysis of variance revealed no significant difference in exodeviation between the two groups during the 24-month follow-up period (p = 0.45). A second operation was performed in 29.3% (58 / 198) of the patients in group F, and in 32.2% (83 / 258) of those in group S (p = 0.51). No significant difference in operation time was observed when we compared the effects of the level of resident training in the surgical treatment of intermittent exotropia. Although the immediate postoperative exodeviation was higher in patients who had undergone surgery assisted by a first-year resident, the surgical outcome during the 24-month follow-up was not significantly different.

  4. Application of da Vinci surgical robotic system in hepatobiliary surgery

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    Chen Jiahai


    Full Text Available The development of minimally invasive surgery has brought a revolutionary change to surgery techniques, and endoscopic surgical robots, especially Da Vinci robotic surgical system, has further broaden the scope of minimally invasive surgery, which has been applied in a variety of surgical fields including hepatobiliary surgery. Today, the application of Da Vinci surgical robot can cover most of the operations in hepatobiliary surgery which has proved to be safe and practical. What’s more, many clinical studies in recent years have showed that Da Vinci surgical system is superior to traditional laparoscopy. This paper summarize the advantage and disadvantage of Da Vinci surgical system, and outlines the current status of and future perspectives on the robot-assisted hepatobiliary surgery based on the cases reports in recent years of the application of Da Vinci surgical robot.

  5. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael


    a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...


    Xia, Shengli; Wang, Xiuhui; Fu, Beigang; Lu, Yaogang; Wang, Minghui


    To explore the clinical value of computer-assisted surgical planning in the treatment of ankle fractures. Between January 2012 and January 2014, open reduction and internal fixation were performed on 42 patients with ankle fractures. There were 22 males and 20 females with an average age of 52 years (range, 19-72 years). The causes were spraining injury (20 cases), traffic accident injury (14 cases), and falling from height injury (8 cases). The time from injury to operation was 5 hours to 12 days (mean, 2.5 days). All fractures were closed trimalleolar fractures. According to Lauge-Hansen classification, 25 cases were rated as supination extorsion type IV, 13 as pronation extorsion type IV, and 4 as pronation abduction type III. The preoperative planning was made by virtual reduction and internal fixation using Superimage software. The mean operation time was 93.7 minutes (range, 76-120 minutes). Delayed wound healing occurred in 1 case, and secondary healing was obtained after treatment; primary healing of incision was achieved in the other patients. Postoperative X-ray films and CT images showed anatomic reduction of fracture and good position of internal fixation. All patients were followed up 14.6 months on average (range, 9-27 months). The range of motion of the affected ankle was close to the normal side at 6-8 weeks. The mean fracture healing time was 13.1 weeks (range, 11-17 weeks). Degenerative change of the ankle joint was observed in 3 cases (7.1%) with manifestation of mild narrowing of joint space on the X-ray films at last follow-up. According to Baird-Jackson score system, the results were excellent in 24 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 88%. Computer-assisted surgical planning for ankle fractures can help surgeons identify type of ankle fractures and improve surgical scheme for guiding fracture reduction and selecting and placing implants, so good effectiveness can be obtained.

  7. A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection. (United States)

    Koh, Dean Chi-Siong; Tsang, Charles Bih-Shou; Kim, Seon-Hahn


    The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci® S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vinci® system with a fourth arm extension. The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3%) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. The standard da Vinci® system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with short-term outcomes similar to those of

  8. Fuzzy-logic-assisted surgical planning in adolescent idiopathic scoliosis. (United States)

    Nault, Marie-Lyne; Labelle, Hubert; Aubin, Carl-Eric; Sangole, Archana; Balazinski, Marek


    Selection of appropriate curve fusion levels for surgery in adolescent idiopathic scoliosis (AIS) is a complex and difficult task and, despite numerous publications, still remains a highly controversial topic. To evaluate a fuzzy-logic-based surgical planning tool by comparing the results suggested by the software with the average outcome recommended by a panel of 5 expert spinal deformity surgeons. It is hypothesized that, given the same information, the fuzzy-logic tool will perform as favorably as the surgeons. Proof-of-concept study evaluating the use of a fuzzy-logic-assisted surgical planning tool in AIS to select the appropriate spinal curve to be instrumented. A cohort of 30 AIS surgical cases with a main thoracic curve was used. Each case included standard measurements recorded from preoperative standing postero-anterior and lateral, supine side bending, and 1-year postoperative standing radiographs. Five experienced spinal deformity surgeons evaluated each case independently and gave their preferred levels of instrumentation and fusion. The cases were then presented to the fuzzy-logic tool to determine whether the high thoracic and/or lumbar curves were to be instrumented. For each case, a percentage value was obtained indicating inclusion/exclusion of the respective curves in the surgical instrumentation procedure. Kappa statistics was used to compare the model output and the average decision of the surgeons. Kappa values of 0.71 and 0.64 were obtained, respectively, for the proximal thoracic and lumbar curves models, thus suggesting a good agreement of the fusion recommendations made by the fuzzy-logic tool and the surgeons. Given the same information, the fuzzy-logic-assisted recommendation of the curve to be instrumented compared favorably with the collective decision of the surgeons. The findings thus suggest that a fuzzy-logic approach is helpful in assisting surgeons with the preoperative selection of curve instrumentation and fusion levels in AIS.

  9. Image-guided neurosurgery. Global concept of a surgical tele-assistance using obstacle detection robotics

    International Nuclear Information System (INIS)

    Desgeorges, M.; Bellegou, N.; Faillot, Th.; Cordoliani, Y.S.; Dutertre, G.; Blondet, E.; Soultrait, F. de; Boissy, J.M.


    Surgical tele-assistance significantly increases accuracy of surgical gestures, especially in the case of brain tumor neurosurgery. The robotic device is tele-operated through a microscope and the surgeon's gestures are guided by real-time overlaying of the X-ray imagery in the microscope. During the device's progression inside the brain, the focus is ensured by the microscope auto-focus feature. The surgeon can thus constantly check his position on the field workstation. Obstacles to avoid or dangerous areas can be previewed in the operation field. This system is routinely used for 5 years in the neurosurgery division of the Val de Grace hospital. More than 400 brain surgery operations have been done using it. An adaptation is used for rachis surgery. Other military hospitals begin to be equipped with similar systems. It will be possible to link them for data transfer. When it will be operational, such a network it will show what could be, in the future, a medical/surgical remote-assistance system designed to take care of wounded/critical conditions people, including assistance to surgical gestures. (authors)

  10. Automated robot-assisted surgical skill evaluation: Predictive analytics approach. (United States)

    Fard, Mahtab J; Ameri, Sattar; Darin Ellis, R; Chinnam, Ratna B; Pandya, Abhilash K; Klein, Michael D


    Surgical skill assessment has predominantly been a subjective task. Recently, technological advances such as robot-assisted surgery have created great opportunities for objective surgical evaluation. In this paper, we introduce a predictive framework for objective skill assessment based on movement trajectory data. Our aim is to build a classification framework to automatically evaluate the performance of surgeons with different levels of expertise. Eight global movement features are extracted from movement trajectory data captured by a da Vinci robot for surgeons with two levels of expertise - novice and expert. Three classification methods - k-nearest neighbours, logistic regression and support vector machines - are applied. The result shows that the proposed framework can classify surgeons' expertise as novice or expert with an accuracy of 82.3% for knot tying and 89.9% for a suturing task. This study demonstrates and evaluates the ability of machine learning methods to automatically classify expert and novice surgeons using global movement features. Copyright © 2017 John Wiley & Sons, Ltd.

  11. Defense Security Assistance Management System

    National Research Council Canada - National Science Library


    ... $10 billion Foreign Military Sales Program. As envisioned, it will replace 13 automated information systems used by the Military Departments and Defense Security Assistance Agency and will provide standardized and improved security assistance...

  12. Pedagogic Approach in the Surgical Learning: The First Period of "Assistant Surgeon" May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy. (United States)

    Favre, Angeline; Huberlant, Stephanie; Carbonnel, Marie; Goetgheluck, Julie; Revaux, Aurelie; Ayoubi, Jean Marc


    Hysterectomy is the most frequent surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal) and appear as a promising surgical technique in gynecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring. We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci ® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France). We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1) and the control of surgical skills phase (Phase 2). The phase was defined by mastering the basic surgical tasks. Secondarily, we compared these two periods for operative time, blood losses, body mass index (BMI), days of hospitalizations, and uterine weight. We, finally, studied the difference of the learning curve between an experimented surgeon (S1) who practiced first the robot-assisted hysterectomies and a less experimented surgeon (S2) who first assisted S1 and then operated on his own patients. A total of 154 robot-assisted hysterectomies were analyzed. Twenty procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 min) compared to the control of surgical skills phase (125.8 min, p  = 0.003). No difference between these two periods for blood losses, BMI, days of hospitalizations and uterine weight was demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant decrease of the operative

  13. Pedagogic approach in the surgical learning: The first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy.

    Directory of Open Access Journals (Sweden)

    Angeline Favre


    Full Text Available Background: Hysterectomy is the most frequently surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal and appear as a promising surgical technique in gynaecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.Methods: We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France. We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1 and the control of surgical skills phase (Phase 2. The phase was defined by mastering the basic surgical tasks. Secondarily we compared these two periods for operative time, blood losses, Body Mass Index (BMI, days of hospitalisations and uterine weight. We finally studied the difference of the learning curve between an experimented surgeon (S1 who practised the first the robot-assisted hysterectomies and a less experimented surgeon (S2 who first assisted S1 and then operated on his own patients.Results: 154 robot-assisted hysterectomies were analysed. 20 procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 minutes compared to the control of surgical skills phase (125.8 minutes, p=0.003. No difference between these two periods for blood losses, BMI, days of hospitalisations and uterine weight were demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant

  14. A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD. (United States)

    Zorn, Lucile; Nageotte, Florent; Zanne, Philippe; Legner, Andras; Dallemagne, Bernard; Marescaux, Jacques; de Mathelin, Michel


    Minimally invasive surgical interventions in the gastrointestinal tract, such as endoscopic submucosal dissection (ESD), are very difficult for surgeons when performed with standard flexible endoscopes. Robotic flexible systems have been identified as a solution to improve manipulation. However, only a few such systems have been brought to preclinical trials as of now. As a result, novel robotic tools are required. We developed a telemanipulated robotic device, called STRAS, which aims to assist surgeons during intraluminal surgical endoscopy. This is a modular system, based on a flexible endoscope and flexible instruments, which provides 10 degrees of freedom (DoFs). The modularity allows the user to easily set up the robot and to navigate toward the operating area. The robot can then be teleoperated using master interfaces specifically designed to intuitively control all available DoFs. STRAS capabilities have been tested in laboratory conditions and during preclinical experiments. We report 12 colorectal ESDs performed in pigs, in which large lesions were successfully removed. Dissection speeds are compared with those obtained in similar conditions with the manual Anubiscope platform from Karl Storz. We show significant improvements ( ). These experiments show that STRAS (v2) provides sufficient DoFs, workspace, and force to perform ESD, that it allows a single surgeon to perform all the surgical tasks and those performances are improved with respect to manual systems. The concepts developed for STRAS are validated and could bring new tools for surgeons to improve comfort, ease, and performances for intraluminal surgical endoscopy.

  15. Computer-assisted virtual autopsy using surgical navigation techniques. (United States)

    Ebert, Lars Christian; Ruder, Thomas D; Martinez, Rosa Maria; Flach, Patricia M; Schweitzer, Wolf; Thali, Michael J; Ampanozi, Garyfalia


    OBJECTIVE; Virtual autopsy methods, such as postmortem CT and MRI, are increasingly being used in forensic medicine. Forensic investigators with little to no training in diagnostic radiology and medical laypeople such as state's attorneys often find it difficult to understand the anatomic orientation of axial postmortem CT images. We present a computer-assisted system that permits postmortem CT datasets to be quickly and intuitively resliced in real time at the body to narrow the gap between radiologic imaging and autopsy. Our system is a potentially valuable tool for planning autopsies, showing findings to medical laypeople, and teaching CT anatomy, thus further closing the gap between radiology and forensic pathology.

  16. Assistive and Rehabilitation Robotic System

    Directory of Open Access Journals (Sweden)

    Adrian Abrudean


    Full Text Available A short introduction concerning the content of Assistive Technology and Rehabilitation Engineering is followed by a study of robotic systems which combine two or more assistive functions. Based on biomechanical aspects, a complex robotic system is presented, starting with the study of functionality and ending with the practical aspects of the prototype development.

  17. Retention of fundamental surgical skills learned in robot-assisted surgery. (United States)

    Suh, Irene H; Mukherjee, Mukul; Shah, Bhavin C; Oleynikov, Dmitry; Siu, Ka-Chun


    Evaluation of the learning curve for robotic surgery has shown reduced errors and decreased task completion and training times compared with regular laparoscopic surgery. However, most training evaluations of robotic surgery have only addressed short-term retention after the completion of training. Our goal was to investigate the amount of surgical skills retained after 3 months of training with the da Vinci™ Surgical System. Seven medical students without any surgical experience were recruited. Participants were trained with a 4-day training program of robotic surgical skills and underwent a series of retention tests at 1 day, 1 week, 1 month, and 3 months post-training. Data analysis included time to task completion, speed, distance traveled, and movement curvature by the instrument tip. Performance of the participants was graded using the modified Objective Structured Assessment of Technical Skills (OSATS) for robotic surgery. Participants filled out a survey after each training session by answering a set of questions. Time to task completion and the movement curvature was decreased from pre- to post-training and the performance was retained at all the corresponding retention periods: 1 day, 1 week, 1 month, and 3 months. The modified OSATS showed improvement from pre-test to post-test and this improvement was maintained during all the retention periods. Participants increased in self-confidence and mastery in performing robotic surgical tasks after training. Our novel comprehensive training program improved robot-assisted surgical performance and learning. All trainees retained their fundamental surgical skills for 3 months after receiving the training program.

  18. Oral and maxillofacial surgery with computer-assisted navigation system. (United States)

    Kawachi, Homare; Kawachi, Yasuyuki; Ikeda, Chihaya; Takagi, Ryo; Katakura, Akira; Shibahara, Takahiko


    Intraoperative computer-assisted navigation has gained acceptance in maxillofacial surgery with applications in an increasing number of indications. We adapted a commercially available wireless passive marker system which allows calibration and tracking of virtually every instrument in maxillofacial surgery. Virtual computer-generated anatomical structures are displayed intraoperatively in a semi-immersive head-up display. Continuous observation of the operating field facilitated by computer assistance enables surgical navigation in accordance with the physician's preoperative plans. This case report documents the potential for augmented visualization concepts in surgical resection of tumors in the oral and maxillofacial region. We report a case of T3N2bM0 carcinoma of the maxillary gingival which was surgically resected with the assistance of the Stryker Navigation Cart System. This system was found to be useful in assisting preoperative planning and intraoperative monitoring.

  19. The expert surgical assistant. An intelligent virtual environment with multimodal input. (United States)

    Billinghurst, M; Savage, J; Oppenheimer, P; Edmond, C


    Virtual Reality has made computer interfaces more intuitive but not more intelligent. This paper shows how an expert system can be coupled with multimodal input in a virtual environment to provide an intelligent simulation tool or surgical assistant. This is accomplished in three steps. First, voice and gestural input is interpreted and represented in a common semantic form. Second, a rule-based expert system is used to infer context and user actions from this semantic representation. Finally, the inferred user actions are matched against steps in a surgical procedure to monitor the user's progress and provide automatic feedback. In addition, the system can respond immediately to multimodal commands for navigational assistance and/or identification of critical anatomical structures. To show how these methods are used we present a prototype sinus surgery interface. The approach described here may easily be extended to a wide variety of medical and non-medical training applications by making simple changes to the expert system database and virtual environment models. Successful implementation of an expert system in both simulated and real surgery has enormous potential for the surgeon both in training and clinical practice.

  20. Virtual interactive presence and augmented reality (VIPAR) for remote surgical assistance. (United States)

    Shenai, Mahesh B; Dillavou, Marcus; Shum, Corey; Ross, Douglas; Tubbs, Richard S; Shih, Alan; Guthrie, Barton L


    Surgery is a highly technical field that combines continuous decision-making with the coordination of spatiovisual tasks. We designed a virtual interactive presence and augmented reality (VIPAR) platform that allows a remote surgeon to deliver real-time virtual assistance to a local surgeon, over a standard Internet connection. The VIPAR system consisted of a "local" and a "remote" station, each situated over a surgical field and a blue screen, respectively. Each station was equipped with a digital viewpiece, composed of 2 cameras for stereoscopic capture, and a high-definition viewer displaying a virtual field. The virtual field was created by digitally compositing selected elements within the remote field into the local field. The viewpieces were controlled by workstations mutually connected by the Internet, allowing virtual remote interaction in real time. Digital renderings derived from volumetric MRI were added to the virtual field to augment the surgeon's reality. For demonstration, a fixed-formalin cadaver head and neck were obtained, and a carotid endarterectomy (CEA) and pterional craniotomy were performed under the VIPAR system. The VIPAR system allowed for real-time, virtual interaction between a local (resident) and remote (attending) surgeon. In both carotid and pterional dissections, major anatomic structures were visualized and identified. Virtual interaction permitted remote instruction for the local surgeon, and MRI augmentation provided spatial guidance to both surgeons. Camera resolution, color contrast, time lag, and depth perception were identified as technical issues requiring further optimization. Virtual interactive presence and augmented reality provide a novel platform for remote surgical assistance, with multiple applications in surgical training and remote expert assistance.

  1. The CALO Meeting Assistant system

    NARCIS (Netherlands)

    Tur, G.; Stolcke, A.; Voss, L.; Peters, S.; Hakkani-Tür, D.; Dowding, J.; Favre, B.; Fernández, R.; Frampton, M.; Frandsen, M.; Frederickson, C.; Graciarena, M.; Kintzing, D.; Leveque, K.; Mason, S.; Niekrasz, J.; Purver, M.; Riedhammer, K.; Shriberg, E.; Tien, J.; Vergyri, D.; Yang, F.


    The CALO Meeting Assistant (MA) provides for distributed meeting capture, annotation, automatic transcription and semantic analysis of multiparty meetings, and is part of the larger CALO personal assistant system. This paper presents the CALO-MA architecture and its speech recognition and

  2. Enhancing fundamental robot-assisted surgical proficiency by using a portable virtual simulator. (United States)

    Chien, Jung Hung; Suh, Irene H; Park, Shi-Hyun; Mukherjee, Mukul; Oleynikov, Dmitry; Siu, Ka-Chun


    The development of a virtual reality (VR) training platform provides an affordable interface. The learning effect of VR and the capability of skill transfer from the VR environment to clinical tasks require more investigation. Here, 14 medical students performed 2 fundamental surgical tasks-bimanual carrying (BC) and peg transfer (PT)-in actual and virtual environments. Participants in the VR group received VR training, whereas participants in the control group played a 3D game. The learning effect was examined by comparing kinematics between pretraining and posttraining in the da Vinci Surgical System. Differences between VR and playing the 3D game were also examined. Those who were trained with the VR simulator had significantly better performance in both actual PT (P = .002) and BC (P VR group compared with the 3D game group. However, playing the 3D game showed no significant enhancement of fundamental surgical skills in the actual PT task. The difference between pretraining and posttraining was significantly larger in the VR group than in the 3D game group in both the time to task completion (P = .002) and the total distance traveled (P = .027) for the actual PT task. Participants who played the 3D game seemed to perform even worse in posttraining. Training with the portable VR simulator improved robot-assisted surgical skill proficiency in comparison to playing a 3D game.

  3. Medical Infrared Thermography assistance in the surgical treatment of axillary Hidradenitis Suppurativa: A case report. (United States)

    Polidori, G; Renard, Y; Lorimier, S; Pron, H; Derruau, S; Taiar, R


    The purpose of this case report is to highlight for the first time the way Medical Infrared Thermography can be a helpful tool to assist the surgeon in the surgical treatment of Hidradenitis Suppurativa inflammatory disease. A 36-year-old man with a 7-year history of Hidradenitis Suppurativa presented inflammatory nodules in the left axilla area corresponding to Hurley stage II. Choice is made to surgically treat this patient using a wide excision protocol combined with a postoperative second intention healing. For the study purpose, an IR FLIR SC620 camera (FLIR Systems, Wilsonville, OR), having a high resolution pixel detector of 640×480 pixels for greater accuracy and higher resolution, has been used. For the first time in the literature, this case report on HS disease supports the idea that real-time medical infrared thermography may be helpful in establishing the true extent of disease preoperatively in the surgical room and in a similar manner, that this technique allows the surgeon to ensure all diseased lesions are removed during surgery. At least, medical infrared thermography seems to be a powerful tool to control the final wide surgical wound, in order to minimize recurrence risk of such a disease. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  4. Computer assisted surgical anatomy mapping : applications in surgical anatomy research, tailor-made surgery and presonalized teaching

    NARCIS (Netherlands)

    A.L.A. Kerver (Anton)


    markdownabstractThis thesis presents a novel anatomy mapping tool named Computer Assisted Surgical Anatomy Mapping (CASAM). It allows researchers to map complex anatomy of multiple specimens and compare their location and course. Renditions such as safe zones or danger zones can be visualized,

  5. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. (United States)

    Kim, Young-Hoo; Kim, Jun-Shik; Choi, Yoowang; Kwon, Oh-Ryong


    Whether total knee arthroplasty with use of computer-assisted surgical navigation can improve the limb and component alignment is a matter of debate. We hypothesized that total knee arthroplasty with use of computer-assisted surgical navigation is superior to conventional total knee arthroplasty with regard to the precision of implant positioning. Sequential simultaneous bilateral total knee arthroplasties were carried out in 160 patients (320 knees). One knee was replaced with use of a computer-assisted surgical navigation system, and the other was replaced conventionally without use of computer-assisted surgical navigation. The two methods were compared for accuracy of orientation and alignment of the components as determined by radiographs and computed tomography scans. The mean duration of follow-up was 3.4 years. The mean preoperative Knee Society score was 26 points, with an improvement to 92 points postoperatively, in the computer-assisted total knee arthroplasty group and 25 points, with an improvement to 93 points postoperatively, in the conventional total knee arthroplasty group. Preoperative and postoperative ranges of motion of the knees were similar in both groups. The operating and tourniquet times were significantly longer in the computer-assisted total knee arthroplasty group than in the conventional total knee arthroplasty group (p component positioning and the number of outliers for the various radiographic parameters (p > 0.05). Our data demonstrate that total knee arthroplasty with use of computer-assisted surgical navigation did not result in more accurate implant positioning than that achieved in conventional total knee arthroplasty, as determined by both radiographs and computed tomography scans.

  6. General surgery residents' perception of robot-assisted procedures during surgical training. (United States)

    Farivar, Behzad S; Flannagan, Molly; Leitman, I Michael


    With the continued expansion of robotically assisted procedures, general surgery residents continue to receive more exposure to this new technology as part of their training. There are currently no guidelines or standardized training requirements for robot-assisted procedures during general surgical residency. The aim of this study was to assess the effect of this new technology on general surgery training from the residents' perspective. An anonymous, national, web-based survey was conducted on residents enrolled in general surgery training in 2013. The survey was sent to 240 Accreditation Council for Graduate Medical Education-approved general surgery training programs. Overall, 64% of the responding residents were men and had an average age of 29 years. Half of the responses were from postgraduate year 1 (PGY1) and PGY2 residents, and the remainder was from the PGY3 level and above. Overall, 50% of the responses were from university training programs, 32% from university-affiliated programs, and 18% from community-based programs. More than 96% of residents noted the availability of the surgical robot system at their training institution. Overall, 63% of residents indicated that they had participated in robotic surgical cases. Most responded that they had assisted in 10 or fewer robotic cases with the most frequent activities being assisting with robotic trocar placement and docking and undocking the robot. Only 18% reported experience with operating the robotic console. More senior residents (PGY3 and above) were involved in robotic cases compared with junior residents (78% vs 48%, p robotic case. Approximately 64% of residents reported that formal training in robotic surgery was important in residency training and 46% of residents indicated that robotic-assisted cases interfered with resident learning. Only 11% felt that robotic-assisted cases would replace conventional laparoscopic surgery in the future. This study illustrates that although the most residents

  7. Statistical shape modelling to aid surgical planning: associations between surgical parameters and head shapes following spring-assisted cranioplasty. (United States)

    Rodriguez-Florez, Naiara; Bruse, Jan L; Borghi, Alessandro; Vercruysse, Herman; Ong, Juling; James, Greg; Pennec, Xavier; Dunaway, David J; Jeelani, N U Owase; Schievano, Silvia


    Spring-assisted cranioplasty is performed to correct the long and narrow head shape of children with sagittal synostosis. Such corrective surgery involves osteotomies and the placement of spring-like distractors, which gradually expand to widen the skull until removal about 4 months later. Due to its dynamic nature, associations between surgical parameters and post-operative 3D head shape features are difficult to comprehend. The current study aimed at applying population-based statistical shape modelling to gain insight into how the choice of surgical parameters such as craniotomy size and spring positioning affects post-surgical head shape. Twenty consecutive patients with sagittal synostosis who underwent spring-assisted cranioplasty at Great Ormond Street Hospital for Children (London, UK) were prospectively recruited. Using a nonparametric statistical modelling technique based on mathematical currents, a 3D head shape template was computed from surface head scans of sagittal patients after spring removal. Partial least squares (PLS) regression was employed to quantify and visualise trends of localised head shape changes associated with the surgical parameters recorded during spring insertion: anterior-posterior and lateral craniotomy dimensions, anterior spring position and distance between anterior and posterior springs. Bivariate correlations between surgical parameters and corresponding PLS shape vectors demonstrated that anterior-posterior (Pearson's [Formula: see text]) and lateral craniotomy dimensions (Spearman's [Formula: see text]), as well as the position of the anterior spring ([Formula: see text]) and the distance between both springs ([Formula: see text]) on average had significant effects on head shapes at the time of spring removal. Such effects were visualised on 3D models. Population-based analysis of 3D post-operative medical images via computational statistical modelling tools allowed for detection of novel associations between surgical

  8. e of the Surgical Glove in Modified Vacuum-Assisted Wound Healing

    Directory of Open Access Journals (Sweden)

    Shankar Ram Hemmanur


    Full Text Available Vacuum-assisted wound healing has been proven to be more efficacious than conventionaldressings. Vacuum dressing has been frequently modified given the restrictions in resourcesavailable. Here we present a modified method of vacuum dressing by using surgical orgynaecological gloves for lower and upper limb wounds. Vacuum dressing was applied withparts of a surgical or gynaecological glove and Opsite with T-tailing of the suction outlet.Vacuum-assisted wound healing using the surgical gloves showed relatively good woundhealing in the amputation stump, finger, arm, and leg in the cases studied.

  9. Surgical Blood Loss and Laparoscopic-Assisted Vaginal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Wei-Chien Wu


    Conclusion: Greater SBL (≥ 150 mL during LAVH was significantly associated with longer operating time, but had no detrimental effect on short-term surgical outcomes. Thus, efforts to minimize intraoperative bleeding and so reduce operative time will be beneficial for women undergoing LAVH.

  10. Investing in a surgical outcomes auditing system. (United States)

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben


    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care.

  11. Investing in a Surgical Outcomes Auditing System (United States)

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben


    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763


    Directory of Open Access Journals (Sweden)

    Zulene Maria de Vasconcelos Varela


    Full Text Available We objectified in this study with qualitative handling, to analyze the nurse's care in the people'sadmission in Surgical Center, starting from this professional's assistematic observation, accomplishing thisprocedure. In the chosen institution, the space for admission is common to all the elements of the team, to thepeople's flow and customers, that stay close one of the other ones, generating erroneous interpretations in thecommunication, hindering of that the efective care. The nurse's concern, in developing the admission, as ownprerogative and humanização was evident. The continuity of that procedure, it is hindered by the surgical team,for the patient's liberation, what is leaving out the care alternatives and generating dissatisfaction in theprofessionals.

  13. Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot


    Duan, Xingguang; Gao, Liang; Wang, Yonggui; Li, Jianxi; Li, Haoyuan; Guo, Yanjun


    In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigatio...

  14. Operations Monitoring Assistant System Design (United States)


    Logic. Artificial Inteligence 25(1)::75-94. January.18. 41 -Nils J. Nilsson. Problem-Solving Methods In Artificli Intelligence. .klcG raw-Hill B3ook...operations monitoring assistant (OMA) system is designed that combines operations research, artificial intelligence, and human reasoning techniques and...KnowledgeCraft (from Carnegie Group), and 5.1 (from Teknowledze). These tools incorporate the best methods of applied artificial intelligence, and

  15. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy.

    Directory of Open Access Journals (Sweden)

    Shaoli Liu

    Full Text Available The "robotic-assisted liver tumor coagulation therapy" (RALTCT system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1 multiple needles are needed to destroy the entire tumor, (2 the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3 the placement of multiple needles should avoid interference with each other, (4 an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles' operating environment, and (5 the multiple needle-insertion trajectories should be consistent with the needle-driven robot's movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle "collision-free reachable workspace" (CFRW, which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor

  16. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy. (United States)

    Liu, Shaoli; Xia, Zeyang; Liu, Jianhua; Xu, Jing; Ren, He; Lu, Tong; Yang, Xiangdong


    The "robotic-assisted liver tumor coagulation therapy" (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles' operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot's movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle "collision-free reachable workspace" (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor therapy

  17. The effect of music on robot-assisted laparoscopic surgical performance. (United States)

    Siu, Ka-Chun; Suh, Irene H; Mukherjee, Mukul; Oleynikov, Dmitry; Stergiou, Nick


    Music is often played in the operating room to increase the surgeon's concentration and to mask noise. It could have a beneficial effect on surgical performance. Ten participants with limited experience with the da Vinci robotic surgical system were recruited to perform two surgical tasks: suture tying and mesh alignment when classical, jazz, hip-hop, and Jamaican music were presented. Kinematics of the instrument tips of the surgical robot and surface electromyography of the subjects were recorded. Results revealed that a significant music effect was found for both tasks with decreased time to task completion (P = .005) and total travel distance (P = .021) as well as reduced muscle activations ( P = .016) and increased median muscle frequency (P = .034). Subjects improved their performance significantly when they listened to either hip-hop or Jamaican music. In conclusion, music with high rhythmicity has a beneficial effect on robotic surgical performance. Musical environment may benefit surgical training and make acquisition of surgical skills more efficient.

  18. Treatment of Brodie's Syndrome using parasymphyseal distraction through virtual surgical planning and RP assisted customized surgical osteotomy guide-A mock surgery report (United States)

    Dahake, Sandeep; Kuthe, Abhaykumar; Mawale, Mahesh


    This paper aims to describe virtual surgical planning (VSP), computer aided design (CAD) and rapid prototyping (RP) systems for the preoperative planning of accurate treatment of the Brodie's Syndrome. 3D models of the patient's maxilla and mandible were separately generated based on computed tomography (CT) image data and fabricated using RP. During the customized surgical osteotmy guide (CSOG) design process, the correct position was identified and the geometry of the CSOG was generated based on affected mandible of the patient and fabricated by a RP technique. Surgical approach such as preoperative planning and simulation of surgical procedures was performed using advanced software. The VSP and RP assisted CSOG was used to avoid the damage of the adjacent teeth and neighboring healthy tissues. Finally the mock surgery was performed on the biomodel (i.e. diseased RP model) of mandible with reference to the normal maxilla using osteotomy bur with the help of CSOG. Using this CSOG the exact osteotomy of the mandible and the accurate placement of the distractor were obtained. It ultimately improved the accuracy of the surgery in context of the osteotomy and distraction. The time required in cutting the mandible and placement of the distractor was found comparatively less than the regular free hand surgery.

  19. Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master-slave manipulation. (United States)

    Wilson, Jason T; Gerber, Matthew J; Prince, Stephen W; Chen, Cheng-Wei; Schwartz, Steven D; Hubschman, Jean-Pierre; Tsao, Tsu-Chin


    Since the advent of robotic-assisted surgery, the value of using robotic systems to assist in surgical procedures has been repeatedly demonstrated. However, existing technologies are unable to perform complete, multi-step procedures from start to finish. Many intraocular surgical steps continue to be manually performed. An intraocular robotic interventional surgical system (IRISS) capable of performing various intraocular surgical procedures was designed, fabricated, and evaluated. Methods were developed to evaluate the performance of the remote centers of motion (RCMs) using a stereo-camera setup and to assess the accuracy and precision of positioning the tool tip using an optical coherence tomography (OCT) system. The IRISS can simultaneously manipulate multiple surgical instruments, change between mounted tools using an onboard tool-change mechanism, and visualize the otherwise invisible RCMs to facilitate alignment of the RCM to the surgical incision. The accuracy of positioning the tool tip was measured to be 0.205±0.003 mm. The IRISS was evaluated by trained surgeons in a remote surgical theatre using post-mortem pig eyes and shown to be effective in completing many key steps in a variety of intraocular surgical procedures as well as being capable of performing an entire cataract extraction from start to finish. The IRISS represents a necessary step towards fully automated intraocular surgery and demonstrated accurate and precise master-slave manipulation for cataract removal and-through visual feedback-retinal vein cannulation. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Photovoltaic assisted solar drying system

    International Nuclear Information System (INIS)

    Ruslan, M.H.; Othman, M.Y.; Baharuddin Yatim; Kamaruzzaman Sopian; Ali, M.I.; Ibarahim, Z.


    A photovoltaic assisted solar drying system has been constructed at the Solar Energy Research Park, Universiti Kebangsaan Malaysia. This drying system uses a custom designed parallel flow V-groove type collector. A fan powered by photovoltaic source assists the air flow through the drying system. A funnel with increasing diameter towards the top with ventilator turbine is incorporated into the system to facilitate the air flow during the absence of photovoltaic energy source. This drying system is designed with high efficiency and portability in mind so that it can readily be used at plantation sites where the crops are harvested or produced. A daily mean efficiency about 44% with mean air flow rate 0.16 kgs -1 has been achieved at mean daily radiation intensity of 800 Wm -2 . daily mean temperature of air drying chamber under the above conditions is 46 o C. Study has shown that the air flow and air temperature increase with the increase of solar radiation intensity. On a bright sunny day with instantaneous solar intensity about 600 Wm -2 , the temperature of air entering the drying chamber of 45 o C has been measured. In the absence of photovoltaic or in natural convection flow, the instantaneous efficiency decreased when solar radiation increased. The instantaneous efficiency recorded are 35% and 27% respectively at 570 Wm -2 and 745 Wm -2 of solar radiation. The temperature of drying chamber for the same amount of solar radiation are 42 o C and 48 o C respectively. Thus, the solar dryer shows a great potential for application in drying process of agricultural produce

  1. Endoscope-assisted treatment of scaphocephaly: report of a case and new surgical technique

    Directory of Open Access Journals (Sweden)

    Domagoj Jugović


    Full Text Available The most common craniosynostosis, scaphocephaly, is the consequence of premature closure of the sagittal suture. Craniosynostosis does not just pose a cosmetic problem, but it can also lead to the permanent neurological deficits. Therefore early diagnosis and treatment are crucial for good outcome. Open surgery with large skin incision is currently the standard procedure. We present our first endoscope-assisted surgical procedure for scaphocephaly. The infant did not need transfusion or intensive therapy after the surgery and skin incision was minimal. This minimal invasive, new surgical technique and its development were described.  

  2. Direct manipulation of tool-like masters for controlling a master-slave surgical robotic system. (United States)

    Zhang, Linan; Zhou, Ningxin; Wang, Shuxin


    Robotic-assisted minimally invasive surgery (MIS) can benefit both patients and surgeons. However, the learning curve for robotically assisted procedures can be long and the total system costs are high. Therefore, there is considerable interest in new methods and lower cost controllers for a surgical robotic system. In this study, a knife-master and a forceps-master, shaped similarly to a surgical knife and forceps, were developed as input devices for control of a master-slave surgical robotic system. In addition, a safety strategy was developed to eliminate the master-slave orientation difference and stabilize the surgical system. Master-slave tracking experiments and a ring-and-bar experiment showed that the safety tracking strategy could ensure that the robot system moved stably without any tremor in the tracking motion. Subjects could manipulate the surgical tool to achieve the master-slave operation with less training compared to a mechanical master. Direct manipulation of the small, light and low-cost surgical tools to control a robotic system is a possible operating mode. Surgeons can operate the robotic system in their own familiar way, without long training. The main potential safety issues can be solved by the proposed safety control strategy. Copyright © 2013 John Wiley & Sons, Ltd.

  3. [Surgical reconstruction of maxillary defects using a computer-assisted techniques]. (United States)

    Zhang, W B; Yu, Y; Wang, Y; Liu, X J; Mao, C; Guo, C B; Yu, G Y; Peng, X


    The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function. Maxillary defects, resulting from tumor resection, can cause severe functional and cosmetic deformities. Furthermore, maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons. Nowadays, vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction. In the last decade, we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results. However, this experience based clinical procedure still remainssome problems in accuracy and efficiency. In recent years, computer assisted techniques are now widely used in oral and maxillofacial surgery. We have performed a series of study on maxillary reconstruction with computer assisted techniques. The computer assisted techniques used for maxillary reconstruction mainly include: (1) Three dimensional (3D) reconstruction and tumor mapping: providing a 3D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective; (2) Virtual planning: simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer, so that to make an ideal surgical plan; (3) 3D printing: producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery; (4) Surgical navigation: the bridge between virtual plan and real surgery, confirming the virtual plan during the surgery and guarantee the accuracy; (5) Computer assisted analyzing and evaluating: making a quantitative and objective of the final result and evaluating the outcome. We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction, including: (1) 3D tumor mapping technique for accurate

  4. Truncal anaesthesia of the maxillary nerve for outpatient surgically assisted rapid maxillary expansion. (United States)

    Robiony, M; Demitri, V; Costa, F; Politi, M; Cugini, U


    We present our experience of transcutaneous truncal anaesthesia of the maxillary nerve in association with transmucosal anaesthesia of the sphenopalatine ganglion in surgically assisted rapid maxillary expansion. Twelve patients with a skeletal transverse discrepancy of the maxilla were treated in our department from 1994 to 1995. Maxillary transcutaneous nerve block was done with a Quincke 8 cm spinal needle together with transmucosal anaesthesia of the sphenopalatine ganglion. Mepivacaine without adrenaline and sodium bicarbonate 1/10 was used for truncal anaesthesia and lidocaine-prilocaine cream for transmucosal anaesthesia. A Le Fort I osteotomy, lateral nasal wall osteotomy, pterygomaxillary osteotomy, and a palatal osteotomy were done for all patients before the maxillary expansion. Total anaesthesia of the maxillary area facilitated the operations and appreciably reduced the amount of postoperative pain. The ease of achieving effective anaesthesia before and after operation and the absence of side-effects make this form of anaesthetic particularly useful in surgically assisted rapid maxillary expansion.

  5. Development of brake assist system. Summary of hydraulic brake assist system; Brake assist system no kaihatsu. Ekiatsushiki brake assist system no gaiyo

    Energy Technology Data Exchange (ETDEWEB)

    Hara, M.; Ota, M.; Shimizu, S. [Toyota, Motor Corp., Aichi (Japan)


    We have already developed vacuum-booster-type Brake Assist System that supplies additional braking power when panic braking is recognized. We are convinced that the expansion of Brake Assist System will become more important issue in the future. Therefore we have developed hydraulic Brake Assist System with increasing its controllability and reducing its discomfort. This system have a brake pressure sensor to detect emergency braking operation and an antilock device to supply additional braking power. 8 refs., 11 figs.

  6. Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership. (United States)

    DeCarlo, Linda


    CHANGES IN THE HEALTH CARE environment and reimbursement practices are creating opportunities for nurse entrepreneurs to be partners with other professional nurses and physicians. Advanced practice nurses (APNs) who want to step into an entrepreneurial role must have strong clinical expertise, specific personal characteristics, interpersonal skills, and business acumen. ESTABLISHING A MULTIDISCIPLINARY partnership for providing surgical assisting services has many benefits and presents many challenges.

  7. Robot-assisted sacrocolpopexy for pelvic organ prolapse: surgical technique and outcomes at a single high-volume institution. (United States)

    Ploumidis, Achilles; Spinoit, Anne-Françoise; De Naeyer, Geert; Schatteman, Peter; Gan, Melanie; Ficarra, Vincenzo; Volpe, Alessandro; Mottrie, Alexandre


    Pelvic organ prolapse (POP) represents a common female pelvic floor disorder that has a serious impact on quality of life. Several types of procedures with different surgical approaches have been described to correct these defects, but the optimal management is still debated. To describe our surgical technique of robot-assisted sacrocolpopexy (RASC) for POP and to assess its safety and long-term outcomes. A retrospective review of the medical records of 95 consecutive patients who underwent RASC for POP at our centre from April 2006 to December 2011 was performed. RASC with use of polypropylene meshes was performed in all cases using a standardised technique with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in a four-arm configuration. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications, and outcomes of RASC were assessed. A descriptive statistical analysis was performed. Median operative time was 101 min. No conversion to open surgery was needed. One vaginal and two bladder injuries occurred and were repaired intraoperatively. Only one Clavien grade 3 postoperative complication was observed (bowel obstruction treated laparoscopically). At a median follow-up of 34 mo, persistent POP was observed in four cases (4.2%). One mesh erosion occurred and required robot-assisted removal of the mesh. Ten (10.5%) patients complained de novo urgency after RASC, which resolved in the first few weeks after surgery. No significant de novo bowel or sexual symptoms were reported. Our technique of RASC for correction of POP is safe and effective, with limited risk of complications and good long-term results in the treatment of all types of POP. The robotic surgical system facilitates precise and accurate placement of the meshes with short operative time, thereby favouring wider diffusion of minimally invasive treatment of POP. We studied the treatment of patients with vaginal prolapse by using a robot-assisted

  8. Surgical PACS for the digital operating room. Systems engineering and specification of user requirements. (United States)

    Korb, Werner; Bohn, Stefan; Burgert, Oliver; Dietz, Andreas; Jacobs, Stephan; Falk, Volkmar; Meixensberger, Jürgen; Strauss, Gero; Trantakis, Christos; Lemke, Heinz U


    For better integration of surgical assist systems into the operating room, a common communication and processing plattform that is based on the users needs is needed. The development of such a system, a Surgical Picture Aquisition and Communication System (S-PACS), according the systems engineering cycle is oulined in this paper. The first two steps (concept and specification) for the engineering of the S-PACS are discussed.A method for the systematic integration of the users needs', the Quality Function Deployment (QFD), is presented. The properties of QFD for the underlying problem and first results are discussed. Finally, this leads to a first definition of an S-PACS system.

  9. Surgical outcome of video-assisted thoracic surgery for acute thoracic empyema using pulsed lavage irrigation. (United States)

    Nakamura, Hiroshige; Taniguchi, Yuji; Miwa, Ken; Adachi, Yoshin; Fujioka, Shinji; Haruki, Tomohiro


    The essential points of video-assisted thoracic surgery (VATS) for acute thoracic empyema are the decortication of thickened pleura, resection of necrotic tissues and fibrin blocks, and drainage. Pulsed lavage irrigation, which is commonly used in orthopedic surgery as a method of sufficiently performing the technique, was used under a thoracoscope to study the efficacy of the treatment for acute thoracic empyema. The subjects comprised 31 patients who had undergone VATS for acute thoracic empyema. There were 26 men and 5 women with an average age of 60.5 years. For the surgical technique, the thickened pus-producing pleura were decorticated under a thoracoscope. The pulsed lavage irrigation system was used after the intrathoracic space had become a single cavity. Using the tip for an intraspinal space, lavage and suctioning were repeated with 5-10 l of a pressurized warm saline solution. Fibrin blocks and necrotic tissues were easily removed by spray washing with pressurized fluid. The operating time was 150.8 min; the amount of bleeding, including suctioned pleural effusion, was 478.5 g; and the postoperative duration of drainage was 10.7 days. During the postoperative course, the addition of open window thoracotomy due to the relapse of empyema due to methicillin-resistant Staphylococcus aureus was observed in only one patient (3.2%). All of the other patients improved despite their concomitant diseases. The use of pulsed lavage irrigation under a thoracoscope for acute thoracic empyema provides simple, efficient débridement or drainage.

  10. Chemically Assisted Photocatalytic Oxidation System (United States)

    Andino, Jean; Wu, Chang-Yu; Mazyck, David; Teixeira, Arthur A.


    The chemically assisted photocatalytic oxidation system (CAPOS) has been proposed for destroying microorganisms and organic chemicals that may be suspended in the air or present on surfaces of an air-handling system that ventilates an indoor environment. The CAPOS would comprise an upstream and a downstream stage that would implement a tandem combination of two partly redundant treatments. In the upstream stage, the air stream and, optionally, surfaces of the air-handling system would be treated with ozone, which would be generated from oxygen in the air by means of an electrical discharge or ultraviolet light. In the second stage, the air laden with ozone and oxidation products from the first stage would be made to flow in contact with a silica-titania photocatalyst exposed to ultraviolet light in the presence of water vapor. Hydroxyl radicals generated by the photocatalytic action would react with both carbon containing chemicals and microorganisms to eventually produce water and carbon dioxide, and ozone from the first stage would be photocatalytically degraded to O2. The net products of the two-stage treatment would be H2O, CO2, and O2.

  11. Phyllodes tumor diagnosed after ultrasound-guided vacuum-assisted excision: should it be followed by surgical excision? (United States)

    Youk, Ji Hyun; Kim, Hana; Kim, Eun-Kyung; Son, Eun Ju; Kim, Min Jung; Kim, Jeong-Ah


    Our aim was to retrospectively evaluate the results of ultrasound (US)-guided vacuum-assisted excision (US-VAE) of phyllodes tumors (PTs). A total of 41 PTs diagnosed at US-VAE followed by surgery (n = 27) or at least 2 y of US monitoring (n = 14) were included. By comparison of US-VAE pathology with surgical histology or follow-up US results, cases were divided into upgraded (malignant) and non-upgraded (benign) groups. These two groups were compared with respect to clinical, procedural and US features. Among 27 surgical cases, 2 (8.7%) of 23 benign PTs were upgraded to malignant PTs. The Breast Imaging Reporting and Data System category was retrospectively assigned as 4a (50%) or 4b (50%) in the upgraded group (n = 2) and 3 (64%) or 4a (36%) in the non-upgraded group (n = 39) (p = 0.018). Residual tumor was observed at the site of US-VAE in 15 of 27 surgical cases and 0 of 14 US follow-up cases (36.6%, 15/41). Given the rates of upgrade to malignancy (8.7%) and residual tumor (36.6%), PTs diagnosed after US-VAE should be surgically excised. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  12. Effect of Spatial Cognitive Ability on Gain in Robot-Assisted Surgical Skills of Urological Surgeons. (United States)

    Teishima, Jun; Hattori, Minoru; Inoue, Shogo; Hieda, Keisuke; Kobatake, Kohei; Shinmei, Shunsuke; Egi, Hiroyuki; Ohdan, Hideki; Matsubara, Akio


    Although previous studies have demonstrated the needs for a spatial cognitive ability that can give an accurate understanding of the position, orientation, and size and form of the objects in endoscopic surgery, there has been no study on the relationship between the skills of robot-assisted surgery and spatial cognitive ability. To assess the effect of spatial cognitive ability on gain in robot-assisted surgical skills of urological surgeons. The robot-assisted surgery skills of 24 urological surgeons who had no previous experience with the Mimic dV-Trainer (MdVT) and had not been the main surgeon in robot-assisted surgery and 20 volunteer medical students who had no previous experience of the MdVT were assessed by using a program consisting of 4 kinds of tasks. Their performances were recorded using a built-in scoring algorithm. Their spatial cognitive abilities were also assessed using a mental rotation test. Although there was a significant correlation between the spatial cognitive ability and a score of 2 for the more difficult tasks for student groups using the MdVT, there was no significant correlation between them for all tasks for groups of urological surgeons. The results of the present study indicate that differences in spatial cognitive ability in urological surgeons have no effect on the gain in fundamental robot-assisted surgery skills whereas there was a significant correlation between the spatial cognitive ability and fundamental robot-assisted surgical skills in the volunteers. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. Survey on Robot-Assisted Surgical Techniques Utilization in US Pediatric Surgery Fellowships. (United States)

    Maizlin, Ilan I; Shroyer, Michelle C; Yu, David C; Martin, Colin A; Chen, Mike K; Russell, Robert T


    Robotic technology has transformed both practice and education in many adult surgical specialties; no standardized training guidelines in pediatric surgery currently exist. The purpose of our study was to assess the prevalence of robotic procedures and extent of robotic surgery education in US pediatric surgery fellowships. A deidentified survey measured utilization of the robot, perception on the utility of the robot, and its incorporation in training among the program directors of Accreditation Council for Graduate Medical Education (ACGME) pediatric surgery fellowships in the United States. Forty-one of the 47 fellowship programs (87%) responded to the survey. While 67% of respondents indicated the presence of a robot in their facility, only 26% reported its utilizing in their surgical practice. Among programs not utilizing the robot, most common reasons provided were lack of clear supportive evidence, increased intraoperative time, and incompatibility of instrument size to pediatric patients. While 58% of program directors believe that there is a future role for robotic surgery in children, only 18% indicated that robotic training should play a part in pediatric surgery education. Consequently, while over 66% of survey respondents received training in robot-assisted surgical technique, only 29% of fellows receive robot-assisted training during their fellowship. A majority of fellowships have access to a robot, but few utilize the technology in their current practice or as part of training. Further investigation is required into both the technology's potential benefits in the pediatric population and its role in pediatric surgery training.

  14. Multicentre prospective evaluation of implant-assisted mandibular removable partial dentures: surgical and prosthodontic outcomes. (United States)

    Payne, Alan G T; Tawse-Smith, Andrew; Wismeijer, Daniel; De Silva, Rohana K; Ma, Sunyoung


    To determine implant survival and prosthodontic maintenance of implant-assisted mandibular removable partial dentures in a multicentre prospective study up to 10 years. Forty-eight participants with mandibular distal extension partial dentures were selected. A control group of 12 New Zealand participants had new conventional mandibular partial dentures made. Three test groups of 36 participants in New Zealand (n = 12), the Netherlands (n = 12) and Colombia (n = 12) had bilateral distal implants placed. Surgical and prosthodontic outcomes were documented with only healing caps placed (Stage 1) and with an attachment system (Stage 2). No implants failed after 3 years. Four late implant failures in three participants occurred in New Zealand (two unilateral implant failures after 5 and 8 years and two bilateral implant failures in the same participant after 6 and 10 years); two unilateral late implant failures occurred in the Netherlands and no late failures in Colombia. Implant survival rate was 92% by 10 years. Resonance frequency measurements were taken at surgery implant stability quotient (ISQ) 62.44 ± 7.46; range 40 - 79), baseline (ISQ 63.22 ± 6.17; range 50 - 74) and after 3 years (ISQ 66.38 ± 6.77; range 55 - 83). In New Zealand and Colombia, measured crestal bone levels were 2.03 ± 0.71 mm and 2.20 ± 0.81 mm, respectively, at baseline and 3 years. For Stage I, principal prosthodontic maintenance issues were loose healing caps among 10 New Zealand participants, four Colombian participants and one Netherlands participant. For Stage 2, matrix activation and overdenture puncture fractures resulted in 41 events (25 participants) in New Zealand over 10 years, whilst over 3 years, there were 14 events in nine Colombian participants and six events in five Netherlands participants. This clinical multicentre research complements previous case reports, case series, retrospective and prospective studies on the notion of implant-assisted

  15. Computer-assisted surgical planning and simulation for unilateral condylar benign lesions causing facial asymmetry. (United States)

    Lu, Chuan; He, Dongmei; Yang, Chi; Huang, Dong; Ellis, Edward


    The purpose of this study was to investigate the best surgical sequence for the treatment of unilateral condylar benign lesions causing facial asymmetry by applying computer-assisted surgical planning and simulation. Computed tomography (CT) data from 12 patients whose maxillary cant was corrected by maintaining the vertical position of the central incisors and equally intruding the long side of the maxilla and extruding the short side were analyzed by ProPlan CMF 1.4 software (Materialise Medical, Leuven, Belgium). Condylectomy and double jaw orthognathic surgery with 2 different surgical sequences were simulated: 1) maxillary LeFort I osteotomy first (MaxF), then condylectomy, followed by bilateral sagittal split ramus osteotomy (BSSO); and 2) mandible first (ManF), beginning with condylectomy, then BSSO, and lastly LeFort I osteotomy. The greatest space between the maxillary and mandibular first molar in the interim positions was measured virtually to compare the 2 surgical sequences. The vertical distance between the upper and lower teeth of ManF patients was significantly smaller than that of MaxF patients (mean 2.99 mm, P < .001). When occlusal cants are corrected by equally intruding one side and extruding the other side of the maxillary dentition, the interim position is more conducive to sequencing corrective surgery by performing condylectomy, then BSSO, followed by Le Fort I osteotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Pitfalls of robot-assisted radical prostatectomy: a comparison of positive surgical margins between robotic and laparoscopic surgery. (United States)

    Tozawa, Keiichi; Yasui, Takahiro; Umemoto, Yukihiro; Mizuno, Kentaro; Okada, Atsushi; Kawai, Noriyasu; Takahashi, Satoru; Kohri, Kenjiro


    To compare the surgical outcomes of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy, including the frequency and location of positive surgical margins. The study cohort comprised 708 consecutive male patients with clinically localized prostate cancer who underwent laparoscopic radical prostatectomy (n = 551) or robot-assisted radical prostatectomy (n = 157) between January 1999 and September 2012. Operative time, estimated blood loss, complications, and positive surgical margins frequency were compared between laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. There were no significant differences in age or body mass index between the laparoscopic radical prostatectomy and robot-assisted radical prostatectomy patients. Prostate-specific antigen levels, Gleason sum and clinical stage of the robot-assisted radical prostatectomy patients were significantly higher than those of the laparoscopic radical prostatectomy patients. Robot-assisted radical prostatectomy patients suffered significantly less bleeding (P robot-assisted radical prostatectomy group. In the laparoscopic radical prostatectomy group, positive surgical margins were detected in the apex (52.0%), anterior (5.3%), posterior (5.3%) and lateral regions (22.7%) of the prostate, as well as in the bladder neck (14.7%). In the robot-assisted radical prostatectomy patients, they were observed in the apex, anterior, posterior, and lateral regions of the prostate in 43.0%, 6.9%, 25.9% and 15.5% of patients, respectively, as well as in the bladder neck in 8.6% of patients. Positive surgical margin distributions after robot-assisted radical prostatectomy and laparoscopic radical prostatectomy are significantly different. The only disadvantage of robot-assisted radical prostatectomy is the lack of tactile feedback. Thus, the robotic surgeon needs to take this into account to minimize the risk of positive surgical margins. © 2014 The Japanese Urological

  17. The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings. (United States)

    Badalato, Gina M; Shapiro, Edan; Rothberg, Michael B; Bergman, Ari; RoyChoudhury, Arindam; Korets, Ruslan; Patel, Trushar; Badani, Ketan K


    Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference. Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance. Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (Probot tasks, respectively (Probotic and open approaches for raw time scores (Phand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts. The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.

  18. Camera-based driver assistance systems (United States)

    Grimm, Michael


    In recent years, camera-based driver assistance systems have taken an important step: from laboratory setup to series production. This tutorial gives a brief overview on the technology behind driver assistance systems, presents the most significant functionalities and focuses on the processes of developing camera-based systems for series production. We highlight the critical points which need to be addressed when camera-based driver assistance systems are sold in their thousands, worldwide - and the benefit in terms of safety which results from it.

  19. A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch. (United States)

    Becher-Deichsel, Anja; Aurich, Jörg E; Schrammel, Nadine; Dupré, Gilles


    The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5-10.5 years; median weight 37.0 kg, range 12.9-64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1-7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0-7.0 cm). Median surgical time was 57 minutes (range 48-65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Directory of Open Access Journals (Sweden)

    Riccardo Muradore


    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  1. Wound management with vacuum assisted closure in surgical site infection after ankle surgery. (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan


    The aim of this study was to compare the efficacy of vacuum assisted closure (VAC) with standard moist wound care (SMWC) in surgical site infection after ankle surgery. A prospective cohort was performed among patients with surgical site infection after ankle surgery between 2012 and 2013. The follow-up period was three month, and the efficacy end point was complete wound closure rate. Ninety-four patients were analyzed, with 61 patients in the VAC group and 33 in the SMWC group. The complete wound closure rate in the VAC group was higher than that in the SMWC group at 3 month follow up (90.2% Vs. 72.7%, p = 0.028). The median time to complete wound closure was 31 days (95% CI 20.2-41.8) for VAC, and 63 days (95% CI 46.9-79.1) for SMWC (χ(2) = 4.023, p = 0.045). In the superficial infection subgroup, the median times to complete wound closure were 20 days (95% CI 14.2-35.1) in the VAC group and 42 days (95% CI 35.4-69.4) in SMWC group (χ(2) = 4.331, p = 0.041). In the deep subgroup, the median times to complete wound closure were 46 days (95% CI 28.2-65.9) in the VAC group and 75 days (95% CI 43.2-79.6) in SMWC group (χ(2) = 6.475, p = 0.026). Our result showed that vacuum assisted closure was more effective than standard moist wound care in surgical site infection after ankle surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  2. Surgical treatment of an acquired posterior urethral diverticulum with cystoscopy assisted robotic technique. (United States)

    Guneri, Cagri; Kirac, Mustafa; Biri, Hasan


    A 42-year-old man with a history of recurrent urethral stenosis, recurrent urinary tract infection and macroscopic hematuria has referred to our clinic. He underwent several internal urethrotomies and currently using clean intermittent self-catheterization. During the internal urethrotomy, we noted a large posterior urethral diverticulum (UD) between verumontanum and bladder neck. His obstructive symptoms were resolved after the catheter removal. But perineal discomfort, urgency and dysuria were prolonged about 3-4 weeks. Urinalysis and urine culture confirmed recurrent urinary tract infections. Due to this conditions and symptoms, we planned a surgical approach which was planned as transperitoneal robotic-assisted laparoscopic approach. This technique is still applied for the diverticulectomy of the bladder. In addition to this we utilized the cystoscopy equipments for assistance. During this process, cystoscope was placed in the UD to help the identification of UD from adjacent tissues like seminal vesicles by its movement and translumination. Operating time was 185 min. On the post-operative third day he was discharged. Foley catheter was removed after 2 weeks. Urination was quite satisfactory. His perineal discomfort was resolved. The pathology report confirmed epidermoid (tailgut) cyst of the prostate. Urethrogram showed no radiologic signs of UD after 4 weeks. Irritative and obstructive symptoms were completely resolved after 3 months. No urinary incontinence, erectile dysfunction or retrograde ejaculation was noted. While posterior UD is an extremely rare situation, surgical treatment of posterior UD remains uncertain. To our knowledge, no above-mentioned cystoscopy assisted robotic technique for the treatment was described in the literature.

  3. The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. (United States)

    Fernández-García, P; Marco-Doménech, S F; Lizán-Tudela, L; Ibáñez-Gual, M V; Navarro-Ballester, A; Casanovas-Feliu, E

    To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Pilot study of design method for surgical robot using workspace reproduction system. (United States)

    Seno, Hiroto; Kawamura, Kazuya; Kobayashi, Yo; Fujie, Masakatsu G


    Recent development methods for surgical robots have an inherent problem. The user-friendliness of operating robot cannot be revealed until completion of the robot. To assist the design of a surgical robot that is user-friendly in terms of surgeon's operation, we propose a system that considers the operation manner of surgeon during the design phase of the robot. This system includes the following functionality: 1) a master manipulator that measures the operation manner of the surgeon (operator), and 2) a slave simulator in which the mechanical parameters can be configured freely. The operator can use the master manipulator to operate the slave simulator. Using this system, we investigate the necessity of considering the operator's manner when developing a surgical robot. In the experiment, we used three instruments with mechanisms that differed with respect to the length between bending joints and measured the trajectory of each instrument tip position during the surgical task. The results show that there are differences in the trajectories of each mechanism. Based on the results, changes in the mechanism of the surgical robot influenced the operator's manner. Therefore, when designing the mechanism for a surgical robot, there is a need to consider how this influences the operator's manner.

  5. Can a teaching assistant experience in a surgical anatomy course influence the learning curve for nontechnical skill development for surgical residents? (United States)

    Heidenreich, Mark J; Musonza, Tashinga; Pawlina, Wojciech; Lachman, Nirusha


    The foundation upon which surgical residents are trained to work comprises more than just critical cognitive, clinical, and technical skill. In an environment where the synchronous application of expertise is vital to patient outcomes, the expectation for optimal functioning within a multidisciplinary team is extremely high. Studies have shown that for most residents, one of the most difficult milestones in the path to achieving professional expertise in a surgical career is overcoming the learning curve. This view point commentary provides a reflection from the two senior medical students who have participated in the Student-as-Teacher program developed by the Department of Anatomy at Mayo Clinic, designed to prepare students for their teaching assistant (TA) role in anatomy courses. Both students participated as TAs in a six week surgical anatomy course for surgical first assistant students offered by the School of Health Sciences at Mayo Clinic. Development of teaching skills, nontechnical leadership, communication, and assessment skills, are discussed in relation to their benefits in preparing senior medical students for surgical residency. © 2015 American Association of Anatomists.

  6. Receiving Assistance and Local Food System Participation

    Directory of Open Access Journals (Sweden)

    Rebecca L. Som Castellano


    Full Text Available A body of literature has noted that local food systems (LFSs may not involve active participation by individuals with lower incomes. This is, in part, a function of racial and class hegemony, as well as physical and financial accessibility of LFSs. LFS institutions, such as farmers’ markets, have been working to facilitate receipt of food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP. Charitable assistance programs, such as food banks, have also been actively working to engage in LFSs, for example, by making local foods available. However, little research has explored the role that receiving public or charitable assistance can play in influencing LFS participation. In this article, I utilize quantitative and qualitative data collected from across the state of Ohio to examine the relationship between receiving assistance and LFS participation for women, who remain predominately responsible for food provisioning in the U.S., including among those who participate in LFSs. Quantitative results suggest that receiving assistance can increase participation in LFSs. Qualitative data provides more nuanced information about the importance of food assistance for women who want to participate in LFSs, and suggest that it is essential that food cooperatives and farmers’ markets are equipped to receive food assistance programs, such as SNAP, in order for women with lower incomes to participate in LFSs.

  7. Adaptive Dialogue Systems for Assistive Living Environments (United States)

    Papangelis, Alexandros


    Adaptive Dialogue Systems (ADS) are intelligent systems, able to interact with users via multiple modalities, such as speech, gestures, facial expressions and others. Such systems are able to make conversation with their users, usually on a specific, narrow topic. Assistive Living Environments are environments where the users are by definition not…

  8. Toast: The power system operators assistant

    Energy Technology Data Exchange (ETDEWEB)

    Talukdar, S.N.; Cardozo, E.; Leao, L.


    The environments in which power system operators work are becoming more complex. New constraints are appearing, old constraints are tightening, and the number of decision variables is increasing. To cope with these trends, operators need intelligent assistants to help manage information and lighten their decision-making burdens. Such assistants can be divided into two types: Phase-1 assistants for off-line uses and Phase-2 assistants for on-line uses and Phase-2 assistants for on-line, real-time uses. Toast is an evolving Phase-1 assistant. Of the nine possible functions of an assistant, Toast has immediate potential in two-diagnosis and criticism. Its diagnostic knowledge, though hardly complete, is extensive enough to be useful to human operators. In contrast, its abilities to critique proposed courses of action are much less developed and, as yet, consist only of facilities to simulate some of the these courses of action. Toast has been written in Cops, a programming environment that allows for distributed processing and has a readily extensible library of both symbolic and numerical programs. These features should make the task of expanding Toast relatively painless. Of the many directions in which expansions could occur, we plan on adding diagnostic capabilities in the area of power system security. This area was identified in a study as the most worthy of development.

  9. Planned posterior assisted levitation in severe subluxated cataract: Surgical technique and clinical results

    Directory of Open Access Journals (Sweden)

    Tova Lifshitz


    Full Text Available We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

  10. Predicting Complications Following Robot-Assisted Partial Nephrectomy with the ACS NSQIP®Universal Surgical Risk Calculator. (United States)

    Winoker, Jared S; Paulucci, David J; Anastos, Harry; Waingankar, Nikhil; Abaza, Ronney; Eun, Daniel D; Bhandari, Akshay; Hemal, Ashok K; Sfakianos, John P; Badani, Ketan K


    We evaluated the predictive value of the ACS NSQIP® (American College of Surgeons National Surgical Quality Improvement Program®) surgical risk calculator in a tertiary referral cohort of patients who underwent robot-assisted partial nephrectomy. We queried our prospectively maintained, multi-institutional database of patients treated with robot-assisted partial nephrectomy and input the preoperative details of 300 randomly selected patients into the calculator. Accuracy of the calculator was assessed by the ROC AUC and the Brier score. The observed rate of any complication in our cohort was 14% while the mean predicted rate of any complication using the calculator was 5.42%. The observed rate of serious complications (Clavien score 3 or greater) was 3.67% compared to the predicted rate of 4.89%. Low AUC and high Brier score were calculated for any complication (0.51 and 0.1272) and serious complications (0.55 and 0.0352, respectively). The calculated AUC was low for all outcomes, including venous thromboembolism (0.67), surgical site infection (0.51) and pneumonia (0.44). The ACS NSQIP risk calculator poorly predicted and discriminated which patients would experience complications after robot-assisted partial nephrectomy. These findings suggest the need for a more tailored outcome prediction model to better assist urologists risk stratify patients undergoing robot-assisted partial nephrectomy and counsel them on individual surgical risks. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Vision and Task Assistance using Modular Wireless In Vivo Surgical Robots (United States)

    Platt, Stephen R.; Hawks, Jeff A.; Rentschler, Mark E.


    Minimally invasive abdominal surgery (laparoscopy) results in superior patient outcomes compared to conventional open surgery. However, the difficulty of manipulating traditional laparoscopic tools from outside the body of the patient generally limits these benefits to patients undergoing relatively low complexity procedures. The use of tools that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Our previous work demonstrated that miniature mobile and fixed-based in vivo robots using tethers for power and data transmission can successfully operate within the abdominal cavity. This paper describes the development of a modular wireless mobile platform for in vivo sensing and manipulation applications. Design details and results of ex vivo and in vivo tests of robots with biopsy grasper, staple/clamp, video, and physiological sensor payloads are presented. These types of self-contained surgical devices are significantly more transportable and lower in cost than current robotic surgical assistants. They could ultimately be carried and deployed by non-medical personnel at the site of an injury to allow a remotely located surgeon to provide critical first response medical intervention irrespective of the location of the patient. PMID:19237337

  12. Vision and task assistance using modular wireless in vivo surgical robots. (United States)

    Platt, Stephen R; Hawks, Jeff A; Rentschler, Mark E


    Minimally invasive abdominal surgery (laparoscopy) results in superior patient outcomes compared to conventional open surgery. However, the difficulty of manipulating traditional laparoscopic tools from outside the body of the patient generally limits these benefits to patients undergoing relatively low complexity procedures. The use of tools that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Our previous work demonstrated that miniature mobile and fixed-based in vivo robots using tethers for power and data transmission can successfully operate within the abdominal cavity. This paper describes the development of a modular wireless mobile platform for in vivo sensing and manipulation applications. Design details and results of ex vivo and in vivo tests of robots with biopsy grasper, staple/clamp, video, and physiological sensor payloads are presented. These types of self-contained surgical devices are significantly more transportable and lower in cost than current robotic surgical assistants. They could ultimately be carried and deployed by nonmedical personnel at the site of an injury to allow a remotely located surgeon to provide critical first response medical intervention irrespective of the location of the patient.

  13. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. (United States)

    De Carlo, Francesco; Celestino, Francesco; Verri, Cristian; Masedu, Francesco; Liberati, Emanuele; Di Stasi, Savino Mauro


    Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP. A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review. 44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes. Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.

  14. Surgical drill system and surgical drill bit to be used therein

    NARCIS (Netherlands)

    Margallo Balbas, E.; Wieringa, P.A.; French, P.J.; Lee, R.A.; Breedveld, P.


    Surgical drill system comprising a mechanical drill bit and means for imaging the vicinity of the drill bit tip, said means comprising: at least one optical fiber having a distal end and a proximal end, said distal end being located adjacent said drill bit tip, an optical processing unit, said

  15. Independent Navigation System for a Surgical Colonoscope

    Directory of Open Access Journals (Sweden)

    Lilia A. Ochoa-Luna


    Full Text Available This paper provides a novel algorithm to attain the independent navigation of a colonoscopy surgical endoscope. First, it introduces a brief description of this issue through the scientist advance for medical robotics. It then makes a quickly count of the existent methods and at the end it provides the basis in order to propose a new alternative solution with help from vision-guidance. That means that images will be processed and interpreted with the purpose of maintaining the endoscope always at the intestine center. All this considered will help us to reduce colonoscopy surgeries consequences and the most important advantage of this new method proposed is that surgeons will accomplish their work easier and more efficiently.

  16. ESSAA: Embedded system safety analysis assistant (United States)

    Wallace, Peter; Holzer, Joseph; Guarro, Sergio; Hyatt, Larry


    The Embedded System Safety Analysis Assistant (ESSAA) is a knowledge-based tool that can assist in identifying disaster scenarios. Imbedded software issues hazardous control commands to the surrounding hardware. ESSAA is intended to work from outputs to inputs, as a complement to simulation and verification methods. Rather than treating the software in isolation, it examines the context in which the software is to be deployed. Given a specified disasterous outcome, ESSAA works from a qualitative, abstract model of the complete system to infer sets of environmental conditions and/or failures that could cause a disasterous outcome. The scenarios can then be examined in depth for plausibility using existing techniques.

  17. Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot. (United States)

    Duan, Xingguang; Gao, Liang; Wang, Yonggui; Li, Jianxi; Li, Haoyuan; Guo, Yanjun


    In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, "kinematics + optics" hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.

  18. Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot

    Directory of Open Access Journals (Sweden)

    Xingguang Duan


    Full Text Available In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, “kinematics + optics” hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.

  19. Modelling and Experiment Based on a Navigation System for a Cranio-Maxillofacial Surgical Robot (United States)

    Duan, Xingguang; Gao, Liang; Li, Jianxi; Li, Haoyuan; Guo, Yanjun


    In view of the characteristics of high risk and high accuracy in cranio-maxillofacial surgery, we present a novel surgical robot system that can be used in a variety of surgeries. The surgical robot system can assist surgeons in completing biopsy of skull base lesions, radiofrequency thermocoagulation of the trigeminal ganglion, and radioactive particle implantation of skull base malignant tumors. This paper focuses on modelling and experimental analyses of the robot system based on navigation technology. Firstly, the transformation relationship between the subsystems is realized based on the quaternion and the iterative closest point registration algorithm. The hand-eye coordination model based on optical navigation is established to control the end effector of the robot moving to the target position along the planning path. The closed-loop control method, “kinematics + optics” hybrid motion control method, is presented to improve the positioning accuracy of the system. Secondly, the accuracy of the system model was tested by model experiments. And the feasibility of the closed-loop control method was verified by comparing the positioning accuracy before and after the application of the method. Finally, the skull model experiments were performed to evaluate the function of the surgical robot system. The results validate its feasibility and are consistent with the preoperative surgical planning.

  20. Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery. (United States)

    Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell


    This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.

  1. [Vacuum-assisted closure as a treatment modality for surgical site infection in cardiac surgery]. (United States)

    Simek, M; Nemec, P; Zálesák, B; Hájek, R; Kaláb, M; Fluger, I; Kolár, M; Jecmínková, L; Gráfová, P


    The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection. From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 +/- 9.7 years and the median BMI was 33.2 +/- 5.0 kg/m2. Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%). Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 +/- 22.6 days. The median number of dressing changes was 4.6 +/- 1.8. The median VAC treatment time until surgical closure was 9.7 +/- 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy. The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

  2. Use of three-dimensional, CAD/CAM-assisted, virtual surgical simulation and planning in the pediatric craniofacial population. (United States)

    Gray, Rachel; Gougoutas, Alexander; Nguyen, Vinh; Taylor, Jesse; Bastidas, Nicholas


    Virtual Surgical Planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM) have recently helped improve efficiency and accuracy in many different craniofacial surgeries. Research has mainly focused on the use in the adult population with the exception of the use for mandibular distractions and cranial vault remodeling in the pediatric population. This study aims to elucidate the role of VSP and CAD/CAM in complex pediatric craniofacial cases by exploring its use in the correction of midface hypoplasia, orbital dystopia, mandibular reconstruction, and posterior cranial vault expansion. A retrospective analysis of thirteen patients who underwent 3d, CAD/CAM- assisted preoperative surgical planning between 2012 and 2016 was performed. All CAD/CAM assisted surgical planning was done in conjunction with a third party vendor (either 3D Systems or Materialise). Cutting and positioning guides as well as models were produced based on the virtual plan. Surgeries included free fibula mandible reconstruction (n = 4), lefort I osteotomy and distraction (n = 2), lefort II osteotomy with monobloc distraction (n = 1), expansion of the posterior vault for correction of chiari malformation (n = 3), and secondary orbital and midface reconstruction for facial trauma (n = 3). The patient's age, diagnosis, previous surgeries, length of operating time, complications, and post-surgery satisfaction were determined. In all cases we found presurgical planning was helpful to improve accuracy and significantly decrease intra-operative time. In cases where distraction was used, the planned and actual vectors were found to be accurate with excellent clinical outcomes. There were no complications except for one patient who experienced a wound infection post-operatively which did not alter the ultimate reconstruction. All patients experienced high satisfaction with their outcomes and excellent subjective aesthetic results were achieved. Preoperative planning using

  3. Comparison of surgical, functional, and oncological outcomes of open and robot-assisted partial nephrectomy

    Directory of Open Access Journals (Sweden)

    Ugur Boylu


    Full Text Available Background: We aimed to compare the surgical, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN with open partial nephrectomy (OPN in the management of small renal masses. Materials and Methods: Between 2009 and 2013, a total of 46 RAPN patients and 20 OPN patients was included in this study. Patients′ demographics, mean operative time, estimated blood loss (EBL, warm ischemia time (WIT, length of hospital stay, pre- and post-operative renal functions, complications and oncological outcomes were recorded, prospectively. Results: Mean tumor size was 4.04 cm in OPN group and 3.56 cm in RAPN group (P = 0.27. Mean R.E.N.A.L nephrometry score was 6.35 in OPN group and 5.35 in RAPN group (P = 0.02. The mean operative time was 152 min in OPN group and 225 min in RAPN group (P = 0.006. The mean EBL in OPN and RAPN groups were 417 ml and 268 ml, respectively (P = 0.001. WIT in OPN group was significantly shorter than RAPN group (18.02 min vs. 23.33 min, P = 0.003. The mean drain removal time and the length of hospital stay were longer in OPN group. There were no significant differences in terms of renal functional outcomes and postoperative complications between groups. Conclusion: Minimally invasive surgical management of renal masses with RAPN offers better outcomes in terms of EBL and length of stay. However, the mean operative time and WIT were significantly shorter in OPN group. RAPN is a safe and effective minimally invasive alternative to OPN in terms of oncological and functional outcomes.

  4. Cedar Avenue driver assist system evaluation report. (United States)


    This paper summarizes an evaluation of the Driver Assist System (DAS) used by the Minnesota Valley Transit Authority (MTVA) for bus shoulder operations. The DAS is a GPS-based technology suite that provides lane-position feedback to the driver via a ...

  5. Noninvasive Assisted Ventilation in Pulmonary Gas Exchange Dysfunctions in Cardiac Surgical Patients

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov


    Full Text Available Background. Postextubation pulmonary gas exchange dysfunctions are a potential complication in the activation of cardio-surgical patients in the early periods after surgical intervention. Objective: to evaluate the efficiency of noninvasive assisted ventilation (NIAV as a method for correcting the pulmonary gas exchange disturbances developing after early activation of cardiosurgical patients. Subjects and methods. The study included 64 patients (36 males and 28 females aged 21 to 72 (54±2 years who had been operated on under extracorporeal circulation (EC. The duration of EC and myocardial ischemia was 104±6 and 73±4 min, respectively. The indications for NIAV were the clinical manifestations of acute respiratory failure (ARF and/or PaCO2>50 mm Hg and/or PaO2/FiO2Results. During NIAV, there was improvement (p<0.05 of lung oxygenizing function (the increase in PaO2/FiO2 was 23%, a reduction in Qs/Qt from 21.1±1.9 to 13.9±1.0% (p<0.05. NIAV was accompanied by a decrease in PaCO2 (p<0.05. Hypercapnia regressed in 7 patients with isolated lung ventilatory dysfunction (PaCO2>50 mm Hg an hour after initiation of NIAV. During and after NIAV, there were reductions in right atrial pressure, mean pulmonary pressure, indexed total pulmonary vascular resistance (ITPVR (p<0.05. Prior to, during, and following NIAV, mean blood pressure, cardiac index, and indexed total pulmonary vascular resstance did not change greatly. In hypercapnia, the duration of NIAV was significantly less than that in lung oxygenizing function (2.8±0.2 hours versus 4.7±0.5 hours. That of ICU treatment was 23±4 hours. Fifty-two (81% patients were transferred from ICUs to cardiosurgical units on the following day after surgery. Conclusion. In most cases, NIAV promotes a rapid and effective correction of postextubation lung ventilatory and oxygenizing dysfunctions occurring after early activation of cardiosurgical patients. Key words: non-invasive assisted ventilation, early

  6. Application of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for living donor liver transplantation. (United States)

    Wei, Lin; Zhu, Zhi-Jun; Lü, Yi; Jiang, Wen-Tao; Gao, Wei; Zeng, Zhi-Gui; Shen, Zhong-Yang


    Precise evaluation of the live donor's liver is the most important factor for the donor's safety and the recipient's prognosis in living donor liver transplantation (LDLT). Our study assessed the clinical value of computer-assisted three-dimensional quantitative assessment and a surgical planning tool for donor evaluation in LDLT. Computer-assisted three-dimensional (3D) quantitative assessment was used to prospectively provide quantitative assessment of the graft volume for 123 consecutive donors of LDLT and its accuracy and efficiency were compared with that of the standard manual-traced method. A case of reduced monosegmental LDLT was also assessed and a surgical planning tool displayed the precise surgical plan to avoid large-for-size syndrome. There was no statistically significant difference between the detected graft volumes with computer-assisted 3D quantitative assessment and manual-traced approaches ((856.76 ± 162.18) cm(3) vs. (870.64 ± 172.54) cm(3), P = 0.796). Estimated volumes by either method had good correlation with the actual graft weight (r-manual-traced method: 0.921, r-3D quantitative assessment method: 0.896, both P assisted 3D quantitative assessment approach was significantly more efficient taking half the time of the manual-traced method ((16.91 ± 1.375) minutes vs. (39.27 ± 2.102) minutes, P size syndrome. Computer-assisted 3D quantitative assessment provided precise evaluation of the graft volume. It also assisted surgeons with a better understanding of the hepatic 3D anatomy and was useful for the individual surgical planning tool.

  7. [Interest of surgical companionship during the training period of robot-assisted radical prostatectomy]. (United States)

    du Pouget, L; Nouhaud, F X; Blah, M; Defortescu, G; Ndangang, M; Grise, P; Pfister, C


    Study of the learning curve of robot-assisted radical prostatectomy, evaluating intraoperative difficulties and postoperative complications according to Clavien-Dindo classification. Retrospective study of our first 157 consecutive patients treated with robot-assisted prostatectomy for localized prostate cancer between September 2011 and December 2014. Comparison of learning for each group of 50 procedures and then comparison between patients operated on by a pair of two seniors specially trained for robotic surgery and patients operated on by one mixed pair including a surgeon junior coached by one senior of the first group. Only postoperative complications decreased significantly from the 51st patient (P=0.04). The curves showing the evolution of the operative time decreased with a parallel trend between the two pairs, but with more variability in the mixed pair. There was no significant difference in terms of intraoperative difficulties (P=0.59), nor postoperative complications (P=0.56) mainly of grade 2. The blood loss, transfusion rate, duration of hospitalization and readmission rates did not differ. Lymph node dissection did not affect outcomes. For oncological results, the overall rate of positive surgical margins (R+) was 30.6 % in the initial pair against 24.2 % in the mixed group with no significant difference. Nevertheless, the subpopulation study objectified a R+ rate of 12.86 % for pT2 against 42.85 % for pT3. The early involvement of a junior surgeon who did not receive specific training, but benefiting from the guidance of a senior surgeon, did not compromise the results while allowing a faster learning curve with a rate of operative complications close to the one observed by the senior pair. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Aviation System Analysis Capability Executive Assistant Design (United States)

    Roberts, Eileen; Villani, James A.; Osman, Mohammed; Godso, David; King, Brent; Ricciardi, Michael


    In this technical document, we describe the design developed for the Aviation System Analysis Capability (ASAC) Executive Assistant (EA) Proof of Concept (POC). We describe the genesis and role of the ASAC system, discuss the objectives of the ASAC system and provide an overview of components and models within the ASAC system, and describe the design process and the results of the ASAC EA POC system design. We also describe the evaluation process and results for applicable COTS software. The document has six chapters, a bibliography, three appendices and one attachment.

  9. Thermocompressor powered artificial heart assist system

    International Nuclear Information System (INIS)

    Moise, J.C.; Rudnicki, M.I.; Faeser, R.J.


    The development of a fully implantable, left ventricular assist system is described. The system utilizes a radioisotope-powered Stirling cycle thermocompressor and an all-pneumatic actuation and control system to drive a pusher-plate type blood pump. This basic approach has been shown to be efficient and workable by implantation experiments on calves. The recent effort has been directed toward the fabrication and development of a fourth-generation system, designed to reduce weight, volume and isotope inventory. Extensive endurance and accelerated-life testing has been undertaken. The improved design concepts utilized in the system and pertinent test results are discussed

  10. 21 CFR 884.6200 - Assisted reproduction laser system. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction laser system. 884.6200... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6200 Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device...

  11. Review of advanced driver assistance systems (ADAS) (United States)

    Ziebinski, Adam; Cupek, Rafal; Grzechca, Damian; Chruszczyk, Lukas


    New cars can be equipped with many advanced safety solutions. Airbags, seatbelts and all of the essential passive safety parts are standard equipment. Now cars are often equipped with new advanced active safety systems that can prevent accidents. The functions of the Advanced Driver Assistance Systems are still growing. A review of the most popular available technologies used in ADAS and descriptions of their application areas are discussed in this paper.

  12. Magnetic Launch Assist System Demonstration Test (United States)


    Engineers at the Marshall Space Flight Center (MSFC) have been testing Magnetic Launch Assist Systems, formerly known as Magnetic Levitation (MagLev) technologies. To launch spacecraft into orbit, a Magnetic Launch Assist system would use magnetic fields to levitate and accelerate a vehicle along a track at a very high speed. Similar to high-speed trains and roller coasters that use high-strength magnets to lift and propel a vehicle a couple of inches above a guideway, the launch-assist system would electromagnetically drive a space vehicle along the track. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. This photograph shows a subscale model of an airplane running on the experimental track at MSFC during the demonstration test. This track is an advanced linear induction motor. Induction motors are common in fans, power drills, and sewing machines. Instead of spinning in a circular motion to turn a shaft or gears, a linear induction motor produces thrust in a straight line. Mounted on concrete pedestals, the track is 100-feet long, about 2-feet wide, and about 1.5- feet high. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the take-off, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  13. Periodontal and dental effects of surgically assisted rapid maxillary expansion, assessed by using digital study models (United States)

    Siqueira, Danilo Furquim; Cardoso, Mauricio de Almeida; Capelozza, Leopoldino; Goldenberg, Dov Charles; Fernandes, Mariana dos Santos


    OBJECTIVE: The present study assessed the maxillary dental arch changes produced by surgically assisted rapid maxillary expansion (SARME). METHODS: Dental casts from 18 patients (mean age of 23.3 years) were obtained at treatment onset (T1), three months after SARME (T2) and 6 months after expansion (T3). The casts were scanned in a 3D scanner (D-250, 3Shape, Copenhagen, Denmark). Maxillary dental arch width, dental crown tipping and height were measured and assessed by ANOVA and Tukey's test. RESULTS: Increased transversal widths from T1 and T2 and the maintenance of these values from T2 and T3 were observed. Buccal teeth tipping also showed statistically significant differences, with an increase in all teeth from T1 to T2 and a decrease from T2 to T3. No statistically significant difference was found for dental crown height, except for left first and second molars, although clinically irrelevant. CONCLUSION: SARME proved to be an effective and stable procedure, with minimum periodontal hazards. PMID:26154457

  14. Evaluation of surgically assisted maxillary expansion using acoustic rhinometry and postero-anterior cephalometry. (United States)

    Baraldi, C E; Pretto, S M; Puricelli, E


    Correction of maxillary transverse deficiencies is a common procedure in adult patients presenting dentofacial anomalies. Nasal characteristics of these patients, as well as the effects of these procedures upon nasal patency, have not been well described yet. In the present study, measurements performed by acoustic rhinometry and frontal cephalometry in 13 patients presenting maxillary deficiencies, before and after surgically assisted maxillary expansion (SARME), were compared with those of 10 individuals with normal dentofacial characteristics and without nasal symptoms. The variables analysed were minor cross-sectional area (MCA) and nasal volume, maxillomandibular transverse index and nasal and maxillary width. The results showed a smaller transverse width and MCA in the patients as compared with normal controls. All measurements showed a tendency to increase after SARME. The nasal volumes did not differ. The nasal width showed wide variation. There was no correlation among the variables. Patients presenting maxillary transverse deficiency seem to have lower values for nasal MCA, with a tendency to increase after SARME.

  15. Periodontal and dental effects of surgically assisted rapid maxillary expansion, assessed by using digital study models

    Directory of Open Access Journals (Sweden)

    Danilo Furquim Siqueira


    Full Text Available OBJECTIVE: The present study assessed the maxillary dental arch changes produced by surgically assisted rapid maxillary expansion (SARME. METHODS: Dental casts from 18 patients (mean age of 23.3 years were obtained at treatment onset (T1, three months after SARME (T2 and 6 months after expansion (T3. The casts were scanned in a 3D scanner (D-250, 3Shape, Copenhagen, Denmark. Maxillary dental arch width, dental crown tipping and height were measured and assessed by ANOVA and Tukey's test. RESULTS: Increased transversal widths from T1 and T2 and the maintenance of these values from T2 and T3 were observed. Buccal teeth tipping also showed statistically significant differences, with an increase in all teeth from T1 to T2 and a decrease from T2 to T3. No statistically significant difference was found for dental crown height, except for left first and second molars, although clinically irrelevant. CONCLUSION: SARME proved to be an effective and stable procedure, with minimum periodontal hazards.

  16. [High-risk prostate cancer surgical margins during robot-assisted radical prostatectomy]. (United States)

    Duperron, C; Moulin, M; Koutlidis, N; Mourey, E; Cormier, L


    To evaluate the feasibility of robot-assisted radical prostatectomy (RARP) in high risk prostate cancer (HR). The rate of positive surgical margins (PSM) was compared between anticipated HR cancer according to D'Amico risk classification and discovered postoperative HR cancer. A retrospective study was conducted between 2006 and 2013 on patients who underwent RARP. Before surgery, patients were divided according to the D'Amico risk classification. After surgery, HR was defined as pT3a or pT3b, or Gleason score≥8 or positive lymph nodes. The rate of PSM was compared according to the D'Amico risk classification and postoperative HR. During the study, 485 patients were reviewed. Before surgery, 10 % of cancers were classified as D'Amico 3 (49/485). After surgery, 27.6 % (134/485) were classified as HR. There was a significant difference between the rate of PSM in HR/D'Amico 3 and HR/non D'Amico 3 cancer, respectively 22.9 % and 34.3 % (P<0.001). The RARP is feasible in HR with an average of 30 % of PSM as in open surgery. However, the accurate assessment of preoperative HR will allow a more adapted dissection and a decrease of rate of PSM. So it is necessary to improve the detection of HR and so to select the most suitable cancer for surgery. Level 5. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery. (United States)

    Geppert, Barbara; Lönnerfors, Celine; Persson, Jan


    Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. University hospital. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, psurgery (n=64) but a longer operating time (136 compared to 110 minutes, p=0.0004). For women with a BMI ≥35 kg/m(2) , surgical time in the late robot group and the laparotomy group was equal (136 compared to 128 minutes, p=0.31). Robot-assisted laparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.


    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Jain


    Full Text Available BACKGROUND Surgical teaching and learning needs lots of practical exposure and hands on training. It often becomes difficult to demonstrate practically hundreds of medical student’s steps of surgical examination, various surgical minor or major procedures on living patients. Three-dimensional demonstration of theoretical topics helps in easy understanding of the subject. On many occasions, theory classes using lectures and slide projection techniques become cumbersome and monotonous for both teachers and students leading to failure to achieve fruitful results. Computer and 3D simulator-assisted teaching may help in some cases, but yet to become available in many developing countries. Without proper practical knowledge when a surgical action is attempted on a living patient, there is always a chance of error. Keeping all these facts in view and the limited teaching resources available, over hundred self-made inexpensive teaching models are developed out of scrap materials and are used to teach medical students in medical colleges of Assam and the results compared with conventional teaching. MATERIALS AND METHODS In this study, the efficacy and effectiveness of the model-assisted teaching is compared with that of conventional teaching over a span of two years. RESULTS Some of the shortcomings of conventional teaching can be overcome by model-assisted teaching in terms of overall student attendance in the classes and the acceptance and understanding of the topic concerned. CONCLUSION These models help in filling the voids in surgical learning and can be used as an effective adjunct to conventional surgical teaching.

  19. Osmotically-assisted desalination method and system (United States)

    Achilli, Andrea; Childress, Amy E.; Cath, Tzahi Y.


    Systems and methods for osmotically assisted desalination include using a pressurized concentrate from a pressure desalination process to pressurize a feed to the desalination process. The depressurized concentrate thereby produced is used as a draw solution for a pressure-retarded osmosis process. The pressure-retarded osmosis unit produces a pressurized draw solution stream that is used to pressurize another feed to the desalination process. In one example, the feed to the pressure-retarded osmosis process is impaired water.

  20. Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: A literature review

    Directory of Open Access Journals (Sweden)

    Hsiu-Hsia Lin


    Full Text Available By incorporating three-dimensional (3D imaging and computer-aided design and manufacturing techniques, 3D computer-assisted technology has been applied widely to provide accurate guidance for assessment and treatment planning in clinical practice. This technology has recently been used in orthognathic surgery to improve surgical planning and outcome. The modality will gradually become popular. This study reviewed the literature concerning the use of computer-assisted techniques in orthognathic surgery including surgical planning, simulation, intraoperative translation of the virtual surgery, and postoperative evaluation. A Medline, PubMed, ProQuest, and ScienceDirect search was performed to find relevant articles with regard to 3D computer-assisted orthognathic surgery in the past 10 years. A total of 460 articles were revealed, out of which 174 were publications addressed the topic of this study. The purpose of this article is to present an overview of the state-of-art methods for 3D computer-assisted technology in orthognathic surgery. From the review we can conclude that the use of computer-assisted technique in orthognathic surgery provides the benefit of optimal functional and aesthetic results, patient satisfaction, precise translation of the treatment plan, and facilitating intraoperative manipulation.

  1. A GPU Accelerated Spring Mass System for Surgical Simulation

    DEFF Research Database (Denmark)

    Mosegaard, Jesper; Sørensen, Thomas Sangild


    There is a growing demand for surgical simulators to dofast and precise calculations of tissue deformation to simulateincreasingly complex morphology in real-time. Unfortunately, evenfast spring-mass based systems have slow convergence rates for largemodels. This paper presents a method to accele...... to accelerate computation of aspring-mass system in order to simulate a complex organ such as theheart. This acceleration is achieved by taking advantage of moderngraphics processing units (GPU)....

  2. Comparison of surgical outcomes between open and robot-assisted minimally invasive pancreaticoduodenectomy. (United States)

    Kim, Hyeong Seok; Han, Youngmin; Kang, Jae Seung; Kim, Hongbeom; Kim, Jae Ri; Koon, Wooil; Kim, Sun-Whe; Jang, Jin-Young


    Robot surgery is a new method that maintains advantages and overcomes disadvantages of conventional methods, even in pancreatic surgery. This study aimed to evaluate safety and benefits of robot-assisted minimally invasive pancreaticoduodenectomy (robot PD). This study included 237 patients who underwent PD between 2015 and 2017. Demographics and surgical outcomes were evaluated. Fifty-one patients underwent robot PD and 186 underwent open PD. Robot PD group had younger age (60.7 vs. 65.4 years, P = 0.006) and lower body mass index (22.7 vs. 24.0, P = 0.007). Robot PD group had lower proportion of patients with firm or hard pancreatic texture (15.7% vs. 38.2%, P = 0.004) and smaller pancreatic duct size (2.3 vs. 3.3 mm, P = 0.002). Two groups had similar operation time (robot vs. open: 335.6 vs. 330.1 min) and complications (15.7% vs. 21.0%), including postoperative pancreatic fistula rate (6.0% vs. 12.0%). Robot PD group had lower postoperative pain score (3.7 vs. 4.1 points, P = 0.008), and shorter postoperative stay (10.6 vs. 15.3 days, P = 0.001). Robot PD is comparable to open PD in early outcomes. Robot PD is safe and feasible and enables early recovery; indication for robot PD is expected to expand in the near future. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  3. Video-Assisted Thoracic Surgical Lobectomy for Lung Cancer: Description of a Learning Curve. (United States)

    Yao, Fei; Wang, Jian; Yao, Ju; Hang, Fangrong; Cao, Shiqi; Cao, Yongke


    Video-assisted thoracic surgical (VATS) lobectomy is gaining popularity in the treatment of lung cancer. The aim of this study is to investigate the learning curve of VATS lobectomy by using multidimensional methods and to compare the learning curve groups with respect to perioperative clinical outcomes. We retrospectively reviewed a prospective database to identify 67 consecutive patients who underwent VATS lobectomy for lung cancer by a single surgeon. The learning curve was analyzed by using moving average and the cumulative sum (CUSUM) method. With the moving average and CUSUM analyses for the operation time, patients were stratified into two groups, with chronological order defining early and late experiences. Perioperative clinical outcomes were compared between the two learning curve groups. According to the moving average method, the peak point for operation time occurred at the 26th case. The CUSUM method also showed the operation time peak point at the 26th case. When results were compared between early- and late-experience periods, the operation time, duration of chest drainage, and postoperative hospital stay were significantly longer in the early-experience group (cases 1 to 26). The intraoperative estimated blood loss was significantly less in the late-experience group (cases 27 to 67). CUSUM charts showed a decreasing duration of chest drainage after the 36th case and shortening postoperative hospital stay after the 37th case. Multidimensional statistical analyses suggested that the learning curve for VATS lobectomy for lung cancer required ∼26 cases. Favorable intraoperative and postoperative care parameters for VATS lobectomy were observed in the late-experience group.

  4. Robot-assisted radical prostatectomy in an initial Japanese series: the impact of prior abdominal surgery on surgical outcomes. (United States)

    Yumioka, Tetsuya; Iwamoto, Hideto; Masago, Toshihiko; Morizane, Shuichi; Yao, Akihisa; Honda, Masashi; Muraoka, Kuniyasu; Sejima, Takehiro; Takenaka, Atsushi


    To evaluate the influence of prior abdominal surgery on surgical outcomes of robot-assisted radical prostatectomy in an early single center experience in Japan. We reviewed medical records of patients with localized prostate cancer who underwent robot-assisted radical prostatectomy from October 2010 to September 2013 at Tottori University Faculty of Medicine, Yonago, Tottori, Japan. Patients with prior abdominal surgery were compared with those with no prior surgery with respect to total operative time, port-insertion time, console time, positive surgical margin and perioperative complication rate. Furthermore, the number of patients requiring minimal adhesion lysis was compared between the two groups. Of 150 patients who underwent robot-assisted radical prostatectomy, 94 (63%) had no prior abdominal surgery, whereas 56 patients (37%) did. The mean total operative time was 329 and 333 min (P = 0.340), mean port insertion time was 40 and 34.5 min (P = 0.003), mean console time was 255 and 238 min (P = 0.145), a positive surgical margin was observed in 17.9% and 17.0% patients (P = 0.896), and the incidence of perioperative complications was 25% and 23.4% (P = 0.825), respectively, in those with and without prior abdominal surgery. In the prior abdominal surgery group, 48 patients (80.4%) required adhesion lysis at the time of trocar placement or while operating the robotic console. Robot-assisted radical prostatectomy appears to be a safe approach for patients with prior abdominal surgery without increasing total operative time, robotic console time, positive surgical margin or the incidence of perioperative complications. © 2014 The Japanese Urological Association.

  5. Accuracy of Computer-Assisted Template-Guided Autotransplantation of Teeth With Custom Three-Dimensional Designed/Printed Surgical Tooling: A Cadaveric Study. (United States)

    Anssari Moin, David; Verweij, Jop Pieter; Waars, Hugo; van Merkesteyn, Richard; Wismeijer, Daniel


    The aim of the present cadaveric study was to assess the accuracy of computer-assisted template-guided autotransplantation of teeth with custom 3-dimensional (3D) designed/printed surgical tooling. Ten partially edentulous human mandibular cadavers were scanned using a cone-beam computed tomography (CBCT) system and an intraoral scanning system. The 3D data of these cadavers were imported to specialized software and used to analyze the region of the recipient sites, and the donor teeth were selected. Subsequently, congruent to the donor teeth, custom surgical tooling and surgical-guided templates were designed and 3D printed. The guided osteotomies were performed and the donor teeth transplanted. To evaluate the planned donor teeth positions compared with the transplanted donor teeth positions, the mandibles were scanned again using the CBCT system, and software matching was applied to measure the accuracy of the procedure. The mean angular deflection of the transplanted donor teeth with the planned donor teeth positions was 5.6 ± 5.4°. Comparing the 3D positions of the shoulders, a mean deviation of 3.15 ± 1.16 mm and a mean apical deviation of 2.61 ± 0.78 mm were found. The described method of computer-assisted template-guided autotransplantation of teeth with custom 3D designed/printed surgical tooling could potentially provide a relatively accurate alternative for the currently available treatment approaches. Further research should focus on improving the accuracy of this technique and evaluating the clinical success and advantages of this method. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Study on real-time force feedback for a master-slave interventional surgical robotic system. (United States)

    Guo, Shuxiang; Wang, Yuan; Xiao, Nan; Li, Youxiang; Jiang, Yuhua


    In robot-assisted catheterization, haptic feedback is important, but is currently lacking. In addition, conventional interventional surgical robotic systems typically employ a master-slave architecture with an open-loop force feedback, which results in inaccurate control. We develop herein a novel real-time master-slave (RTMS) interventional surgical robotic system with a closed-loop force feedback that allows a surgeon to sense the true force during remote operation, provide adequate haptic feedback, and improve control accuracy in robot-assisted catheterization. As part of this system, we also design a unique master control handle that measures the true force felt by a surgeon, providing the basis for the closed-loop control of the entire system. We use theoretical and empirical methods to demonstrate that the proposed RTMS system provides a surgeon (using the master control handle) with a more accurate and realistic force sensation, which subsequently improves the precision of the master-slave manipulation. The experimental results show a substantial increase in the control accuracy of the force feedback and an increase in operational efficiency during surgery.

  7. Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes. (United States)

    Morelli, Luca; Perutelli, Alessandra; Palmeri, Matteo; Guadagni, Simone; Mariniello, Maria Donatella; Di Franco, Gregorio; Cela, Vito; Brundu, Benedetta; Salerno, Maria Giovanna; Di Candio, Giulio; Mosca, Franco


    Sexual and urinary dysfunctions are complications in radical treatment of deep infiltrating endometriosis (DIE) with colorectal involvement. The aim of this article is to report the preliminary results of our single-institution experience with robotic treatment of DIE, evaluating intraoperative and postoperative surgical outcomes and focusing on the impact of this surgical approach on autonomic functions such as urogenital preservation and sexual well-being. From January 2011 through December 2013, a case series of 10 patients underwent robotic radical treatment of DIE with colorectal resection using the da Vinci System. Surgical data were evaluated, together with perioperative urinary and sexual function as assessed by means of self-administered validated questionnaires. None of the patients reported significant postoperative complications. Questionnaires concerning sexual well-being, urinary function, and impact of symptoms on quality of life demonstrated a slight worsening of all parameters 1 month after surgery, while data were comparable to the preoperative period 1 year after surgery. Dyspareunia was the only exception, as it was significantly improved 12 months after surgery. Robot-assisted surgery seems to be advantageous in highly complicated procedures where extensive dissection and proper anatomy re-establishment is required, as in DIE with colorectal involvement. Our preliminary results show that robot-assisted surgery could be associated with a low risk of complications and provide good preservation of urinary function and sexual well-being.

  8. Intelligent surgical laser system configuration and software implementation (United States)

    Hsueh, Chi-Fu T.; Bille, Josef F.


    An intelligent surgical laser system, which can help the ophthalmologist to achieve higher precision and control during their procedures, has been developed by ISL as model CLS 4001. In addition to the laser and laser delivery system, the system is also equipped with a vision system (IPU), robotics motion control (MCU), and a tracking closed loop system (ETS) that tracks the eye in three dimensions (X, Y and Z). The initial patient setup is computer controlled with guidance from the vision system. The tracking system is automatically engaged when the target is in position. A multi-level tracking system is developed by integrating our vision and tracking systems which have been able to maintain our laser beam precisely on target. The capabilities of the automatic eye setup and the tracking in three dimensions provides for improved accuracy and measurement repeatability. The system is operated through the Surgical Control Unit (SCU). The SCU communicates with the IPU and the MCU through both ethernet and RS232. Various scanning pattern (i.e., line, curve, circle, spiral, etc.) can be selected with given parameters. When a warning is activated, a voice message is played that will normally require a panel touch acknowledgement. The reliability of the system is ensured in three levels: (1) hardware, (2) software real time monitoring, and (3) user. The system is currently under clinical validation.

  9. Systemic inflammation worsens outcomes in emergency surgical patients. (United States)

    Becher, Robert D; Hoth, J Jason; Miller, Preston R; Meredith, J Wayne; Chang, Michael C


    Acute care surgeons are uniquely aware of the importance of systemic inflammatory response and its influence on postoperative outcomes; concepts like damage control have evolved from this experience. For surgeons whose practice is mostly elective, the significance of such systemic inflammation may be underappreciated. This study sought to determine the influence of preoperative systemic inflammation on postoperative outcome in patients requiring emergent colon surgery. Emergent colorectal operations were identified in the American College of Surgeons National Surgical Quality Improvement Program 2008 dataset. Four groups were defined by the presence and magnitude of the inflammatory response before operation: no inflammation, systemic inflammatory response syndrome (SIRS), sepsis, or severe sepsis/septic shock. Thirty-day survival was analyzed by Kaplan-Meier method. A total of 3,305 patients were identified. Thirty-day survival was significantly different (p emergency surgical patients. In SIRS or sepsis patients, operations surgical intervention and suggest a potential role for damage control operations in emergency general surgery. II, prognostic study.

  10. The effect of video-assisted oral feedback versus oral feedback on surgical communicative competences in undergraduate training. (United States)

    Ruesseler, M; Sterz, J; Bender, B; Hoefer, S; Walcher, F


    Feedback can significantly improve future performance. Reviewing one's performance by video is discussed as useful adjunct to debriefing, particularly for non-technical skills. Communicative competencies are an essential part of daily clinical practice; thus should be taught and assessed during undergraduate training. The aim of this study was to compare the educational value of video-assisted feedback versus oral feedback in communicative competencies in the surgical context. Fourth-year medical students completed a 210-min training unit of 'taking patient's history and obtaining informed consents prior to surgery' using role plays. Oral feedback was received directly thereafter using agenda-led, outcome-based guidelines (ALOBA). In the study group, the role plays were video-taped and reviewed thereafter. Afterwards, students completed two OSCE stations, where they were assessed regarding their communicative competencies and the content of the clinical scenario. One-hundred students (49 receiving video-assisted feedback, 51 oral) participated in the study. Those receiving video-assisted feedback performed significantly better in overall score in both OSCE stations (p communicative competencies at taking patient history (p = 0.029 or better), and in 2 of 5 items at obtaining informed consent (p = 0.008, <0.001). The educational effect size for both tasks was large. Using our methodology, video-assisted feedback offered a significant educational benefit over oral feedback alone during a simulated patient encounter in a surgical context.

  11. Current surgical treatment option, utilizing robot-assisted laparoscopic surgery in obese women with endometrial cancer: Farghalys technique

    International Nuclear Information System (INIS)

    Farghaly, S.A.


    Background: Endometrial cancer is the most prevalent cancer of the female genital tract in North America. Minimally invasive laparoscopic-assisted surgery and panniculectomy in obese women with endometrial cancer are associated with an improved lymph node count, and lower rate of incisional complications than laparotomy. Methods: Technique for robot-assisted laparoscopic surgery for obese women with endometrial cancer is detailed. Results: Robot-assisted laparoscopic surgical staging, pelvic and para-aortic lymphadenectomy and panniculectomy allow us to avoid the use of postoperative pelvic radiation which is recommended in women with histopathology high-risk findings: deep myometrial invasion or high grade histology. The procedure has the advantage of three-dimensional vision, ergonomic, intuitive control, and wristed instrument that approximate the motion of the human hand. Conclusion: Robot-assisted laparoscopic surgical staging, and panniculectomy in these patients are a safe, and effective alternative to laparoscopic, and laparotomy surgery. It is an ideal tool for performing the complex oncologic procedures encountered in endometrial cancer staging that requires delicate retroperitoneal, pelvic and para-aortic lymph node dissection, while maintaining the principles of oncologic surgery but in a minimally invasive fashion.

  12. Assisted Learning Systems in e-Education

    Directory of Open Access Journals (Sweden)

    Gabriel ZAMFIR


    Full Text Available Human society, analyzed as a learning environment, presumes different languages in order to know, to understand or to develop it. This statement results as a default application of the cog-nitive domain in the educational scientific research, and it highlights a key feature: each essen-tial discovery was available for the entire language compatible society. E-Society is constructed as an application of E-Science in social services, and it is going to reveal a learning system for each application of the information technology developed for a compatible society. This article is proposed as a conceptual one focused on scientific research and the interrelationship be-tween the building blocks of research, defined as an engine for any designed learning system applied in the cognitive domain. In this approach, educational research become a learning sys-tem in e-Education. The purpose of this analysis is to configure the teacher assisted learning system and to expose its main principles which could be integrated in standard assisted instruc-tion applications, available in e-Classroom, supporting the design of specific didactic activities.

  13. Initial Clinical Experience With Surgical Technique of Robot-assisted Transperitoneal Laparoscopic Partial Nephrectomy

    Directory of Open Access Journals (Sweden)

    Cheng-Kuang Yang


    Conclusion: Robot-assisted LPN is feasible and may be a viable alternative to open or LPN in selected patients with small exophytic renal tumors. Compared with standard LPN, the robotic assisted LPN approach with precise renal reconstruction under a safe warm ischemia time is feasible and can be easily adopted by those with experience in robot-assisted surgery.

  14. A robotic assistant system for cardiac interventions under MRI guidance (United States)

    Li, Ming; Mazilu, Dumitru; Wood, Bradford J.; Horvath, Keith A.; Kapoor, Ankur


    In this paper we present a surgical assistant system for implanting prosthetic aortic valve transapically under MRI guidance, in a beating heart. The system integrates an MR imaging system, a robotic system, as well as user interfaces for a surgeon to plan the procedure and manipulate the robot. A compact robotic delivery module mounted on a robotic arm is used for delivering both balloon-expandable and self-expanding prosthesis. The system provides different user interfaces at different stages of the procedure. A compact fiducial pattern close to the volume of interest is proposed for robot registration. The image processing and the transformation recovery methods using this fiducial in MRI are presented. The registration accuracy obtained by using this compact fiducial is comparable to the larger multi-spherical marker registration method. The registration accuracy using these two methods is less than 0.62+/-0.50 deg (mean +/- std. dev.) and 0.63+/-0.72 deg (mean +/- std. dev.), respectively. We evaluated each of the components and show that they can work together to form a complete system for transapical aortic valve replacement.

  15. Polymeric heart valves for surgical implantation, catheter-based technologies and heart assist devices. (United States)

    Bezuidenhout, Deon; Williams, David F; Zilla, Peter


    Efficient function and long-term durability without the need for anticoagulation, coupled with the ability to be accommodated in many different types of patient, are the principal requirements of replacement heart valves. Although the clinical use of valves appeared to have remained steady for several decades, the evolving demands for the elderly and frail patients typically encountered in the developed world, and the needs of much younger and poorer rheumatic heart disease patients in the developing world have now necessitated new paradigms for heart valve technologies and associated materials. This includes further consideration of durable elastomeric materials. The use of polymers to produce flexible leaflet valves that have the benefits of current commercial bioprosthetic and mechanical valves without any of their deficiencies has been held desirable since the mid 1950s. Much attention has been focused on thermoplastic polyurethanes in view of their generally good physico-chemical properties and versatility in processing, coupled with the improving biocompatibility and stability of recent formulations. Accelerated in vitro durability of between 600 and 1000 million cycles has been achieved using polycarbonate urethanes, and good resistance to degradation, calcification and thrombosis in vivo has been shown with some polysiloxane-based polyurethanes. Nevertheless, polymeric valves have remained relegated to use in temporary ventricular assist devices for bridging heart failure patients to transplantation. Some recent studies suggest that there is a greater degree of instability in thermoplastic materials than hitherto believed so that significant challenges remain in the search for the combination of durability and biocompatibility that would allow polymeric valves to become a clinical reality for surgical implantation. Perhaps more importantly, they could become candidates for use in situations where minimally invasive transcatheter procedures are used to

  16. Active gated imaging in driver assistance system (United States)

    Grauer, Yoav


    In this paper, we shall present the active gated imaging system (AGIS) in relation to the automotive field. AGIS is based on a fast-gated camera and pulsed illuminator, synchronized in the time domain to record images of a certain range of interest. A dedicated gated CMOS imager sensor and near infra-red (NIR) pulsed laser illuminator, is presented in this paper to provide active gated technology. In recent years, we have developed these key components and learned the system parameters, which are most beneficial to nighttime (in all weather conditions) driving in terms of field of view, illumination profile, resolution, and processing power. We shall present our approach of a camera-based advanced driver assistance systems (ADAS) named BrightEye™, which makes use of the AGIS technology in the automotive field.

  17. Wind turbine assisted diesel generator systems (United States)

    Schienbein, L. A.


    The need to reduce the cost of energy in remote communities served by diesel generators has led to the investigation of the use of wind energy to replace some or all of the fuel consumed. The development of wind-turbine-assisted diesel generators in Canada has progressed from the design and testing of a 12-kW unit to the design of a prototype 100-kW wind turbine diesel hybrid. This paper presents the results of the 12-kW tests and the implementation of the test results, and the results of further engineering and cost analyses in the design of a prototype 100-kW wind turbine diesel hybrid system. The value of wind energy in a wind turbine diesel hybrid is greatly improved if the diesel generator system itself is designed to operate more efficiently at part load, with or without wind power assistance. Excess wind energy and wind turbine power fluctuations (which result in voltage and frequency fluctuations) can be minimized by selecting the best rotor operating speed.

  18. Robotically assisted MRgFUS system (United States)

    Jenne, Jürgen W.; Krafft, Axel J.; Maier, Florian; Rauschenberg, Jaane; Semmler, Wolfhard; Huber, Peter E.; Bock, Michael


    Magnetic resonance imaging guided focus ultrasound surgery (MRgFUS) is a highly precise method to ablate tissue non-invasively. The objective of this ongoing work is to establish an MRgFUS therapy unit consisting of a specially designed FUS applicator as an add-on to a commercial robotic assistance system originally designed for percutaneous needle interventions in whole-body MRI systems. The fully MR compatible robotic assistance system InnoMotion™ (Synthes Inc., West Chester, USA; formerly InnoMedic GmbH, Herxheim, Germany) offers six degrees of freedom. The developed add-on FUS treatment applicator features a fixed focus ultrasound transducer (f = 1.7 MHz; f' = 68 mm, NA = 0.44, elliptical shaped -6-dB-focus: 8.1 mm length; O/ = 1.1 mm) embedded in a water-filled flexible bellow. A Mylar® foil is used as acoustic window encompassed by a dedicated MRI loop coil. For FUS application, the therapy unit is directly connected to the head of the robotic system, and the treatment region is targeted from above. A newly in-house developed software tool allowed for complete remote control of the MRgFUS-robot system and online analysis of MRI thermometry data. The system's ability for therapeutic relevant focal spot scanning was tested in a closed-bore clinical 1.5 T MR scanner (Magnetom Symphony, Siemens AG, Erlangen, Germany) in animal experiments with pigs. The FUS therapy procedure was performed entirely under MRI guidance including initial therapy planning, online MR-thermometry, and final contrast enhanced imaging for lesion detection. In vivo trials proved the MRgFUS-robot system as highly MR compatible. MR-guided focal spot scanning experiments were performed and a well-defined pattern of thermal tissue lesions was created. A total in vivo positioning accuracy of the US focus better than 2 mm was estimated which is comparable to existing MRgFUS systems. The newly developed FUS-robotic system offers an accurate, highly flexible focus positioning. With its access

  19. System design and animal experiment study of a novel minimally invasive surgical robot. (United States)

    Wang, Wei; Li, Jianmin; Wang, Shuxin; Su, He; Jiang, Xueming


    Robot-assisted minimally invasive surgery has shown tremendous advances over the traditional technique. However, currently commercialized systems are large and complicated, which vastly raises the system cost and operation room requirements. A MIS robot named 'MicroHand' was developed over the past few years. The basic principle and the key technologies are analyzed in this paper. Comparison between the proposed robot and the da Vinci system is also presented. Finally, animal experiments were carried out to test the performance of MicroHand. Fifteen animal experiments were carried out from July 2013 to December 2013. All animal experiments were finished successfully. The proposed design method is an effective way to resolve the drawbacks of previous generations of the da Vinci surgical system. The animal experiment results confirmed the feasibility of the design. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety. (United States)

    Kuo, Calvin C; Robb, William J


    The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.

  1. Thriving on Chaos: The Development of a Surgical Information System (United States)

    Olund, Steven R.


    Hospitals present unique challenges to the computer industry, generating a greater quantity and variety of data than nearly any other enterprise. This is complicated by the fact that a hospital is not one homogenous organization, but a bundle of semi-independent groups with unique data requirements. Therefore hospital information systems must be fast, flexible, reliable, easy to use and maintain, and cost-effective. The Surgical Information System at Rush Presbyterian-St. Luke's Medical Center, Chicago is such system. It uses a Sequent Balance 21000 multi-processor superminicomputer, running industry standard tools such as the Unix operating system, a 4th generation programming language (4GL), and Structured Query Language (SQL) relational database management software. This treatise illustrates a comprehensive yet generic approach which can be applied to almost any clinical situation where access to patient data is required by a variety of medical professionals.

  2. Application of Virtual Surgical Planning with Computer Assisted Design and Manufacturing Technology to Cranio-Maxillofacial Surgery

    Directory of Open Access Journals (Sweden)

    Linping Zhao


    Full Text Available Computer aided design and manufacturing (CAD/CAM technology today is the standardin manufacturing industry. The application of the CAD/CAM technology, together withthe emerging 3D medical images based virtual surgical planning (VSP technology, tocraniomaxillofacial reconstruction has been gaining increasing attention to reconstructivesurgeons. This article illustrates the components, system and clinical management of theVSP and CAD/CAM technology including: data acquisition, virtual surgical and treatmentplanning, individual implant design and fabrication, and outcome assessment. It focusesprimarily on the technical aspects of the VSP and CAD/CAM system to improve thepredictability of the planning and outcome.

  3. Application of Virtual Surgical Planning with Computer Assisted Design and Manufacturing Technology to Cranio-Maxillofacial Surgery

    Directory of Open Access Journals (Sweden)

    Linping Zhao


    Full Text Available Computer aided design and manufacturing (CAD/CAM technology today is the standard in manufacturing industry. The application of the CAD/CAM technology, together with the emerging 3D medical images based virtual surgical planning (VSP technology, to craniomaxillofacial reconstruction has been gaining increasing attention to reconstructive surgeons. This article illustrates the components, system and clinical management of the VSP and CAD/CAM technology including: data acquisition, virtual surgical and treatment planning, individual implant design and fabrication, and outcome assessment. It focuses primarily on the technical aspects of the VSP and CAD/CAM system to improve the predictability of the planning and outcome.

  4. Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy. (United States)

    Newman, Richard M; Umer, Affan; Bozzuto, Bethany J; Dilungo, Jennifer L; Ellner, Scott


    As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost. The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis. The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05). Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Integration of a Robotic Arm with the Surgical Assistant Workstation Software Framework

    NARCIS (Netherlands)

    Young, J.; Elhawary, H.; Popovic, A.


    We have integrated the Philips Research robot arm with the Johns Hopkins University cisst library, an open-source platform for computerassisted surgical intervention. The development of a Matlab to C++ wrapper to abstract away servo-level details facilitates the rapid development of a


    Directory of Open Access Journals (Sweden)

    Naohisa HASHIMOTO


    Full Text Available This paper proposes a new concept of elderly driver assistance systems, which performs the assistance by cooperative driving between two vehicles, and describes some experiments with elderly drivers. The assistance consists of one vehicle driven by an elderly driver called a guest vehicle and the other driven by a assisting driver called a host vehicle, and the host vehicle assists or escorts the guest vehicle through the inter-vehicle communications. The functions of the systems installed on a single-seat electric vehicle are highly evaluated by subjects of elderly drivers in virtual streets on a test track.

  7. Design, implementation and testing of master slave robotic surgical system

    International Nuclear Information System (INIS)

    Ali, S.A.


    The autonomous manipulation of the medical robotics is needed to draw up a complete surgical plan in development. The autonomy of the robot comes from the fact that once the plan is drawn up off-line, it is the servo loops, and only these, that control the actions of the robot online, based on instantaneous control signals and measurements provided by the vision or force sensors. Using only these autonomous techniques in medical and surgical robotics remain relatively limited for two main reasons: Predicting complexity of the gestures, and human Safety. Therefore, Modern research in haptic force feedback in medical robotics is aimed to develop medical robots capable of performing remotely, what a surgeon does by himself. These medical robots are supposed to work exactly in the manner that a surgeon does in daily routine. In this paper the master slave tele-robotic system is designed and implemented with accuracy and stability by using 6DOF (Six Degree of Freedom) haptic force feedback devices. The master slave control strategy, haptic devices integration, application software designing using Visual C++ and experimental setup are considered. Finally, results are presented the stability, accuracy and repeatability of the system. (author)

  8. Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE

    Directory of Open Access Journals (Sweden)

    Daniel Paludo Brunetto

    Full Text Available ABSTRACT Introduction: Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE. More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE. Objective: The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA. Methods: All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained. Conclusion: It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.

  9. Foreign Assistance Coordination and Tracking System (FACTS Info) (United States)

    US Agency for International Development — Foreign assistance planning and reporting system for USAID and Department of State (DOS); supports both reporting needs and transactional budget planning and...

  10. Osteomark: a surgical navigation system for oral and maxillofacial surgery. (United States)

    Bouchard, C; Magill, J C; Nikonovskiy, V; Byl, M; Murphy, B A; Kaban, L B; Troulis, M J


    The purpose of this project was to test a surgical navigation tool designed to help execute a surgical treatment plan. It consists of an electromagnetically tracked pencil that is used to mark bone intraoperatively. The device was tested on a precision block, an ex vivo pig mandible and during performance of six endoscopic vertical ramus osteotomies on pig cadavers. The difference between actual pencil position and that displayed by the computer was measured three times each at ten 2mm holes on the block (n=30 observations) and on the ex vivo mandible (n=11 measurements). Errors between planned and actual osteotomy locations for the cadaver procedures were measured. The mean distance between known and displayed locations was 1.55 ± 0.72 mm on the precision block and 2.10 ± 0.88 mm on the pig mandible. The error measured marking the same point on the block multiple (n=5) times was 0.58 ± 0.37 mm. The mean error on the simulated osteotomies was 2.35 ± 1.35 mm. Osteomark was simple to use and permitted localisation of holes and osteotomies with acceptable accuracy. In the future, the device and algorithms will be revised to further decrease error and the system will be tested on live animals. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials. (United States)

    Tansarli, Giannoula S; Vardakas, Konstantinos Z; Stratoulias, Constantinos; Peppas, George; Kapaskelis, Anastasios; Falagas, Matthew E


    We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

  12. Cognitive assisted living ambient system: a survey

    Directory of Open Access Journals (Sweden)

    Ruijiao Li


    Full Text Available The demographic change towards an aging population is creating a significant impact and introducing drastic challenges to our society. We therefore need to find ways to assist older people to stay independently and prevent social isolation of these population. Information and Communication Technologies (ICT provide various solutions to help older adults to improve their quality of life, stay healthier, and live independently for a time. Ambient Assisted Living (AAL is a field to investigate innovative technologies to provide assistance as well as healthcare and rehabilitation to impaired seniors. The paper provides a review of research background and technologies of AAL.

  13. Robot-Assisted Laparoscopic Radical Prostatectomy for Patients with Prostatic Cancer and Factors Promoting Installation of the Robotic Surgical Equipment-Questionnaire Survey


    塚本, 泰司; 田中, 滋


    We conducted a questionnaire survey of hospitals with robot-assisted surgical equipment to study changes of the surgical case loads after its installation and the managerial strategies for its purchase. The study included 154 hospitals (as of April 2014) that were queried about their radical prostatectomy case loads from January 2009 to December 2013, strategies for installation of the equipment in their hospitals, and other topics related to the study purpose. The overall response rate of ho...


    Energy Technology Data Exchange (ETDEWEB)

    Frank Macri


    Rolls-Royce Corporation has completed a cooperative agreement under Department of Energy (DOE) contract DE-FC21-96MC33066 in support of the Advanced Turbine Systems (ATS) program to stimulate industrial power generation markets. This DOE contract was performed during the period of October 1995 to December 2002. This final technical report, which is a program deliverable, describes all associated results obtained during Phases 3A and 3B of the contract. Rolls-Royce Corporation (formerly Allison Engine Company) initially focused on the design and development of a 10-megawatt (MW) high-efficiency industrial gas turbine engine/package concept (termed the 701-K) to meet the specific goals of the ATS program, which included single digit NOx emissions, increased plant efficiency, fuel flexibility, and reduced cost of power (i.e., $/kW). While a detailed design effort and associated component development were successfully accomplished for the 701-K engine, capable of achieving the stated ATS program goals, in 1999 Rolls-Royce changed its focus to developing advanced component technologies for product insertion that would modernize the current fleet of 501-K and 601-K industrial gas turbines. This effort would also help to establish commercial venues for suppliers and designers and assist in involving future advanced technologies in the field of gas turbine engine development. This strategy change was partly driven by the market requirements that suggested a low demand for a 10-MW aeroderivative industrial gas turbine, a change in corporate strategy for aeroderivative gas turbine engine development initiatives, and a consensus that a better return on investment (ROI) could be achieved under the ATS contract by focusing on product improvements and technology insertion for the existing Rolls-Royce small engine industrial gas turbine fleet.

  15. Robot-assisted laparoscopic management of duplex renal anomaly: Comparison of surgical outcomes to traditional pure laparoscopic and open surgery. (United States)

    Herz, Daniel; Smith, Jennifer; McLeod, Daryl; Schober, Megan; Preece, Janae; Merguerian, Paul


    Surgical management of duplex renal anomaly (DRA) is complex because of individual anatomic variation, competing priorities of vesicoureteral reflux (VUR) and ureteral obstruction present in the same child, the varied differential function of the different renal moieties, and the presence of voiding dysfunction and recurrent urinary tract infection (UTI). Robot-assisted laparoscopic (RAL) surgical management has been under-reported in this group of children but is becoming a viable alternative to traditional open surgery. The aim was to report the surgical outcomes of a series of children with DRA who had RAL surgery and compare these outcomes to historical cohorts of open and laparoscopic surgery. This was a retrospective analysis of a prospective series of children who had RAL surgery for DRA over an 8-year period. Forty-five RAL surgeries were performed in 47 children. RAL heminephrectomy (RAL HN) was performed in 19 children for poorly or non-functional renal moiety. One had staged bilateral RAL HN. RAL ureteroureterostomy (RAL UU) was performed in 14 children for upper pole ureteral obstruction. Thirteen RAL common sheath ureteral reimplants (RAL csUN) with or without ureteral tapering were performed in 12 children with VUR and UTI. Diagnosis and demographics, results of preoperative imaging, intraoperative time stamps, perioperative complications, success rate, and renal outcomes were recorded. Low-grade VUR present preoperatively in the RAL UU group all resolved within the follow-up period. Four (25%) children in the RAL HN group developed de novo VUR after surgery, which resolved in two (50%) and required surgery in two (50%). Grade I VUR after RAL csUR that occurred in two (14.3%) children was asymptomatic and observed when off preventative antibiotics. Most children with DRA who need surgical treatment can be offered RAL surgery. We report good outcomes and improved operative times for RAL HN and UU that approach historical open and pure laparoscopic

  16. Computer assistant test and consultive system for aircraft fluid element (United States)

    Liu, Jin-Ru

    The fluid bearing elements of an aircraft's control system are discussed in the context of aviation maintenance engineering. This paper explores the development of an artificially intelligent assistant to aid in the maintenance of hydraulic control systems.

  17. Central-Approach Surgical Repair of Coarctation of the Aorta with a Back-up Left Ventricular Assist Device for an Infant Presenting with Severe Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Tae Hoon Kim


    Full Text Available A two-month-old infant presented with coarctation of the aorta, severe left ventricular dysfunction, and moderate to severe mitral regurgitation. Through median sternotomy, the aortic arch was repaired under cardiopulmonary bypass and regional cerebral perfusion. The patient was postoperatively supported with a left ventricular assist device for five days. Left ventricular function gradually improved, eventually recovering with the concomitant regression of mitral regurgitation. Prompt surgical repair of coarctation of the aorta is indicated for patients with severe left ventricular dysfunction. A central approach for surgical repair with a back-up left ventricular assist device is a safe and effective treatment strategy for these patients.

  18. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis. (United States)

    Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf


    Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

  19. Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy. (United States)

    Li, Shuang-Jiang; Zhou, Kun; Wu, Yan-Ming; Wang, Ming-Ming; Shen, Cheng; Wang, Zhi-Qiang; Che, Guo-Wei; Liu, Lun-Xu


    The purpose of our cohort study was to investigate the effects of pleural adhesions on perioperative outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC). We performed a single-center retrospective analysis on the prospectively-maintained dataset at our unit from February 2014 to November 2015. Patients were divided into two groups (Group A: presence of pleural adhesions; Group B: absence of pleural adhesions) according to our grading system of pleural adhesions when entering the chest cavity. Demographic differences in perioperative outcomes between these two groups were initially estimated. A multivariate logistic-regression analysis was then performed to confirm the predictive value of the presence of pleural adhesions. A total of 593 NSCLC patients undergoing VATS lobectomy were enrolled. The conversion and postoperative morbidity rates were 3.2% and 29.2%, respectively. There were 154 patients with pleural adhesions (Group A) and 439 patients without pleural adhesions (Group B). Group A patients had significantly higher rates of conversion to thoracotomy (9.1% vs. 1.1%; Ppleural adhesions was also significantly associated with the prolonged length of chest tube drainage (log-rank Ppleural adhesions was identified as an independent risk factor for conversion to thoracotomy [odds ratio (OR) =5.49; P=0.003] and surgical complications (OR =1.94; P=0.033) by multivariate logistic-regression analyses. Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing VATS lobectomy for NSCLC. Our study calls for an internationally accepted grading system for the presence of pleural adhesions to stratify the surgical risk.

  20. Surgical planning for radical prostatectomies using three-dimensional visualization and a virtual reality display system (United States)

    Kay, Paul A.; Robb, Richard A.; King, Bernard F.; Myers, R. P.; Camp, Jon J.


    Thousands of radical prostatectomies for prostate cancer are performed each year. Radical prostatectomy is a challenging procedure due to anatomical variability and the adjacency of critical structures, including the external urinary sphincter and neurovascular bundles that subserve erectile function. Because of this, there are significant risks of urinary incontinence and impotence following this procedure. Preoperative interaction with three-dimensional visualization of the important anatomical structures might allow the surgeon to understand important individual anatomical relationships of patients. Such understanding might decrease the rate of morbidities, especially for surgeons in training. Patient specific anatomic data can be obtained from preoperative 3D MRI diagnostic imaging examinations of the prostate gland utilizing endorectal coils and phased array multicoils. The volumes of the important structures can then be segmented using interactive image editing tools and then displayed using 3-D surface rendering algorithms on standard work stations. Anatomic relationships can be visualized using surface displays and 3-D colorwash and transparency to allow internal visualization of hidden structures. Preoperatively a surgeon and radiologist can interactively manipulate the 3-D visualizations. Important anatomical relationships can better be visualized and used to plan the surgery. Postoperatively the 3-D displays can be compared to actual surgical experience and pathologic data. Patients can then be followed to assess the incidence of morbidities. More advanced approaches to visualize these anatomical structures in support of surgical planning will be implemented on virtual reality (VR) display systems. Such realistic displays are `immersive,' and allow surgeons to simultaneously see and manipulate the anatomy, to plan the procedure and to rehearse it in a realistic way. Ultimately the VR systems will be implemented in the operating room (OR) to assist the

  1. Surgical guidance system using hand-held probe with accompanying positron coincidence detector

    Energy Technology Data Exchange (ETDEWEB)

    Majewski, Stanislaw; Weisenberger, Andrew G.


    A surgical guidance system offering different levels of imaging capability while maintaining the same hand-held convenient small size of light-weight intra-operative probes. The surgical guidance system includes a second detector, typically an imager, located behind the area of surgical interest to form a coincidence guidance system with the hand-held probe. This approach is focused on the detection of positron emitting biomarkers with gamma rays accompanying positron emissions from the radiolabeled nuclei.

  2. Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

    Directory of Open Access Journals (Sweden)

    Jose M. Cabello


    Full Text Available INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIAL AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

  3. The Effect of Visual-Spatial Ability on the Learning of Robot-Assisted Surgical Skills. (United States)

    Abe, Takashige; Raison, Nicholas; Shinohara, Nobuo; Shamim Khan, M; Ahmed, Kamran; Dasgupta, Prokar

    The aim of this study was to determine the correlation of visual-spatial ability with progression along the learning curve for robotic surgical skills training. A total of 21 novice participants were recruited. All participants completed a training program consisting of 5 training sessions of 30 minutes of virtual reality (VR) simulation and 30 minutes of dry laboratory training. The VR simulation part was the subject of the present study. During VR simulation training, participants performed the basic skill exercises of Camera Targeting 1, Pick and Place, and Peg Board 1 followed by advanced skill exercises of Suture Sponge 1 and Thread the Rings. The visual-spatial ability was assessed using a mental rotation test (MRT). Pearson correlation coefficients were used to assess the relationship between the MRT score and simulator score for the aforementioned 5 tasks. Student t test was used to compare the simulator score between high- and low-MRT score groups. A median MRT score of 26/40 (range: 13-38) was observed. Approximately 19 participants completed the full curriculum but 2 did not complete "Thread the Rings" during the study period. A significant correlation was observed between the MRT score and simulator score only in "Suture Sponge 1" over the first 3 attempts (first: r = 0.584, p = 0.0054; second: r = 0.443, p = 0.0443; third: r = 0.4458, p = 0.0428). After the third attempt, this significant correlation was lost. Comparison of the score for "Suture Sponge 1" between the high-MRT and low-MRT scoring participants divided by a median MRT score of 26 also showed a significant difference in the score until the third trial. Our observations suggest that the spatial cognitive ability influences the initial learning of robotic suturing skills. Further studies are necessary to verify the usefulness of an individual's spatial ability to tailor the surgical training program. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Surgical aspects of Operation Bali Assist: initial wound surgery on the tarmac and in flight. (United States)

    Read, David; Ashford, Bruce


    The explosion of three bombs on 12 October 2002 in Kuta, Bali resulted in mass casualties akin to those seen in war. The aim of the present report is to describe the sequence of events of Operation Bali Assist including triage, resuscitation and initial wound surgery in Bali at Sanglah Hospital in the aeromedical staging facility (ASF), Denpasar airport and the evacuation to Darwin. A descriptive report is provided of the event and includes; resuscitation, anaesthesia, initial burns surgery management including escharotomy and fasciotomy, head injury management and importance of supplies and medical records with a description of the evacuation to Darwin. Operation Bali Assist involved five C130 Hercules aircraft and aeromedical evacuation medical and nursing teams managing 66 casualties in the Denpasar area and their evacuation to Royal Darwin Hospital with ketamine the most useful anaesthetic agent and cling film the most useful burns dressing. Twelve procedures were performed at the ASF including seven escharotomies, three fasciotomies and two closed reductions. One escharotomy was performed in flight. The important lessons learnt from the exercise is the inclusion of a surgeon in the aeromedical evacuation team, the importance of debridement and delayed primary closure, the usefulness of cling film as a burns dressing and the importance of continuous assessment. Future disaster planning exercises need to consider a patient age mix that might be expected in a shopping mall, rather than the young adult encountered in Bali, a more familiar age mix for Australian Defence Force medical staff.

  5. Automatic systems for assistance in improving pronunciations

    CSIR Research Space (South Africa)

    Badenhorst, JAC


    Full Text Available Improving the pronunciations of non-native language learners is an important task in a multilingual society. We focus on segmental aspects of pronunciation, and investigate the design of automated assistants that can be used to improve (1...

  6. Design and validation of advanced driver assistance systems

    NARCIS (Netherlands)

    Gietelink, O.J.


    This thesis presents new tools and methods for the design and validation of advanced driver assistance systems (ADASs). ADASs aim to improve driving comfort and traffic safety by assisting the driver in recognizing and reacting to potentially dangerous traffic situations. A major challenge in

  7. Video-Assisted Laser Resection of Lung Metastases-Feasibility of a New Surgical Technique. (United States)

    Meyer, Christian; Bartsch, Detlef; Mirow, Nikolas; Kirschbaum, Andreas


    Background  Our pilot study describes our initial experience to do a laser resection of lung metastases under video-assisted thoracoscopic control via a minithoracotomy. With this approach, if needed, mediastinal lymphadenectomy is also possible. Methods  In this study, 15 patients (11 men and 4 women, mean age: 60 years) with resectable lung metastases of different solid primary tumors (colorectal cancer in seven patients, melanoma in three patients, renal cell carcinoma in two patients, and one each with oropharyngeal cancer, breast cancer, and seminoma) were included. An anterior minithoracotomy incision (approximately 5-7 cm length) was created in the fifth intercostal space and a soft tissue retractor (Alexis Protector; Applied Medical) was positioned. Two additional working ports were inserted. The entire lung was palpated via the minithoracotomy. All detected lung metastases were removed under thoracoscopic control. Nonanatomic resections were performed using a diode-pumped neodymium-doped yttrium aluminium garnet laser (LIMAX120; KLS Martin GmbH & Co KG) with a laser power of 80 W in a noncontact modus. Deeper parenchymal lesions were sutured. Results  A total of 29 lung metastases up to 30 mm in size were resected and all metastases diagnosed on preoperative imaging were detected. All diagnosed lung metastases were completely resected (R0). The median operation time was 102 (range: 85-120) minutes. Median blood loss was 47.6 mL and no postoperative complications occurred. Neither local recurrences nor new lung metastases were observed within 6 months after the procedures. Conclusion  Video-assisted laser resection of lung metastases is safe, effective, and fulfills the requirements of modern lung metastases surgery. Georg Thieme Verlag KG Stuttgart · New York.

  8. Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning. (United States)

    Yuan, Peng; Mai, Huaming; Li, Jianfu; Ho, Dennis Chun-Yu; Lai, Yingying; Liu, Siting; Kim, Daeseung; Xiong, Zixiang; Alfi, David M; Teichgraeber, John F; Gateno, Jaime; Xia, James J


    There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.

  9. Surgeons' display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy. (United States)

    Moore, Lee J; Wilson, Mark R; McGrath, John S; Waine, Elizabeth; Masters, Rich S W; Vine, Samuel J


    Research has demonstrated the benefits of robotic surgery for the patient; however, research examining the benefits of robotic technology for the surgeon is limited. This study aimed to adopt validated measures of workload, mental effort, and gaze control to assess the benefits of robotic surgery for the surgeon. We predicted that the performance of surgical training tasks on a surgical robot would require lower investments of workload and mental effort, and would be accompanied by superior gaze control and better performance, when compared to conventional laparoscopy. Thirty-two surgeons performed two trials on a ball pick-and-drop task and a rope-threading task on both robotic and laparoscopic systems. Measures of workload (the surgery task load index), mental effort (subjective: rating scale for mental effort and objective: standard deviation of beat-to-beat intervals), gaze control (using a mobile eye movement recorder), and task performance (completion time and number of errors) were recorded. As expected, surgeons performed both tasks more quickly and accurately (with fewer errors) on the robotic system. Self-reported measures of workload and mental effort were significantly lower on the robotic system compared to the laparoscopic system. Similarly, an objective cardiovascular measure of mental effort revealed lower investment of mental effort when using the robotic platform relative to the laparoscopic platform. Gaze control distinguished the robotic from the laparoscopic systems, but not in the predicted fashion, with the robotic system associated with poorer (more novice like) gaze control. The findings highlight the benefits of robotic technology for surgical operators. Specifically, they suggest that tasks can be performed more proficiently, at a lower workload, and with the investment of less mental effort, this may allow surgeons greater cognitive resources for dealing with other demands such as communication, decision-making, or periods of increased



    Shaleen; Mahendra; Shahapurkar; Md. Javed; Ankur; Shiv; Eshan


    : Post-operative wound infection is defined as surgical site infection from 0-30 days after surgery, or infection to surgical site till one year in cases of implants like mesh, vascular grafts and prosthesis. This study was done to find out incidence of post-operative wound infection in surgical patients in rural setup. This study of post-operative wound infection was carried out from August 2008 to August 2010. The study is of 3275 patients who underwent surgery in the A.V.B....

  11. Diapason: an assistant system for supervision

    International Nuclear Information System (INIS)

    Coudouneau, L.; Leyval, L.; Montmain, J.; Penalva, J.M.


    Simulation and assisted diagnosis are the contributions DIAPASON provides to supervision. The reasonings are based on a qualitative model, a knowledge base and a set of constraints on the values of the process variables, all three issued from a single representation of the process. After an overview of the qualitative simulation, the on line interpretation of the latter and the heuristic diagnosis, the cooperation of these three units is pointed out [fr

  12. Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume. (United States)

    Tachibana, Hidekazu; Takagi, Toshio; Kondo, Tsunenori; Ishida, Hideki; Tanabe, Kazunari


    To compare surgical outcomes, including renal function and the preserved renal parenchymal volume, between robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy using propensity score-matched analyses. In total, 253 patients, with a normal contralateral kidney, who underwent laparoscopic partial nephrectomy (n = 131) or robot-assisted laparoscopic partial nephrectomy (n = 122) with renal arterial clamping between 2010 and 2015, were included. Patients' background and tumor factors were adjusted by propensity score matching. Surgical outcomes, including postoperative renal function, complications, warm ischemia time and preserved renal parenchymal volume, evaluated by volumetric analysis, were compared between the surgical procedures. After matching, 64 patients were assigned to each group. The mean age was 56-57 years, and the mean tumor size was 22 mm. Approximately 50% of patients had low complexity tumors (RENAL nephrometry score 4-7). The incidence rate of acute kidney failure was significantly lower in the robot-assisted laparoscopic partial nephrectomy (11%) than laparoscopic partial nephrectomy (23%) group (P = 0.049), and warm ischemia time shorter in the robot-assisted laparoscopic partial nephrectomy (17 min) than laparoscopic partial nephrectomy (25 min) group (P < 0.0001). The preservation rate of renal function, measured by the estimated glomerular filtration rate, at 6 months post-surgery was 96% for robot-assisted laparoscopic partial nephrectomy and 90% for laparoscopic partial nephrectomy (P < 0.0001). The preserved renal parenchymal volume was higher for robot-assisted laparoscopic partial nephrectomy (89%) than laparoscopic partial nephrectomy (77%; P < 0.0001). The rate of perioperative complications, surgical margin status and length of hospital stay were equivalent for both techniques. Robot-assisted laparoscopic partial nephrectomy allows to achieve better preservation of renal function and parenchymal volume

  13. A novel approach for computer-assisted template-guided autotransplantation of teeth with custom 3d designed/printed surgical tooling. An ex vivo proof of concept

    NARCIS (Netherlands)

    Anssari Moin, D.; Derksen, W.; Verweij, J.P.; van Merkesteyn, R.; Wismeijer, D.


    Purpose: The aim of this study was to introduce a novel method for accurate autotransplantation with computer-assisted guided templates and assembled custom-designed surgical tooling and to test the feasibility and accuracy of this method ex vivo. Materials and Methods: A partially edentulous human

  14. Accuracy of computer-assisted template-guided autotransplantation of teeth with custom three-dimensional designed/printed surgical tooling : A cadaveric study

    NARCIS (Netherlands)

    Anssari Moin, D.; Verweij, J.P.; Waars, H.; van Merkesteyn, R.; Wismeijer, D.


    Purpose: The aim of the present cadaveric study was to assess the accuracy of computer-assisted template-guided autotransplantation of teeth with custom 3-dimensional (3D) designed/printed surgical tooling. Materials and Methods: Ten partially edentulous human mandibular cadavers were scanned using

  15. Portable OCT-assisted surgical treatment of intracorneal pre-Descemet epithelial cyst: a case report. (United States)

    Kim, Sang Woo; Kim, Eung Kweon


    Intracorneal epithelial cysts are a rare clinical condition that can occur anywhere in the corneal tissue; however, they appear most commonly in the stroma. They are sometimes challenging to treat because of their location, depth, and visual outcomes. Herein, we report a pre-Descemet epithelial cyst that was successfully treated surgically, with guidance from Fourier-domain optical coherence tomography (FD-OCT). This interventional case report presents a patient with gradually decreasing vision caused by a pre-Descemet epithelial cyst. A 4-year-old girl with no history of trauma or ocular surgery showed a deep-seated intracorneal cyst in her left eye (8 o'clock corneoscleral area, dissecting into the pre-Descemet cornea). The cyst was threatening the visual axis. An epithelial cyst was diagnosed after drainage on the basis of the cyst contents. We irrigated inside the cyst using 10% trichloroacetic acid (TCA), distilled water, and 1% 5-fluorouracil (5-FU) solutions for chemical cyto-destruction of the lining epithelial cells of the cystic wall. We used a portable FD-OCT during operation to guide this procedure, without perforating the Descemet's membrane and endothelial layer. Recurrence could be prevented after removal of the cystic tissue located in the sclera area outside of the limbus. No recurrence was noted during the 4-year follow-up. When treating centrally deep-seated intracorneal epithelial cysts, clinicians must consider recurrence, endothelial damage, and visual outcome. Herein we report the case of a deep-seated, intracorneoscleral epithelial cyst that was completely resolved with chemical cyto-destruction and removal of the intrascleral cystic tissue under the guidance with FD-OCT; thus, endothelial damage could be minimized.

  16. Computer-assisted learning: cyberPatient--a step in the future of surgical education. (United States)

    Karim Qayumi, A; Qayumi, T


    Computer-assisted learning is a hot topic and is evolving parallel with the rapidly growing computer technology. Today, modern computers with sophisticated software are able to create a new dimension in the application of many important pedagogical principles and philosophies. Modern computers with excellent multimedia applications are capable of simulating a realistic situation that enriches the educational environment, improves the learning process, and brings new challenges to the process of "learning by doing." The use of computers in medical industry and in medical education lags far behind other applications in the industrial world. Although a great many computer-assisted learning programs have been developed in the last decade and patient simulation has been attempted, there are no computer programs in the market that are capable of simulating the realism of the patient-doctor relationship. cyberActive Technology Ltd. has been able to complete this mission. The computer software cyberPatient developed by cyberActive Technology Ltd. is able to realize this long-term dream of medical students and educators. The discrepancy between theoretical and practical medical knowledge in the classical medical education was greater than in any other aspect of science. In classical medical education, diseases were taught beginning with etiology and pathogenesis to signs and symptoms. In practice, the patient comes to the doctor with complaints, and the doctor has to think backward to find out about the etiology and pathogenesis. This discrepancy created enormous difficulties for interns and young doctors with respect to the application of theoretical medicine to medical practice. This was one of the reasons why medical schools turned to a new problem-based learning curriculum. The new curriculum, however, has brought new challenges and problems of its own. Some of the problems include patient availability, increased demands for teachers, and, in turn, significant increases

  17. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique (United States)

    De Cupis, Vincenzo; De Cupis, Mauro


    Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

  18. Plexus (Phillips Laboratory Expert System-Assisted User Software)

    National Research Council Canada - National Science Library

    Myers, Thomas


    This report summarizes the results of the Phillips Lab PLEXUS project to design, build, and distribute a user friendly, expert system assisted, GUI enhanced software suite of sophisticated atmospheric...

  19. System for robot-assisted real-time laparoscopic ultrasound elastography (United States)

    Billings, Seth; Deshmukh, Nishikant; Kang, Hyun Jae; Taylor, Russell; Boctor, Emad M.


    Surgical robots provide many advantages for surgery, including minimal invasiveness, precise motion, high dexterity, and crisp stereovision. One limitation of current robotic procedures, compared to open surgery, is the loss of haptic information for such purposes as palpation, which can be very important in minimally invasive tumor resection. Numerous studies have reported the use of real-time ultrasound elastography, in conjunction with conventional B-mode ultrasound, to differentiate malignant from benign lesions. Several groups (including our own) have reported integration of ultrasound with the da Vinci robot, and ultrasound elastography is a very promising image guidance method for robotassisted procedures that will further enable the role of robots in interventions where precise knowledge of sub-surface anatomical features is crucial. We present a novel robot-assisted real-time ultrasound elastography system for minimally invasive robot-assisted interventions. Our system combines a da Vinci surgical robot with a non-clinical experimental software interface, a robotically articulated laparoscopic ultrasound probe, and our GPU-based elastography system. Elasticity and B-mode ultrasound images are displayed as picture-in-picture overlays in the da Vinci console. Our system minimizes dependence on human performance factors by incorporating computer-assisted motion control that automatically generates the tissue palpation required for elastography imaging, while leaving high-level control in the hands of the user. In addition to ensuring consistent strain imaging, the elastography assistance mode avoids the cognitive burden of tedious manual palpation. Preliminary tests of the system with an elasticity phantom demonstrate the ability to differentiate simulated lesions of varied stiffness and to clearly delineate lesion boundaries.

  20. Using a simulation assistant in modeling manufacturing systems (United States)

    Schroer, Bernard J.; Tseng, Fan T.; Zhang, S. X.; Wolfsberger, John W.


    Numerous simulation languages exist for modeling discrete event processes, and are now ported to microcomputers. Graphic and animation capabilities were added to many of these languages to assist the users build models and evaluate the simulation results. With all these languages and added features, the user is still plagued with learning the simulation language. Futhermore, the time to construct and then to validate the simulation model is always greater than originally anticipated. One approach to minimize the time requirement is to use pre-defined macros that describe various common processes or operations in a system. The development of a simulation assistant for modeling discrete event manufacturing processes is presented. A simulation assistant is defined as an interactive intelligent software tool that assists the modeler in writing a simulation program by translating the modeler's symbolic description of the problem and then automatically generating the corresponding simulation code. The simulation assistant is discussed with emphasis on an overview of the simulation assistant, the elements of the assistant, and the five manufacturing simulation generators. A typical manufacturing system will be modeled using the simulation assistant and the advantages and disadvantages discussed.

  1. Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery. (United States)

    Miyano, Go; Ochi, Takanori; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki


    We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.

  2. Endoscope-assisted retrosigmoid intradural suprameatal approach for surgical treatment of trigeminal schwannomas. (United States)

    Samii, Madjid; Alimohamadi, Maysam; Gerganov, Venelin


    Trigeminal schwannomas are the most common intracranial nonvestibular schwannomas, and the dumbbell-shaped subtype is the most challenging. To evaluate the efficiency and safety of the endoscope-assisted retrosigmoid intradural suprameatal approach (EA-RISA) for dumbbell trigeminal schwannomas and to compare EA-RISA with classic RISA. A retrospective study of all patients with trigeminal schwannomas was performed with a focus on dumbbell tumors. Tumors were classified according to a modified Samii classification. Extent of tumor removal, outcome, and morbidity rates in the 2 subgroups were compared. Twenty patients were enrolled: 8 had dumbbell-shaped tumors (type C1), 8 had middle fossa tumors (A1-3), 3 had extracranial extension (D2), and 1 had posterior fossa tumor. Gross total resection was achieved in 15 and near-total resection in 5 patients. In 4 patients with dumbbell tumors, the classic RISA (Samii approach) was used; EA-RISA was used in the other 4 patients. The extent of petrous apex drilling was determined individually on the basis of the anatomic variability of suprameatal tubercle and degree of tumor-induced petrous apex erosion; in 2 patients, only minimal drilling was needed. The endoscope was applied after microsurgical tumor removal and in 3 of 4 patients revealed a significant unrecognized tumor remnant in the anterolateral and superolateral aspects of the Meckel cave. Thus, the EA-RISA technique allowed gross total resection of the tumor. The EA-RISA enlarges the exposure obtained with the classic RISA. Its judicious use can help achieve safe and radical removal of dumbbell-shaped trigeminal schwannomas (C1 type).

  3. [Stress distribution of surgically assisted tooth-borne rapid maxillary expansion via three different types of osteotomies]. (United States)

    Jiang, Wen-hui; Wang, Xu-dong; Wang, Dong-mei


    To investigate the stress distribution of craniofacial bones during surgically assisted tooth-borne rapid maxillary expansion (SARME) via three different osteotomies. Three-dimensional finite element model of craniofacial bones with a tooth-borne appliance was generated. According to the different osteotomies, the models were categorized as three groups: Type I-isolated midpalatal osteotomy, Type II-Le Fort I and midpalatal osteotomies, Type III-Le Fort I and midpalatal osteotomies and bilateral pterygomaxillary disjunction. In all three models, with 4 different displacements, von-Mises stress was measured and analysed at 11 anatomical structures of the craniofacial bones. An obvious reduction of the stress was observed followed by the larger extent of the surgery. The maximum stress of the bones was only noticed in Type I model. Stress on lamina of the pterygoid acutely increased in the Type II model compared with the Type I model. In Type III model, after separation of the pterygomaxillary junctions, stress on lamina of the pterygoid decreased rapidly and meanwhile stressed on the majority of the midfacial bones also decreased. In Type III osteotomies, anatomical structures of the upper craniofacial bones suffered from an increase of the stress. Surgical procedures would be of great help to reduce the stress on the craniofacial region in the rapid maxillary expansion postoperatively. Fractures of the cranial base may occur at a greater chance because of stress focusing on lamina of the pterygoid. So, separation of the pterygomaxillary junctions during the operation is suggested. Increasing stress on the upper craniofacial bones can be observed after separation of the pterygomaxillary junctions due to changes of stress transduction pathways.

  4. Computer-assisted learning versus a lecture and feedback seminar for teaching a basic surgical technical skill. (United States)

    Rogers, D A; Regehr, G; Yeh, K A; Howdieshell, T R


    Rapid improvements in computer technology allow us to consider the use of computer-assisted learning (CAL) for teaching technical skills in surgical training. The objective of this study was to compare in a prospective, randomized fashion, CAL with a lecture and feedback seminar (LFS) for the purpose of teaching a basic surgical skill. Freshman medical students were randomly assigned to spend 1 hour in either a CAL or LFS session. Both sessions were designed to teach them to tie a two-handed square knot. Students in both groups were given knot tying boards and those in the CAL group were asked to interact with the CAL program. Students in the LFS group were given a slide presentation and were given individualized feedback as they practiced this skill. At the end of the session the students were videotaped tying two complete knots. The tapes were independently analyzed, in a blinded fashion, by three surgeons. The total time for the task was recorded, the knots were evaluated for squareness, and each subject was scored for the quality of performance. Data from 82 subjects were available for the final analysis. Comparison of the two groups demonstrated no significant difference between the proportion of subjects who were able to tie a square knot. There was no difference between the average time required to perform the task. The CAL group had significantly lower quality of performance (t = 5.37, P effective in conveying the cognitive information associated with this skill. However, the significantly lower performance score demonstrates that the students in the CAL group did not attain a proficiency in this skill equal to the students in the LFS group. Comments by the students suggest that the lack of feedback in this model of CAL was the significant difference between these two educational methods.

  5. State of the art Advanced Driver Assistance Systems (ADAS).

    NARCIS (Netherlands)

    OEI, H.-L.


    An overview of state-of-the-art ADA Advanced Driver Assistance systems is given. First a main structuring system for the ADA systems is presented, needed for purposes of relevancy, and consistency : the three phases in the accident process, i.e. pre-crash, crash and post-crash; the driving task at

  6. [Adjuvant systemic antibiotic therapy for surgically treated spondylodiscitis]. (United States)

    Marmelstein, D; Homagk, N; Hofmann, G O; Röhl, K; Homagk, L


    Recognised methods for the treatment of spondylodiscitis in correspondence to the immobilisation are systemic antibiotic therapy. However, the available data for recommendations of specific antibiotic therapy are very heterogeneous. The aim of this study was to focus on the adjuvant antibiotic therapy in surgical treated cases of spondylodiscitis and to reach a guideline regarding its application in patients' spondylodiscitis. Between 01.10.1998 and 31.12.2011 276 inpatient cases of spondylodiscitis were surgically treated, documented and included in the study. The study involved medical history, germ status, localisation and extent of spondylodiscitis and antibiotic treatment. Between 01.01.2012 and 31.12.2013 a further 20 cases of spondylodiscitis were treated according to a standardised treatment regimen of antibiotic therapy and included in the study. The age distribution shows a marked prominence of 60 to 80 year-olds, with a leading localisation of spondylodiscitis in the lumbar spine with 55 % followed by the thoracic spine (33 %) and the cervical spine (12 %). A constant observation during the study periods was the delayed diagnosis of more than 1 month of spondylodiscitis, so that about 60 % of the patients were not receiving any treatment for their disease at the time of hospitalisation. The aetiology of spondylodiscitis is very heterogeneous and remained unknown in 34 % of cases. However, diabetes mellitus appeared as a disease favouring the occurrence of spondylodiscitis since it was concomitant with almost 50 % of patients with spondylodiscitis. The bacterial spectrum is limited in our area to staphylococci, with a predominance of Staphylococcus aureus. At least about 10 % of the germs are multi-drug resistant. In 45 % of cases, pathogen detection was unsuccessful. Clindamycin is the most commonly used antibiotic in the treatment of spondylodiscitis and is used in 26.8 % in combinations with other antibiotics. The antibiotic therapy

  7. Orthognathic positioning system: intraoperative system to transfer virtual surgical plan to operating field during orthognathic surgery. (United States)

    Polley, John W; Figueroa, Alvaro A


    To introduce the concept and use of an occlusal-based "orthognathic positioning system" (OPS) to be used during orthognathic surgery. The OPS consists of intraoperative occlusal-based devices that transfer virtual surgical planning to the operating field for repositioning of the osteotomized dentoskeletal segments. The system uses detachable guides connected to an occlusal splint. An initial drilling guide is used to establish stable references or landmarks. These are drilled on the bone that will not be repositioned adjacent to the osteotomy line. After mobilization of the skeletal segment, a final positioning guide, referenced to the drilled landmarks, is used to transfer the skeletal segment according to the virtual surgical planning. The OPS is digitally designed using 3-dimensional computer-aided design/computer-aided manufacturing technology and manufactured with stereolithographic techniques. Virtual surgical planning has improved the preoperative assessment and, in conjunction with the OPS, the execution of orthognathic surgery. The OPS has the possibility to eliminate the inaccuracies commonly associated with traditional orthognathic surgery planning and to simplify the execution by eliminating surgical steps such as intraoperative measuring, determining the condylar position, the use of bulky intermediate splints, and the use of intermaxillary wire fixation. The OPS attempts precise translation of the virtual plan to the operating field, bridging the gap between virtual and actual surgery. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Innovative procedure for computer-assisted genioplasty: three-dimensional cephalometry, rapid-prototyping model and surgical splint. (United States)

    Olszewski, R; Tranduy, K; Reychler, H


    The authors present a new procedure of computer-assisted genioplasty. They determined the anterior, posterior and inferior limits of the chin in relation to the skull and face with the newly developed and validated three-dimensional cephalometric planar analysis (ACRO 3D). Virtual planning of the osteotomy lines was carried out with Mimics (Materialize) software. The authors built a three-dimensional rapid-prototyping multi-position model of the chin area from a medical low-dose CT scan. The transfer of virtual information to the operating room consisted of two elements. First, the titanium plates on the 3D RP model were pre-bent. Second, a surgical guide for the transfer of the osteotomy lines and the positions of the screws to the operating room was manufactured. The authors present the first case of the use of this model on a patient. The postoperative results are promising, and the technique is fast and easy-to-use. More patients are needed for a definitive clinical validation of this procedure. Copyright 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Computer assisted inventory control system | Dessalegn | Zede ...

    African Journals Online (AJOL)

    The information system in business and manufacturing organizations is better organized with the help of computers. In a computer based system, the flow of information within the different departments of an organization and with the external environment can easily be maintained. A computer based decision support system ...


    Directory of Open Access Journals (Sweden)

    Sadayuki TSUGAWA


    Full Text Available In recent years, ITS projects in Japan, Europe and the US have been characterized by a strong emphasis on safe driver assistance systems designed to prevent traffic accidents. As it has become clear that eradicating accidents will be impossible by means of vehicle passive safety and single-vehicle active safety efforts alone, research and development of systems for preventing accidents through road-vehicle cooperation and vehicle-vehicle cooperation have been promoted in Japan (ASV, AHS, Europe (PReVENT, SAFESPOT and the US (VII. The key to such technology is road-to-vehicle communications and inter-vehicle communications. On the other hand, a number of driver assistance systems have been brought to market, including lidar-based forward collision warnings, ACC, lane keeping support and drowsiness warnings, but their penetration rates in Japan are extremely low. Furthermore, one major challenge is that safe driver assistance systems based on road-vehicle and vehicle-vehicle cooperation are premised upon a high penetration rate. Finally, we introduce a system for improving driver acceptance of safe driver assistance systems based on driver monitoring and forward monitoring as well as cooperative driver assistance systems for elderly drivers, an issue now receiving attention in Japan.

  11. Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes. (United States)

    Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari


    To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and shorter postoperative length of hospital stay can be obtained with robot-assisted laparoscopic partial nephrectomy

  12. Reliability analysis of large, complex systems using ASSIST (United States)

    Johnson, Sally C.


    The SURE reliability analysis program is discussed as well as the ASSIST model generation program. It is found that semi-Markov modeling using model reduction strategies with the ASSIST program can be used to accurately solve problems at least as complex as other reliability analysis tools can solve. Moreover, semi-Markov analysis provides the flexibility needed for modeling realistic fault-tolerant systems.

  13. The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis

    NARCIS (Netherlands)

    de Vries, Eefje N.; Dijkstra, Lucia; Smorenburg, Susanne M.; Meijer, R. Peter; Boermeester, Marja A.


    ABSTRACT: BACKGROUND: Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS)

  14. Development and validation of the SURgical PAtient Safety System (SURPASS) checklist

    NARCIS (Netherlands)

    de Vries, E. N.; Hollmann, M. W.; Smorenburg, S. M.; Gouma, D. J.; Boermeester, M. A.


    Introduction: A large number of preventable adverse events are encountered during hospital admission and in particular around surgical procedures. Checklists may well be effective in surgery to prevent errors and adverse events. We developed, validated and evaluated a SURgical PAtient Safety System

  15. The SEP "Robot": A Valid Virtual Reality Robotic Simulator for the Da Vinci Surgical System?

    NARCIS (Netherlands)

    van der Meijden, O. A. J.; Broeders, I. A. M. J.; Schijven, M. P.


    The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's

  16. Terrace Layout Using a Computer Assisted System (United States)

    Development of a web-based terrace design tool based on the MOTERR program is presented, along with representative layouts for conventional and parallel terrace systems. Using digital elevation maps and geographic information systems (GIS), this tool utilizes personal computers to rapidly construct ...

  17. Comparison of cardiopulmonary responses during sedation with epidural and local anesthesia for laparoscopic-assisted jejunostomy feeding tube placement with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical jejunostomy feeding tube placement in healthy dogs. (United States)

    Hewitt, Saundra A; Brisson, Brigitte A; Sinclair, Melissa D; Sears, William C


    To evaluate the use of laparoscopic-assisted jejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement. 15 healthy mixed-breed dogs. Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5 dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O(2) delivery were calculated. All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O(2) delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were found between groups undergoing laparoscopic-assisted and open surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs. Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.

  18. The effect of surgically assisted rapid maxillary expansion on sleep architecture: an exploratory risk study in healthy young adults. (United States)

    Bach, N; Tuomilehto, H; Gauthier, C; Papadakis, A; Remise, C; Lavigne, F; Lavigne, G J; Huynh, N


    Maxillary transverse deficiencies (MTD) cause malocclusions. Rapid maxillary expansion treatment is commonly used treatment for correcting such deficiencies and has been found to be effective in improving respiration and sleep architecture in children with obstructive sleep apnoea (OSA). However, thus far, the effect of surgically assisted rapid maxillary expansion (SARME) treatment on sleep architecture and breathing of normal subjects has not been assessed. We hypothesised that sleep quality will improve after maxillary expansion treatment. The objective of this study is to access the effect of maxillary expansion treatment on sleep structure and respiratory functions in healthy young adults with severe MTD. This is a prospective and exploratory clinical study. Twenty-eight consecutive young adult patients (15 males and 13 females, mean age 20·6 ± 5·8 years) presenting with severe MTD at the orthodontic examination were recruited into the study. All the participants underwent a standardised SARME procedure (mean expansion 6·5 ± 1·8 and 8·2 ± 1·8 mm, intercanine and intermolar distance, respectively) to correct malocclusion caused by MTD. An overnight in-laboratory polysomnography, before and after the treatment, was performed. The mean follow-up time was 9 months. The main outcome parameters were the changes in sleep architecture, including sleep stages, arousals, slow-wave activity (SWA) and respiratory variables. Before surgery, young adult patients with MTD presented no evidence of sleep breathing problems. At baseline sleep recording, 7 of 28 (25%) had apnoea-hypopnoea index (AHI) ≥ 5 events per hour. No negative effect of the SARME was observed in questionnaires or sleep laboratory parameters. In the patients with a higher baseline AHI (AHI ≥ 5 h of sleep), we observed a reduction in AHI after surgical treatment (P = 0·028). SARME did not have a negative effect on any sleep or respiration parameters in healthy young individuals

  19. Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy 
(A Report of 129 Cases

    Directory of Open Access Journals (Sweden)

    Tong WANG


    Full Text Available Background and objective The development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is difficult. This clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC. Methods The clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. Thin-section computed tomography (CT was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition. Results Results of the pathological examination of 37 solid pulmonary nodules (SPNs revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcinomas (IAs, 2 metastatic cancers, 2 small cell lung cancers (SCLCs, 16 hamartomas, and 12 nonspecific chronic inflammations. The results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs, 4 adenocarcinomas in situ (AIS, 1 atypical adenomatous hyperplasia (AAH, 1 SCLC, and 18 nonspecific chronic inflammations. The results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspecific chronic inflammations. Wedge resection under video-assisted thoracoscopic surgery (VATS was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with

  20. Coping with the worrying complexity of cooperative driver assistance systems

    NARCIS (Netherlands)

    Ouden, F.C. den; Papp, Z.; Zoutendijk, A.M.; Netten, B.D.; Agovic, K.


    In recent years a clear trend became visible towards vehicles equipped with intelligent driver assistance systems based on cooperation between vehicle and infrastructure. The main reason for this is the high potential cooperative systems show to increase traffic throughput and safety and to decrease

  1. Expert System Software Assistant for Payload Operations (United States)

    Rogers, Mark N.


    The broad objective of this expert system software based application was to demonstrate the enhancements and cost savings that can be achieved through expert system software utilization in a spacecraft ground control center. Spacelab provided a valuable proving ground for this advanced software technology; a technology that will be exploited and expanded for future ISS operations. Our specific focus was on demonstrating payload cadre command and control efficiency improvements through the use of "smart" software which monitors flight telemetry, provides enhanced schematic-based data visualization, and performs advanced engineering data analysis.

  2. Towards intelligent robot-assisted rehabilitation systems (United States)

    Barkana, Duygun Erol


    This article presents an intelligent control architecture that is used to monitor the task and safety issues to provide assessment of the progress and to alter the task parameters. Additionally, a verbal feedback recognition system is integrated inside the intelligent control architecture to incorporate patients' and therapists' feedback to make necessary modifications to impart effective therapy during the execution of the task in an automated manner. Hybrid system modelling technique is used to design the intelligent control architecture. Experimental results are presented to demonstrate the efficacy of the intelligent control architecture.

  3. LHCb Conditions database operation assistance systems (United States)

    Clemencic, M.; Shapoval, I.; Cattaneo, M.; Degaudenzi, H.; Santinelli, R.


    The Conditions Database (CondDB) of the LHCb experiment provides versioned, time dependent geometry and conditions data for all LHCb data processing applications (simulation, high level trigger (HLT), reconstruction, analysis) in a heterogeneous computing environment ranging from user laptops to the HLT farm and the Grid. These different use cases impose front-end support for multiple database technologies (Oracle and SQLite are used). Sophisticated distribution tools are required to ensure timely and robust delivery of updates to all environments. The content of the database has to be managed to ensure that updates are internally consistent and externally compatible with multiple versions of the physics application software. In this paper we describe three systems that we have developed to address these issues. The first system is a CondDB state tracking extension to the Oracle 3D Streams replication technology, to trap cases when the CondDB replication was corrupted. Second, an automated distribution system for the SQLite-based CondDB, providing also smart backup and checkout mechanisms for the CondDB managers and LHCb users respectively. And, finally, a system to verify and monitor the internal (CondDB self-consistency) and external (LHCb physics software vs. CondDB) compatibility. The former two systems are used in production in the LHCb experiment and have achieved the desired goal of higher flexibility and robustness for the management and operation of the CondDB. The latter one has been fully designed and is passing currently to the implementation stage.

  4. Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System. (United States)

    Waltho, Daniel; Hatchell, Alexandra; Thoma, Achilleas


    Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed. A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making. The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features. Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.

  5. Anatomy and Physiology. Module Set II: Major Body Systems. Teacher Edition [and] Student Edition. Surgical Technology. (United States)

    Hilley, Robert

    This document, which is the second part of a two-part set of modules on anatomy and physiology for future surgical technicians, contains the teacher and student editions of an introduction to anatomy and physiology that consists of modules on the following body systems: integumentary system; skeletal system; muscular system; nervous system;…

  6. Surgical planning of total hip arthroplasty: accuracy of computer-assisted EndoMap software in predicting component size

    International Nuclear Information System (INIS)

    Davila, Jesse A.; Kransdorf, Mark J.; Duffy, Gavan P.


    The purpose of our study was to assess the accuracy of a computer-assisted templating in the surgical planning of patients undergoing total hip arthroplasty utilizing EndoMap software (Siemans AG, Medical Solutions, Erlangen, Germany). Endomap Software is an electronic program that uses DICOM images to analyze standard anteroposterior radiographs for determination of optimal prosthesis component size. We retrospectively reviewed the preoperative radiographs of 36 patients undergoing uncomplicated primary total hip arthroplasty, utilizing EndoMap software, Version VA20. DICOM anteroposterior radiographs were analyzed using standard manufacturer supplied electronic templates to determine acetabular and femoral component sizes. No additional clinical information was reviewed. Acetabular and femoral component sizes were assessed by an orthopedic surgeon and two radiologists. Mean and estimated component size was compared with component size as documented in operative reports. The mean estimated acetabular component size was 53 mm (range 48-60 mm), 1 mm larger than the mean implanted size of 52 mm (range 48-62 mm). Thirty-one of 36 acetabular component sizes (86%) were accurate within one size. The mean calculated femoral component size was 4 (range 2-7), 1 size smaller than the actual mean component size of 5 (range 2-9). Twenty-six of 36 femoral component sizes (72%) were accurate within one size, and accurate within two sizes in all but four cases (94%). EndoMap Software predicted femoral component size well, with 72% within one component size of that used, and 94% within two sizes. Acetabular component size was predicted slightly better with 86% within one component size and 94% within two component sizes. (orig.)

  7. Efficacy of vacuum-assisted closure therapy on rehabilitation during the treatment for surgical site infection after cardiovascular surgery. (United States)

    Yoshimoto, Akihiro; Inoue, Takafumi; Fujisaki, Masayuki; Morizumi, Sei; Suematsu, Yoshihiro


    Surgical site infection (SSI) after cardiovascular procedures is a severe complication, potentially leading to high morbidity and mortality. In addition, during the treatment of SSI, rehabilitation is delayed, which can severely impair postoperative recovery. The aim of this study was to assess the effect of vacuum-assisted closure (VAC) therapy on rehabilitation during the treatment of SSI after cardiovascular surgery. From January 2008 to March 2015, 10 patients underwent VAC therapy for SSI after cardiovascular operations. The patient characteristics, duration of VAC therapy, time interval from the implementation of VAC to physical therapy (PT) (T1), ambulation (T2) and walking (T3), functional independent measure (FIM), and maximum consecutive walking capacity (MCWC) were retrospectively analyzed. Nine patients underwent mid-sternal incision and one patient underwent thoraco-abdominal incision. The mean time interval from the beginning of VAC therapy to PT, ambulation, and walking was 0.38 ± 0.50, 0.63 ± 0.71, and 1.38 ± 1.86 days, respectively. The average FIM was 84.5 ± 14.0 at the beginning of VAC therapy and 106.7 ± 18.5 at the end of VAC therapy (P = 0.000494). On average, MCWC was 52.3 ± 54.6 m at the installation of VAC therapy and 189.7 ± 152.8 m at the completion of VAC therapy (P = 0.0169). FIM and MCWC improvement rate was better in VAC group than non-VAC group although these data are not suitable for statistical analysis because of a small sample size. Although further studies are warranted, VAC therapy may have a role in facilitating rehabilitation and improving the prognosis of SSI cases after major cardiovascular operations.

  8. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth

    Directory of Open Access Journals (Sweden)

    Sembronio Salvatore


    Full Text Available Abstract There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth.

  9. A Hybrid Neuromechanical Ambulatory Assist System (United States)


    Systems Inc., Shirley, NY, USA) arm as shown in Figure 4. The dynamometer arm was set in passive mode and passive resistance (torque) was Table 1... arm and HKC mechanism was subtracted from the total measured torque to determine the resistive torque due to fluid flow in the hydraulic circuit. The...orthosis – Part I: Spring parameters. Applied Bionics and Biomechanics, 9:303-316, 2012. a) b) Figure 10. a) Passive resistance at 30° of hip

  10. The state of the vegetative nervous system in patients with gonarthrosis for surgical treatment before and after surgical treatment

    Directory of Open Access Journals (Sweden)



    Full Text Available Aim. Analyzing the vegetative tensity of organism» functional systems before and after surgical treatment of elderly patients with metabolic-and-dystrophic gonarthrosis. Methods. The evaluation of vegetative homeostasis, reactivity of the vegetative nervous system by the data of variation pulsometry («REAN-POLY» RGPA-6/12, Taganrog in 60 patients with gonarthrosis at the age of 50-72 years and the disease duration — 9+1.5 years before and after surgical treatment: total tunnelization (Group I, tunnelization with osteotomy of leg bones for correction of limb biomechanical axis (Group II, treatment-and-diagnostic arthroscopy (Group III. Results. The reduction of the level of hypoxia tolerance and the decrease of the processes of general adaptation one month after surgery in Group I was registered in 40% of patients. As for patients of Group II, by the end of the period of fixation with the llizarov device — in 50%. As for those of Group III after arthroscopy — in 10% of patients. Among the patients whose 1С / 1С calculated parameter after surgical treatment was registered <1.0, its values were >10.0 before treatment in 70% of cases. At rest, marked vagotonia was registered with hypersympathicotonic reaction to orthotest, as well as with sharp decrease of the proportion of second-order slow waves while transition to standing position (VLF proportion <10.0%, thereby reflecting organism»s energy deficiency state. Conclusion. Preoperative examination. When VLF proportion after orthotest is registered <10.0%, such patients should be referred to risk group and prescribed in-depth examination. The index of centralization (1С dynamics for orthotest (1С test/1С rest is one of the criteria of functional recovery level for the particular patient: its increase points to the positive dynamics of restorative rehabilitative process, and the values <1.0 —to the negative one.

  11. Can a Teaching Assistant Experience in a Surgical Anatomy Course Influence the Learning Curve for Nontechnical Skill Development for Surgical Residents? (United States)

    Heidenreich, Mark J.; Musonza, Tashinga; Pawlina, Wojciech; Lachman, Nirusha


    The foundation upon which surgical residents are trained to work comprises more than just critical cognitive, clinical, and technical skill. In an environment where the synchronous application of expertise is vital to patient outcomes, the expectation for optimal functioning within a multidisciplinary team is extremely high. Studies have shown…

  12. Effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius

    Directory of Open Access Journals (Sweden)

    Jian-Nian Wang


    Full Text Available Objective: To analyze the effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius. Methods: A total of 200 elderly patients with fracture of distal radius treated from September 2010 to September 2015 were randomly divided into observation group and control group (n=100. Control group received routine surgical treatment, and observation group underwent Gukang capsule-assisted surgical treatment. Fracture healing was compared between two groups, serum microcirculation and bone metabolism indexes were detected 1 week after operation, X-ray examination was performed 6 months after operation and imaging parameters were measured. Results: Regression time of postoperative affected-side limb swelling and radiographic healing time of broken ends of fractured bone of observation group were significantly shorter than those of control group; 1 week after operation, serum TXB2, CTX-I, CTX-II, RANK, RANKL and TRACP5b levels as well as TXB-2/6-Keto-PGF1α ratio of observation group were significantly lower than those of control group, and 6-Keto-PGF1α, ALP, OPG, PICP, BGP and 1,25(OH2D3 levels were significantly higher than those of control group. Conclusions: Gukang capsule-assisted surgery helps promote the fracture healing in elderly patients with fracture of distal radius and can improve microcirculation and bone metabolism.

  13. Adolescent patient with bilateral crossbite treated with surgically assisted rapid maxillary expansion: a case report evaluated by the 3d laser scanner, and using FESA method. (United States)

    Ivanov, Ch I; Velemínská, J; Dostálová, T; Foltán, R


    Our purpose in this case report is to present an orthodontic treatment obtained and the results achieved in 17-year-old white female patient with Angle Class II malocclusion and bilateral posterior crossbite. Patient was treated with bonded acrylic Hyrax appliance and surgically assisted rapid maxillary expansion (SARME). The multiloop system 0.16 TMA (ß titanium) arch wire was used in the alignment phase and on purpose to prohibit bite opening and optimize threedimensional movement control. After treatment bonded lingual retainers were placed in between maxillary central incisors and in mandible canine-to-canine. A functional removable Klammt appliance was used for retention. The 3D Laser Scanner Roland LPX-250 was used in order to obtain digital dental casts. Evaluation of the treatment results was measured on these models and using finite element scaling analysis (FESA). An Angle Class I relationship was obtained after 2½ years of treatment, function and facial aesthetics were improved. The shape of the palate changed significant in the width direction, not significantly in length and high direction. The greatest expansion of palate was found in the region between the palatal cusps of the first molars 26.6%, followed by first 21.9% and second premolars 16.5%. SARME in adult patients with bilateral cross bite and maxillary deficiency lead to satisfactory results. The 3D laser scanned models and their measurements, using advanced software's are successfully used for precise studies.

  14. Assistance System for Traffic Signs Inventory

    Directory of Open Access Journals (Sweden)

    Karel Zídek


    Full Text Available We can see arising trend in the automotive industry in last years – autonomous cars that are driven just by on-board computers. The traffic signs tracking system must deal with real conditions with data that are frequently obtained in poor light conditions, fog, heavy rain or are otherwise disturbed. Completely same problem is solved by mapping companies that are producing geospatial data for different information systems, navigations, etc. They are frequently using cars equipped with a wide range of measuring instruments including panoramic cameras. These measurements are frequently done during early morning hours when the traffic conditions are acceptable. However, in this time, the sun position is usually not optimal for the photography. Most of the traffic signs and other street objects are heavily underexposed. Hence, it is difficult to find an automatic approach that can identify them reliably. In this article, we focus on methods designed to deal with the described conditions. An overview of the state-of-the-art methods is outlined. Further, where it is possible, we outline an implementation of the described methods using well-known Open Computer Vision library. Finally, emphasis is placed on the methods that can deal with low light conditions, fog or other situations that complicate the detection process.

  15. Wire in the Cable-Driven System of Surgical Robot (United States)

    Wang, X. F.; Lv, N.; Mu, H. Z.; Xue, L. J.


    During the evolution of the surgical robot, cable plays an important role. It translates motion and force precisely from surgeon’s hand to the tool’s tips. In the paper, the vertical wires, the composition of cable, are mathematically modeled from a geometric point of view. The cable structure and tension are analyzed according to the characteristics of wire screw twist. The structural equations of the wires in different positions are derived for both non-bent cable and bent cable, respectively. The bending moment formula of bent cable is also obtained. This will help researchers find suitable cable and design more matched pulley.

  16. Medical Devices; General and Plastic Surgery Devices; Classification of the Magnetic Surgical Instrument System. Final order. (United States)


    The Food and Drug Administration (FDA) is classifying the Magnetic Surgical Instrument System into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the magnetic surgical instrument system's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  17. LHCb Conditions Database Operation Assistance Systems

    CERN Multimedia

    Shapoval, Illya


    The Conditions Database of the LHCb experiment (CondDB) provides versioned, time dependent geometry and conditions data for all LHCb data processing applications (simulation, high level trigger, reconstruction, analysis) in a heterogeneous computing environment ranging from user laptops to the HLT farm and the Grid. These different use cases impose front-end support for multiple database technologies (Oracle and SQLite are used). Sophisticated distribution tools are required to ensure timely and robust delivery of updates to all environments. The content of the database has to be managed to ensure that updates are internally consistent and externally compatible with multiple versions of the physics application software. In this paper we describe three systems that we have developed to address these issues: - an extension to the automatic content validation done by the “Oracle Streams” replication technology, to trap cases when the replication was unsuccessful; - an automated distribution process for the S...

  18. Guidance-assist system for the blind (United States)

    Farcy, Rene; Damaschini, Roland M.


    We propose navigational aid systems for the blind relying on active laser profilometry and infrared proximetry with a real time vibrotactile interface. The Teletact and the Vigitact are small hand held or badge worn devices to improve the spatial perception, the mobility and the security of blind people. The Teletact is a hand held laser telemeter and gives an accurate 3D spatial perception up to ten meters. The Vigitact is an infrared scanner and provides an automatic vigilance from knees to head up to two meters. Both devices are now commercially available. We will report on the basic functional parts of these devices, the results of everyday use by blind people, and future technological improvements.

  19. Integrated Context-Aware Driver Assistance System Architecture

    Directory of Open Access Journals (Sweden)

    Elhadi M. Shakshuki


    Full Text Available Recently, significant improvements have been made in the area of vehicular communication systems. Furthermore, vehicle-to-vehicle communication is considered a key concept for keeping roads safe. An efficient implementation of these systems is necessary to ensure the safety of driving situations and to reduce the collision rates. This paper proposes a Context-Aware Driver Assistance System that links drivers with the physical environment surrounding them using multiple types of sensors and traffic systems as well as considering the senior driver's difficulties and the system processing time. This is achieved by developing a warning system that assists drivers to avoid collisions and improve their response times. The proposed system architecture consists of a set of components to process the user's request such as parking assistance, and to provide responses and advices when needed. These components include communication, knowledge exchange, knowledge update, and context-history. Also, it includes other processes such as context-history manipulation, hazard detection, and hazard detection control. The main goal of the proposed system is to reduce the number of car accidents and improve driver's decisions. The NXT Robotic environment is used to demonstrate the feasibility of the proposed system.

  20. Predicting the acceptance of advanced rider assistance systems. (United States)

    Huth, Véronique; Gelau, Christhard


    The strong prevalence of human error as a crash causation factor in motorcycle accidents calls for countermeasures that help tackling this issue. Advanced rider assistance systems pursue this goal, providing the riders with support and thus contributing to the prevention of crashes. However, the systems can only enhance riding safety if the riders use them. For this reason, acceptance is a decisive aspect to be considered in the development process of such systems. In order to be able to improve behavioural acceptance, the factors that influence the intention to use the system need to be identified. This paper examines the particularities of motorcycle riding and the characteristics of this user group that should be considered when predicting the acceptance of advanced rider assistance systems. Founded on theories predicting behavioural intention, the acceptance of technologies and the acceptance of driver support systems, a model on the acceptance of advanced rider assistance systems is proposed, including the perceived safety when riding without support, the interface design and the social norm as determinants of the usage intention. Since actual usage cannot be measured in the development stage of the systems, the willingness to have the system installed on the own motorcycle and the willingness to pay for the system are analyzed, constituting relevant conditions that allow for actual usage at a later stage. Its validation with the results from user tests on four advanced rider assistance systems allows confirming the social norm and the interface design as powerful predictors of the acceptance of ARAS, while the extent of perceived safety when riding without support did not have any predictive value in the present study. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. New Operator Assistance Features in the CMS Run Control System

    Energy Technology Data Exchange (ETDEWEB)

    Andre, J.M.; et al.


    During Run-1 of the LHC, many operational procedures have been automated in the run control system of the Compact Muon Solenoid (CMS) experiment. When detector high voltages are ramped up or down or upon certain beam mode changes of the LHC, the DAQ system is automatically partially reconfigured with new parameters. Certain types of errors such as errors caused by single-event upsets may trigger an automatic recovery procedure. Furthermore, the top-level control node continuously performs cross-checks to detect sub-system actions becoming necessary because of changes in configuration keys, changes in the set of included front-end drivers or because of potential clock instabilities. The operator is guided to perform the necessary actions through graphical indicators displayed next to the relevant command buttons in the user interface. Through these indicators, consistent configuration of CMS is ensured. However, manually following the indicators can still be inefficient at times. A new assistant to the operator has therefore been developed that can automatically perform all the necessary actions in a streamlined order. If additional problems arise, the new assistant tries to automatically recover from these. With the new assistant, a run can be started from any state of the sub-systems with a single click. An ongoing run may be recovered with a single click, once the appropriate recovery action has been selected. We review the automation features of CMS Run Control and discuss the new assistant in detail including first operational experience.

  2. Seeking and Providing Assistance while Learning to Use Information Systems (United States)

    Babin, Lisa-Marie; Tricot, Andre; Marine, Claudette


    Throughout their lives, people are faced with various learning situations, for example when they learn how to use new software, services or information systems. However, research in the field of Interactive Learning Environments shows that learners needing assistance do not systematically seek or use help, even when it is available. The aim of the…

  3. Probabilistic approach for validation of advanced driver assistance systems

    NARCIS (Netherlands)

    Gietelink, O.J.; Schutter, B. de; Verhaegen, M.


    This paper presents a methodological approach for validation of advanced driver assistance systems. The methodology relies on the use of randomized algorithms that are more efficient than conventional validation that uses simulations and field tests, especially with increasing complexity of the

  4. Assisted supervision of a computer aided tele-operation system

    Energy Technology Data Exchange (ETDEWEB)

    Le Bars, H.; Gravez, P.; Fournier, R.


    This paper talks about Computer Aided Tele-operation (CAT) in dismantling and maintenance of nuclear plants. The current research orientations at CEA, basic concepts of the supervision assistance system and the realisation of a prototype are presented. (TEC). 3 refs., 4 figs.

  5. Traffic modelling validation of advanced driver assistance systems

    NARCIS (Netherlands)

    Tongeren, R. van; Gietelink, O.J.; Schutter, B. de; Verhaegen, M.


    This paper presents a microscopic traffic model for the validation of advanced driver assistance systems. This model describes single-lane traffic and is calibrated with data from a field operational test. To illustrate the use of the model, a Monte Carlo simulation of single-lane traffic scenarios

  6. Generic Model Predictive Control Framework for Advanced Driver Assistance Systems

    NARCIS (Netherlands)

    Wang, M.


    This thesis deals with a model predictive control framework for control design of Advanced Driver Assistance Systems, where car-following tasks are under control. The framework is applied to design several autonomous and cooperative controllers and to examine the controller properties at the

  7. Assisted supervision of a computer aided tele-operation system

    International Nuclear Information System (INIS)

    Le Bars, H.; Gravez, P.; Fournier, R.


    This paper talks about Computer Aided Tele-operation (CAT) in dismantling and maintenance of nuclear plants. The current research orientations at CEA, basic concepts of the supervision assistance system and the realisation of a prototype are presented. (TEC). 3 refs., 4 figs

  8. Laparoscopy-assisted Robotic Myomectomy Using the DA Vinci System

    Directory of Open Access Journals (Sweden)

    Shih-Peng Mao


    Conclusion: Minimally invasive surgery is the trend of the future. Robot-assisted laparoscopic surgery is a new technique for myomectomy. This robotic system provides a three-dimensional operative field and an easy-to-use control panel, which may be of great help when applying the suturing techniques and may shorten the learning curve. More experience with and long-term follow-up of robotic surgery may be warranted to further validate the role the robot-assisted approach in gynecologic surgery.

  9. [Robot-Assisted Laparoscopic Radical Prostatectomy for Patients with Prostatic Cancer and Factors Promoting Installation of the Robotic Surgical Equipment-Questionnaire Survey]. (United States)

    Tsukamoto, Taiji; Tanaka, Shigeru


    We conducted a questionnaire survey of hospitals with robot-assisted surgical equipment to study changes of the surgical case loads after its installation and the managerial strategies for its purchase. The study included 154 hospitals (as of April 2014) that were queried about their radical prostatectomy case loads from January 2009 to December 2013, strategies for installation of the equipment in their hospitals, and other topics related to the study purpose. The overall response rate of hospitals was 63%, though it marginally varied according to type and area. The annual case load was determined based on the results of the questionnaire and other modalities. It increased from 3,518 in 2009 to 6,425 in 2013. The case load seemed to be concentrated in hospitals with robot equipment since the increase of their number was very minimal over the 5 years. The hospitals with the robot treated a larger number of newly diagnosed patients with the disease than before. Most of the patients were those having localized cancer that was indicated for radical surgery, suggesting again the concentration of the surgical case loads in the hospitals with robots. While most hospitals believed that installation of a robot was necessary as an option for treatment procedures, the future strategy of the hospital, and other reasons, the action of the hospital to gain prestige may be involved in the process of purchasing the equipment. In conclusion, robot-assisted laparoscopic radical prostatectomy has become popular as a surgical procedure for prostate cancer in our society. This may lead to a concentration of the surgical case load in a limited number of hospitals with robots. We also discuss the typical action of an acute-care hospital when it purchases expensive clinical medical equipment.

  10. Handbook of driver assistance systems basic information, components and systems for active safety and comfort

    CERN Document Server

    Hakuli, Stephan; Lotz, Felix; Singer, Christina


    This fundamental work explains in detail systems for active safety and driver assistance, considering both their structure and their function. These include the well-known standard systems such as Anti-lock braking system (ABS), Electronic Stability Control (ESC) or Adaptive Cruise Control (ACC). But it includes also new systems for protecting collisions protection, for changing the lane, or for convenient parking. The book aims at giving a complete picture focusing on the entire system. First, it describes the components which are necessary for assistance systems, such as sensors, actuators, mechatronic subsystems, and control elements. Then, it explains key features for the user-friendly design of human-machine interfaces between driver and assistance system. Finally, important characteristic features of driver assistance systems for particular vehicles are presented: Systems for commercial vehicles and motorcycles.

  11. Expert systems for plant operations training and assistance

    International Nuclear Information System (INIS)

    Pack, R.W.; Lazar, P.M.; Schmidt, R.V.; Gaddy, C.D.


    The project described in this paper explored the use of expert systems for plant operations training and assistance. Three computer technologies were reviewed: computer-aided instruction, expert systems, and expert training systems (ETS). The technology of CAI has been developed since the early 1960s, and a wide range of applications are available commercially today. Expert systems have been developed primarily as job performance aids, and the number of commercial applications is increasing. A fully developed ETS has models of the trainer and trainee, in addition to a knowledge base

  12. Processing system of jaws tomograms for pathology identification and surgical guide modeling

    International Nuclear Information System (INIS)

    Putrik, M. B.; Ivanov, V. Yu.; Lavrentyeva, Yu. E.


    The aim of the study is to create an image processing system, which allows dentists to find pathological resorption and to build surgical guide surface automatically. X-rays images of jaws from cone beam tomography or spiral computed tomography are the initial data for processing. One patient’s examination always includes up to 600 images (or tomograms), that’s why the development of processing system for fast automation search of pathologies is necessary. X-rays images can be useful not for only illness diagnostic but for treatment planning too. We have studied the case of dental implantation – for successful surgical manipulations surgical guides are used. We have created a processing system that automatically builds jaw and teeth boundaries on the x-ray image. After this step, obtained teeth boundaries used for surgical guide surface modeling and jaw boundaries limit the area for further pathologies search. Criterion for the presence of pathological resorption zones inside the limited area is based on statistical investigation. After described actions, it is possible to manufacture surgical guide using 3D printer and apply it in surgical operation

  13. Feasibility of transoral lateral oropharyngectomy using a robotic surgical system for tonsillar cancer. (United States)

    Park, Young Min; Lee, Jeong Gwon; Lee, Won Sang; Choi, Eun Chang; Chung, Sa Myung; Kim, Se-Heon


    Conventional surgical approaches for tonsillar carcinomas have a great risk for developing treatment-related morbidity. To minimize this morbidity, transoral lateral oropharyngectomy (TLO) using the robotic surgical system was performed, and the efficacy and feasibility of this procedure was evaluated. TLO was performed using the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA). It consists of a surgeon's console and a manipulator cart equipped with three robotic arms. The surgeon is provided with three-dimensional magnified images from the endoscopic arm and can control two instrument arms for delicate operations from the console. Safe resection of tonsillar carcinoma was possible with the three-dimensional magnified images. When proceeding with resection of the buccopharyngeal fascia, we could prevent damage to the carotid artery, which is located posterolateral to the tonsillar fossa, since the joint at the distal part of the robotic arm can be bent freely from side to side. By using the 30 degrees endoscope, we can achieve a better surgical view of the base of the tongue area. TLO was performed successfully in all five patients without surgical complications. The mean operating time was 44 min, and an average of 19 min was required for setting up the robotic system. TLO using the robotic system will be a good option for organ preservation therapy in the treatment of carcinomas of the tonsil and the tonsillar fossa in the future.

  14. [CO2-laser-assisted de-epithelialization of perforation margins of persistent tympanic membrane perforations. An alternative to conventional surgical procedures]. (United States)

    Bessler, C; Haisch, A; Jovanovic, S; Sedlmaier, B


    The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated. A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested. Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment. A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.

  15. Improved transoral dissection of the tongue base with a next-generation robotic surgical system. (United States)

    Chen, Michelle M; Orosco, Ryan K; Lim, Gil Chai; Holsinger, F Christopher


    To describe the application of a novel, flexible, single-port robotic surgical system for transoral tongue base resection, and compare it to the current multiport, rigid-arm robotic surgical system. Preclinical anatomic study using four human cadavers. Transoral resection of the tongue base using the da Vinci Sp and the Si robotic surgical systems. A standardized operative procedure is outlined, and operative parameters were compared between robotic systems. Successful completion of tongue base resection was achieved in all cadavers using both the Sp and the Si systems. The optimal entry guide and instrument position for the Sp system was with the cannula rotated 180° from the standard position so that the camera was in the most inferior (caudal) channel. In the optimal configuration, no instrument exchanges were needed with the Sp system, but use of the Si system required one instrument exchange. This is the first preclinical anatomic study of robotic tongue base resection that compares a novel single-port robotic system to the current multiarm system. Surgical workflow was more streamlined with the da Vinci Sp system, and the new capabilities of simultaneous dissection, traction, and counter traction allowed for improved dissection and vessel control. NA. Laryngoscope, 128:78-83, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals. (United States)

    Shih, Ya-Chen Tina; Shen, Chan; Hu, Jim C


    The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. This study used hospital annual utilization data, annual financial data, and discharge data for year 2011 from the California Office of Statewide Health Planning and Development. We first performed bivariate analysis to compare mean profit margin by hospital and market characteristics and to examine whether these characteristics differed between hospitals that had one or more robotic surgical systems in 2011 and those that did not. We applied the t test and the F test to compare mean profit margin between two groups and among three or more groups, respectively. We then conducted multilevel logistic regression to determine the association between ownership of robotic surgical systems and having a positive profit margin after controlling for other hospital and market characteristics and accounting for possible correlation among hospitals located within the same market. The study sample included 167 California hospitals with valid financial information. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant (odds ratio [OR] = 6.2; P = 0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area. As robotic surgical systems become widely disseminated, hospital decision makers should carefully evaluate the financial and clinical implications before making a capital investment in this technology. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. Patient-specific system for prognosis of surgical treatment outcomes of human cardiovascular system (United States)

    Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.


    Object of study: Improvement of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of cardiovascular system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of practicing cardiovascular surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical practice at approximation of numerical experiment to the real conditions.

  18. Laparoscopic-assisted surgical reconstruction of a rare congenital abdominal wall defect in two children misdiagnosed with prune-belly syndrome. (United States)

    Fishman, Andrew I; Franco, Israel


    Abdominal wall laxity is typically associated with prune-belly syndrome (PBS). Incomplete forms of PBS have been rarely reported with only the abdominal wall laxity. Herein, we describe a rare congenital abdominal wall defect that has been confused with PBS and illustrate the laparoscopic-assisted surgical technique used for reconstruction. Two boys with symmetrical, bilateral absence or hypoplasia of the internal and external oblique muscles and no genitourinary abnormalities underwent a laparoscopic-assisted abdominal wall reconstruction utilizing the technique previously described by Firlit. Each patient had a Ct scan which confirmed the absence of the oblique muscles. In one patient EMG data confirmed no electrical activity of the obliques. Radiologic evaluation of the urinary tracts revealed no abnormalities. The abdominal wall was plicated utilizing bilateral subcostal incisions. Both patients had excellent cosmetic and functional results with no weakness or bulging of the lateral abdominal wall and improvement of associated symptoms. We believe these two cases and their congenital abdominal wall defects are a rare and often misdiagnosed muscular deficiency separate from PBS. The novel laparoscopic-assisted surgical technique illustrated is feasible and highly successful for these and possible other patients with similar rare congenital abdominal wall defects. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  19. Prospective validation of a surgical complications grading system in a cohort of 2114 patients. (United States)

    Mazeh, Haggi; Cohen, Oded; Mizrahi, Ido; Hamburger, Tamar; Stojadinovic, Alexander; Abu-Wasel, Bassam; Alaiyan, Bilal; Freund, Herbert R; Eid, Ahmed; Nissan, Aviram


    We recently reported a grading system for surgical complications. This system proved to have a high sensitivity for recording minor but meaningful complications prolonging hospital stay in patients after colorectal surgery. We aimed to prospectively validate the complication grading system in a general surgery department over 1 year. All surgical procedures and related complications were prospectively recorded between January 1st and December 31st, 2009. Surgical complications were graded on a severity scale of 1-5. The system classifies short-term outcome by grade emphasizing intensity of therapy required for treatment of the defined complication. During the study period, 2114 patients underwent surgery. Elective and oncological surgeries were performed in 1606 (76%) and 465 (22%) patients, respectively. There were 422 surgical complications in 304 (14%) patients (Grade 1/2: 203 [67%]; Grade 3/4: 90 [29%]; Grade 5: 11 [4%]). Median length of stay correlated significantly with complication severity: 2.3 d for no complication, 6.2 and 11.8 d for Grades 1/2 and 3/4, respectively (P 2 (OR 2.07, P Grade (OR 1.85, P = 0.001), oncological (OR 2.82, P 120 min (OR 2.08, P grading surgical complications permits standardized reporting of surgical morbidity according to the severity of impact. Prospective validation of this system supports its use in a general surgery setting as a tool for surgical outcome assessment and quality assurance. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Research of the master-slave robot surgical system with the function of force feedback. (United States)

    Shi, Yunyong; Zhou, Chaozheng; Xie, Le; Chen, Yongjun; Jiang, Jun; Zhang, Zhenfeng; Deng, Ze


    Surgical robots lack force feedback, which may lead to operation errors. In order to improve surgical outcomes, this research developed a new master-slave surgical robot, which was designed with an integrated force sensor. The new structure designed for the master-slave robot employs a force feedback mechanism. A six-dimensional force sensor was mounted on the tip of the slave robot's actuator. Sliding model control was adopted to control the slave robot. According to the movement of the master system manipulated by the surgeon, the slave's movement and the force feedback function were validated. The motion was completed, the standard deviation was calculated, and the force data were detected. Hence, force feedback was realized in the experiment. The surgical robot can help surgeons to complete trajectory motions with haptic sensation. Copyright © 2017 John Wiley & Sons, Ltd.

  1. Physician extenders on surgical services: the need for a systems perspective. (United States)

    Smith, Heather; Kuziemsky, Craig; Champion, Caitlin


    Adding physician extenders (PEs) to surgical teams has the potential to affect care delivery in multiple ways. To develop evidence-based recommendations on integrating PEs into surgical teams, we must recognize that patient care is a complex, adaptive system and requires a health systems perspective to understand how changes will affect outcomes. It is the best method of assessing the system adaptations and trade-offs of adding PEs prior to implementation. Such work would help to optimize research and management of limited health care resources.

  2. Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements (United States)

    Kammler, Juergen; Nahler, Alexander; Neeser, Kurt; Lichtenauer, Michael; Edlinger, Christoph; Kellermair, Joerg; Kiblboeck, Daniel; Lambert, Thomas; Auer, Johannes; Steinwender, Clemens


    Introduction Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB). Materials and methods We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB. Results Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; p< 0.001) and the procedure time was significantly longer with TSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours. Conclusion PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries. PMID:29509774

  3. Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements. (United States)

    Kypta, Alexander; Blessberger, Hermann; Kammler, Juergen; Nahler, Alexander; Neeser, Kurt; Lichtenauer, Michael; Edlinger, Christoph; Kellermair, Joerg; Kiblboeck, Daniel; Lambert, Thomas; Auer, Johannes; Steinwender, Clemens


    Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB). We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB. Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; pTSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours. PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries.

  4. Modeling and evaluation of hand-eye coordination of surgical robotic system on task performance. (United States)

    Gao, Yuanqian; Wang, Shuxin; Li, Jianmin; Li, Aimin; Liu, Hongbin; Xing, Yuan


    Robotic-assisted minimally invasive surgery changes the direct hand and eye coordination in traditional surgery to indirect instrument and camera coordination, which affects the ergonomics, operation performance, and safety. A camera, two instruments, and a target, as the descriptors, are used to construct the workspace correspondence and geometrical relationships in a surgical operation. A parametric model with a set of parameters is proposed to describe the hand-eye coordination of the surgical robot. From the results, optimal values and acceptable ranges of these parameters are identified from two tasks. A 90° viewing angle had the longest completion time; 60° instrument elevation angle and 0° deflection angle had better performance; there is no significant difference among manipulation angles and observing distances on task performance. This hand-eye coordination model provides evidence for robotic design, surgeon training, and robotic initialization to achieve dexterous and safe manipulation in surgery. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Natural Language Assistant: A Dialog System for Online Product Recommendation


    Chai, Joyce; Horvath, Veronika; Nicolov, Nicolas; Stys, Margo; Kambhatla, Nanda; Zadrozny, Wlodek; Melville, Prem


    With the emergence of electronic-commerce systems, successful information access on electroniccommerce web sites becomes essential. Menu-driven navigation and keyword search currently provided by most commercial sites have considerable limitations because they tend to overwhelm and frustrate users with lengthy, rigid, and ineffective interactions. To provide an efficient solution for information access, we have built the NATURAL language ASSISTANT (NLA), a web-based natural language dialog sy...

  6. A cable-driven soft robot surgical system for cardiothoracic endoscopic surgery: preclinical tests in animals. (United States)

    Wang, Hesheng; Zhang, Runxi; Chen, Weidong; Wang, Xiaozhou; Pfeifer, Rolf


    Minimally invasive surgery attracts more and more attention because of the advantages of minimal trauma, less bleeding and pain and low complication rate. However, minimally invasive surgery for beating hearts is still a challenge. Our goal is to develop a soft robot surgical system for single-port minimally invasive surgery on a beating heart. The soft robot described in this paper is inspired by the octopus arm. Although the octopus arm is soft and has more degrees of freedom (DOFs), it can be controlled flexibly. The soft robot is driven by cables that are embedded into the soft robot manipulator and can control the direction of the end and middle of the soft robot manipulator. The forward, backward and rotation movement of the soft robot is driven by a propulsion plant. The soft robot can move freely by properly controlling the cables and the propulsion plant. The soft surgical robot system can perform different thoracic operations by changing surgical instruments. To evaluate the flexibility, controllability and reachability of the designed soft robot surgical system, some testing experiments have been conducted in vivo on a swine. Through the subxiphoid, the soft robot manipulator could enter into the thoracic cavity and pericardial cavity smoothly and perform some operations such as biopsy, ligation and ablation. The operations were performed successfully and did not cause any damage to the surrounding soft tissues. From the experiments, the flexibility, controllability and reachability of the soft robot surgical system have been verified. Also, it has been shown that this system can be used in the thoracic and pericardial cavity for different operations. Compared with other endoscopy robots, the soft robot surgical system is safer, has more DOFs and is more flexible for control. When performing operations in a beating heart, this system maybe more suitable than traditional endoscopy robots.

  7. Early experience with the da Vinci® surgical system robot in gynecological surgery at King Abdulaziz University Hospital

    Directory of Open Access Journals (Sweden)

    Sait KH


    Full Text Available Khalid H SaitObstetrics and Gynecology Department, Faculty of Medicine, Gynecology Oncology Unit, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaBackground: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital.Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times.Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the first 15 procedures performed. The average hospital stay was 3 days. Complications occurred in five patients (14%, and none were directly related to the robotic system.Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical difficulty with the robotic system is limited. There is definitely a learning curve that requires performance of gynecological surgical procedures using the robot.Keywords: da Vinci robot, gynecological surgery, laparoscopy

  8. A system analysis of a suboptimal surgical experience

    Directory of Open Access Journals (Sweden)

    Richards Michael


    Full Text Available Abstract Background System analyses of incidents that occur in the process of health care delivery are rare. A case study of a series of incidents that one of the authors experienced after routine urologic surgery is presented. We interpret the sequence of events as a case of cascading incidents that resulted in outcomes that were suboptimal, although fortunately not fatal. Methods A system dynamics approach was employed to develop illustrative models (flow diagrams of the dynamics of the patient's interaction with surgery and emergency departments. The flow diagrams were constructed based upon the experience of the patient, chart review, discussion with the involved physicians as well as several physician colleagues, comparison of our diagrams with those developed by the hospital of interest for internal planning purposes, and an iterative process with one of the co-authors who is a system dynamics expert. A dynamic hypothesis was developed using insights gained by building the flow diagrams. Results The incidents originated in design flaws and many small innocuous system changes that have occurred incrementally over time, which by themselves may have no consequence but in conjunction with some system randomness can have serious consequences. In the patient's case, the incidents that occurred in preoperative assessment and surgery originated in communication and procedural failures. System delays, communication failures, and capacity issues contributed largely to the subsequent incidents. Some of these issues were controllable by the physicians and staff of the institution, whereas others were less controllable. To the system's credit, some of the more controllable issues were addressed, but systemic problems like overcrowding are unlikely to be addressed in the near future. Conclusion This is first instance that we are aware of in the literature where a system dynamics approach has been used to analyze a patient safety experience. The

  9. Robotic-assisted laparoscopic exenteration in recurrent cervical cancer Robotics improved the surgical experience for 2 women with recurrent cervical cancer. (United States)

    Davis, Mitzie-Ann; Adams, Sarah; Eun, Daniel; Lee, David; Randall, Thomas C


    Pelvic exenteration can be used to cure women with a central pelvic recurrence or persistence of gynecologic malignancy after initial definitive therapy. Refinements in patient selection, operative techniques, and surgical instrumentation have significantly improved outcomes over the past 60 years, but the procedure is still associated with significant mortality, morbidity, and recovery time. New technologies have made it possible to approach radical gynecologic surgeries in a minimally invasive fashion. We present 2 patients successfully treated with robotic-assisted anterior pelvic exenteration for treatment of persistent or recurrent cervical cancer after definitive radiotherapy. Copyright 2010 Mosby, Inc. All rights reserved.

  10. A Novel Approach for Computer-Assisted Template-Guided Autotransplantation of Teeth With Custom 3D Designed/Printed Surgical Tooling. An Ex Vivo Proof of Concept. (United States)

    Anssari Moin, David; Derksen, Wiebe; Verweij, J P; van Merkesteyn, Richard; Wismeijer, Daniel


    The aim of this study was to introduce a novel method for accurate autotransplantation with computer-assisted guided templates and assembled custom-designed surgical tooling and to test the feasibility and accuracy of this method ex vivo. A partially edentulous human mandibular cadaver was scanned with a cone-beam computed tomography (CBCT) system and an intraoral scan system. The 3-dimensional (3D) data of this cadaver were imported into specialized software and used to analyze the region of the recipient site and the donor tooth was selected. Subsequently, congruent to the donor tooth, custom surgical tools and a surgical guided template were designed and 3D printed. The guided osteotomy was performed and the donor tooth was transplanted. To evaluate the planned position of the donor tooth in relation to the position of the transplanted donor tooth, the mandible with the transplanted donor tooth was rescanned with the CBCT system and software matching was applied to measure the accuracy of the procedure. The angular deflection of the transplanted donor tooth in relation to the planned donor tooth position was 3.1°. When comparing the 3D positions of the shoulder, there was a deviation of 1.25 mm and an apical deviation of 0.89 mm. With the use of currently available technology, it is feasible to accurately plan and create in a virtual simulation a donor tooth position with congruent custom surgical tools and to transfer this to a clinical setting with 3D printing. However, further research on multiple levels is needed to explore this novel approach. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Custom titanium sleeve for surgical treatment of mechanically assisted crevice corrosion in the well-fixed, noncontemporary stem in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Thomas Leibiger


    Full Text Available Adverse local tissue reaction associated with total hip replacement may occur when mechanically assisted crevice corrosion occurs at metal-metal modular junctions in which at least one of the components is fabricated from cobalt-chromium alloy. Complete removal of components may be associated with significant morbidity; when components are well fixed and in acceptable position, it may be appropriate to consider modular rather than complete revision. We have diagnosed mechanically assisted crevice corrosion in total hip arthroplasty patients with noncontemporary but well-fixed femoral components and found that modular conversion to a ceramic femoral head to remove a source of CoCr corrosion and fretting products was only possible by having a custom titanium sleeve manufactured. Surgical implantation with a revision style Biolox ceramic head (CeramTec, Plochingen, Germany was then achieved.

  12. 3D Surgical Simulation (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael


    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  13. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. (United States)

    Ortega, Gezzer; Rhee, Daniel S; Papandria, Dominic J; Yang, Jessica; Ibrahim, Andrew M; Shore, Andrew D; Makary, Martin A; Abdullah, Fizan


    Surgical wound classification has been the foundation for infectious risk assessment, perioperative protocol development, and surgical decision-making. The wound classification system categorizes all surgeries into: clean, clean/contaminated, contaminated, and dirty, with estimated postoperative rates of surgical site infection (SSI) being 1%-5%, 3%-11%, 10%-17%, and over 27%, respectively. The present study evaluates the associated rates of the SSI by wound classification using a large risk adjusted surgical patient database. A cross-sectional study was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset between 2005 and 2008. All surgical cases that specified a wound class were included in our analysis. Patient demographics, hospital length of stay, preoperative risk factors, co-morbidities, and complication rates were compared across the different wound class categories. Surgical site infection rates for superficial, deep incisional, and organ/space infections were analyzed among the four wound classifications using multivariate logistic regression. A total of 634,426 cases were analyzed. From this sample, 49.7% were classified as clean, 35.0% clean/contaminated, 8.56% contaminated, and 6.7% dirty. When stratifying by wound classification, the clean, clean/contaminated, contaminated, and dirty wound classifications had superficial SSI rates of 1.76%, 3.94%, 4.75%, and 5.16%, respectively. The rates of deep incisional infections were 0.54%, 0.86%, 1.31%, and 2.1%. The rates for organ/space infection were 0.28%, 1.87%, 2.55%, and 4.54%. Using ACS-NSQIP data, the present study demonstrates substantially lower rates of surgical site infections in the contaminated and dirty wound classifications than previously reported in the literature. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Design of automatic thruster assisted mooring systems for ships

    Directory of Open Access Journals (Sweden)

    Jan P. Strand


    Full Text Available This paper addresses the mathematical modelling and controller design of an automatic thruster assisted position mooring system. Such control systems are applied to anchored floating production offloading and storage vessels and semi-subs. The controller is designed using model based control with a LQG feedback controller in conjunction with a Kalman filter. The controller design is in addition to the environmental loads accounting for the mooring forces acting on the vessel. This is reflected in the model structure and in the inclusion of new functionality.

  15. A vision-based system for fast and accurate laser scanning in robot-assisted phonomicrosurgery. (United States)

    Dagnino, Giulio; Mattos, Leonardo S; Caldwell, Darwin G


    Surgical quality in phonomicrosurgery can be improved by open-loop laser control (e.g., high-speed scanning capabilities) with a robust and accurate closed-loop visual servoing systems. A new vision-based system for laser scanning control during robot-assisted phonomicrosurgery was developed and tested. Laser scanning was accomplished with a dual control strategy, which adds a vision-based trajectory correction phase to a fast open-loop laser controller. The system is designed to eliminate open-loop aiming errors caused by system calibration limitations and by the unpredictable topology of real targets. Evaluation of the new system was performed using CO(2) laser cutting trials on artificial targets and ex-vivo tissue. This system produced accuracy values corresponding to pixel resolution even when smoke created by the laser-target interaction clutters the camera view. In realistic test scenarios, trajectory following RMS errors were reduced by almost 80 % with respect to open-loop system performances, reaching mean error values around 30 μ m and maximum observed errors in the order of 60 μ m. A new vision-based laser microsurgical control system was shown to be effective and promising with significant positive potential impact on the safety and quality of laser microsurgeries.

  16. Bolting Cabin Assistance System Using a Sensor Network

    Directory of Open Access Journals (Sweden)

    Yung-Hak Mo


    Full Text Available The bolting cabin assistance system prevents operators from facing dangerous situations. This system consists of a bolting robot control system and a top view supervisory system. In order to control the bolting robot, circular Hough transforms and fuzzy reasoning are used. First, the circular Hough transform roughly estimates the location of the bolt hole. After that, errors of estimation are compensated for using fuzzy reasoning. In order to track a bolt hole, a region of interest (ROI is used. By setting the region in which to search for a bolt hole, the algorithm tracks the location of the bolt hole. In order to choose an ROI, a template-based matching algorithm is used. In order to make the top view supervisory system, four cameras are installed at the left, right, front and back of the robot. The four individual images from the various cameras are combined to make the top view image after correcting for distortion.

  17. A review of training research and virtual reality simulators for the da Vinci surgical system. (United States)

    Liu, May; Curet, Myriam


    PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.

  18. SURGNET: An Integrated Surgical Data Transmission System for Telesurgery

    Directory of Open Access Journals (Sweden)

    Sriram Natarajan


    Full Text Available Remote surgery information requires quick and reliable transmission between the surgeon and the patient site. However, the networks that interconnect the surgeon and patient sites are usually time varying and lossy which can cause packet loss and delay jitter. In this paper we propose SURGNET, a telesurgery system for which we developed the architecture, algorithms and implemented it on a testbed. The algorithms include adaptive packet prediction and buffer time adjustment techniques which reduce the negative effects caused by the lossy and time varying networks. To evaluate the proposed SURGNET system, at the therapist site, we implemented a therapist panel which controls the force feedback device movements and provides image analysis functionality. At the patient site we controlled a virtual reality applet built in Matlab. The varying network conditions were emulated using NISTNet emulator. Our results show that even for severe packet loss and variable delay jitter, the proposed integrated synchronization techniques significantly improve SURGNET performance.

  19. Technical Assistance to Promote Service and System Change. Roadmap to Effective Intervention Practices #4 (United States)

    Blase, Karen A.


    Technical assistance (TA) has long been a standard, overarching strategy for assisting, states, agencies, family members, and practitioners with building capacity for service and system change initiatives. But, what is meant by the term "technical assistance"? What is known about the technical assistance strategies that are likely to…

  20. Computer-assisted design/computer-assisted manufacturing systems: A revolution in restorative dentistry

    Directory of Open Access Journals (Sweden)

    Arbaz Sajjad


    Full Text Available For the better part of the past 20 years, dentistry has seen the development of many new all-ceramic materials and restorative techniques fueled by the desire to capture the ever elusive esthetic perfection. This has resulted in the fusion of the latest in material science and the pen ultimate in computer-assisted design/computer-assisted manufacturing (CAD/CAM technology. This case report describes the procedure for restoring the esthetic appearance of both the left and right maxillary peg-shaped lateral incisors with a metal-free sintered finely structured feldspar ceramic material using the latest laboratory CAD/CAM system. The use of CAD/CAM technology makes it possible to produce restorations faster with precision- fit and good esthetics overcoming the errors associated with traditional ceramo-metal technology. The incorporation of this treatment modality would mean that the dentist working procedures will have to be adapted in the methods of CAD/CAM technology.

  1. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation. (United States)

    Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter


    To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Person or system - What leads to surgical advances? (United States)

    Hughes, Sean Pf


    To understand the relationship between standardisation and originality in surgery, the contributions of three surgeons in the 20th century are analysed. The individual Arbuthnot Lane, the collectivist Robert Jones and the scientist Alexis Carrel changed the practice of orthopaedic surgery. It is argued that the factors influencing innovation are not binary but multifactorial and that advances in surgery occur when individual freedom is permitted within a system. It is concluded that innovation and standardisation in orthopaedic surgery need not conflict with each other.

  3. Pilot study on verification of effectiveness on operability of assistance system for robotic tele-surgery using simulation. (United States)

    Kawamura, Kazuya; Kobayashi, Yo; Fujie, Masakatsu G


    Tele-surgery enables medical care even in remote regions, and has been accomplished in clinical cases by means of dedicated communication lines. To make tele-surgery a more widespread method of providing medical care, a surgical environment needs to be made available using public lines of communication, such as the Internet. Moreover, a support system during surgery is required, as the use of surgical tools is performed in an environment subject to delay. In our research, we focus on the operability of specific tasks conducted by surgeons during a medical procedure, with the aim of clarifying, by means of a simulation, the optimum environment for robotic tele-surgery. In the study, we set up experimental systems using our proposed simulation system. In addition, we investigate the mental workloads on subjects and verify the effect of visual-assistance information as a pilot study. The operability of the task of gripping soft tissue was evaluated using a subjective workload assessment tool, the NASA Task Load Index. Results show that the tasks were completed, but the workload did not improve to less than 300ms and 400ms in the simulated environment. Verifying the effect of the support system was an important task under a more-than 200ms delay using this experiment, and future studies will evaluate the operability of the system under varying conditions of comfort. In addition, an intra-operative assistance system will be constructed using a simulation.

  4. The surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy for periampullary neoplasms: a comparative study of a single center. (United States)

    Liu, Rong; Zhang, Tao; Zhao, Zhi-Ming; Tan, Xiang-Long; Zhao, Guo-Dong; Zhang, Xuan; Xu, Yong


    Pancreaticoduodenectomy (PD) is a difficult and complex operation. The introduction of robotics has opened up new angles in pancreatic surgery. This study aims to assess the surgical outcomes of robot-assisted laparoscopic pancreaticoduodenectomy relative to its laparoscopic counterpart. A retrospective study was designed to compare the surgical outcomes of 27 robot-assisted laparoscopic pancreaticoduodenectomy (RPD) and 25 laparoscopic pancreaticoduodenectomy (LPD). Perioperative data, including operating time, complication, morbidity and mortality, estimated blood loss, and postoperative length of stay, were analyzed. The robotic group exhibited significantly shorter operative time (mean 387 vs. 442 min), shorter hospital stay (mean 17 vs. 24 days), and less blood loss (mean 219 vs. 334 ml) than those in the LPD group. No statistical difference was observed between the two groups in terms of complication rate, mortality rate, R0 resection rate, and number of harvested lymph node. RPD is more efficient and secure process than LPD among properly selected patients. RPD is therefore a feasible alternative to the laparoscopic procedure. Further studies are needed to evaluate the cost effectiveness of the robotic approach for PD.

  5. Thermodynamic analysis of solar assisted multi-functional trigeneration system

    Directory of Open Access Journals (Sweden)

    Önder KIZILKAN


    Full Text Available In this study, modelling and thermodynamic analysis of solar assisted trigeneration system was carried out. The required thermal energy for gas and vapor cycles were supplied from solar tower which is a new concept for gas cycle applications. Additionally, an absorption refrigeration cycle, vapor production process, drying process and water heating process were integrated to the system. Energy and exergy efficiencies of the trigeneration system were determined by the application of first and second law analyses. The results showed that the gas cycle efficiency was found to be 31%, vapor cycle efficiency was found to be 28% and coefficient of performance (COP values of the refrigeration system was found to be 0.77. Also the highest exergy destruction rate was found to be 4154 kW in solar tower.Keywords: Solar tower, Trigeneration, Gas cycle, Vapor cycle, Energy, Exergy

  6. BellBot - A Hotel Assistant System Using Mobile Robots

    Directory of Open Access Journals (Sweden)

    Joaquín López


    Full Text Available There is a growing interest in applying intelligent technologies to assistant robots. These robots should have a number of characteristics such as autonomy, easy reconfiguration, robust perception systems and they should be oriented towards close interaction with humans. In this paper we present an automatic hotel assistant system based on a series of mobile platforms that interact with guests and service personnel to help them in different tasks. These tasks include bringing small items to customers, showing them different points of interest in the hotel, accompanying the guests to their rooms and providing them with general information. Each robot can also autonomously handle some daily scheduled tasks. Apart from user-initiated and scheduled tasks, the robots can also perform tasks based on events triggered by the building's automation system (BAS. The robots and the BAS are connected to a central server via a local area network. The system was developed with the Robotics Integrated Development Environment (RIDE and was tested intensively in different environments.

  7. 49 CFR 570.56 - Vacuum brake assist unit and vacuum brake system. (United States)


    ... 49 Transportation 6 2010-10-01 2010-10-01 false Vacuum brake assist unit and vacuum brake system... Vehicles With GVWR of More Than 10,000 Pounds § 570.56 Vacuum brake assist unit and vacuum brake system. The following requirements apply to vehicles with vacuum brake assist units and vacuum brake systems...

  8. 21 CFR 864.9125 - Vacuum-assisted blood collection system. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vacuum-assisted blood collection system. 864.9125... Blood and Blood Products § 864.9125 Vacuum-assisted blood collection system. (a) Identification. A vacuum-assisted blood collection system is a device intended for medical purposes that uses a vacuum to...

  9. Integrated Patient Coordination System (IntPaCS): a bespoke tool for surgical patient management. (United States)

    Chopra, Shiv; Hachach-Haram, Nadine; Baird, Daniel L H; Elliott, Katherine; Lykostratis, Harry; Renton, Sophie; Shalhoub, Joseph


    Efficient handover of patient information is fundamental for patient care and service efficiency. An audit exploring surgeons' views on written handover within a Trust's surgical specialties concluded that clear deficiencies existed. Such concerns have been echoed in the General Medical Council's guidance on safe surgical handover. To design and implement bespoke software for surgical handover using the audit results of surgeons' perceptions of existing processes. To gain feedback from the surgical department on this new software and implement a long-term sustainability strategy. Following an initial review, a proposal was presented for a new patient management tool. The software was designed and developed in-house to reflect the needs of our surgeons. The bespoke programme used open-source coding and was maintained on a secure server. A review of surgical handover occurred 12 and 134 weeks post-implementation of the new software. Integrated Patient Coordination System (IntPaCS) was successfully developed and delivered. The system is a centralised platform that enables the visualisation, handover and audit/research of surgical inpatient information in any part of the hospital. Feedback found that clinicians found it less stressful to create a post-take handover (60% vs 36%) than using a Word document. IntPaCS was found to be quicker to use too (15 min (SD 4) vs 24 min (SD 7.5)). Finally, the new system was considered safer with less reported missing/incorrect patient data (48% vs 9%). This study has shown that careful use of emerging technology and innovation over time has the potential to improve all aspects of clinical governance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  10. First report on joint use of a Da Vinci® surgical system with transfer of surgical know-how between two public hospitals. (United States)

    Mattei, Agostino; Thoms, Michael; Ferrari, Matteo; La Croce, Giovanni; Danuser, Hansjörg; Schmid, Hans-Peter; Engeler, Daniel


    The costs of a Da Vinci® device for robot- assisted surgery, in particular for robot-assisted radical prostatectomy (RARP), can be a considerable issue for hospitals with limited caseloads. Since January 2011 the cantonal hospitals of Lucerne and St. Gallen (Switzerland) have shared a four-arm Da Vinci® device, transferring the surgical know-how by a Lucerne teaching surgeon to a St. Gallen surgeon. Complete pre- and perioperative data, including 3-month surgical RARP outcomes, were prospectively documented. For statistical analysis, Wilcoxon, exact Poisson and χ(2) tests were used. During the first year, the two hospitals (61 RARP patients in Lucerne, 19 RARP patients in St. Gallen) did not differ significantly in preoperative, perioperative or oncological and functional results except for prostate volume (median 33 [interquartile range 24-40] vs. 40 [interquartile range 33-57] ml; p = 0.02), operation time (mean 252 ± 49 vs. 351 ± 50 min; p = 0.0001), number of lymph nodes removed (median 16 [interquartile range 13-21] vs. 15 [interquartile range 8-16] nodes; p = 0.02), biopsy (p = 0.04) and specimen Gleason scores (p = 0.03), and length of hospital stay (median 8 [interquartile range 7-14] vs. 9 [interquartile range 8-18] days; p < 0.01). Da Vinci® device sharing with transfer of surgical know-how can reduce the costs of RARP without compromising surgical outcomes, even at the beginning of the learning curve. © 2014 S. Karger AG, Basel.

  11. LED surgical lighting system with multiple free-form surfaces for highly sterile operating theater application. (United States)

    Liu, Peng; Zhang, Yaqin; Zheng, Zhenrong; Li, Haifeng; Liu, Xu


    Although the ventilation system is widely employed in the operating theater, a strictly sterile surgical environment still cannot be ensured because of laminar disturbance, which is mainly caused by the surgical lighting system. Abandoning traditional products, we propose an LED surgical lighting system, which can alleviate the laminar disturbance and provide an appropriate lighting condition for surgery. It contains a certain amount of LED lens units, which are embedded in the ceiling and arranged around the air supply smallpox. The LED lens unit integrated with an LED light source and a free-form lens is required to produce a uniform circular illumination with a large tolerance to the change of lighting distance. To achieve such a dedicated lens, two free-form refractive surfaces, which are converted into two ordinary differential equations by the design method presented in this paper, are used to deflect the rays. The results show that the LED surgical lighting system can provide an excellent illumination environment for surgery, and, apparently, the laminar disturbance also can be relieved.

  12. Driver assistant system for industrial vehicles; Fahrerassistenzsysteme fuer Nutzfahrzeuge

    Energy Technology Data Exchange (ETDEWEB)

    Winterhagen, J.


    It is the intention of DaimlerChrysler AG to automatize future industrial vehicles by means of driver assistant systems. The components - from automatic distance control to fully electric steering - are in different stages of maturity. Some prototypes were presented recently at the Papenburg test site. [German] Fahrerassistenzsysteme werden das Nutzfahrzeug der Zukunft nach Vorstellungen der DaimlerChrysler AG weitestgehend automatisieren. Die dazu notwendigen Techniken - vom automatischen Abstandsregler bis zur vollelektrischen Lenkung - haben unterschiedliche Reifegrade. Einige Prototypen stellte das Unternehmen kuerzlich auf dem Pruefgelaende Papenburg vor. (orig.)

  13. Stress-oriented driver assistance system for electric vehicles. (United States)

    Athanasiou, Georgia; Tsotoulidis, Savvas; Mitronikas, Epaminondas; Lymberopoulos, Dimitrios


    Stress is physiological and physical reaction that appears in highly demanding situations and affects human's perception and reaction capability. Occurrence of stress events within highly dynamic road environment could lead to life-threatening situation. With the perspective of safety and comfort driving provision to anxious drivers, in this paper a stress-oriented Driver Assistance System (DAS) is proposed. The DAS deployed on Electric Vehicle. This novel DAS customizes driving command signal in respect to road context, when stress is detected. The effectiveness of this novel DAS is verified by simulation in MATLAB/SIMULINK environment.

  14. Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms. (United States)

    Marcus, Hani J; Seneci, Carlo A; Payne, Christopher J; Nandi, Dipankar; Darzi, Ara; Yang, Guang-Zhong


    Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance. To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery. The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was performed. Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field. New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

  15. Vacuum-assisted biopsy is a viable alternative to surgical biopsy in the investigation of breast lesions of uncertain malignant potential. (United States)

    Pieri, Andrew; Hemming, Diane; Westgarth, Jackie; Lunt, Linsley


    In patients presenting with a breast lesion, when initial core biopsy histology falls into the category of "uncertain malignant potential" (i.e. a B3 lesion), the next line of investigation has traditionally been a surgical biopsy (SBx). Vacuum-assisted biopsy (VAB) may be a viable minimally invasive alternative to SBx for B3 lesions. The primary aims of this study were to establish whether VAB reduces the need for surgical biopsy and determine VAB sensitivity for carcinoma following initial B3 histology. B3 lesion data was collected from 2004 to 2013 retrospectively, from a single institution that utilises both VAB and SBx. A total of 413 lesions were categorised B3 on initial biopsy. Mean age was 61 years (range: 24-91 years). Mean follow up was 52 months (range: 19-60 months). 156 patients (38%) underwent VAB. Only 20% of patients underwent VAB in 2004, with an increase to 95% by 2013. VAB histology revealed twelve carcinomas, all of which progressed to surgical excision. In six cases, a SBx was required following VAB in order to provide further diagnostic information. In one case, carcinoma was missed on VAB. The increase in VAB use over time suggests that the procedure is well tolerated. The results demonstrate a VAB sensitivity of 92% for carcinoma diagnosis. In 96% of cases (150 of 156), VAB results were conclusive enough to avoid a subsequent SBx. This data suggests that VAB may be a preferable alternative to surgical biopsy for many B3 lesions. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. Three Dimensional Finite Element Analysis of Stress Distribution and Displacement of the Maxilla Following Surgically Assisted Rapid Maxillary Expansion with Tooth- and Bone-Borne Devices

    Directory of Open Access Journals (Sweden)

    Mohsen Dalband


    Full Text Available Objectives: The aim of this study was to investigate the displacement and stress distri- bution during surgically assisted rapid maxillary expansion under different surgical conditions with tooth- and bone-borne devices.Materials and Methods: Three-dimensional (3D finite element model of a maxilla was constructed and an expansion force of 100 N was applied to the left and right molars and premolars with tooth-borne devices and the left and right of mid-palatal sutures at the first molar level with bone-borne devices. Five CAD models were simulated as fol- lows and surgical procedures were used:  G1: control group (without surgery; G2: Le Fort I osteotomy; G3: Le Fort I osteotomy and para-median osteotomy; G4: Le Fort I osteotomy and pterygomaxillary separation; and G5: Le Fort I osteotomy, para-median osteotomy, and pterygomaxillary separation.Results: Maxillary displacement showed a gradual increase from group 1 to group 5 in all three planes of space, indicating that Le Fort I osteotomy combined with para-me- dian osteotomy and pterygomaxillary separation produced the greatest displacement of the maxilla with both bone- and tooth-borne devices. Surgical relief and bone-borne devices resulted in significantly reduced stress on anchored teeth.Conclusion: Combination of Le Fort I and para-median osteotomy with pterygomaxil-lary separation seems to be an effective procedure for increasing maxillary expansion, and excessive stress side effects are lowered around the anchored teeth with the use of bone-borne devices.

  17. Prospective Clinical Study to Evaluate Clinical Performance of a Powered Surgical Stapler in Video-assisted Thoracoscopic Lung Resections

    DEFF Research Database (Denmark)

    Licht, Peter B; Ribaric, Goran; Crabtree, Traves


    Video-assisted thoracic surgery (VATS) research often focuses on postoperative air leak, with special consideration for prolonged air leak. There is limited clinical data regarding how stapling devices might affect performance and postoperative outcomes, including air leak. This prospective resea...

  18. Human-inspired sound environment recognition system for assistive vehicles (United States)

    González Vidal, Eduardo; Fredes Zarricueta, Ernesto; Auat Cheein, Fernando


    Objective. The human auditory system acquires environmental information under sound stimuli faster than visual or touch systems, which in turn, allows for faster human responses to such stimuli. It also complements senses such as sight, where direct line-of-view is necessary to identify objects, in the environment recognition process. This work focuses on implementing human reaction to sound stimuli and environment recognition on assistive robotic devices, such as robotic wheelchairs or robotized cars. These vehicles need environment information to ensure safe navigation. Approach. In the field of environment recognition, range sensors (such as LiDAR and ultrasonic systems) and artificial vision devices are widely used; however, these sensors depend on environment constraints (such as lighting variability or color of objects), and sound can provide important information for the characterization of an environment. In this work, we propose a sound-based approach to enhance the environment recognition process, mainly for cases that compromise human integrity, according to the International Classification of Functioning (ICF). Our proposal is based on a neural network implementation that is able to classify up to 15 different environments, each selected according to the ICF considerations on environment factors in the community-based physical activities of people with disabilities. Main results. The accuracy rates in environment classification ranges from 84% to 93%. This classification is later used to constrain assistive vehicle navigation in order to protect the user during daily activities. This work also includes real-time outdoor experimentation (performed on an assistive vehicle) by seven volunteers with different disabilities (but without cognitive impairment and experienced in the use of wheelchairs), statistical validation, comparison with previously published work, and a discussion section where the pros and cons of our system are evaluated. Significance

  19. Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes


    Mauro Waiswol; Niro Kasahara


    Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients) or Marfan syndrome-associated ectopia lentis (nine patients) with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS) from grade 1 (lens on the whole pupillary area) up to grade 4 (lens absent fro...

  20. 76 FR 71980 - SEDASYS Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Incorporated's... (United States)


    ...] SEDASYS Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Incorporated's Petition for... SEDASYS computer-assisted personalized sedation system (SEDASYS) submitted by Ethicon Endo-Surgery Inc... advisory committee will review CDRH's denial of a PMA for the SEDASYS Computer-Assisted Personalized...

  1. A computerized bioskills system for surgical skills training in total knee replacement. (United States)

    Conditt, M A; Noble, P C; Thompson, M T; Ismaily, S K; Moy, G J; Mathis, K B


    Although all agree that the results of total knee replacement (TKR) are primarily determined by surgical skill, there are few satisfactory alternatives to the 'apprenticeship' model of surgical training. A system capable of evaluating errors of instrument alignment in TKR has been developed and demonstrated. This system also makes it possible quantitatively to assess the source of errors in final component position and limb alignment. This study demonstrates the use of a computer-based system to analyse the surgical skills in TKR through detailed quantitative analysis of the technical accuracy of each step of the procedure. Twelve surgeons implanted a posterior-stabilized TKR in 12 fresh cadavers using the same set of surgical instruments. During each procedure, the position and orientation of the femur, tibia, each surgical instrument, and the trial components were measured with an infrared coordinate measurement system. Through analysis of these data, the sources and relative magnitudes of errors in position and alignment of each instrument were determined, as well as its contribution to the final limb alignment, component positioning and ligament balance. Perfect balancing of the flexion and extension gaps was uncommon (0/15). Under standardized loading, the opening of the joint laterally exceeded the opening medially by an average of approximately 4 mm in both extension (4.1 +/- 2.1 mm) and flexion (3.8 +/- 3.4 mm). In addition, the overall separation of the femur and the tibia was greater in flexion than extension by an average of 4.6 mm. The most significant errors occurred in locating the anterior/posterior position of the entry point in the distal femur (SD = 8.4 mm) and the correct rotational alignment of the tibial tray (SD = 13.2 degrees). On a case-by-case basis, the relative contributions of errors in individual instrument alignments to the final limb alignment and soft tissue balancing were identified. The results indicate that discrete steps in the

  2. 3D interactive surgical visualization system using mobile spatial information acquisition and autostereoscopic display. (United States)

    Fan, Zhencheng; Weng, Yitong; Chen, Guowen; Liao, Hongen


    Three-dimensional (3D) visualization of preoperative and intraoperative medical information becomes more and more important in minimally invasive surgery. We develop a 3D interactive surgical visualization system using mobile spatial information acquisition and autostereoscopic display for surgeons to observe surgical target intuitively. The spatial information of regions of interest (ROIs) is captured by the mobile device and transferred to a server for further image processing. Triangular patches of intraoperative data with texture are calculated with a dimension-reduced triangulation algorithm and a projection-weighted mapping algorithm. A point cloud selection-based warm-start iterative closest point (ICP) algorithm is also developed for fusion of the reconstructed 3D intraoperative image and the preoperative image. The fusion images are rendered for 3D autostereoscopic display using integral videography (IV) technology. Moreover, 3D visualization of medical image corresponding to observer's viewing direction is updated automatically using mutual information registration method. Experimental results show that the spatial position error between the IV-based 3D autostereoscopic fusion image and the actual object was 0.38±0.92mm (n=5). The system can be utilized in telemedicine, operating education, surgical planning, navigation, etc. to acquire spatial information conveniently and display surgical information intuitively. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Lens subluxation grading system: predictive value for ectopia lentis surgical outcomes

    Directory of Open Access Journals (Sweden)

    Mauro Waiswol


    Full Text Available Objective: To present a classification system to grade ectopia lentis and to assess its usefulness as a predictor for surgical outcomes. Methods: Fifty-one eyes of 28 patients with either simple (19 patients or Marfan syndrome-associated ectopia lentis (nine patients with variable degrees of subluxation were operated on. Lens subluxation intensity was graded according to the lens subluxation grading system (LSGS from grade 1 (lens on the whole pupillary area up to grade 4 (lens absent from the pupillary area. Thirty eyes underwent cataract extraction (“dry” aspiration with endocapsular ring and in-the-bag intraocular lens (IOL implantation. Twenty-one eyes underwent cataract extraction (“dry” aspiration with scleral fixation of the IOL. The predictive value of the LSGS was assessed by analyzing the post-operative outcomes, including visual acuity (VA, endothelial cell loss, and complications for each grade on the grading system. Rresults: Patients were classified into grade 1 (19.6%, grade 2 (51% and grade 3 (29.4%. Post-operative VA was lower for eyes with larger degrees of subluxation. The higher the subluxation grade, the higher the endothelial cell loss, as well as, the frequency of vitreous loss and surgical time. Higher subluxation grades prevented optimal surgical outcomes with endocapsular ring and in-the-bag IOL implantation. Cconclusions: The LSGS provides an estimate of the surgical success of ectopia lentis. Adequate standardization of lens subluxation is crucial for understanding studies dealing with the surgical correction of this disorder.

  4. Robotic System Development for Cooperative Orthopedic Drilling Assistance

    Directory of Open Access Journals (Sweden)

    Vijayabaskar Kasi


    Full Text Available This paper describes a robotic bone drilling and screwing system for applications in orthopedic surgery. The goal is to realize two robot manipulators performing cooperative bone drilling. The proposed cooperative bone drilling system can be divided into hardware and software development. The hardware development section consists of two robot manipulator arms, which perform drilling and gripping of the bone, and operates using two joysticks. The software section assists the surgeon in visual and navigation control of those robot manipulators. Controller used in this system can be included in the hardware and software sections. Disturbance observer based position control was used in the robot manipulator maneuver and reposition controller (cooperative control was used in cooperative drilling operation to maintain the alignment of the drill bit during drilling. A mathematical model for the control system was designed and a real environment mimicking simulation for bone drilling was designed. The result of the simulation shows that the cooperative robot system managed to perform cooperative drilling when misalignment occurs during bone drilling. The bone gripping robot managed to restore the drill bit to its ideal alignment in every event of misalignment in the drilling axis. Therefore this cooperative system has potential application in experimental orthopedic surgery.

  5. Analysis of a Hybrid Solar-Assisted Trigeneration System

    Directory of Open Access Journals (Sweden)

    Elisa Marrasso


    Full Text Available A hybrid solar-assisted trigeneration system is analyzed in this paper. The system is composed of a 20 m2 solar field of evacuated tube collectors, a natural gas fired micro combined heat and power system delivering 12.5 kW of thermal power, an absorption heat pump (AHP with a nominal cooling power of 17.6 kW, two storage tanks (hot and cold and an electric auxiliary heater (AH. The plant satisfies the energy demand of an office building located in Naples (Southern Italy. The electric energy of the cogenerator is used to meet the load and auxiliaries electric demand; the interactions with the grid are considered in cases of excess or over requests. This hybrid solution is interesting for buildings located in cities or historical centers with limited usable roof surface to install a conventional solar heating and cooling (SHC system able to achieve high solar fraction (SF. The results of dynamic simulation show that a tilt angle of 30° maximizes the SF of the system on annual basis achieving about 53.5%. The influence on the performance of proposed system of the hot water storage tank (HST characteristics (volume, insulation is also studied. It is highlighted that the SF improves when better insulated and bigger HSTs are considered. A maximum SF of about 58.2% is obtained with a 2000 L storage, whereas the lower thermal losses take place with a better insulated 1000 L tank.

  6. Single-use surgical clothing system for reduction of airborne bacteria in the operating room. (United States)

    Tammelin, A; Ljungqvist, B; Reinmüller, B


    It is desirable to maintain a low bacterial count in the operating room air to prevent surgical site infection. This can be achieved by ventilation or by all staff in the operating room wearing clothes made from low-permeable material (i.e. clean air suits). We investigated whether there was a difference in protective efficacy between a single-use clothing system made of polypropylene and a reusable clothing system made of a mixed material (cotton/polyester) by testing both in a dispersal chamber and during surgical procedures. Counts of colony-forming units (cfu)/m(3) air were significantly lower when using the single-use clothing system in both settings. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  7. Technical assistance contractor occurrence reporting and processing system

    International Nuclear Information System (INIS)


    Members of the Uranium Mill Tailings Remedial Action (UMTRA) Project Technical Assistance Contractor (TAC) are responsible to notify management of TAC occurrence reporting and processing system (ORPS) classified occurrences .An ORPS occurrence is an unexpected or unplanned event on DOE property which causes bodily harm, death, damage to government property, exposure to toxic or hazardous substances above acceptable limits to workers, the environment, or general public. Examples of potential reportable occurrences include, but not limited to, site personnel exposures to airborne contaminants, incidents which could expose the general public to high levels of radiation or other contaminants, a vehicle accident resulting in property damage or personnel injuries. Listed TAC manager/staff contacts, with the assistance of TAC ORPS Program Coordinators, will determine if the occurrence is reportable under Department of Energy (DOE) Order M 232.1-2. The reportable occurrences will be classified as emergency, unusual, or off-normal. If determined to be reportable, listed TAC manager/staff will verbally report the details of the occurrence to the DOE Duty Officer within 2 hours of initial notification, and provide a written report of the event by noon the following work day

  8. Computer assisted radiology

    International Nuclear Information System (INIS)

    Lemke, H.U.; Jaffe, C.C.; Felix, R.


    The proceedings of the CAR'93 symposium present the 126 oral papers and the 58 posters contributed to the four Technical Sessions entitled: (1) Image Management, (2) Medical Workstations, (3) Digital Image Generation - DIG, and (4) Application Systems - AS. Topics discussed in Session (1) are: picture archiving and communication systems, teleradiology, hospital information systems and radiological information systems, technology assessment and implications, standards, and data bases. Session (2) deals with computer vision, computer graphics, design and application, man computer interaction. Session (3) goes into the details of the diagnostic examination methods such as digital radiography, MRI, CT, nuclear medicine, ultrasound, digital angiography, and multimodality imaging. Session (4) is devoted to computer-assisted techniques, as there are: computer assisted radiological diagnosis, knowledge based systems, computer assisted radiation therapy and computer assisted surgical planning. (UWA). 266 figs [de

  9. [Treatment-refractory-dental-extraction-associated pyothorax involving infection by 2 species of oral originated bacteria requires surgical debridement by video assisted thoracoscopic surgery (VATS)]. (United States)

    Rai, Kammei; Matsuo, Kiyoshi; Yonei, Toshiro; Sato, Toshio


    Cases of septic pulmonary embolism (SPE) diagnosed clinically by CT after dental extraction rarely include verification of bacteria from the local infection site. We report the case of a 70-year-old man without background disease suffering severe pyothrax after dental extraction. We detected two species of oral bacteria from his pleural effusion. Treatment was so difficult that it required surgical debridement by video assisted thoracoscopic surgery (VATS), even after the appropriate administration of antibiotics. According to the American Heart Association (AHA) prophylaxis guidelines for preventing infective endocarditis indicate that it is uncommon to prescribe antibiotics to patients without background disease after dental extraction. No appropriate Japanese guidelines exist considering the prevention of SPE causing severe pyothorax as in our case. The hematogenous spread of bacteria such as SPE caused by sepsis after tooth extraction thus requires more attended careful consideration in clinical practice if patients are to be properly protected against potentially serious complications.

  10. Tele-surgical simulation system for training in the use of da Vinci surgery. (United States)

    Suzuki, Shigeyuki; Suzuki, Naoki; Hayashibe, Mitsuhiro; Hattori, Asaki; Konishi, Kozo; Kakeji, Yoshihiro; Hashizume, Makoto


    Laparoscopic surgery including robotic surgery allows the surgeon to be able to conduct minimally invasive surgery. A surgeon is required to master difficult skills for this surgery to compensate for the narrow field of view, limitation of work space, and the lack of depth sensation. To counteract these drawbacks, we have been developing a training simulation system that can allow surgeons to practice and master surgical procedures. In addition, our system aims to distribute a simulation program, to provide a means of collaboration between remote hospitals, and to be able to provide a means for guidance from an expert surgeon. In this paper, we would like to show the surgery simulation for da Vinci surgery, in particular a cholecystectomy. The integral parts of this system are a soft tissue model which is created by the sphere-filled method enabling real-time deformations based on a patient's data, force feedback devices known as a PHANToM and the Internet connection. By using this system a surgeon can perform surgical maneuvers such as pushing, grasping, and detachment in real-time manipulation. Moreover, using the broadband communication, we can perform the tele-surgical simulation for training.

  11. Non-surgical periodontal therapy supplemented with systemically administered azithromycin: a systematic review of RCTs. (United States)

    Buset, Sabrina L; Zitzmann, Nicola U; Weiger, Roland; Walter, Clemens


    Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. This study aims to identify randomized controlled trials evaluating non-surgical periodontal treatment of chronic and/or aggressive periodontitis supplemented with systemically administered azithromycin. A systematic literature search was performed for publications published by 31 March 2014 using electronic databases and hand search. Randomized controlled trials published in English or German language, with a follow-up ≥6 months were included. From 231 titles identified, nine publications were eligible for inclusion. Among the studies included, showing some risk of bias, seven reported on patients with chronic periodontitis and two with aggressive periodontitis. Minor adverse events were described in five studies. A synthesis of results using a vote counting method was applied. Significant (p azithromycin were shown in six studies for probing depth changes and in five studies for clinical attachment level changes. In contrast to aggressive periodontitis patients, data from this analysis indicate a potential benefit of systemic azithromycin as adjunctive to non-surgical periodontal therapy in chronic periodontitis patients. When contraindications for the standard antibiotics are present, azithromycin (AZM) may be considered as alternative systemically administered antibiotic drug in selected cases of chronic periodontitis.

  12. New real-time MR image-guided surgical robotic system for minimally invasive precision surgery

    International Nuclear Information System (INIS)

    Hashizume, M.; Yasunaga, T.; Konishi, K.; Tanoue, K.; Ieiri, S.; Kishi, K.; Nakamoto, H.; Ikeda, D.; Sakuma, I.; Fujie, M.; Dohi, T.


    To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D navigation and 2-D ISC images, as well as the MR-compatible laparoscope. The ISC image was updated every 4 s; no artifact was detected. A newly developed MR image-guided surgical robotic system is feasible for an operator to perform safe and precise minimally invasive procedures. (orig.)

  13. Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards. (United States)

    Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A


    Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (P<.01); the median amount both prescribed and supplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (P<.01); median amount prescribed and supplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, P<.01). WP review of doctor-prepared prescriptions reduced the proportion of patients who were supplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

  14. Surgical time and complications of total transvaginal (total-NOTES, single-port laparoscopic-assisted and conventional ovariohysterectomy in bitches

    Directory of Open Access Journals (Sweden)

    M.A.M. Silva


    Full Text Available The recently developed minimally invasive techniques of ovariohysterectomy (OVH have been studied in dogs in order to optimize their benefits and decrease risks to the patients. The purpose of this study was to compare surgical time, complications and technical difficulties of transvaginal total-NOTES, single-port laparoscopic-assisted and conventional OVH in bitches. Twelve bitches were submitted to total-NOTES (NOTES group, while 13 underwent single-port laparoscopic-assisted (SPLA group and 15 were submitted to conventional OVH (OPEN group. Intra-operative period was divided into 7 stages: (1 access to abdominal cavity; (2 pneumoperitoneum; approach to the right (3 and left (4 ovarian pedicle and uterine body (5; (6 abdominal or vaginal synthesis, performed in 6 out of 12 patients of NOTES; (7 inoperative time. Overall and stages operative times, intra and postoperative complications and technical difficulties were compared among groups. Mean overall surgical time in NOTES (25.7±6.8 minutes and SPLA (23.1±4.0 minutes groups were shorter than in the OPEN group (34.0±6.4 minutes (P<0.05. The intraoperative stage that required the longest time was the approach to the uterine body in the NOTES group and abdominal and cutaneous sutures in the OPEN group. There was no difference regarding the rates of complications. Major complications included postoperative bleeding requiring reoperation in a bitch in the OPEN group, while minor complications included mild vaginal discharge in four patients in the NOTES group and seroma in three bitches in the SPLA group. In conclusion, total-NOTES and SPLA OVH were less time-consuming then conventional OVH in bitches. All techniques presented complications, which were properly managed.

  15. Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense? (United States)

    Schwaitzberg, S D


    More than 500,000 robotically assisted procedures were performed worldwide in 2013. Despite broad adoption, there remains a lack of clarity concerning the added cost of the robotic system to the procedure especially in light of an increasing number of ambulatory procedures which are now marketed by hospitals, surgeons and the manufacturer. These procedures are associated with much less reimbursement than inpatient procedures. It is unclear whether these added expenses can be absorbed in these scenarios. Reports vary in opinion concerning the added net costs during robotically assisted laparoscopic hernia or cholecystectomy. The worldwide revenues, procedures, and the installed base of robotic system data were reviewed and reanalyzed from the 2013 Intuitive Surgical Investors report. This provided an opportunity to look cost per case projections from the vantage point of actual revenue. This analysis was based on revenue of 2.27 billion US dollars in the three categories of capital acquisition, instrumentation and accessories, and service revenue. These revenues were then spread across 523,000 cases with varying assumptions. Without regard to expense offsets, the additional cost ranges from $2908 to $8675 depending on what system was purchased and the ability to distribute costs against case volume. Estimates of commercial and government revenue were then compared against these expenses. The use of the extraordinary technology in the face of low-morbidity low-cost established minimally invasive procedures needs to withstand scrutiny of outcome assessment, revenue and expense considerations and appropriateness review in order to create financially viable approaches to high-volume minimally invasive procedures. Revenue estimates associated with outpatient reimbursement make it difficult to support these expenses, recognizing inpatient procedures represent a different net financial picture.

  16. Incidence of positive surgical margins after robotic assisted radical prostatectomy: Does the surgeon's experience have an influence on all pathological stages? (United States)

    Villamil, A W; Costabel, J I; Billordo Peres, N; Martínez, P F; Giudice, C R; Damia, O H


    The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeon's experience in the oncological results related to pathological stage. An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeon's experience were compared and analyzed. No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeon's experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeon's experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  17. The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China

    Directory of Open Access Journals (Sweden)

    Yen-Chuan Ou


    Full Text Available To analyze the learning curve for cancer control from an initial 250 cases (Group I and subsequent 250 cases (Group II of robotic-assisted laparoscopic radical prostatectomy (RALP performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin (PSM and biochemical recurrence (BCR were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I (22.2% vs 14.2%, respectively, with Gleason score 8-10, P= 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P= 0.017. The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group II. A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle (NVB preservation was significantly influenced by the PSM in high-risk patients (84.1% in the preservation group vs 43.9% in the nonpreservation group. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.

  18. Sensors for advanced driver assistance systems; Sensoren fuer Fahrerassistenzsysteme

    Energy Technology Data Exchange (ETDEWEB)

    Ritschel, W.; Wixforth, T. [Hella KGaA Hueck und Co., Lippstadt (Germany)


    Essential safety applications and those aimed at driver convenience (blind spot surveillance, stop and go, pre-crash, parking assistant) can be effected in vehicles with the aid of radar sensors. The radar sensors used can be differentiated in terms of the bandwidth required (narrow band or ultra-wide band) and in terms of the modulation of the transmission signal (pulse modulation or CW). Ultra-wide band systems at the moment are not eligible for admission and do not conform with the present regulations in the European Union. The sensors currently being developed at hella for production use are characterized by the fact that they cover the primary applications in motor vehicles. In these cases the transmission signals radiated lie within the valid limits currently approved within the European Union. (orig.)

  19. An improved nickel/zinc battery for ventricular assist systems

    Energy Technology Data Exchange (ETDEWEB)

    Coates, D. [Energy Research Corp., Danbury, CT (United States); Ferreira, E. [Energy Research Corp., Danbury, CT (United States); Charkey, A. [Energy Research Corp., Danbury, CT (United States)


    Nickel/zinc batteries are currently being manufactured under contract to the national institutes of health (NIH) for a left ventricular assist device (LVAD). The nickel/zinc system is being developed to replace the current lead-acid battery in this application. First generation prototype cells provide 60 Wh kg{sup -1}, which is a weight saving of more than 35% compared to the lead-acid battery in current use. Further optimization of this design will result in a projected energy density of 70 Wh kg{sup -1} by reducing the cell weight by 15%. Cell characterization and accelerated testing are underway to establish cell performance as a function of cycle life. (orig.)

  20. Survey of pedestrian detection for advanced driver assistance systems. (United States)

    Gerónimo, David; López, Antonio M; Sappa, Angel D; Graf, Thorsten


    Advanced driver assistance systems (ADASs), and particularly pedestrian protection systems (PPSs), have become an active research area aimed at improving traffic safety. The major challenge of PPSs is the development of reliable on-board pedestrian detection systems. Due to the varying appearance of pedestrians (e.g., different clothes, changing size, aspect ratio, and dynamic shape) and the unstructured environment, it is very difficult to cope with the demanded robustness of this kind of system. Two problems arising in this research area are the lack of public benchmarks and the difficulty in reproducing many of the proposed methods, which makes it difficult to compare the approaches. As a result, surveying the literature by enumerating the proposals one--after-another is not the most useful way to provide a comparative point of view. Accordingly, we present a more convenient strategy to survey the different approaches. We divide the problem of detecting pedestrians from images into different processing steps, each with attached responsibilities. Then, the different proposed methods are analyzed and classified with respect to each processing stage, favoring a comparative viewpoint. Finally, discussion of the important topics is presented, putting special emphasis on the future needs and challenges.

  1. Performance test of solar-assisted ejector cooling system

    KAUST Repository

    Huang, Bin-Juine


    A solar-assisted ejector cooling/heating system (SACH-2k) is built and test result is reported. The solar-driven ejector cooling system (ECS) is connected in series with an inverter-type air conditioner (IAC). Several advanced technologies are developed in SACH-k2, including generator liquid level control in ECS, the ECS evaporator temperature control, and optimal control of fan power in cooling tower of ECS. From the field test results, the generator liquid level control performs quite well and keeps stable performance of ejector. The ECS evaporator temperature control also performs satisfactorily to keep ejector performance normally under low or fluctuating solar radiation. The fan power control system cooling tower performs stably and reduces the power consumption dramatically without affecting the ECS performance. The test results show that the overall system COPo including power consumptions of peripheral increases from 2.94-3.3 (IAC alone) to 4.06-4.5 (SACH-k2), about 33-43%. The highest COPo is 4.5. © 2013 Elsevier Ltd and IIR. All rights reserved.

  2. Usability testing of a developed assistive robotic system with virtual assistance for individuals with cerebral palsy: a case study. (United States)

    Jafari, Nooshin; Adams, Kim; Tavakoli, Mahdi; Wiebe, Sandra; Janz, Heidi


    This paper presents a novel application of an assistive robotic system with virtual assistance to enhance manual performance of individuals with cerebral palsy. Cerebral palsy affects one's voluntary motor movements resulting in limited opportunities to actively engage in physical manipulative activities that require fine motor movements and coordination. Lack of object manipulation and environmental exploration can result in further impairments such as cognitive and social delays. The proposed assistive robotic system has been developed to enhance hand movements of people with disabilities when performing a functional task colouring. This paper presents the usability testing of the effectiveness of the developed system with an individual with cerebral palsy in a set of colouring tasks. Assisted and unassisted approaches were compared and analysed through quantitative and qualitative measures. The robotic-based approach was further compared with the participant's typical alternate access method to perform the same proposed tasks. The robotic system with virtual assistance was clinically validated to be significantly more effective, compared to both unassisted and typical approaches, by increasing the hand controllability, reducing the physical load and increasing the easiness of maintaining movements within the lines. Future studies will inform the use of the system for children with disabilities to provide them with assisted play for functional and playful activities. Implications for rehabilitation Robotic system can enhance manual performance in individuals with disabilities. Participating in a robot-mediated play activity could increase children's motivation and engagement. The developed robotic system can contribute to a basis for clinical and home-based implementation of the technology to promote manual play activities for children with disabilities.

  3. The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis. (United States)

    Bertl, Kristina; Parllaku, Arlinda; Pandis, Nikolaos; Buhlin, Kåre; Klinge, Björn; Stavropoulos, Andreas


    To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy. Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported. Medline (PubMed), Embase (Ovid), CENTRAL (Ovid). Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p≤0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group. Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. 21 CFR 884.6170 - Assisted reproduction water and water purification systems. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction water and water purification... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6170 Assisted reproduction water and water purification systems. (a) Identification...

  5. [Surgical robotics in neurosurgery]. (United States)

    Haidegger, Tamás; Benyó, Zoltán


    Surgical robotics is one of the most dynamically advancing areas of biomedical engineering. In the past few decades, computer-integrated interventional medicine has gained significance internationally in the field of surgical procedures. More recently, mechatronic devices have been used for nephrectomy, cholecystectomy, as well as in orthopedics and radiosurgery. Estimates show that 70% of the radical prostatectomies were performed with the da Vinci robot in the United States last year. Robot-aided procedures offer remarkable advantages in neurosurgery both for the patient and the surgeon, making microsurgery and Minimally Invasive Surgery a reality, and even complete teleoperation accessible. This paper introduces surgical robotic systems developed primarily for brain and spine applications, besides, it focuses on the different research strategies applied to provide smarter, better and more advanced tools to surgeons. A new system is discussed in details that we have developed together with the Johns Hopkins University in Baltimore. This cooperatively-controlled system can assist with skull base drilling to improve the safety and quality of neurosurgery while reducing the operating time. The paper presents the entire system, the preliminary results of phantom and cadaver tests and our efforts to improve the accuracy of the components. An effective optical tracking based patient motion compensation method has been implemented and tested. The results verify the effectiveness of the system and allow for further research.

  6. Hardware-Assisted System for Program Execution Security of SOC

    Directory of Open Access Journals (Sweden)

    Wang Xiang


    Full Text Available With the rapid development of embedded systems, the systems’ security has become more and more important. Most embedded systems are at the risk of series of software attacks, such as buffer overflow attack, Trojan virus. In addition, with the rapid growth in the number of embedded systems and wide application, followed embedded hardware attacks are also increasing. This paper presents a new hardware assisted security mechanism to protect the program’s code and data, monitoring its normal execution. The mechanism mainly monitors three types of information: the start/end address of the program of basic blocks; the lightweight hash value in basic blocks and address of the next basic block. These parameters are extracted through additional tools running on PC. The information will be stored in the security module. During normal program execution, the security module is designed to compare the real-time state of program with the information in the security module. If abnormal, it will trigger the appropriate security response, suspend the program and jump to the specified location. The module has been tested and validated on the SOPC with OR1200 processor. The experimental analysis shows that the proposed mechanism can defence a wide range of common software and physical attacks with low performance penalties and minimal overheads.

  7. Sensor-Based Trajectory Generation for Advanced Driver Assistance System

    Directory of Open Access Journals (Sweden)

    Christopher James Shackleton


    Full Text Available This paper investigates the trajectory generation problem for an advanced driver assistance system that could sense the driving state of the vehicle, so that a collision free trajectory can be generated safely. Specifically, the problem of trajectory generation is solved for the safety assessment of the driving state and to manipulate the vehicle in order to avoid any possible collisions. The vehicle senses the environment so as to obtain information about other vehicles and static obstacles ahead. Vehicles may share the perception of the environment via an inter-vehicle communication system. The planning algorithm is based on a visibility graph. A lateral repulsive potential is applied to adaptively maintain a trade-off between the trajectory length and vehicle clearance, which is the greatest problem associated with visibility graphs. As opposed to adaptive roadmap approaches, the algorithm exploits the structured nature of the environment for construction of the roadmap. Furthermore, the mostly organized nature of traffic systems is exploited to obtain orientation invariance, which is another limitation of both visibility graphs and adaptive roadmaps. Simulation results show that the algorithm can successfully solve the problem for a variety of commonly found scenarios.

  8. Flexible 3D laparoscopic assisted reduction and percutaneous fixation of acetabular fractures: Introduction to a new surgical option. (United States)

    Mauffrey, C; Hake, M; Kim, F J


    The gold standard for fractures of the acetabulum is to perform an open reduction and internal fixation in order to achieve anatomical reduction. In a well-defined subset of patients, percutaneous techniques may be employed but achieving reduction by closed means can be challenging especially for fractures with large degrees of displacement. Such patient may include elderly patients who may not have the physiologic reserve to withstand open approaches. In our paper, we present a new option using laparoscopic assisted reduction of the acetabular fracture and percutaneous fixation. The young obese patient refused all forms of blood products transfusion and presented with a displaced transverse posterior wall fracture. While we do not recommend routine use of such technique and recognize its numerous limitations, we present it as an alternative strategy in a small subset of patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Outcomes of a virtual-reality simulator-training programme on basic surgical skills in robot-assisted laparoscopic surgery. (United States)

    Phé, Véronique; Cattarino, Susanna; Parra, Jérôme; Bitker, Marc-Olivier; Ambrogi, Vanina; Vaessen, Christophe; Rouprêt, Morgan


    The utility of the virtual-reality robotic simulator in training programmes has not been clearly evaluated. Our aim was to evaluate the impact of a virtual-reality robotic simulator-training programme on basic surgical skills. A simulator-training programme in robotic surgery, using the da Vinci Skills Simulator, was evaluated in a population including junior and seasoned surgeons, and non-physicians. Their performances on robotic dots and suturing-skin pod platforms before and after virtual-simulation training were rated anonymously by surgeons experienced in robotics. 39 participants were enrolled: 14 medical students and residents in surgery, 14 seasoned surgeons, 11 non-physicians. Junior and seasoned surgeons' performances on platforms were not significantly improved after virtual-reality robotic simulation in any of the skill domains, in contrast to non-physicians. The benefits of virtual-reality simulator training on several tasks to basic skills in robotic surgery were not obvious among surgeons in our initial and early experience with the simulator. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  10. Reliability Assessment for Tie Line Capacity Assistance of Power Systems Based On Multi-Agent System


    Nadheer A. Shalash; Abu Zaharin Bin Ahmad


    Technological developments in industrial innovations have currently been related to interconnected system assistance and distribution networks. This important in order to enable an electrical load to continue receive power in the event of disconnection of load from the main power grid. This paper represents a method for reliability assessment of interconnected power systems based. The multi-agent system consists of four agents. The first agent was the generator agent to using as connected the...

  11. Hemodynamic behavior modeling of a Virtual Surgical Patient based on a Fuzzy Expert System.

    Directory of Open Access Journals (Sweden)

    Paulo Farias Paiva


    Full Text Available The Virtual Reality (VR allows its users to experience a sense of being immersed in synthetic 3D scenarios generated by computer graphics. The so-called Virtual Environments (VEs based on RV can be applied to medical education, enabling: repetitive training and the development of psychomotor skills in surgical procedures without compromising real patients. Surgical simulators that feature Dynamic Virtual Patients (VPs, that is, reacts physiologically to interventions and medical decisions made during the training. These systems present more realism while it offers the possibility of varying clinical cases. This work has as main objective to discuss important issues of modeling the hemodynamic performance of a VP, specifically to simulate blood pressure values (both sistolic and diastolic variables. The model of a VP is presented as result as well as is presented an architecture for its integration to simulators based on VR.

  12. Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses. (United States)

    Crandall, Marie L; Agarwal, Suresh; Muskat, Peter; Ross, Steven; Savage, Stephanie; Schuster, Kevin; Tominaga, Gail T; Shafi, Shahid


    Emergent general surgical diseases encompass a broad spectrum of anatomy and pathophysiology, creating challenges for outcomes assessment, research, and surgical training. The goal of this study was to measure anatomic disease severity for eight emergent general surgical diseases using the uniform grading system of the American Association for the Surgery of Trauma (AAST). The Committee on Patient Assessment and Outcomes of AAST applied the previously developed uniform grading system to eight emergent general surgical diseases using a consensus of experts. It was then reviewed and approved by the Board of Managers of AAST. Severity grades for eight commonly encountered emergent general surgical conditions were created: breast abscess, esophageal perforation, infectious colitis, pelvic inflammatory disease, perirectal abscess, pleural space infections, soft tissue infections, and surgical site infections. The range of grades from I through V, reflect progression from mild disease, limited to within the organ itself, to widespread severe disease. This article provides a uniform grading system for measuring anatomic severity of eight emergent general surgical diseases. Consistent adoption of these grades could improve standardization for quality assurance, outcomes research, and surgical training.

  13. Cooperative advanced Driver assistance Systems - Technological measures for data privacy compliance


    Jäger, Hubert; Schnieder, Lars


    Cooperative advanced driver assistance systems (ADAS) will contribute to road traffic safety: Critical situations will be detected, the driver alerted and control of the vehicle interfered with automatically. However, the introduction of such driver assistance systems presupposes that data privacy issues have already been solved in advance. A necessary condition for the driver to accept and trust new Driver assistance systems is that his/her personal and personally identifiable data will be t...

  14. Ambient light based interaction concept for an integrative driver assistance system – a driving simulator study


    Dziennus, Marc; Kelsch, Johann; Schieben, Anna


    For today’s vehicles several advanced driver assistance systems are on the market supporting the driver in critical driving situations or automating parts of the driving tasks. In the future there will be even more. Currently, those assistance systems do not use a common and consistent interaction strategy to communicate with the driver. The goal of the present study is to present and to evaluate a concept using ambient light for presenting information of different assistance systems in an in...

  15. Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus. (United States)

    Friedrich, Daniel T; Scheithauer, M O; Greve, J; Rotter, N; Doescher, J; Hoffmann, T K; Schuler, P J


    Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients

  16. Novel 3D hexapod computer-assisted orthopaedic surgery system for closed diaphyseal fracture reduction. (United States)

    Tang, Peifu; Hu, Lei; Du, Hailong; Gong, Minli; Zhang, Lihai


    Long-bone fractures are very common in trauma centers. The conventional Arbeitsgemeindschaft fur Osteosynthesefragen (AO) technique contributes to most fracture healing problems, and external fixation technology also has several disadvantages, so new techniques are being explored. A novel hexapod computer-assisted fracture reduction system based on a 3D-CT image reconstruction process is presented for closed reduction of long-bone diaphyseal fractures. A new reduction technique and upgraded reduction device are described and the whole system has been validated. Ten bovine femoral fracture models were used with random fracture patterns. Tests results were as follows: residual deviation 1.24 + 0.65 mm for the axial deflection, 1.19 + 0.37 mm for the translation, 2.34 + 1.79° for the angulation, and 2.83 + 0.9° for the rotation. The reduction mechanism has the advantages of high positioning, reduction and computer accuracy, and intra-operative stability for both patients and surgical team. With further investigation, it could be applied in many kinds of long-bone diaphyseal fractures. Copyright © 2011 John Wiley & Sons, Ltd.

  17. The future for physician assistants. (United States)

    Cawley, J F; Ott, J E; DeAtley, C A


    Physician assistants were intended to be assistants to primary care physicians. Physicians in private practice have only moderately responded to the availability of these professionals. Cutbacks in the numbers of foreign medical graduates entering American schools for graduate medical education, concern for overcrowding in some specialties, and the economic and clinical capabilities of physician assistants have lead to new uses for these persons. Physician assistants are employed in surgery and surgical subspecialties; in practice settings in institutions such as medical, pediatric, and surgical house staff; and in geriatric facilities, occupational medicine clinics, emergency rooms, and prison health systems. The projected surplus of physicians by 1990 may affect the use of physician assistants by private physicians in primary care.

  18. [Successful treatment of surgically induced necrotizing sclerokeratitis (SINS) with systemic immunosuppresive agents and amniotic membrane grafting]. (United States)

    Cordero-Coma, M; Franco-Benito, M; García-Ruiz-de-Morales, J M; Alonso-Orcajo, N; Del Barrio-Manso, I


    We report the case of a 74-year-old female who developed a necrotizing sclerokeratitis affecting her left eye after uncomplicated cataract surgery. She had no previous history of systemic autoimmune disease. Histopathology of the lesion revealed necrotic granulomatosis with an increased number of plasma cells. Surgically induced necrotizing sclerokeratitis (SINS) is a serious entity which requires prompt and aggressive therapy to prevent its potential devastating ocular consequences. Conjunctival resection and amniotic membrane grafting may be necessary to temporarily interrupt local immunologic events in severe cases. However, associated systemic immunomodulatory therapy seems to be mandatory (Arch Soc Esp Oftalmol 2009; 84: 577-580).

  19. Panorama parking assistant system with improved particle swarm optimization method (United States)

    Cheng, Ruzhong; Zhao, Yong; Li, Zhichao; Jiang, Weigang; Wang, Xin'an; Xu, Yong


    A panorama parking assistant system (PPAS) for the automotive aftermarket together with a practical improved particle swarm optimization method (IPSO) are proposed in this paper. In the PPAS system, four fisheye cameras are installed in the vehicle with different views, and four channels of video frames captured by the cameras are processed as a 360-deg top-view image around the vehicle. Besides the embedded design of PPAS, the key problem for image distortion correction and mosaicking is the efficiency of parameter optimization in the process of camera calibration. In order to address this problem, an IPSO method is proposed. Compared with other parameter optimization methods, the proposed method allows a certain range of dynamic change for the intrinsic and extrinsic parameters, and can exploit only one reference image to complete all of the optimization; therefore, the efficiency of the whole camera calibration is increased. The PPAS is commercially available, and the IPSO method is a highly practical way to increase the efficiency of the installation and the calibration of PPAS in automobile 4S shops.

  20. deNIS IIplus - computer-assisted crisis management system

    International Nuclear Information System (INIS)

    Corr, B.


    The management of catastrophes, as natural disasters or manmade disasters, will only be effective and successful if all relevant information is available in time for decision-makers. During previous large-scale disasters it became evident that information needed for the disaster management was only partially available and that there were fundamental deficits in regard to the flow of information between federal states (''Laender'') as well as communication problems between disaster response teams in the effected regions. On this account in summer 2001 the Federal Ministry of the Interior has decided to develop the ''German Emergency Preparedness Information System (deNIS)''. The aim of the enhanced version deNIS II plus is to built up a network for the civil and disaster response and to assist as an information and communication system for decision-makers of the Federal Government and the Laender Governments to better co-ordination relief and rescue teams in the event of a natural disaster or technical accident. Correspondingly the primary task of deNIS is to support the decision-making of disaster management authorities. (orig.)

  1. Validated TRNSYS Model for Solar Assisted Space Heating System

    International Nuclear Information System (INIS)

    Abdalla, Nedal


    The present study involves a validated TRNSYS model for solar assisted space heating system as applied to a residential building in Jordan using new detailed radiation models of the TRNSYS 17.1 and geometric building model Trnsys3d for the Google SketchUp 3D drawing program. The annual heating load for a building (Solar House) which is located at the Royal ScientiFIc Society (RS5) in Jordan is estimated under climatological conditions of Amman. The aim of this Paper is to compare measured thermal performance of the Solar House with that modeled using TRNSYS. The results showed that the annual measured space heating load for the building was 6,188 kWh while the load for the modeled building was 6,391 kWh. Moreover, the measured solar fraction for the solar system was 50% while the modeled solar fraction was 55%. A comparison of modeled and measured data resulted in percentage mean absolute errors for solar energy for space heating, auxiliary heating and solar fraction of 13%, 7% and 10%, respectively. The validated model will be useful for long-term performance simulation under different weather and operating conditions.(author)

  2. Robot-assisted general surgery. (United States)

    Hazey, Jeffrey W; Melvin, W Scott


    With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

  3. Development of hybrid solar-assisted cooling/heating system

    KAUST Repository

    Huang, B.J.


    A solar-assisted ejector cooling/heating system (SACH) was developed in this study. The SACH combines a pump-less ejector cooling system (ECS) with an inverter-type heat pump (R22) and is able to provide a stable capacity for space cooling. The ECS is driven by solar heat and is used to cool the condenser of the R22 heat pump to increase its COP and reduce the energy consumption of the compressor by regulating the rotational speed of the compressor through a control system. In a complete SACH system test run at outdoor temperature 35 °C, indoor temperature 25 °C and compressor speed 20-80 Hz, and the ECS operating at generator temperature 90 °C and condensing temperature 37 °C, the corresponding condensing temperature of the heat pump in the SACH is 24.5-42 °C, cooling capacity 1.02-2.44 kW, input power 0.20-0.98 kW, and cooling COPc 5.11-2.50. This indicates that the use of ECS in SACH can effectively reduce the condensing temperature of the heat pump by 12.6-7.3 °C and reduce the power consumption by 81.2-34.5%. The SACH can also supply heat from the heat pump. At ambient temperature from 5 °C to 35 °C, the heating COPh is in the range 2.0-3.3. © 2010 Elsevier Ltd. All rights reserved.

  4. Reliability analysis framework for computer-assisted medical decision systems

    International Nuclear Information System (INIS)

    Habas, Piotr A.; Zurada, Jacek M.; Elmaghraby, Adel S.; Tourassi, Georgia D.


    We present a technique that enhances computer-assisted decision (CAD) systems with the ability to assess the reliability of each individual decision they make. Reliability assessment is achieved by measuring the accuracy of a CAD system with known cases similar to the one in question. The proposed technique analyzes the feature space neighborhood of the query case to dynamically select an input-dependent set of known cases relevant to the query. This set is used to assess the local (query-specific) accuracy of the CAD system. The estimated local accuracy is utilized as a reliability measure of the CAD response to the query case. The underlying hypothesis of the study is that CAD decisions with higher reliability are more accurate. The above hypothesis was tested using a mammographic database of 1337 regions of interest (ROIs) with biopsy-proven ground truth (681 with masses, 656 with normal parenchyma). Three types of decision models, (i) a back-propagation neural network (BPNN), (ii) a generalized regression neural network (GRNN), and (iii) a support vector machine (SVM), were developed to detect masses based on eight morphological features automatically extracted from each ROI. The performance of all decision models was evaluated using the Receiver Operating Characteristic (ROC) analysis. The study showed that the proposed reliability measure is a strong predictor of the CAD system's case-specific accuracy. Specifically, the ROC area index for CAD predictions with high reliability was significantly better than for those with low reliability values. This result was consistent across all decision models investigated in the study. The proposed case-specific reliability analysis technique could be used to alert the CAD user when an opinion that is unlikely to be reliable is offered. The technique can be easily deployed in the clinical environment because it is applicable with a wide range of classifiers regardless of their structure and it requires neither additional

  5. A high accuracy vehicle positioning system implemented in a lane assistance system when GPS Is unavailable. (United States)


    The use of lane assistance systems can reduce the stress levels experienced by drivers and allow for better lane : keeping in narrow, bus-dedicated lanes. In 2008, the Intelligent Vehicles (IV) Lab at the University of Minnesota : has developed such ...

  6. Clinical study on microsurgical treatment of lumbar disc herniation assisted by METRx system

    Directory of Open Access Journals (Sweden)

    Xin-gang ZHAO


    Full Text Available Objective To explore the techniques and curative effect of microsurgical procedures assisted by minimal exposure tubular retractor system (METRx in the treatment of lumbar disc herniation (LDH.  Methods A total of 51 LDH patients, including 24 patients with L4-5 herniation and 27 patients with L5-S1 herniation, underwent discectomy assisted by METRx system. The operation time, intraoperative blood loss, postoperative complications and hospital stay were recorded. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate the degree of low back pain before operation, one week, 3 months after operation, and in the last follow-up. Lumbar MRI was used to evaluate the decompression of spinal canal.  Results The success rate of operations in 51 cases was 98.04% (50/51. The average operation time was 125 min, the average intraoperative blood loss was 50 ml, the mean hospital stay was 5 d, all patients were followed up for 6-48 months (average 24 months. Compared with preoperation, both VAS and ODI scores decreased significantly one week after operation (P = 0.036, 0.029, 3 months after operation (P = 0.018, 0.023 and in the last follow-up (P = 0.007, 0.013. The improvement rate of ODI was 35.37% in the last follow-up. No infection, postoperative cerebrospinal fluid (CSF fistula, neurological defects or incision infection was found. One patient presented acute abdominalgia on the 2nd day after operation, and was diagnosed as annexitis. One patient showed nerve root irritation symptoms after operation caused by thick nerve root during the surgery. They were cured after symptomatic treatment.  Conclusions Microsurgical procedures for treating LDH assisted by METRx system can effectively relieve nerve root compression, protect the dural sac and nerve roots, and reduce surgical complications. DOI: 10.3969/j.issn.1672-6731.2016.04.008

  7. Impact of robot-assisted spine surgery on health care quality and neurosurgical economics: A systemic review. (United States)

    Fiani, Brian; Quadri, Syed A; Farooqui, Mudassir; Cathel, Alessandra; Berman, Blake; Noel, Jerry; Siddiqi, Javed


    Whenever any new technology is introduced into the healthcare system, it should satisfy all three pillars of the iron triangle of health care, which are quality, cost-effectiveness, and accessibility. There has been quite advancement in the field of spine surgery in the last two decades with introduction of new technological modalities such as CAN and surgical robotic devices. MAZOR SpineAssist/Renaissance was the first robotic system to be approved for the use in spine surgeries in the USA in 2004. In this review, the authors sought to determine if the current literature supports this technology to be cost-effective, accessible, and improve the quality of care for individuals and populations by increasing the likelihood of desired health outcomes. Robotic-assisted surgery seems to provide perfection in surgical ergonomics and surgical dexterity, consequently improving patient outcomes. A lot of data is present on the accuracy, effectiveness, and safety of the robotic-guided technology which reflects remarkable improvements in quality of care, making its utility convincingly undisputable. The technology has been claimed to be cost-effective but there seems to be lack of data in the literature on this topic to validate this claim. Apart from just the outcome parameters, there is an immense need of studies on real-time cost-efficacy, patient perspective, surgeon and resident learning curve, and their experience with this new technology. Furthermore, new studies looking into increased utilities of this technology, such as brain and spine tumor resection, deep brain stimulation procedures, and osteotomies in deformity surgery, might authenticate the cost of the equipment.

  8. Surgical clothing systems in laminar airflow operating room: a numerical assessment. (United States)

    Sadrizadeh, Sasan; Holmberg, Sture


    This study compared two different laminar airflow distribution strategies - horizontal and vertical - and investigated the effectiveness of both ventilation systems in terms of reducing the sedimentation and distribution of bacteria-carrying particles. Three different staff clothing systems, which resulted in source strengths of 1.5, 4 and 5 CFU/s per person, were considered. The exploration was conducted numerically using a computational fluid dynamics technique. Active and passive air sampling methods were simulated in addition to recovery tests, and the results were compared. Model validation was performed through comparisons with measurement data from the published literature. The recovery test yielded a value of 8.1 min for the horizontal ventilation scenario and 11.9 min for the vertical ventilation system. Fewer particles were captured by the slit sampler and in sedimentation areas with the horizontal ventilation system. The simulated results revealed that under identical conditions in the examined operating room, the horizontal laminar ventilation system performed better than the vertical option. The internal constellation of lamps, the surgical team and objects could have a serious effect on the movement of infectious particles and therefore on postoperative surgical site infections. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  9. A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study. (United States)

    Li, B; Shen, S; Jiang, W; Li, J; Jiang, T; Xia, J J; Shen, S G; Wang, X


    The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74mm and 1.93° for the maxillary dental arch, 1.10mm and 2.82° for the mandibular arch, 0.83mm and 2.59° for the mandibular body, and 0.98mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint. Copyright © 2017. Published by Elsevier Ltd.

  10. A comparison of surgical morbidity and scar appearance between gasless, transaxillary endoscopic thyroidectomy (GTET) and minimally invasive video-assisted thyroidectomy (VAT). (United States)

    Lang, Brian Hung-Hin; Wong, Kai-Pun


    The gasless, transaxillary endoscopic thyroidectomy (GTET) and minimally invasive video-assisted thyroidectomy (VAT) are both well-recognized endoscopic thyroid procedures, but how their postoperative outcomes are compared remains unclear. The present study was designed to compare surgical morbidities/complications and scar appearance between GTET and VAT at our institution. Of the 141 patients eligible for endoscopic thyroidectomy, 96 (68.1 %) underwent GTET and 45 (31.9 %) underwent VAT. Patient demographics, indications, operative findings, pain scores on days 0 and 1, and surgical morbidities were compared between the two groups. At 6 months after surgery, all patients were asked about their satisfaction on the cosmetic result by giving a score (Patient Satisfaction Score or PSS) and their scar appearance was assessed by the 11 domains in the Patient and Observer Scar Assessment Scale (POSAS). GTET was associated with a significantly longer operating time (84 vs. 148 min, p = 0.005), higher pain scores on days 0 and 1 (2.9 vs. 2.3, p = 0.042 and 2.2 vs. 1.7, p = 0.033, respectively), overall recurrent laryngeal nerve (RLN) injury (6.3 vs. 0 %, p = 0.043), and overall morbidity rates (12.5 vs. 2.2 %, p = 0.049) than VAT. The actual individual score for the 11 domains in POSAS and for PSS remained similar between the two groups. They remained similar even when patients with morbidity were excluded. GTET was a technically more challenging procedure and was associated with longer hospital stay, longer operating time, more immediate pain, and increased overall RLN injury and morbidity than VAT. The 6-month POSAS and PSS were similar between the two procedures.

  11. A Rapid Prototyping Environment for Cooperative Advanced Driver Assistance Systems

    Directory of Open Access Journals (Sweden)

    Kay Massow


    Full Text Available Advanced Driver Assistance Systems (ADAS were strong innovation drivers in recent years, towards the enhancement of traffic safety and efficiency. Today’s ADAS adopt an autonomous approach with all instrumentation and intelligence on board of one vehicle. However, to further enhance their benefit, ADAS need to cooperate in the future, using communication technologies. The resulting combination of vehicle automation and cooperation, for instance, enables solving hazardous situations by a coordinated safety intervention on multiple vehicles at the same point in time. Since the complexity of such cooperative ADAS grows with each vehicle involved, very large parameter spaces need to be regarded during their development, which necessitate novel development approaches. In this paper, we present an environment for rapidly prototyping cooperative ADAS based on vehicle simulation. Its underlying approach is either to bring ideas for cooperative ADAS through the prototyping stage towards plausible candidates for further development or to discard them as quickly as possible. This is enabled by an iterative process of refining and assessment. We reconcile the aspects of automation and cooperation in simulation by a tradeoff between precision and scalability. Reducing precise mapping of vehicle dynamics below the limits of driving dynamics enables simulating multiple vehicles at the same time. In order to validate this precision, we also present a method to validate the vehicle dynamics in simulation against real world vehicles.

  12. Representation Learning Based Speech Assistive System for Persons With Dysarthria. (United States)

    Chandrakala, S; Rajeswari, Natarajan


    An assistive system for persons with vocal impairment due to dysarthria converts dysarthric speech to normal speech or text. Because of the articulatory deficits, dysarthric speech recognition needs a robust learning technique. Representation learning is significant for complex tasks such as dysarthric speech recognition. We focus on robust representation for dysarthric speech recognition that involves recognizing sequential patterns of varying length utterances. We propose a hybrid framework that uses a generative learning based data representation with a discriminative learning based classifier. In this hybrid framework, we propose to use Example Specific Hidden Markov Models (ESHMMs) to obtain log-likelihood scores for a dysarthric speech utterance to form fixed dimensional score vector representation. This representation is used as an input to discriminative classifier such as support vector machine.The performance of the proposed approach is evaluatedusingUA-Speechdatabase.The recognitionaccuracy is much better than the conventional hidden Markov model based approach and Deep Neural Network-Hidden Markov Model (DNN-HMM). The efficiency of the discriminative nature of score vector representation is proved for "very low" intelligibility words.

  13. Aqueous Two Phase System Assisted Self-Assembled PLGA Microparticles (United States)

    Yeredla, Nitish; Kojima, Taisuke; Yang, Yi; Takayama, Shuichi; Kanapathipillai, Mathumai


    Here, we produce poly(lactide-co-glycolide) (PLGA) based microparticles with varying morphologies, and temperature responsive properties utilizing a Pluronic F127/dextran aqueous two-phase system (ATPS) assisted self-assembly. The PLGA polymer, when emulsified in Pluronic F127/dextran ATPS, forms unique microparticle structures due to ATPS guided-self assembly. Depending on the PLGA concentration, the particles either formed a core-shell or a composite microparticle structure. The microparticles facilitate the simultaneous incorporation of both hydrophobic and hydrophilic molecules, due to their amphiphilic macromolecule composition. Further, due to the lower critical solution temperature (LCST) properties of Pluronic F127, the particles exhibit temperature responsiveness. The ATPS based microparticle formation demonstrated in this study, serves as a novel platform for PLGA/polymer based tunable micro/nano particle and polymersome development. The unique properties may be useful in applications such as theranostics, synthesis of complex structure particles, bioreaction/mineralization at the two-phase interface, and bioseparations.

  14. Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post-surgical use of assisted reproductive techniques. (United States)

    van Dongen, Joyce; Tekle, Fetene B; van Roijen, J Herman


    Study Type - Outcomes (cohort series). Level of Evidence 2b What's known on the subject? and What does the study add? Microsurgical vasectomy reversal is an effective and cost-effective method of reinstating fertility in a man who has previously had a vasectomy. The current literature indicates that the success rate (i.e. potency and pregnancy rates) are dependent primarily on the time elapsed since vasectomy and the age of the female partner. Using a multivariate Cox regression model, evaluation of the influence of preoperative data (including smoking) and semen parameters indicates a significant influence of post-surgical sperm motility only, on time to first pregnancy. The use of assisted reproductive techniques, when natural pregnancy failed, was successful in ≈50% of couples who attempted this procedure and accounted for an absolute increase in pregnancy rate of 14%. • To determine the influence of smoking, postoperative semen characteristics and the use of an assisted reproductive technique (ART) on pregnancy rate in a contemporary series of men undergoing vasectomy reversal. • Between January 2002 and January 2009, 186 vasectomy reversals were performed. Of the 171 patients who could be contacted for follow-up, 162 attempted pregnancy and constitute the study group. • Semen analysis was performed 3 months after the procedure and at subsequent 3-monthly intervals. • Patient characteristics and surgical information were obtained from a computerized database, and follow-up data were collected by telephone interview. • A multivariate Cox regression model was used to discern possible prognosticators with respect to pregnancy outcome. • The overall patency rate was 91.4%, with a natural pregnancy rate of 44.4% and a subsequent 14.2% of patients conceiving using a ARTs resulting in a total pregnancy rate of 58.6%. Multiple pregnancies were obtained by 20.4% of couples. • Smoking of the male or female partner did not influence the probability of

  15. Prevention of Surgical Site Infection After Ankle Surgery Using Vacuum-Assisted Closure Therapy in High-Risk Patients With Diabetes. (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan


    Patients with diabetes have a high risk of surgical site infection (SSI) after ankle surgery. The aim of the present study was to investigate the efficacy of vacuum-assisted closure (VAC) in the prevention of SSI after ankle surgery compared with the efficacy of standard moist wound care (SMWC). A retrospective study was performed of unstable ankle fractures for surgical fixation in patients with diabetes from January 2012 to December 2014. VAC and SMWC were used for surgical incision coverage. The primary outcome was the incidence of SSI, and the secondary outcomes were the length of hospital stay and crude hospital costs. The data from 76 patients were analyzed, with 22 (28.95%) in the VAC group and 54 (71.05%) in the SMWC group. The incidence of SSI was 4.6% in the VAC group compared with 27.8% in the SMWC group (chi-square 5.076; p = .024), and the crude odds ratio for SSI in the VAC group was 0.124 (95% confidence interval 0.002 to 0.938). The length of hospital stay was lower in the VAC group than in the SMWC group (12.6 ± 2.7 days and 15.2 ± 3.5 days, respectively; t = 3.122, p = .003). The crude hospital costs were also lower in the VAC group than in the SMWC group (Chinese yuan 8643.2 ± 1195.3 and 9456.2 ± 1106.3, respectively; t = 2.839, p = .006). After logistic regression analysis, the adjusted odds ratio for the total SSI rate comparing VAC and SMWC was 0.324 (95% confidence interval 0.092 to 0.804; p = .021). Compared with SMWC, VAC can decrease the SSI rate after ankle surgery in patients with diabetes. This finding should be confirmed by prospective, randomized controlled clinical trials. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Dynamics of the recovery of autonomic nervous system in patients after surgical treatment of hemorrhagic stroke.

    Directory of Open Access Journals (Sweden)

    Kuftan Mohammed Nazmi Kuftan


    Full Text Available We talking about the impact of tools and techniques of physical rehabilitation on the performance of the autonomic nervous system (parasympathetic activity and sympathetic tone and heart rate of patients after surgical treatment of hemorrhagic stroke. The experiment had involved 53 patients aged from 37 to 72 years. The survey was conducted on patients' clinical stage of rehabilitation in the second, third and sixth week after surgery. The analysis is based on the measurement of heart rate variability. A positive effect of the use of tools and techniques of physical rehabilitation program on the state of autonomic regulation.

  17. Development of a security system for assisted reproductive technology (ART). (United States)

    Hur, Yong Soo; Ryu, Eun Kyung; Park, Sung Jin; Yoon, Jeong; Yoon, San Hyun; Yang, Gi Deok; Hur, Chang Young; Lee, Won Don; Lim, Jin Ho


    In the field of assisted reproductive technology (ART), medical accidents can result in serious legal and social consequences. This study was conducted to develop a security system (called IVF-guardian; IG) that could prevent mismatching or mix-ups in ART. A software program was developed in collaboration with outside computer programmers. A quick response (QR) code was used to identify the patients, gametes and embryos in a format that was printed on a label. There was a possibility that embryo development could be affected by volatile organic components (VOC) in the printing material and adhesive material in the label paper. Further, LED light was used as the light source to recognize the QR code. Using mouse embryos, the effects of the label paper and LED light were examined. The stability of IG was assessed when applied in clinical practice after developing the system. A total of 104 cycles formed the study group, and 82 cycles (from patients who did not want to use IG because of safety concerns and lack of confidence in the security system) to which IG was not applied comprised the control group. Many of the label paper samples were toxic to mouse embryo development. We selected a particular label paper (P touch label) that did not affect mouse embryo development. The LED lights were non-toxic to the development of the mouse embryos under any experimental conditions. There were no differences in the clinical pregnancy rates between the IG-applied group and the control group (40/104 = 38.5 % and 30/82 = 36.6 %, respectively). The application of IG in clinical practice did not affect human embryo development or clinical outcomes. The use of IG reduces the misspelling of patient names. Using IG, there was a disadvantage in that each treatment step became more complicated, but the medical staff improved and became sufficiently confident in ART to offset this disadvantage. Patients who received treatment using the IG system also went through a somewhat

  18. [The pathogenesis of the systemic inflammatory response syndrome and compensatory antiinflammatory response syndrome following surgical stress]. (United States)

    Ono, Satoshi; Ichikura, Takashi; Mochizuki, Hidetaka


    The inflammation charge cells such as the macrophages, neutrophils, endothelial cells, and fibroblasts are activated in surgical sites when tissue injury occurs due to the operation. Proinflammatory cytokines such as tumor necrosis factor alpha, interleukin (IL)-1, IL-6, and IL-8 are induced from the activated inflammation charge cells. These cytokines amplify the information by autocrine and paracrine action, induce the production of other cytokines, and send the information to the whole body. Increases in body temperature, pulse rate, and leukocyte counts are then observed. This condition is called the systemic inflammatory response syndrome (SIRS) clinically. On the other hand, the production of antiinflammatory cytokines against SIRS is induced simultaneously. The condition in which antiinflammatory cytokines are produced in excess and become dominant systemically is called the compensatory antiinflammatory response syndrome (CARS). No standard concrete diagnosis for CARS has been established, although CARS is a pathogenetic concept. However, recently the analysis of cytokine production and various types of surface molecules in the inflammation charge cells became possible with the development of molecular biological methods. As a result, it was found that the immune system is controlled by the balance between proinflammatory and antiinflammatory cytokine production, and if the compensatory antiinflammatory reaction is sufficiently severe, it will manifest clinically as anergy, with increased susceptibility to infection. In this manuscript, we explain the pathogenesis of SIRS and CARS following surgical stress by analyzing cytokine production and surface membrane molecules in the inflammation charge cells.

  19. A high-accuracy surgical augmented reality system using enhanced integral videography image overlay. (United States)

    Zhang, Xinran; Chen, Guowen; Liao, Hongen


    Image guided surgery has been used in clinic to improve the surgery safety and accuracy. Augmented reality (AR) technique, which can provide intuitive image guidance, has been greatly evolved these years. As one promising approach of surgical AR systems, integral videography (IV) autostereoscopic image overlay has achieved accurate fusion of full parallax guidance into surgical scene. This paper describes an image enhanced high-accuracy IV overlay system. A flexible optical image enhancement system (IES) is designed to increase the resolution and quality of IV image. Furthermore, we introduce a novel IV rendering algorithm to promote the spatial accuracy with the consideration of distortion introduced by micro lens array. Preliminary experiments validated that the image accuracy and resolution are improved with the proposed methods. The resolution of the IV image could be promoted to 1 mm for a micro lens array with pitch of 2.32 mm and IES magnification value of 0.5. The relative deviation of accuracy in depth and lateral directions are -4.68 ± 0.83% and -9.01 ± 0.42%.

  20. [Development and application of information management system for advanced schistosomiasis chemotherapy and assistance in Jiangxi Province]. (United States)

    Mao, Yuan-Hua; Li, Dong; Ning, An; Qiu, Ling; Xiong, Ji-Jie


    To develop the information management system for advanced schistosomiasis chemotherapy and assistance in Jiangxi Province. Based on Access 2003, the system was programmed by Visual Basic 6.0 and packaged by Setup Factory 8.0. In the system, advanced schistosomiasis data were able to be input, printed, indexed, and statistically analyzed. The system could be operated and maintained easily and timely. The information management system for advanced schistosomiasis chemotherapy and assistance in Jiangxi Province is successfully developed.

  1. 76 FR 75887 - SEDASYS Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Incorporated's... (United States)


    ...] SEDASYS Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Incorporated's Petition for... of a premarket approval application (PMA) for the SEDASYS computer-assisted personalized sedation system (SEDASYS) submitted by Ethicon Endo-Surgery Inc. (EES), the sponsor for SEDASYS. This meeting has...

  2. Could a Mobile-Assisted Learning System Support Flipped Classrooms for Classical Chinese Learning? (United States)

    Wang, Y.-H.


    In this study, the researcher aimed to develop a mobile-assisted learning system and to investigate whether it could promote teenage learners' classical Chinese learning through the flipped classroom approach. The researcher first proposed the structure of the Cross-device Mobile-Assisted Classical Chinese (CMACC) system according to the pilot…

  3. 32 CFR 37.1025 - Must I report information to the Defense Assistance Awards Data System? (United States)


    ...,” reports for the Defense Assistance Award Data System, to ensure timely and accurate reporting of data... 32 National Defense 1 2010-07-01 2010-07-01 false Must I report information to the Defense Assistance Awards Data System? 37.1025 Section 37.1025 National Defense Department of Defense OFFICE OF THE...

  4. The study of surgical image quality evaluation system by subjective quality factor method (United States)

    Zhang, Jian J.; Xuan, Jason R.; Yang, Xirong; Yu, Honggang; Koullick, Edouard


    GreenLightTM procedure is an effective and economical way of treatment of benign prostate hyperplasia (BPH); there are almost a million of patients treated with GreenLightTM worldwide. During the surgical procedure, the surgeon or physician will rely on the monitoring video system to survey and confirm the surgical progress. There are a few obstructions that could greatly affect the image quality of the monitoring video, like laser glare by the tissue and body fluid, air bubbles and debris generated by tissue evaporation, and bleeding, just to name a few. In order to improve the physician's visual experience of a laser surgical procedure, the system performance parameter related to image quality needs to be well defined. However, since image quality is the integrated set of perceptions of the overall degree of excellence of an image, or in other words, image quality is the perceptually weighted combination of significant attributes (contrast, graininess …) of an image when considered in its marketplace or application, there is no standard definition on overall image or video quality especially for the no-reference case (without a standard chart as reference). In this study, Subjective Quality Factor (SQF) and acutance are used for no-reference image quality evaluation. Basic image quality parameters, like sharpness, color accuracy, size of obstruction and transmission of obstruction, are used as subparameter to define the rating scale for image quality evaluation or comparison. Sample image groups were evaluated by human observers according to the rating scale. Surveys of physician groups were also conducted with lab generated sample videos. The study shows that human subjective perception is a trustworthy way of image quality evaluation. More systematic investigation on the relationship between video quality and image quality of each frame will be conducted as a future study.

  5. The SEP "robot": a valid virtual reality robotic simulator for the Da Vinci Surgical System? (United States)

    van der Meijden, O A J; Broeders, I A M J; Schijven, M P


    The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's face validity, two questionnaires were constructed. First, a questionnaire was sent to users of the Da Vinci system (reference group) to determine a focused user-group opinion and their recommendations concerning VR-based training applications for robotic surgery. Next, clinical specialists were requested to complete a pre-tested face validity questionnaire after performing a suturing task on the SEP robot simulator. To determine the SEP's construct validity, outcome parameters of the suturing task were compared, for example, relative to participants' endoscopic experience. Correlations between endoscopic experience and outcome parameters of the performed suturing task were tested for significance. On an ordinal five-point, scale the average score for the quality of the simulator software was 3.4; for its hardware, 3.0. Over 80% agreed that it is important to train surgeons and surgical trainees to use the Da Vinci. There was a significant but marginal difference in tool tip trajectory (p = 0.050) and a nonsignificant difference in total procedure time (p = 0.138) in favor of the experienced group. In conclusion, the results of this study reflect a uniform positive opinion using VR training in robotic surgery. Concepts of face and construct validity of the SEP robotic simulator are present; however, these are not strong and need to be improved before implementation of the SEP robotic simulator in its present state for a validated training curriculum to be successful .

  6. Influence of surgical implantation angle of left ventricular assist device outflow graft and management of aortic valve opening on the risk of stroke in heart failure patients (United States)

    Chivukula, V. Keshav; McGah, Patrick; Prisco, Anthony; Beckman, Jennifer; Mokadam, Nanush; Mahr, Claudius; Aliseda, Alberto


    Flow in the aortic vasculature may impact stroke risk in patients with left ventricular assist devices (LVAD) due to severely altered hemodynamics. Patient-specific 3D models of the aortic arch and great vessels were created with an LVAD outflow graft at 45, 60 and 90° from centerline of the ascending aorta, in order to understand the effect of surgical placement on hemodynamics and thrombotic risk. Intermittent aortic valve opening (once every five cardiac cycles) was simulated and the impact of this residual native output investigated for the potential to wash out stagnant flow in the aortic root region. Unsteady CFD simulations with patient-specific boundary conditions were performed. Particle tracking for 10 cardiac cycles was used to determine platelet residence times and shear stress histories. Thrombosis risk was assessed by a combination of Eulerian and Lagrangian metrics and a newly developed thrombogenic potential metric. Results show a strong influence of LVAD outflow graft angle on hemodynamics in the ascending aorta and consequently on stroke risk, with a highly positive impact of aortic valve opening, even at low frequencies. Optimization of LVAD implantation and management strategies based on patient-specific simulations to minimize stroke risk will be presented

  7. Expansão rápida da maxila cirurgicamente assistida: estudo preliminar Surgically assisted rapid maxillary expasion: a preliminar study

    Directory of Open Access Journals (Sweden)

    Belmiro Cavalcanti do Egito Vasconcelos


    Full Text Available A expansão rápida da maxila cirurgicamente assistida é eficiente para o tratamento de deficiências transversais da maxila em pacientes adultos. OBJETIVO: Estudar duas técnicas de expansão rápida da maxila cirurgicamente assistida - com separação ou não dos processos pterigóides. MATERIAL E MÉTODOS: O estudo de coorte contemporânea longitudinal foi composto de 10 pacientes, com 18-40 anos de idade e com discrepância transversa da maxila de mais de 4mm. Dois grupos foram estabelecidos de forma aleatória, cinco pacientes em cada grupo, de acordo com a separação ou não dos processos pterigóides. Além disso, em ambos os grupos, foram realizadas as osteotomias dos pilares zigomáticos e da sutura intermaxilar. A discrepância transversal foi medida em modelos de estudo, uma radiografia cefalométrica póstero-anterior avaliou os planos zigomáticos superior e inferior e a distância inter-tuberes e uma radiografia oclusal avaliou a disjunção intermaxilar no período pré-operatório e 30 dias de pós-operatório. Um período de 7 dias foi aguardado após as osteotomias, antes de iniciar a expansão de um quarto de volta por dia. RESULTADOS: Não houve diferença estatística entre as medidas pré e pós-operatórias. CONCLUSÃO: Há poucos estudos controlados na literatura comparando as duas técnicas de expansão cirúrgica da maxila. Estudos com amostras maiores devem ser realizados.Surgically assisted rapid maxillary expansion is efficient for the treatment of transverse maxillary deficiencies in skeletally mature patients. AIM: To study two techniques for surgically assisted rapid maxillary expansion: with or without pterygoid plate detachment. MATERIAL AND METHODS: A longitudinal cohort study sample including ten patients aged 18-40 years, with a skeletal transverse discrepancy in the maxilla of more than 4 mm. Two groups were established on a randomized basis, five patients in each group, according to the detachment or

  8. [System for assessing the nutritional status of the surgical patient at admission. Nutritional assessment in surgery]. (United States)

    López Caballero, M; Pérez Suárez, I; Martínez García, C; Román García, I; Martínez Gallego, R M; Ruiz Coracho, P


    Many studies have shown that the prevalence of malnutrition in hospitals is high. Our aim in this study is to ensure the systematic use of a preoperative nutritional evaluation (PNE) that ensures simplicity and usefulness in hospital nursing assistance. A total of 96 patients were studied, of whom 31 were diagnosed as having neoplasia and 65 non-neoplasia. For the purpose of this evaluation, the Chang method was used, completed with the application of retarded immunity skin tests. Malnutrition was observed in 71% por patients with neoplasia, mainly corresponding to slight Marasmo grade. In non-neoplasic patients malnutrition was 46%, also corresponding to slight Marasmo grade. In patients with neoplasia, anergy was evident in 54.9% of cases, and accounted for 23.1% in non-neoplasic patients. The development of anergy in both types of patients was significantly greater (p less than 0.05) in patients over 65 years of age. The inclusion of a PNE should form part of the nursing protocols, being used systematically in the study and control of surgical patients.

  9. Development of the dual SMART micro-surgical system using common-path swept source optical coherence tomography. (United States)

    Park, H C; Yeo, C B; Gehlbach, P L; Song, C


    Manual micro-surgical tasks are fundamentally divided into grasping, cutting and injecting maneuvers performed on biological tissues. Efficient dissection of fibrous tissue from the surface of the retina often requires grasping and cutting maneuvers carried out simultaneously. True bimanual surgery requires that the surgeon contend with the innate hand tremor of two hands at once as well as unpredicted patient's movement. In this study, we develop and test a dual SMART micro-surgical system to suppress bimanual hand tremor during micro-surgical dissection.

  10. Computer versus paper system for recognition and management of sepsis in surgical intensive care. (United States)

    Croft, Chasen A; Moore, Frederick A; Efron, Philip A; Marker, Peggy S; Gabrielli, Andrea; Westhoff, Lynn S; Lottenberg, Lawrence; Jordan, Janeen; Klink, Victoria; Sailors, R Matthew; McKinley, Bruce A


    A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes. A system was designed to provide early recognition and guide patient-specific management of sepsis including (1) modified early warning signs-sepsis recognition score (MEWS-SRS; summative point score of ranges of vital signs, mental status, white blood cell count; after every 4 hours) by bedside nurse; (2) suspected site assessment (vascular access, lung, abdomen, urinary tract, soft tissue, other) at bedside by physician or extender; (3) sepsis management protocol (replicable, point-of-care decisions) at bedside by nurse, physician, and extender. The system was implemented first using paper and then a computerized system. Sepsis severity was defined using standard criteria. In January to May 2012, a paper system was used to manage 77 consecutive sepsis encounters (3.9 ± 0.5 cases per week) in 65 patients (77% male; age, 53 ± 2 years). In June to December 2012, a computerized system was used to manage 132 consecutive sepsis encounters (4.4 ± 0.4 cases per week) in 119 patients (63% male; age, 58 ± 2 years). MEWS-SRS elicited 683 site assessments, and 201 had sepsis diagnosis and protocol management. The predominant site of infection was abdomen (paper, 58%; computer, 53%). Recognition of early sepsis tended to occur more using the computerized system (paper, 23%; computer, 35%). Hospital mortality rate for surgical ICU sepsis (paper, 20%; computer, 14%) was less with the computerized system. A computerized sepsis management system improves care process and outcome. Early sepsis is recognized and managed with greater frequency compared with severe sepsis or septic shock. The system

  11. LIRA - License Renewal Assistant an expert system advisor for system and component screening

    International Nuclear Information System (INIS)

    Wood, R.M.; DeLuke, R.J.; Lu, Yi; Catron, S.R.


    In developing a license renewal application for a nuclear power plant, it is necessary to identify those systems and components for which age-related degradation must be evaluated and addressed in detail. One approach, used in the Monticello Lead Plant project, is to screen all plant systems and components, based on criteria developed by the Nuclear Utility Management and Resources Council (NUMARC). This paper describes an expert system developed as an assistant in the application of the screening methodology. 4 refs., 5 figs., 1 tab

  12. Accuracy of a direct drill-guiding system with minimal tolerance of surgical instruments used for implant surgery: a prospective clinical study. (United States)

    Lee, Du-Hyeong; An, Seo-Young; Hong, Min-Ho; Jeon, Kyoung-Bae; Lee, Kyu-Bok


    A recently introduced direct drill-guiding implant surgery system features minimal tolerance of surgical instruments in the metal sleeve by using shank-modified drills and a sleeve-incorporated stereolithographic guide template. The purpose of this study was to evaluate the accuracy of this new guided surgery system in partially edentulous patients using geometric analyses. For the study, 21 implants were placed in 11 consecutive patients using the direct drill-guiding implant surgery system. The stereolithographic surgical guide was fabricated using cone-beam computed tomography, digital scanning, computer-aided design and computer-assisted manufacturing, and additive manufacturing processes. After surgery, the positional and angular deviations between planned and placed implants were measured at the abutment level using implant-planning software. The Kruskal-Wallis test and Mann-Whitney U test were used to compare the deviations (α=.05). The mean horizontal deviations were 0.593 mm (SD 0.238) mesiodistally and 0.691 mm (SD 0.344) buccolingually. The mean vertical deviation was 0.925 mm (SD 0.376) occlusogingivally. The vertical deviation was significantly larger than the horizontal deviation (P=.018). The mean angular deviation was 2.024 degrees (SD 0.942) mesiodistally and 2.390 degrees (SD 1.142) buccolingually. The direct drill-guiding implant surgery system demonstrates high accuracy in placing implants. Use of the drill shank as the guiding component is an effective way for reducing tolerance.

  13. Surgical treatment of female stress urinary incontinence with the Gynecare TVT Secur™ System – preliminary report

    Directory of Open Access Journals (Sweden)

    Włodzimierz Baranowski


    Full Text Available Introduction: Sling procedures were first introduced over 100 years ago in the treatment of stress urinaryincontinence. Since then they have evolved to become less invasive and safer. The sling procedure using theGynecare TVT Secur™ system is a new therapeutic option for women with stress urinary incontinence.Objectives: To evaluate the efficacy and safety of Gynecare TVT Secur™ in the surgical treatment of stressurinary incontinence in women. Material and methods: The study comprised consecutive female patients admitted to the Department ofGynaecology and Gynaecological Oncology of the Military Institute of Health Services in Warsaw, Poland, whohad been qualified for surgical treatment of stress urinary incontinence on the basis of physical signs and symptomsand the findings of a urodynamic study. The procedure was performed using the Gynecare TVT Secur™system with tapes introduced in an H- or U-shape mode. Results: Between October 2006 and September 2009, 77 sling procedures using the Gynecare TVT Secur™system were performed in women with stress urinary incontinence. Their mean age was 55.1 (30-76 years, meanBMI 28.5 (20.2-43.8 kg/m2. Sixty-nine implants were positioned in H-shape mode, 8 in U-shape mode. Fortyninewomen (63.6% were menopausal, 14 (18.2% previously had three or more natural deliveries, 13 (16.8%had a history of gynaecological surgeries. Thirty-one procedures were performed under general anaesthesia and46 under local anaesthesia. The mean duration of the surgery was 9 (4-42 minutes. It was possible to dischargefifty-seven (74% women on the day of the surgery. Urine retention was observed only in 1 (1.7% woman. Noother complications were recorded. Conclusions: The surgical treatment of urinary incontinence with sling procedures using the Gynecare TVTSecur™ system shows good immediate efficacy and safety. Considering this as well as the short duration ofthe procedure and its good tolerability under local anaesthesia, use

  14. Coding and Billing in Surgical Education: A Systems-Based Practice Education Program. (United States)

    Ghaderi, Kimeya F; Schmidt, Scott T; Drolet, Brian C

    Despite increased emphasis on systems-based practice through the Accreditation Council for Graduate Medical Education core competencies, few studies have examined what surgical residents know about coding and billing. We sought to create and measure the effectiveness of a multifaceted approach to improving resident knowledge and performance of documenting and coding outpatient encounters. We identified knowledge gaps and barriers to documentation and coding in the outpatient setting. We implemented a series of educational and workflow interventions with a group of 12 residents in a surgical clinic at a tertiary care center. To measure the effect of this program, we compared billing codes for 1 year before intervention (FY2012) to prospectively collected data from the postintervention period (FY2013). All related documentation and coding were verified by study-blinded auditors. Interventions took place at the outpatient surgical clinic at Rhode Island Hospital, a tertiary-care center. A cohort of 12 plastic surgery residents ranging from postgraduate year 2 through postgraduate year 6 participated in the interventional sequence. A total of 1285 patient encounters in the preintervention group were compared with 1170 encounters in the postintervention group. Using evaluation and management codes (E&M) as a measure of documentation and coding, we demonstrated a significant and durable increase in billing with supporting clinical documentation after the intervention. For established patient visits, the monthly average E&M code level increased from 2.14 to 3.05 (p patients the monthly average E&M level increased from 2.61 to 3.19 (p educational and workflow interventions, which improved resident coding and billing of outpatient clinic encounters. Using externally audited coding data, we demonstrate significantly increased rates of higher complexity E&M coding in a stable patient population based on improved documentation and billing awareness by the residents. Copyright

  15. [The effectiveness of a system using re-useable linens to reduce the expense of surgical operations]. (United States)

    Nagano, Kazuko; Morita, Saori; Shinoda, Maiko; Kawana, Yuki; Satou, Yuu; Yokozuka, Makito


    We introduced a system that uses re-useable linens for surgical operations in 2008. After 3 years from introduction we were able to reduce the expense of about yen 4,340,000 per year and CO2 production of 9,548 kg CO2 x m(-2) per year. We were convinced of the effect on reducing the expense of surgical operations and of decreasing the level of CO2 production that leads to global warming.

  16. Effect of an Office-Based Surgical Safety System on Patient Outcomes


    Rosenberg, Noah M.; Urman, Richard Dennis; Gallagher, Sean; Stenglein, John Joseph; Liu, Xiaoxia; Shapiro, Fred E.


    Objective: To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications. Methods: We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plast...

  17. Electromagnetic launch systems for civil aircraft assisted take-off

    Directory of Open Access Journals (Sweden)

    Bertola Luca


    Full Text Available This paper considers the feasibility of different technologies for an electromagnetic launcher to assist civil aircraft take-off. This method is investigated to reduce the power required from the engines during initial acceleration. Assisted launch has the potential of reducing the required runway length, reducing noise near airports and improving overall aircraft efficiency through reducing engine thrust requirements. The research compares two possible linear motor topologies which may be efficaciously used for this application. The comparison is made on results from both analytical and finite element analysis (FEA.

  18. Systemic Inflammatory Reaction in Females with Severe Gestosis During Surgical Delivery

    Directory of Open Access Journals (Sweden)

    I. V. Mikhno


    Full Text Available Objective: to study the impact the impact of surgical delivery on the time course of changes in the concentration of tumor necrosis factor-а (TNF-а, interleukin (IL-1/8, y-interferon, IL-4, IL-6, IL-10, and neopterin in the venous blood of women with severe gestosis and to develop a method for correcting a perioperative systemic inflammatory reaction (SIR.Subjects and methods: 89 females in whom surgical delivery had been performed under spinal anesthesia were examined. A control group comprised 30 females with uncomplicated pregnancy; Group 1 included 29 females with severe gestosis; Group 2 consisted of 30 females with severe gestosis to whom the developed method of perioperative SIR correction with dexametha-sone and pentoxyphylline was applied. Solid-phase enzyme immunoassay was used to determine the peripheral blood level of the cytokines and neopterin. The study was conducted in the following steps: 1 before surgery; 2 during surgery (after aponeurosis suturing, 3, 4, and 5 on days 1, 3, and 5 postoperatively, respectively.Results. In females with uncomplicated pregnancy, surgical delivery was accompanied by increases in the concentrations of IL-1/8 and neopterin. This reaction was limited by the increased synthesis of IL-10. Beginning with the third postoperative day, there was a reduction in the level of proinflammatory cytokines. Significantly elevated venous blood concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and decreased levels of anti-inflammatory cytokines, such as IL-10 and IL-4, were detectable in pregnant females with severe gestosis. Against the above background, surgical delivery caused an increase in the synthesis of proinflammatory cytokines and neopterin with the high level being within 5 postoperative days. The developed method for correction of perioperative SIR in females with severe gestosis lowered the concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and neopterin and promoted the recovery of cytokine

  19. Video-based lane estimation and tracking for driver assistance: Survey, system, and evaluation


    McCall, J C; Trivedi, Mohan Manubhai


    Driver-assistance systems that monitor driver intent, warn drivers of lane departures, or assist in vehicle guidance are all being actively considered. It is therefore important to take a critical look at key aspects of these systems, one of which is lane-position tracking. It is for these driver-assistance objectives that motivate the development of the novel "video-based lane estimation and tracking" (VioLET) system. The system is designed using steerable filters for robust and accurate lan...

  20. A multimedia electronic patient record (ePR) system for image-assisted minimally invasive spinal surgery. (United States)

    Documet, Jorge; Le, Anh; Liu, Brent; Chiu, John; Huang, H K


    This paper presents the concept of bridging the gap between diagnostic images and image-assisted surgical treatment through the development of a one-stop multimedia electronic patient record (ePR) system that manages and distributes the real-time multimodality imaging and informatics data that assists the surgeon during all clinical phases of the operation from planning Intra-Op to post-care follow-up. We present the concept of this multimedia ePR for surgery by first focusing on image-assisted minimally invasive spinal surgery as a clinical application. Three clinical phases of minimally invasive spinal surgery workflow in Pre-Op, Intra-Op, and Post-Op are discussed. The ePR architecture was developed based on the three-phased workflow, which includes the Pre-Op, Intra-Op, and Post-Op modules and four components comprising of the input integration unit, fault-tolerant gateway server, fault-tolerant ePR server, and the visualization and display. A prototype was built and deployed to a minimally invasive spinal surgery clinical site with user training and support for daily use. A step-by-step approach was introduced to develop a multimedia ePR system for imaging-assisted minimally invasive spinal surgery that includes images, clinical forms, waveforms, and textual data for planning the surgery, two real-time imaging techniques (digital fluoroscopic, DF) and endoscope video images (Endo), and more than half a dozen live vital signs of the patient during surgery. Clinical implementation experiences and challenges were also discussed.

  1. Reduction in surgical fog with a warm humidified gas management protocol significantly shortens procedure time in pediatric robot-assisted laparoscopic procedures. (United States)

    Meenakshi-Sundaram, B; Furr, J R; Malm-Buatsi, E; Boklage, B; Nguyen, E; Frimberger, D; Palmer, B W


    The adoption of robot-assisted laparoscopic (RAL) procedures in the field of urology has occurred rapidly, but is, to date, without pediatric-specific instrumentation. Surgical fog is a significant barrier to safe and efficient laparoscopy. This appears to be a significant challenge when adapting three-dimensional 8.5-mm scopes to use in pediatric RAL surgery. The objective of the present study was to compare matched controls from a prospectively collected database to procedures that were performed utilizing special equipment and a protocol to minimize surgical fog in pediatric RAL procedures. A prospectively collected database of all patients who underwent RAL pediatric urology procedures was used to compare: procedure, age, sex, American Society of Anesthesiologists score, weight, console time, number of times the camera was removed to clean the lens during a procedure, length of hospital stay, and morphine equivalents required in the postoperative period. A uniquely developed protocol was used, it consisted of humidified (95% relative humidity) and warmed CO 2 gas (95 °F) insufflation via Insuflow® on a working trocar, with active smoke evacuation via PneuVIEW®XE on the opposite working trocar with a gas pass through of 3.5-5 l/min. The outcomes were compared with matched controls (Summary Fig). The novel gas protocol was utilized in 13 procedures (five pyeloplasties, two revision pyeloplasties, three ureteroureterostomies (UU), three nephrectomies) and compared with 13 procedures (six pyeloplasties, one revision pyeloplasty, three UU, three nephrectomies) prior to the protocol development. There was no statistical difference in age (P = 0.78), sex (P = 0.11), ASA score (P = 1.00) or weight (P = 0.69). There were no open conversions, ≥Grade 2 Clavien complications, or readmissions within 30 days in either group. This novel gas protocol yielded a statistically significant reduction in procedure time, by decreasing the number of times the camera was

  2. An integrated smart system for ambient-assisted living

    CSIR Research Space (South Africa)

    Foko, Thato E


    Full Text Available customised to the South African environment to support ambient assisted living. The technology takes advantage of South Africa’s digitalisation programme to provide broadband access in the support of AAL. Digital television as a gateway to internet access...

  3. Abortion - surgical (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  4. Computer assisted roentgenology

    International Nuclear Information System (INIS)

    Trajkova, N.; Velkova, K.


    This is a report on the potentials and superiorities of computer tomography (CT), assumed as an up-to-date imaging examination method in medicine. The current trend in the development of computer assisted roentgenology consists in the implementation of new computer and communication systems promoting diagnostic and therapeutic activities. CT-study application is discussed with special reference to diagnosis and treatment of brain, lung, mediastinal and abdominal diseases. The new trends in the particular implementation of CT are presented, namely: CT-assisted biopsy, CT-assisted abscess drainage, drug administration under CT control, as well as the wide use of CT in orthopaedic surgery, otorinolaryngology etc. Also emphasis is laid on the important role played by three-dimensional technologies in computer-assisted surgery, leading to qualitatively new stage in the surgical therapeutic approach to patients

  5. Using a hybrid electronic medical record system for the surveillance of adverse surgical events and human error in a developing world surgical service. (United States)

    Laing, Grant; Bruce, John; Skinner, David; Allorto, Nikki; Aldous, Colleen; Thomson, Sandie; Clarke, Damian


    The quantification and analysis of adverse events is essential to benchmark surgical outcomes and establish a foundation for quality improvement interventions. We developed a hybrid electronic medical record (HEMR) system for the accurate collection and integration of data into a structured morbidity and mortality (M&M) meeting. The HEMR system was implemented on January 1, 2013. It included a mechanism to capture and classify adverse events using the ICD-10 coding system. This was achieved by both prospective reporting by clients and by retrospective sentinel-event-trawling performed by administrators. From January 1, 2013 to March 20, 2014, 6,217 patients were admitted within the tertiary surgical service of Greys Hospital. A total of 1,314 (21.1 %) adverse events and 315 (5.1 %) deaths were recorded. The adverse events were divided into 875 "pathology-related" morbidities and 439 "error-related" morbidities. Pathology-related morbidities included 725 systemic complications and 150 operative complications. Error-related morbidities included 257 cognitive errors, 158 (2.5 %) iatrogenic injuries, and 24 (1.3 %) missed injuries. Error accounted for 439 (33 %) of the total number of adverse events. A total of 938 (71.4 %) adverse events were captured prospectively, whereas the remaining 376 (28.6 %) were captured retrospectively. The ICD-10 coding system was found to have some limitations in its classification of adverse events. The HEMR system has provided the necessary platform within our service to benchmark the incidence of adverse events. The use of the international ICD-10 coding system has identified some limitations in its ability to classify and categorise adverse events in surgery.

  6. 78 FR 22536 - Procedural Manual for the Election Assistance Commission's Voting System Test Laboratories... (United States)


    ... ELECTION ASSISTANCE COMMISSION Procedural Manual for the Election Assistance Commission's Voting...) is publishing a procedural manual for its Voting System Testing and Certification Program. This... draft procedural manual on or before 5:00 p.m. EDT on June 17, 2013. ADDRESSES: Submit comments via...

  7. 75 FR 74025 - Procedural Manual for the Election Assistance Commission's Voting System Testing and... (United States)


    ... ELECTION ASSISTANCE COMMISSION Procedural Manual for the Election Assistance Commission's Voting... (EAC) is publishing a procedural manual for its Voting System Testing and Certification Program. This... procedural manual on or before 5 p.m. EDT on January 31, 2011. ADDRESSES: Submit comments via e-mail to...

  8. An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease. (United States)

    Garzón-Maldonado, F J; Gutiérrez-Bedmar, M; Serrano-Castro, V; Requena-Toro, M V; Padilla-Romero, L; García-Casares, N

    Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Toilet Assistive System Designed for the Reduction of Accidental Falls in the Bathroom Using Admittance Controller

    Directory of Open Access Journals (Sweden)

    Martin J.-D. Otis


    Full Text Available This paper suggests an assistive system for the toilet with the objective of measuring human activities and to provide intelligent mechanical assistance to help seating and standing. The project intends to develop a seating assistance as a technical aid in order to reduce accidents and falls in the bathroom. The preferred technique is human-robot physical interaction algorithms known in collaborative robotics (cobot and adapting it to a personalized assistance technology installed on a smart toilet. First, the design of the mechanical assistance is presented. Then, an admittance controller is designed and implemented in order to help the user in a similar way as a cobot could be used. This technique could be used to assist the user and improve balance with adequate training and an adequate configuration of the admittance controller.

  10. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra


    To examine the costs to the public health care system of couples in medically assisted reproduction.......To examine the costs to the public health care system of couples in medically assisted reproduction....

  11. An economic evaluation of a systems-based strategy to expedite surgical treatment of hip fractures. (United States)

    Dy, Christopher J; McCollister, Kathryn E; Lubarsky, David A; Lane, Joseph M


    A recent systematic review has indicated that mortality within the first year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds forty-eight hours. Further investigation has shown that avoidable, systems-based factors contribute substantially to delay in surgery. In this study, an economic evaluation was conducted to determine the cost-effectiveness of a hypothetical scenario in which resources are allocated to expedite surgery so that it is performed within forty-eight hours after admission. We created a decision tree to tabulate incremental cost and quality-adjusted life years in order to evaluate the cost-effectiveness of two potential strategies. Several factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within forty-eight hours, and mortality associated with delayed surgery, were considered. One strategy focused solely on expediting preoperative evaluation by employing personnel to conduct the necessary diagnostic tests and a hospitalist physician to conduct the medical evaluation outside of regular hours. The second strategy added an on-call team (nurse, surgical technologist, and anesthesiologist) to staff an operating room outside of regular hours. The evaluation-focused strategy was cost-effective, with an incremental cost-effectiveness ratio of $2318 per quality-adjusted life year, and became cost-saving (a dominant therapeutic approach) if =93% of patients underwent expedited surgery, the hourly cost of retaining a diagnostic technologist on call was strategy. The second strategy, which added an on-call surgical team, was also cost-effective, with an incremental cost-effectiveness ratio of $43,153 per quality-adjusted life year. Sensitivity analysis revealed that this strategy remained cost-effective if the odds ratio of one-year mortality associated with delayed surgery was >1.28, =88% of patients underwent early surgery, or =339.9 patients with a

  12. Establishing the customized occlusal plane in systemized surgical treatment objectives of class III. (United States)

    Baek, Seung-Hak; Ahn, Hyo-Won; Yang, Sang-Duck; Choi, Jin-Young


    The purpose of this study was to present a new approach for establishing the customized occlusal plane for an individual patient in systemized surgical treatment objective of class III cases. After the correction of incisor inclination to occlusal planes (U1-MxOP and L1-MnOP), the intermaxillary relationship can be established with normal overbite/overjet and maximum intercuspation. The anterior limits of the maxilla and the mandible can be positioned according to A to N perpendicular, Frankfort horizontal (FH) to AB plane angle, and upper incisor display. The vertical level of the upper first molar can then be determined in relation to the Y plane (an imaginary arch drawn using the distance between the lower incisor edge point and the rotation center point of the condylar head as a radius) and a triangle projected by the upper and lower limits of the FH to the occlusal plane (FH-OP triangle). Soft-tissue facial balance can be checked with the lip/chin projection in relation to the true vertical line at subnasale and the lower third facial height ratio. Appropriate superior impaction of the posterior part of the maxilla in relation to the Y plane and FH-OP triangle in case 1 produced significant improvement of the facial profile and occlusion. However, case 2 showed that the amount of superior impaction of the posterior part of the maxilla was not enough to produce a significant setback of the mandible and retraction of the lip and chin. The systemized surgical treatment objective flowchart that could set the customized occlusal plane for an individual patient might provide a useful guideline for obtaining optimal aesthetics and functional occlusion in class III cases.

  13. The galenic venous system: Surgical anatomy and its angiographic and magnetic resonance venographic correlations

    International Nuclear Information System (INIS)

    Kilic, Tuerker; Ozduman, Koray; Cavdar, Safiye; Oezek, M. Memet; Pamir, M. Necmettin


    Objective: This study aims at evaluating the adequacy of digital subtraction angiography and magnetic resonance venography in imaging of the galenic venous system for surgical planning of approaches to the pineal region. Anatomical dissections were carried out in 10 cadavers of several age groups and these were compared to imaging findings in 10 living subjects. Methods: The presence or absence of 10 predetermined veins or vein groupings belonging to the galenic venous system were prospectively analyzed in 10 cadaver dissections and imaging findings of 10 age matched human subjects. The studied vessels were the vein of galen, the internal cerebral veins, both basal vein of Rosenthals, internal occipital vein, occipitotemporal veins, precentral cerebellar veins, tectal veins, pineal veins, superior vermian veins (including superior cerebellar veins (SCVs)) and posterior pericallosal veins. Each of the subjects had both digital subtraction angiography and magnetic resonance venography studies performed. Diagnostic digital subtraction angiography was performed using the transfemoral route and the venous phase was used for the study. Magnetic resonance venography was performed in 1.5 T MRI equipment using the 2D-TOF sequence. All studies were reported to be normal. Results: There was wide variation in the anatomy of the galenic venous system. There were interpersonal, intrapersonal and age related variations. Both the digital subtraction angiography and the magnetic resonance venography were efficient at demonstrating large veins. However, smaller veins were less readily demonstrated in either study. The general sensitivities of the digital subtraction angiography and the magnetic resonance venography for the galenic venous system were 45.5% and 32.5%, respectively. Surgically important veins were missed in most studies. Conclusions: Anatomically, the galenic venous system is highly variable. This variability is caused by interpersonal, intrapersonal and age related

  14. Study of the Operational Safety of a Vascular Interventional Surgical Robotic System

    Directory of Open Access Journals (Sweden)

    Jian Guo


    Full Text Available This paper proposes an operation safety early warning system based on LabView (2014, National Instruments Corporation, Austin, TX, USA for vascular interventional surgery (VIS robotic system. The system not only provides intuitive visual feedback information for the surgeon, but also has a safety early warning function. It is well known that blood vessels differ in their ability to withstand stress in different age groups, therefore, the operation safety early warning system based on LabView has a vascular safety threshold function that changes in real-time, which can be oriented to different age groups of patients and a broader applicable scope. In addition, the tracing performance of the slave manipulator to the master manipulator is also an important index for operation safety. Therefore, we also transformed the slave manipulator and integrated the displacement error compensation algorithm in order to improve the tracking ability of the slave manipulator to the master manipulator and reduce master–slave tracking errors. We performed experiments “in vitro” to validate the proposed system. According to previous studies, 0.12 N is the maximum force when the blood vessel wall has been penetrated. Experimental results showed that the proposed operation safety early warning system based on LabView combined with operating force feedback can effectively avoid excessive collisions between the surgical catheter and vessel wall to avoid vascular puncture. The force feedback error of the proposed system is maintained between ±20 mN, which is within the allowable safety range and meets our design requirements. Therefore, the proposed system can ensure the safety of surgery.

  15. Benchtop and Animal Validation of a Projective Imaging System for Potential Use in Intraoperative Surgical Guidance. (United States)

    Gan, Qi; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Hu, Chuanzhen; Shao, Pengfei; Xu, Ronald X


    We propose a projective navigation system for fluorescence imaging and image display in a natural mode of visual perception. The system consists of an excitation light source, a monochromatic charge coupled device (CCD) camera, a host computer, a projector, a proximity sensor and a Complementary metal-oxide-semiconductor (CMOS) camera. With perspective transformation and calibration, our surgical navigation system is able to achieve an overall imaging speed higher than 60 frames per second, with a latency of 330 ms, a spatial sensitivity better than 0.5 mm in both vertical and horizontal directions, and a projection bias less than 1 mm. The technical feasibility of image-guided surgery is demonstrated in both agar-agar gel phantoms and an ex vivo chicken breast model embedding Indocyanine Green (ICG). The biological utility of the system is demonstrated in vivo in a classic model of ICG hepatic metabolism. Our benchtop, ex vivo and in vivo experiments demonstrate the clinical potential for intraoperative delineation of disease margin and image-guided resection surgery.

  16. A multidisciplinary systems-based practice learning experience and its impact on surgical residency education. (United States)

    Siri, Jean; Reed, Alan I; Flynn, Timothy C; Silver, Michele; Behrns, Kevin E


    To design and implement a multidisciplinary systems-based practice learning experience that is focused on improving and standardizing the preoperative quality of care for general surgical patients. Four parameters of preoperative care were designated as quality assessment variables, including bowel preparation, perioperative beta-blockade, prophylactic antibiotic use, and deep venous thrombosis prevention. Four groups of general surgery residents (PGY I-V), each led by 1 chief resident, were assigned a quality parameter, performed an evidence-based current literature review, and formulated a standardized management approach based on the level of evidence and recommendations available. Because preoperative preparation includes anesthetic care and operating room preparation, we presented our findings at the Department of Surgery Grand Rounds in a multidisciplinary format that included presentations by each resident group, the Department of Anesthesia, the Department of Medicine, and the Department of Nursing. The aim of the multidisciplinary quality assurance conference was to present the evidence-based literature findings in order to determine how standardization of preoperative care would alter anesthetic and nursing care, and to obtain feedback about management protocols. To determine the educational impact of this model of integrated systems-based practice quality assessment on the teaching experience, residents were queried regarding the value of this educational venue and responses were rated on a Likert scale. Resident participation was excellent. The residents garnered valuable information by performing a literature review and evaluating the best preoperative preparation given each parameter. Furthermore, integration of their findings into systems-based practice including anesthesia and nursing care provided an appreciation of the complexities of care as well as the associated need for appropriate medical knowledge, communication, and professionalism. The

  17. Adaptive importance sampling for probabilistic validation of advanced driver assistance systems

    NARCIS (Netherlands)

    Gietelink, O.J.; Schutter, B. de; Verhaegen, M.


    We present an approach for validation of advanced driver assistance systems, based on randomized algorithms. The new method consists of an iterative randomized simulation using adaptive importance sampling. The randomized algorithm is more efficient than conventional simulation techniques. The

  18. Proving autonomous vehicle and advanced driver assistance systems safety : final research report. (United States)


    The main objective of this project was to provide technology for answering : crucial safety and correctness questions about verification of autonomous : vehicle and advanced driver assistance systems based on logic. : In synergistic activities, we ha...

  19. IR Beacon System for Assisted or Automated Landing of Aircraft, Phase I (United States)

    National Aeronautics and Space Administration — OKSI proposes to design an optical system to support assisted or automated precision approach of fixed or rotary wing aircraft, or other low altitude airspace...

  20. Design methodology for fault-tolerant control of advanced driver assistance systems

    NARCIS (Netherlands)

    Gietelink, O.J.; Ploeg, J.; Schutter, B. de; Verhaegen, M.H.G.


    The objective of this project is to develop a methodology for the design, testing, evaluation and implementation of control systems for Advanced Driver Assistance Systems (ADAS). Examples of ADAS are collision avoidance systems, lane departure warning systems, pre-crash sensing, and adaptive cruise

  1. Using a Dialogue System Based on Dialogue Maps for Computer Assisted Second Language Learning (United States)

    Choi, Sung-Kwon; Kwon, Oh-Woog; Kim, Young-Kil; Lee, Yunkeun


    In order to use dialogue systems for computer assisted second-language learning systems, one of the difficult issues in such systems is how to construct large-scale dialogue knowledge that matches the dialogue modelling of a dialogue system. This paper describes how we have accomplished the short-term construction of large-scale and…

  2. Robot-assisted submandibular gland excision via modified facelift incision


    Jung, Seung Wook; Kim, Young Kwan; Cha, Yong Hoon; Koh, Yoon Woo; Nam, Woong


    Background The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. Case presentation The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar c...

  3. Shift and Duty Scheduling of Surgical Technicians in Naval Hospitals

    National Research Council Canada - National Science Library

    Nurse, Nigel


    Surgical technicians at Naval hospitals provide a host of services related to surgical procedures that include handing instruments to surgeons, assisting operating room nurses, prepping and cleaning...

  4. The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery. (United States)

    Inaba, Kenji; Okoye, Obi; Aksoy, Hande; Skiada, Dimitra; Ault, Glenn; Sener, Stephen; Lam, Lydia; Benjamin, Elizabeth; Demetriades, Demetrios


    To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery. Emergency surgery patients are at high risk for retained foreign bodies. All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed. In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8. Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.

  5. Gravity-assist heat pipes for thermal control systems

    International Nuclear Information System (INIS)

    Deverall, J.E.; Keddy, E.S.; Kemme, J.E.; Phillips, J.R.


    Sodium heat pipes, operating in the gravity-assist mode, have been incorporated into irradiation capsules to provide a means for establishing and controlling a desired specimen temperature. Investigations were made of new wick structures for potassium heat pipes to operate at lower temperatures and higher heat transfer rates, and a helical trough wick structure was developed with an improved heat transfer capability in the temperature range of interest. Test results of these heat pipes led to the study of a new heat pipe limit which had not previously been considered. (12 references) (U.S.)

  6. Automatic delirium prediction system in a Korean surgical intensive care unit. (United States)

    Oh, Suk-Hwa; Park, Eun-Ju; Jin, Yinji; Piao, Jinshi; Lee, Sun-Mi


    In Korea, regular screening for delirium is not considered essential. In addition, delirium is often associated with vague concepts, making it harder to identify high-risk patients and impeding decision-making. To assess the impact of the Automatic PREdiction of DELirium in Intensive Care Units (APREDEL-ICU) system on nursing-sensitive and patient outcomes for surgical ICU patients and to evaluate nurse satisfaction with the system and its usability. A pre-post research design was adopted. Our study included 724 patients admitted before the implementation of the APREDEL-ICU (January to December 2010) and 1111 patients admitted after the system was installed (May 2011 to April 2012). The APREDEL-ICU uses a pop-up window message to inform the nursing staff of patients at risk for delirium, allowing evidence-based nursing interventions to be applied to the identified patients. A total of 42 nurses were surveyed to determine the system's usability and their level of satisfaction with it. After the implementation of APREDEL-ICU, high-risk patients, determined using a prediction algorithm, showed a slight decrease in the incidence of delirium, but the changes were not significant. However, significant decreases in the number and duration of analgesic/narcotic therapies were observed after the implementation of the system. Nurse self-evaluation results showed an improvement in all categories of knowledge regarding delirium care. The use of a prediction and alerting system for ICU patients at high risk of delirium showed a potential increase in the quality of delirium care, including early detection and proper intervention. © 2013 British Association of Critical Care Nurses.

  7. Study on the System Design of a Solar Assisted Ground Heat Pump System Using Dynamic Simulation

    Directory of Open Access Journals (Sweden)

    Min Gyung Yu


    Full Text Available Recently, the use of hybrid systems using multiple heat sources in buildings to ensure a stable energy supply and improve the system performance has gained attention. Among them, a heat pump system using both solar and ground heat was developed and various system configurations have been introduced. However, establishing a suitable design method for the solar-assisted ground heat pump (SAGHP system including a thermal storage tank is complicated and there are few quantitative studies on the detailed system configurations. Therefore, this study developed three SAGHP system design methods considering the design factors focused on the thermal storage tank. Using dynamic energy simulation code (TRNSYS 17, individual performance analysis models were developed and long-term quantitative analysis was carried out to suggest optimum design and operation methods. As a result, it was found that SYSTEM 2 which is a hybrid system with heat storage tank for only a solar system showed the highest average heat source temperature of 14.81 °C, which is about 11 °C higher than minimum temperature in SYSTEM 3. Furthermore, the best coefficient of performance (COP values of heat pump and system were 5.23 and 4.32 in SYSYEM 2, using high and stable solar heat from a thermal storage tank. Moreover, this paper considered five different geographical and climatic locations and the SAGHP system worked efficiently in having high solar radiation and cool climate zones and the system COP was 4.51 in the case of Winnipeg (Canada where the highest heating demand is required.

  8. [Past roles and future prospects of the National Clinical Database for board-certifying systems of the Japan Surgical Society]. (United States)

    Kitago, Minoru; Kitagawa, Yuko


    Board-certifying systems play an important role as guideposts in postgraduate training courses to develop superior surgeons with both general and subspecialty surgery competence. The board-certified surgeon designation of the Japan Surgical Society (JSS) as the first guidepost has provided the foundations for board-certified surgeon systems of subspecialty surgical societies as the second guidepost. In April 2010, the National Clinical Database (NCD) was founded by the JSS and other societies. Data on surgery and treatment have been entered into the NCD from January 1, 2011, and more than 1 million cases were submitted to the NCD in that year. The NCD is an unprecedented, advanced activity. The data will be used for the authorization of board-certified surgeons of subspecialty surgical societies as well as that of the JSS. The data will be also used for benchmarking, and clinical research teams will cooperate with the NCD.

  9. Yttrium-90 microsphere selective internal radiation therapy for liver metastases following systemic chemotherapy and surgical resection for metastatic adrenocortical carcinoma. (United States)

    Makary, Mina S; Krishner, Lawrence S; Wuthrick, Evan J; Bloomston, Mark P; Dowell, Joshua D


    Adrenocortical carcinoma (ACC) is a rare malignancy with generally poor outcomes and limited treatment options. While surgical resection can be curative for early local disease, most patients present with advanced ACC owing to nonspecific symptoms. For those patients, treatment options include systemic chemotherapy and locoregional therapies including radiofrequency ablation and transarterial chemoembolization. We present the first reported case of utilizing yttrium-90 microsphere selective internal radiation therapy (SIRT) in combination with first line EDP-M (Etoposide, Doxorubicin, Cisplatin, Mitotane) chemotherapy and debulking surgical primary tumor resection for treatment of metastatic ACC. Stable complete radiologic response has been maintained after twelve months with resolution of clinical symptoms. These findings prompt the need for further consideration and studies to elucidate the role of SIRT in combination with systemic and surgical treatment for metastatic ACC.

  10. [Robot-assisted vs laparoscopic gastric bypass : First experiences with the DaVinci system in bariatric surgery]. (United States)

    Beckmann, J H; Aselmann, H; Egberts, J H; Bernsmeier, A; Laudes, M; Becker, T; Schafmayer, C; Ahrens, M


    Conventional laparoscopy is the gold standard in bariatric surgery. Internationally, robot-assisted surgery is gaining in importance. Up to now there are only few reports from Germany on the use of the system in bariatric surgery. Since January 2017 we have been performing robot-assisted gastric bypass surgery. It remains unclear whether the use of the robotic system has advantages over the well-established laparoscopic technique. Within a period from January to early August 2017 a total of 53 gastric bypass operations were performed. Of these 16 proximal redo Roux-en-Y gastric bypass operations were performed with the DaVinci Si system versus 29 laparoscopic procedures. A retrospective analysis of the perioperative course was carried out. Body weight, body mass index (BMI), Edmonton obesity staging system (EOSS) and American Society of Anesthesiologists (ASA) classification did not show significant differences. There were also no significant differences in terms of estimated blood loss, intraoperative complications, duration of surgery, postoperative inflammatory parameters and weight loss. There was no mortality and no need for revisional surgery in either group. After laparoscopic surgery there was a delayed occurrence of a leak of the gastrojejunostomy followed by readmission and endoscopic negative pressure wound therapy. The results show that the proximal Roux-en-Y gastric bypass can be performed safely and efficiently using the DaVinci surgical system. Significant differences to the conventional laparoscopic procedure were not found. Larger randomized controlled trials are needed to define the role of the DaVinci system in bariatric surgery.

  11. The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity. (United States)

    Wang, Li-ya; Du, Hong-ming; Zhang, Gang; Tang, Wei; Liu, Lei; Jing, Wei; Long, Jie


    The craniomaxillofacial defect and deformity always leads to serious dysfunction in mastication and facial contour damage, significantly reducing patients' quality of life. However, surgical reconstruction of a craniomaxillofacial hard tissue defect or deformity is extremely complex and often does not result in desired facial morphology. Improving the result for patients with craniomaxillofacial defect and deformity remains a challenge for surgeons. Using digital technology for surgical diagnosis and treatment may help solve this problem. Computer-assisted surgical technology and surgical navigation technology are included in the accurate digital diagnosis and treatment system we propose. These technologies will increase the accuracy of the design of the operation plan. In addition, the intraoperative real-time navigating location system controlling the robotic arm or advanced intelligent robot will provide accurate, individualized surgical treatment for patients. Here we propose the hypothesis that a digital surgical diagnosis and treatment technology may provide a new approach for precise surgical reconstruction of complicated craniomaxillofacial defect and deformity. Our hypothesis involves modern digital surgery, a three-dimensional navigation surgery system and modern digital imaging technology, and our key aim is to establish a technological platform for customized digital surgical design and surgical navigation for craniomaxillofacial defect and deformity. If the hypothesis is proven practical, this novel therapeutic approach could improve the result of surgical reconstruction for craniomaxillofacial defect and deformity for many patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study. (United States)

    Exarchopoulos, Themistocles; Charitidou, Efstratia; Dedeilias, Panagiotis; Charitos, Christos; Routsi, Christina


    Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients. ©2015 American Association of Critical-Care Nurses.

  13. Compact Hip-Force Sensor for a Gait-Assistance Exoskeleton System. (United States)

    Choi, Hyundo; Seo, Keehong; Hyung, Seungyong; Shim, Youngbo; Lim, Soo-Chul


    In this paper, we propose a compact force sensor system for a hip-mounted exoskeleton for seniors with difficulties in walking due to muscle weakness. It senses and monitors the delivered force and power of the exoskeleton for motion control and taking urgent safety action. Two FSR (force-sensitive resistors) sensors are used to measure the assistance force when the user is walking. The sensor system directly measures the interaction force between the exoskeleton and the lower limb of the user instead of a previously reported force-sensing method, which estimated the hip assistance force from the current of the motor and lookup tables. Furthermore, the sensor system has the advantage of generating torque in the walking-assistant actuator based on directly measuring the hip-assistance force. Thus, the gait-assistance exoskeleton system can control the delivered power and torque to the user. The force sensing structure is designed to decouple the force caused by hip motion from other directional forces to the sensor so as to only measure that force. We confirmed that the hip-assistance force could be measured with the proposed prototype compact force sensor attached to a thigh frame through an experiment with a real system.

  14. Model Transformation in context of Driver Assistance System


    Kappattanavar, Abhishek Mallikarjuna


    In today’s world we see that Embedded Systems forms a major part in the life of a human being. Almost every device today has an electronic chip embedded in it. When it comes to automotive, these electronic devices are multiplying. This has resulted in innovative methods of developing Embedded Systems. Among them, Model Based Development has become very popular and a standard way of developing embedded systems. Now, we can see that most embedded systems, especially the automotive systems, are ...

  15. [Horus: technological innovation in pharmaceutical assistance within the Brazilian unified health system]. (United States)

    Costa, Karen Sarmento; Nascimento, José Miguel do


    To analyze results of the Horus Information System, comparing elements of this system with some international experiences. Horus is a technological innovation introduced in 2009 in the Pharmaceutical management information system of the Sistema Único de Saúde (Brazilian Unified Health System). In 2011, local managers and health professionals of 1,247 municipalities (16 states) that adhered to Horus answered questionnaires on pharmaceutical assistance in primary care and about the Horus system. This is a descriptive and exploratory study, developed with the use of quantitative and qualitative methods of research. Multivariate tools were used for data collection and interpretative support of the statistical inference and thematic analysis. The main changes identified after the implementation of this system were: improvement on technical and scientific quality control of Pharmaceutical Assistance, improvement on the supply of medications and health care; training of human resources and knowledge management; improvement on the relationship health managers/users; development in the administrative management and greater inter-state management; and improvement on the technological infrastructure. In terms of health information systems, these categories are consistent with programs and obstacles observed in international experiences. The biggest gap identified was the fact that Horus was not included in a national policy of health information systems, which is in a process of consolidation in Brazil. The national database of actions and services within the Pharmaceutical Assistance will enable the collection, analysis and dissemination of information regarding integrated pharmaceutical assistance in the Brazilian context. The Horus System is a technological innovation that enables the management of the Pharmaceutical Assistance. The national base will enable the definition and agreement on national indicators of Pharmaceutical Assistance, aiming to produce evidence of

  16. [Implementation of a post-discharge surgical site infection system in herniorrhaphy and mastectomy procedures]. (United States)

    San Juan Sanz, Isabel; Díaz-Agero-Pérez, Cristina; Robustillo-Rodela, Ana; Pita López, María José; Oliva Iñiguez, Lourdes; Monge-Jodrá, Vicente


    Monitoring surgical site infection (SSI) performed during hospitalization can underestimate its rates due to the shortening in hospital stay. The aim of this study was to determine the actual rates of SSI using a post-discharge monitoring system. All patients who underwent herniorraphy or mastectomy in the Hospital Universitario Ramón y Cajal from 1 January 2011 to 31 December 2011 were included. SSI data were collected prospectively according to the continuous quality improvement indicators (Indicadores Clinicos de Mejora Continua de la Calidad [INCLIMECC]) monitoring system. Post-discharge follow-up was conducted by telephone survey. A total of 409patients were included in the study, of whom 299 underwent a herniorraphy procedure, and 110 underwent a mastectomy procedure. For herniorrhaphy, the SSI rate increased from 6.02% to 7.6% (the post-discharge survey detected 21.7% of SSI). For mastectomy, the SSI rate increased from 1.8% to 3.6% (the post-discharge survey detected 50% of SSI). Post-discharge monitoring showed an increased detection of SSI incidence. Post-discharge monitoring is useful to analyze the real trend of SSI, and evaluate improvement actions. Post-discharge follow-up methods need to standardised. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  17. Getting ADAS on the Road : Actors' Interactions in Advanced Driver Assistance Systems Deployment

    NARCIS (Netherlands)

    Walta, L.


    Currently, many car drivers spend many hours in congested traffic. If their cars would have been equipped with an electronic system that automatically follows the car in front of them, congestion might have been prevented. Such a system is an example of Advanced Driver Assistance Systems (ADAS).

  18. Computer-Assisted English Learning System Based on Free Conversation by Topic (United States)

    Choi, Sung-Kwon; Kwon, Oh-Woog; Kim, Young-Kil


    This paper aims to describe a computer-assisted English learning system using chatbots and dialogue systems, which allow free conversation outside the topic without limiting the learner's flow of conversation. The evaluation was conducted by 20 experimenters. The performance of the system based on a free conversation by topic was measured by the…

  19. A cohort study of a general surgery electronic consultation system: safety implications and impact on surgical yield. (United States)

    Ulloa, Jesus G; Russell, Marika D; Chen, Alice Hm; Tuot, Delphine S


    Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case). Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014. Electronic consultation requests were reviewed for the presence/absence of consult domains: symptom acuity/severity, diagnostic evaluation, concurrent medical conditions, and attempted diagnosis. Logic regression was used to examine the association between completeness of consult requests and scheduling an ambulatory clinic visit. Surgical yield was also calculated, as was the percentage of patients requiring unanticipated healthcare visits. In 2014, 1743 electronic consultations were submitted to general surgery. Among the 150 abstracted, the presence of consult domains ranged from 49% to 99%. Consult completeness was not associated with greater likelihood of scheduling an ambulatory visit. Seventy-six percent of consult requests (114/150) were scheduled for a clinic appointment and surgical yield was 46%; without an eConsult system, surgical yield would have been 35% (p=0.07). Among patients not scheduled for a clinic visit (n=36), 4 had related unanticipated emergency department visits. Econsult systems can be used to safely optimize the surgical yield of a safety-net general surgery service.

  20. Surgical, functional and audiological evaluation of new Baha(®) Attract system implantations. (United States)

    Gawęcki, Wojciech; Stieler, Olgierd Maciej; Balcerowiak, Andrzej; Komar, Dariusz; Gibasiewicz, Renata; Karlik, Michał; Szyfter-Harris, Joanna; Wróbel, Maciej


    Bone-anchored hearing aids are well-established solutions for treatment of hearing-impaired patients. However, classical systems with percutaneous abutments have disadvantages concerning aesthetics, hygiene and adverse soft tissue reactions. The study aimed to evaluate surgical, functional and audiological results of a new Baha(®) Attract system, in which the sound processor is attached by magnetic force. Twenty patients implanted with a Baha(®) Attract system were divided into two groups: A-bilateral mixed and conductive hearing loss, B-single-sided deafness, and evaluated during a 6-month follow-up. Parameters analysed comprised: (1) surgery and wound healing, (2) postoperative functional results (GBI, APHAB and BAHU questionnaires), (3) audiological results (free field speech in noise audiometry in two situations: with signal from implant side and from contralateral side). Obtained results revealed: mean time of surgery-44 min, soft tissue reduction-30 %, bone polishing-20 %, haematoma-10 %. Functional results showed: GBI total score-29.6 points, APHAB global score mean gain-23.5 %, BAHU 'good or very good' score for: aesthetic-85 %, hygiene-100 %, ease of placing the processor-100 %, stability of attraction-75 %. Audiological results-mean gain for the two analysed situations: 32.9 % (group A-36.5 %, group B-27.5 %). To conclude, the data obtained prove the safety and effectiveness of the Baha(®) Attract system in patients with conductive and mixed hearing loss as well as in patients with single-sided deafness. Cosmetic aspects are highly acceptable and the idea of Attract itself is important for patients with limited manual dexterity.

  1. Potential for in-car speed assistance systems : results of a large-scale survey in Belgium and the Netherlands

    NARCIS (Netherlands)

    Vlassenroot, S.; Marchau, V.; De Mol, J.; Brookhuis, K.; Witlox, F.

    Speeding is generally considered to be a major cause of road traffic accidents. In-car speed assistance systems aim at reducing speeding. Several trials with different types of in-car speed assistance systems, in particular intelligent speed assistance (ISA), have shown that ISA can be an effective

  2. Transitional versus surgical menopause in a rodent model: etiology of ovarian hormone loss impacts memory and the acetylcholine system. (United States)

    Acosta, Jazmin I; Mayer, Loretta; Talboom, Joshua S; Tsang, Candy Wing S; Smith, Constance J; Enders, Craig K; Bimonte-Nelson, Heather A


    Clinical research suggests that type of ovarian hormone loss at menopause influences cognition. Until recently ovariectomy (OVX) has been the primary rodent model to examine effects of ovarian hormone loss on cognition. This model limits evaluations to abrupt and complete ovarian hormone loss, modeling less than 13% of women who receive surgical menopause. The majority of women do not have their ovaries surgically removed and undergo transitional hormone loss via ovarian follicular depletion. 4-Vinylcyclohexene-diepoxide (VCD) produces gradual ovarian follicular depletion in the rodent, with hormone profiles more similar to naturally menopausal women vs. OVX. We directly compared VCD and OVX models to examine whether type of hormone loss (transitional vs. surgical) impacted cognition as assessed on a maze battery as well as the cholinergic system tested via scopolamine mnemonic challenge and brain acetylcholinesterase activity. Middle-aged rats received either sham surgery, OVX surgery, VCD, or VCD then OVX to assess effects of removal of residual ovarian output after transitional menopause and follicular depletion. VCD-induced transitional menopause impaired learning of a spatial recent memory task; surgical removal of residual ovarian hormones by OVX abolished this negative effect of transitional menopause. Furthermore, transitional menopause before OVX was better for memory than an abrupt loss of hormones via OVX only. Surgical ovarian hormone loss, regardless of menopause history, increased hippocampal acetylcholinesterase activity. Circulating gonadotropin and androstenedione levels were related to cognitive competence. Collectively, findings suggest that in the rat, initiation of transitional menopause before surgical ovary removal can benefit mnemonic function and could obviate some negative cognitive consequences of surgical menopause alone.

  3. Embedded Control System for Smart Walking Assistance Device. (United States)

    Bosnak, Matevz; Skrjanc, Igor


    This paper presents the design and implementation of a unique control system for a smart hoist, a therapeutic device that is used in rehabilitation of walking. The control system features a unique human-machine interface that allows the human to intuitively control the system just by moving or rotating its body. The paper contains an overview of the complete system, including the design and implementation of custom sensors, dc servo motor controllers, communication interfaces and embedded-system based central control system. The prototype of the complete system was tested by conducting a 6-runs experiment on 11 subjects and results are showing that the proposed control system interface is indeed intuitive and simple to adopt by the user.

  4. Plasma-Assisted Life and Ecological Operating System (PALEOS) (United States)

    National Aeronautics and Space Administration — Practical implementation of long-duration, human space missions will require robust, reliable, advanced life support systems. Such systems have been the subject of...

  5. Training and Technical Assistance for Small Systems Funding (United States)

    Provides water and wastewater system staff and private well owners with training and tools to enhance system operations and management practices, and support EPA’s continuing efforts to protect public health and promote sustainability.

  6. Registration of 2D C-Arm and 3D CT Images for a C-Arm Image-Assisted Navigation System for Spinal Surgery. (United States)

    Chang, Chih-Ju; Lin, Geng-Li; Tse, Alex; Chu, Hong-Yu; Tseng, Ching-Shiow


    C-Arm image-assisted surgical navigation system has been broadly applied to spinal surgery. However, accurate path planning on the C-Arm AP-view image is difficult. This research studies 2D-3D image registration methods to obtain the optimum transformation matrix between C-Arm and CT image frames. Through the transformation matrix, the surgical path planned on preoperative CT images can be transformed and displayed on the C-Arm images for surgical guidance. The positions of surgical instruments will also be displayed on both CT and C-Arm in the real time. Five similarity measure methods of 2D-3D image registration including Normalized Cross-Correlation, Gradient Correlation, Pattern Intensity, Gradient Difference Correlation, and Mutual Information combined with three optimization methods including Powell's method, Downhill simplex algorithm, and genetic algorithm are applied to evaluate their performance in converge range, efficiency, and accuracy. Experimental results show that the combination of Normalized Cross-Correlation measure method with Downhill simplex algorithm obtains maximum correlation and similarity in C-Arm and Digital Reconstructed Radiograph (DRR) images. Spine saw bones are used in the experiment to evaluate 2D-3D image registration accuracy. The average error in displacement is 0.22 mm. The success rate is approximately 90% and average registration time takes 16 seconds.

  7. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan


    body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients......Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications...... surgery, skull-base surgery, and foreign body removal were the areas of interests. Results: The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign...

  8. Noninvasive continuous blood pressure monitoring by the ClearSight system during robot-assisted laparoscopic radical prostatectomy. (United States)

    Sakai, Yoko; Yasuo M, Tsutsumi; Oyama, Takuro; Murakami, Chiaki; Kakuta, Nami; Tanaka, Katsuya


    Robot-assisted laparoscopic radical prostatectomy (RALRP) is commonly performed in the surgical treatment of prostate cancer. However, the steep Trendelenburg position (25) and pneumoperitoneum required for this procedure can sometimes cause hemodynamic changes. Although blood pressure is traditionally monitored invasively during RALRP, the ClearSight system (BMEYE, Amsterdam, The Netherlands) enables a totally noninvasive and simple continuous blood pressure and cardiac output monitoring based on finger arterial pressure pulse contour analysis. We therefore investigated whether noninvasive continuous arterial blood pressure measurements using the ClearSight system were comparable to those obtained invasively in patients undergoing RALRP. Ten patients scheduled for RALRP with American Society of Anesthesiologists physical status I-II were included in this study. At each of the seven defined time points, noninvasive and invasive blood pressure measurements were documented and compared in each patient using Bland-Altman analysis. Although the blood pressure measured with the ClearSight system correlated with that measured invasively, a large difference between the values obtained by the two devices was noted. The ClearSight system was unable to detect blood pressure accurately during RALRP, suggesting that blood pressure monitoring using this device alone is not feasible in this small patient population. J. Med. Invest. 65:69-73, February, 2018.

  9. The omni-directional image assisted optical surveillance system (United States)

    Chen, Yung-Hsiang; Hwang, Chi-Hung; Wang, Wei-Chung; Lin, Chun-Fu


    This paper presents a high resolution optical surveillance system which integrated an omni-directional imager as an event finder/ system trigger. The omni-directional optics, a fish-eye camera in this study, provides a wider field of view (FOV) which can monitor widely range continuously without scanning mechanism but offers sufficient information which includes sign of field event and direction and then drive high resolution surveillance camera for detail imaging. To archive an optical triggering surveillance system, the scale-invariant feature transform (SIFT) is implemented to detect features both from images taken by omni-directional imager and the high resolution surveillance camera. Considering the FOV of high resolution surveillance system is narrow, to ensure the pointing of high resolution surveillance system, feature matching is also implemented in this system to identify the images obtained by high resolution surveillance system are identical to the existing omni-directional image obtained from fish-eye camera. This provides a robust and accurate solution to the problem of optical radar surveillance system localization in unknown environments. An experiment is performed on outdoor image sequences with demonstrating the efficiency of our algorithm.

  10. Simple and surgical exodontia. (United States)

    DeBowes, Linda J


    Preemptive and postoperative pain management is part of patient care when performing extractions. Simple extractions can become complicated when tooth roots are fractured. Adequate lighting,magnification, and surgical techniques are important when per-forming surgical (complicated) extractions. Radiographs should be taken before extractions and also during the procedure to assist with difficult extractions. Adequate flap design and bone removal are necessary when performing surgical extractions. Complications, including ocular trauma, jaw fracture, and soft tissue trauma, are avoided or minimized with proper patient selection and technique.

  11. DOE Robotic and Remote Systems Assistance to the Government of Japan

    Energy Technology Data Exchange (ETDEWEB)

    Derek Wadsworth; Victor Walker


    At the request of the Government of Japan, DOE did a complex wide survey of available remotely operated and robotic systems to assist in the initial assessment of the damage to the Fukushima Daiichi reactors following an earthquake and subsequent tsunami. As a result several radiation hardened cameras and a Talon robot were identified as systems that could immediately assist in the effort and were subsequently sent to Japan. These systems were transferred to the Government of Japan and used to map radiation levels surrounding the damaged facilities. This report describes the equipment, its use, data collected, and lessons learned from the experience.

  12. Expert systems for assisting the analysis of hazards

    International Nuclear Information System (INIS)

    Evrard, J.M.; Martinez, J.M.; Souchet, Y.


    The advantage of applying expert systems in the analysis of safety in the operation of nuclear power plants is discussed. Expert systems apply a method based on a common representation of nuclear power plants. The main steps of the method are summarized. The applications given concern in the following fields: the analysis of hazards in the electric power supplies of a gas-graphite power plant; the evaluation of the availability of safety procedures in a PWR power plant; the search for the sources of leakage in a PWR power plant. The analysis shows that expert systems are a powerful tool in the study of safety of nuclear power plants [fr

  13. Dissipation Assisted Quantum Memory with Coupled Spin Systems (United States)

    Jiang, Liang; Verstraete, Frank; Cirac, Ignacio; Lukin, Mikhail


    Dissipative dynamics often destroys quantum coherences. However, one can use dissipation to suppress decoherence. A well-known example is the so-called quantum Zeno effect, in which one can freeze the evolution using dissipative processes (e.g., frequently projecting the system to its initial state). Similarly, the undesired decoherence of quantum bits can also be suppressed using controlled dissipation. We propose and analyze the use of this generalization of quantum Zeno effect for protecting the quantum information encoded in the coupled spin systems. This new approach may potentially enhance the performance of quantum memories, in systems such as nitrogen-vacancy color-centers in diamond.

  14. Optimizing Patient Surgical Management Using WhatsApp Application in the Italian Healthcare System. (United States)

    Nardo, Bruno; Cannistrà, Marco; Diaco, Vincenzo; Naso, Agostino; Novello, Matteo; Zullo, Alessandra; Ruggiero, Michele; Grande, Raffaele; Sacco, Rosario


    Smartphones changed the method by which doctors communicate with each other, offer modern functionalities sensitive to the context of use, and can represent a valuable ally in the healthcare system. Studies have shown that WhatsApp™ application can facilitate communication within the healthcare team and provide the attending physician a constant oversight of activities performed by junior team members. The aim of the study was to use WhatsApp between two distant surgical teams involved in a program of elective surgery to verify if it facilitates communication, enhances learning, and improves patient care preserving their privacy. We conducted a focused group of surgeons over a 28-month period (from March 2013 to July 2015), and from September 2014 to July 2015, a group of selected specialists communicated healthcare matters through the newly founded "WhatsApp Surgery Group." Each patient enrolled in the study signed a consent form to let the team communicate his/her clinical data using WhatsApp. Communication between team members, response times, and types of messages were evaluated. Forty six (n = 46) patients were enrolled in the study. A total of 1,053 images were used with an average of 78 images for each patient (range 41-143). 125 h of communication were recorded, generating 354 communication events. The expert surgeon had received the highest number of questions (P, 0.001), while the residents asked clinical questions (P, 0.001) and were the fastest responders to communications (P, 0.001). Our study investigated how two distant clinical teams may exploit such a communication system and quantifies both the direction and type of communication between surgeons. WhatsApp is a low cost, secure, and fast technology and it offers the opportunity to facilitate clinical and nonclinical communications, enhance learning, and improve patient care preserving their privacy.

  15. Central Nervous System Birth Defects in Surgically Treated Infants in Sarajevo Region of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Selma Aličelebić


    Full Text Available Congenital anomalies of the central nervous system (CNS are common. The prevalence of these anomalies shows considerable geographical variation and female predominance. The aim of this work was to obtain the frequency of different CNS congenital anomalies types and their sex distribution among cases hospitalized in a Department of Neurosurgery, University of Sarajevo Clinics Center, Bosnia and Herzegovina, during the period January 2001 to December 2004. Retrospective study was carried out on the basis of the clinical records. Standard methods of descriptive statistics were performed for the data analysis. A total of 103 cases were surgically treated in the period from 2001 through 2004. Out of that number 56 (54,4% were female patients, while 47 (46,6% were male patients. Seven different CNS birth defect types were found in this investigation. These were: spina bifida (42 cases or 40,78%, congenital hydrocephalus (35 cases or 33,98%, arachnoid cyst (15 cases or 14,56%, Dandy-Walker syndrome (5 cases or 4,85%, dermoid cyst (4 cases or 3,88%, one of Arnold-Chiari syndrome (0,98% and one of encefalocele (0,98%. According to this investigation, CNS congenital birth defects were slightly higher in females (54,4%. The most frequent types were spina bifida (40,78% both in females (22,33% and in males (18,45%, hydrocephalus (33,98% and arachnoid cyst (14,56%. The anomalies of the other organ systems, associated with CNS anomalies obtained in this investigation, were pes equinovarus, cheiloshisis, cardiomegalia and palatoshisis. They were found in six cases (5,82%, equal in both sexes.

  16. Preliminary Study of Solar Chimney Assisted Cooling System for SMART

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Il; Park, Seong Jun; Lee, Young Hyeon; Park, Hyo Chan; Park, Youn Won [BEES Inc., KAIST, Daejeon (Korea, Republic of)


    In this paper, the possibility of application for a complete passive final heat removal system using a solar chimney power plant for SMART NPP was estimated. Additionally the size of the cooling system was approximately calculated under the some assumptions. In order to estimate the applicability of SCPP as a complete passive secondary cooling system for SMART, we try to calculate the size of heat exchanger and simulate SCPP performance. As a result, it was found that SCPP could be coupled with SMART and some of waste heat could be recovered into electricity without any change in SCPP size. The related all parameters satisfying the constraint of the final heat removal system for SMART were calculated. Using the constraint of the amount of heat to be removed from SMART, two kinds of SCPP performances were analyzed; one for a stand alone SCPP in Fig 8(a) and second for SCPP with SMART in Fig 8(b)

  17. Development of knowledgebase system for assisting signal validation scheme design

    International Nuclear Information System (INIS)

    Kitamura, M.; Baba, T.; Washio, T.; Sugiyama, K.


    The purpose of this study is to develop a knowledgebase system to be used as a tool for designing signal validation schemes. The outputs from the signal validation scheme can be used as; (1) auxiliary signals for detecting sensor failures, (2) inputs to advanced instrumentation such as disturbance analysis and diagnosis system or safety parameter display system, and (3) inputs to digital control systems. Conventional signal validation techniques such as comparison of redundant sensors, limit checking, and calibration tests have been employed in nuclear power plants. However, these techniques have serious drawbacks, e.g. needs for extra sensors, vulnerability to common mode failures, limited applicability to continuous monitoring, etc. To alleviate these difficulties, a new signal validation technique has been developed by using the methods called analytic redundancy and parity space. Although the new technique has been proved feasible as far as preliminary tests are concerned, further developments should be made in order to enhance its practical applicability

  18. Effective Acquisition Strategies for Systems Engineering and Technical Assistance (SETA) (United States)


    which, in its original form, altogether banned contractors from developing a system and providing SETA services for that system. Defense...even though it is not delivering the estimated savings ( Erwin , 2010). He went on to say that reducing costs was never the primary purpose of...insourcing; rather, he stated that it was to bring inherently governmental positions back into the government ( Erwin , 2010). Inherently Governmental

  19. Satellite Imagery Assisted Road-Based Visual Navigation System (United States)

    Volkova, A.; Gibbens, P. W.


    There is a growing demand for unmanned aerial systems as autonomous surveillance, exploration and remote sensing solutions. Among the key concerns for robust operation of these systems is the need to reliably navigate the environment without reliance on global navigation satellite system (GNSS). This is of particular concern in Defence circles, but is also a major safety issue for commercial operations. In these circumstances, the aircraft needs to navigate relying only on information from on-board passive sensors such as digital cameras. An autonomous feature-based visual system presented in this work offers a novel integral approach to the modelling and registration of visual features that responds to the specific needs of the navigation system. It detects visual features from Google Earth* build a feature database. The same algorithm then detects features in an on-board cameras video stream. On one level this serves to localise the vehicle relative to the environment using Simultaneous Localisation and Mapping (SLAM). On a second level it correlates them with the database to localise the vehicle with respect to the inertial frame. The performance of the presented visual navigation system was compared using the satellite imagery from different years. Based on comparison results, an analysis of the effects of seasonal, structural and qualitative changes of the imagery source on the performance of the navigation algorithm is presented. * The algorithm is independent of the source of satellite imagery and another provider can be used

  20. Registration accuracy enhancement of a surgical navigation system for anterior cruciate ligament reconstruction: A phantom and cadaveric study. (United States)

    Kim, Youngjun; Lee, Byung Hoon; Mekuria, Kinde; Cho, Hyunchul; Park, Sehyung; Wang, Joon Ho; Lee, Deukhee


    Recently, surgical navigation systems have been widely used to improve the results of various orthopaedic surgeries. However, surgical navigation has not been successful in anterior cruciate ligament reconstruction, owing to its inaccuracy and inconvenience. This study investigated the registration of preoperative and intraoperative data, which are the key components in improving accuracy of the navigation system. An accurate registration method was proposed using new optical tracking markers and landmark retake. A surgical planning and navigation system for anterior cruciate ligament reconstruction was developed and implemented. The accuracy of the proposed system has been evaluated using phantoms and eight cadaveric knees. The present study investigated only the registration accuracy excluding the errors of optical tracking hardware and surgeon. The target registration errors of femoral tunnelling for anterior cruciate ligament reconstruction in phantoms were found to be 0.24±0.03mm and 0.19±0.10° for the tunnel entry position and tunnel direction, respectively. The target registration errors measured using cadavers were 0.9mm and 1.94°, respectively. The preclinical experimental results showed that the proposed methods enhanced the registration accuracy of the developed system. As the system becomes more accurate, surgeons could more precisely position and orient the femoral and tibial tunnels to their original anatomical locations. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. MED-NODE : A computer-assisted melanoma diagnosis system using non-dermoscopic images

    NARCIS (Netherlands)

    Giotis, Ioannis; Molders, Nynke; Land, Sander; Biehl, Michael; Jonkman, Marcel F.; Petkov, Nicolai


    Melanoma is one of the most aggressive types of skin cancer and in many cases it is difficult to differentiate from benign naevi. In this contribution we present a decision support (expert) system, which we call MED-NODE, able to assist physicians with this challenging task. The proposed system

  2. Human likeness: cognitive and affective factors affecting adoption of robot-assisted learning systems (United States)

    Yoo, Hosun; Kwon, Ohbyung; Lee, Namyeon


    With advances in robot technology, interest in robotic e-learning systems has increased. In some laboratories, experiments are being conducted with humanoid robots as artificial tutors because of their likeness to humans, the rich possibilities of using this type of media, and the multimodal interaction capabilities of these robots. The robot-assisted learning system, a special type of e-learning system, aims to increase the learner's concentration, pleasure, and learning performance dramatically. However, very few empirical studies have examined the effect on learning performance of incorporating humanoid robot technology into e-learning systems or people's willingness to accept or adopt robot-assisted learning systems. In particular, human likeness, the essential characteristic of humanoid robots as compared with conventional e-learning systems, has not been discussed in a theoretical context. Hence, the purpose of this study is to propose a theoretical model to explain the process of adoption of robot-assisted learning systems. In the proposed model, human likeness is conceptualized as a combination of media richness, multimodal interaction capabilities, and para-social relationships; these factors are considered as possible determinants of the degree to which human cognition and affection are related to the adoption of robot-assisted learning systems.

  3. Computer-Assisted Career Guidance Systems: A Part of NCDA History (United States)

    Harris-Bowlsbey, JoAnn


    The first computer-assisted career planning systems were developed in the late 1960s and were based soundly on the best of career development and decision-making theory. Over the years, this tradition has continued as the technology that delivers these systems' content has improved dramatically and as they have been universally accepted as…

  4. A Graphical User-Interface Development Tool for Intelligent Computer- Assisted Instruction Systems (United States)


    Assisted Instruction Systems by Francius Suwono Lieutenant Colonel, Indonesian AirForce B. S Aeronautics, Indonesian Air Force Academy, 1969 Submitted in...MORA 81] Moran, T P. , The Command Language Grammar : A representation for the user inerface of interactive computer systems, International Journal

  5. Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing. (United States)

    Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F


    Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

  6. Feasibility of a Hydraulic Power Assist System for Use in Hybrid Neuroprostheses. (United States)

    Foglyano, Kevin M; Kobetic, Rudi; To, Curtis S; Bulea, Thomas C; Schnellenberger, John R; Audu, Musa L; Nandor, Mark J; Quinn, Roger D; Triolo, Ronald J


    Feasibility of using pressurized hydraulic fluid as a source of on-demand assistive power for hybrid neuroprosthesis combining exoskeleton with functional neuromuscular stimulation was explored. Hydraulic systems were selected as an alternative to electric motors for their high torque/mass ratio and ability to be located proximally on the exoskeleton and distribute power distally to assist in moving the joints. The power assist system (PAS) was designed and constructed using off-the-shelf components to test the feasibility of using high pressure fluid from an accumulator to provide assistive torque to an exoskeletal hip joint. The PAS was able to provide 21 Nm of assistive torque at an input pressure of 3171 kPa with a response time of 93 ms resulting in 32° of hip flexion in an able-bodied test. The torque output was independent of initial position of the joint and was linearly related to pressure. Thus, accumulator pressure can be specified to provide assistive torque as needed in exoskeletal devices for walking or stair climbing beyond those possible either volitionally or with electrical stimulation alone.

  7. Surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation with insulin systemic circulation reflux and enteric drainage

    Directory of Open Access Journals (Sweden)

    Ming CAI


    Full Text Available Objective The present paper aims to summarize the surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation(SPKT with insulin systemic circulation reflux and enteric drainage to reduce surgical risks and complications and improve the long-term survival of transplanted organs.Methods The present paper retrospectively analyzes the clinical data,surgical techniques,and prevention of surgery-related complications from five cases that received SPKT with insulin systemic circulation reflux and enteric drainage.These five patients suffered from Type 1 diabetes mellitus and diabetic nephropathy resulting in uremia.They were admitted to the Organ Transplant Center of the 309th Hospital of PLA from 2003 to 2010.Results Of the five successful SPKT cases,three patients had normally functioning graft pancreas and kidneys and were able to stop their insulin and hypoglycemic drug medications and dialysis.Two cases had delayed kidney graft functions.One suffered perioperative death due to infection and multiple organ failure,and the other received graft pancreas resection due to a leaky gut caused by donor duodenal segment necrosis.The graft kidney,however,retained normal function.The insulin medication was stopped after an average time of 15 days,and blood creatinine returned to its normal level after 10 days.The graft survival was checked after 12 months to 96 months(by July of 2011,and the graft procedure was found to be successful.Conclusions SPKT with insulin systemic circulation reflux and enteric drainage is the preferred surgical technique for pancreas transplantation.Enhanced surgical skills and effective perioperative management can help reduce,and even eliminate,postoperative complications and improve graft survival.

  8. Designing an Assistant System Encouraging Ergonomic Computer Usage

    Directory of Open Access Journals (Sweden)

    Hüseyin GÜRÜLER


    Full Text Available Today, people of almost every age group are users of computers and computer aided systems. Technology makes our life easier, but it can also threaten our health. In recent years, one of the main causes of the proliferation of diseases such as lower back pain, neck pain or hernia, Arthritis, visual disturbances and obesity is wrong computer usage. The widespread use of computers also increases these findings. The purpose of this study is to direct computer users to use computers more carefully in terms of ergonomics. The user-interactive system developed for this purpose controls distance of the user to the screen and calculates the look angle and the time spent looking at the screen and provides audio or text format warning when necessary. It is thought that this system will reduce the health problems caused by the frequency of computer usage by encouraging individuals to use computers ergonomically.

  9. New operator assistance features in the CMS Run Control System

    CERN Document Server

    Andre, Jean-Marc Olivier; Branson, James; Brummer, Philipp Maximilian; Chaze, Olivier; Cittolin, Sergio; Contescu, Cristian; Craigs, Benjamin Gordon; Darlea, Georgiana Lavinia; Deldicque, Christian; Demiragli, Zeynep; Dobson, Marc; Doualot, Nicolas; Erhan, Samim; Fulcher, Jonathan F; Gigi, Dominique; Michail Gładki; Glege, Frank; Gomez Ceballos, Guillelmo; Hegeman, Jeroen Guido; Holzner, Andre Georg; Janulis, Mindaugas; Jimenez Estupinan, Raul; Masetti, Lorenzo; Meijers, Franciscus; Meschi, Emilio; Mommsen, Remigius; Morovic, Srecko; O'Dell, Vivian; Orsini, Luciano; Paus, Christoph Maria Ernst; Petrova, Petia; Pieri, Marco; Racz, Attila; Reis, Thomas; Sakulin, Hannes; Schwick, Christoph; Simelevicius, Dainius; Zejdl, Petr; Vougioukas, M.


    The Run Control System of the Compact Muon Solenoid (CMS) experiment at CERN is a distributed Java web application running on Apache Tomcat servers. During Run-1 of the LHC, many operational procedures have been automated. When detector high voltages are ramped up or down or upon certain beam mode changes of the LHC, the DAQ system is automatically partially reconfigured with new parameters. Certain types of errors such as errors caused by single-event upsets may trigger an automatic recovery procedure. Furthermore, the top-level control node continuously performs cross-checks to detect sub-system actions becoming necessary because of changes in configuration keys, changes in the set of included front-end drivers or because of potential clock instabilities. The operator is guided to perform the necessary actions through graphical indicators displayed next to the relevant command buttons in the user interface. Through these indicators, consistent configuration of CMS is ensured. However, manually following t...

  10. Urinary System Birth Defects in Surgically Treated Infants in Sarajevo Region of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Selma Aličelebić


    Full Text Available Congenital anomalies of the urinary system are relatively common anomalies. In Bosnia and Herzegovina there is no existent unique evidence of congenital anomalies and registries. The aim of this study was to obtain the frequency of different urinary tract anomalies types and their sex distribution among cases hospitalized in the Department of Pediatric Surgery of the University of Sarajevo Clinics Centre, Bosnia and Herzegovina, during the period from January 2002 to December 2006. Retrospective study was carried out on the basis of clinical records. Standard methods of descriptive statistics were performed for the data analysis. Among 289 patients that were surgically treated 62,37% of the patients were male patients, while 37,63% were female patients. Twenty nine different urinary system anomalies types were found in this study. These were: vesicoureteral reflux (99 cases or 30,75%, hypospadias (62 cases or 19,26%, pelviureteric junction obstruction (42 cases or 13,04%, megaureter (35 cases or 10,87%, duplex pelvis and ureter (16 cases or 4,97%, bladder diverticulum (8 cases or 2,48%, ureterocoele (7 cases or 2,17%, stenosis of the external urethral opening (6 cases or 1,86%, ectopic kidney, duplex kidney and pelvis (each 5 cases or 1,55%, polycystic kidneys and urethral stricture (each 4 cases or 1,24%, multicystic kidney (3 cases or 0,93%, kidney agenesis, ureter agenesis, urethral diverticulum, ectopic ureter, horseshoe kidney and fetal kidney (each 2 cases or 0,62%, renal aplasia, urethral atresia, renal cyst, urachal cyst, epispadias, bladder exstrophy, renal hypoplasia, renal malrotation and Prune-Belly syndrome (each 1 case or 0,31%. According to this study, urinary tract anomalies were more common in male than in female patients (62,37%, Generally, the most frequent anomaly type was vesicoureteral reflux in total number of 99 cases, and in females (66 cases, but hypospadias was the most common anomaly in males (62 cases. The anomalies

  11. Hardware-assisted software clock synchronization for homogeneous distributed systems (United States)

    Ramanathan, P.; Kandlur, Dilip D.; Shin, Kang G.


    A clock synchronization scheme that strikes a balance between hardware and software solutions is proposed. The proposed is a software algorithm that uses minimal additional hardware to achieve reasonably tight synchronization. Unlike other software solutions, the guaranteed worst-case skews can be made insensitive to the maximum variation of message transit delay in the system. The scheme is particularly suitable for large partially connected distributed systems with topologies that support simple point-to-point broadcast algorithms. Examples of such topologies include the hypercube and the mesh interconnection structures.

  12. Design of Sail-Assisted Unmanned Surface Vehicle Intelligent Control System

    Directory of Open Access Journals (Sweden)

    Yong Ma


    Full Text Available To achieve the wind sail-assisted function of the unmanned surface vehicle (USV, this work focuses on the design problems of the sail-assisted USV intelligent control systems (SUICS and illustrates the implementation process of the SUICS. The SUICS consists of the communication system, the sensor system, the PC platform, and the lower machine platform. To make full use of the wind energy, in the SUICS, we propose the sail angle of attack automatic adjustment (Sail_4A algorithm and present the realization flow for each subsystem of the SUICS. By using the test boat, the design and implementation of the SUICS are fulfilled systematically. Experiments verify the performance and effectiveness of our SUICS. The SUICS enhances the intelligent utility of sustainable wind energy for the sail-assisted USV significantly and plays a vital role in shipping energy-saving emission reduction requirements issued by International Maritime Organization (IMO.

  13. Combined desalination and solar-assisted air-conditioning system

    International Nuclear Information System (INIS)

    Gude, Veera Gnaneswar; Nirmalakhandan, Nagamany


    Analysis of a new desalination process utilizing low grade thermal energy is presented. In this process, fresh water is distilled from saline water under near-vacuum pressures created by passive means, enabling low-temperature distillation with lower energy requirements. The energy for low-temperature distillation is provided by a thermal energy storage (TES) system maintained at 55 deg. C utilizing any low grade waste heat source. In this study, heat rejected by the condenser of a modified absorption refrigeration system (ARS) is evaluated as a possible source to drive this desalination process. The energy for the generator of the ARS is provided by a combination of solar collector system and grid power. Results of this study show that the thermal energy rejected by an ARS of cooling capacity of 3.25 kW (0.975 tons of refrigeration) along with an additional energy input of 208 kJ/kg of desalinated water is adequate to produce desalinated water at an average rate of 4.5 kg/h. This energy consumption is competitive with that of the multi-stage flash distillation process of similar capacity (338 kJ/kg). An integrated process model and performance curves of the proposed approach are presented in this paper. Effects of process parameters on the performance of the system are also presented

  14. Dynamic state estimation assisted power system monitoring and protection (United States)

    Cui, Yinan

    The advent of phasor measurement units (PMUs) has unlocked several novel methods to monitor, control, and protect bulk electric power systems. This thesis introduces the concept of "Dynamic State Estimation" (DSE), aided by PMUs, for wide-area monitoring and protection of power systems. Unlike traditional State Estimation where algebraic variables are estimated from system measurements, DSE refers to a process to estimate the dynamic states associated with synchronous generators. This thesis first establishes the viability of using particle filtering as a technique to perform DSE in power systems. The utility of DSE for protection and wide-area monitoring are then shown as potential novel applications. The work is presented as a collection of several journal and conference papers. In the first paper, we present a particle filtering approach to dynamically estimate the states of a synchronous generator in a multi-machine setting considering the excitation and prime mover control systems. The second paper proposes an improved out-of-step detection method for generators by means of angular difference. The generator's rotor angle is estimated with a particle filter-based dynamic state estimator and the angular separation is then calculated by combining the raw local phasor measurements with this estimate. The third paper introduces a particle filter-based dual estimation method for tracking the dynamic states of a synchronous generator. It considers the situation where the field voltage measurements are not readily available. The particle filter is modified to treat the field voltage as an unknown input which is sequentially estimated along with the other dynamic states. The fourth paper proposes a novel framework for event detection based on energy functions. The key idea is that any event in the system will leave a signature in WAMS data-sets. It is shown that signatures for four broad classes of disturbance events are buried in the components that constitute the

  15. Electromyography comparison of normal chair-desk system and assistant chair-desk system on fatigue. (United States)

    Kwon, Moon-Seok; Lee, Sang-Ho; Cho, Ik-Rae; Won, Yu-Mi; Han, Mi-Kyung; Jung, Kon-Nym; Lee, Jae-Hee; Chin, Ji-Hyoung; Rho, Jae-Hun; Kim, Ju-Yeon; Yang, Jae-Bong; No, Jae-Kui; Park, Tae-Geun; Lee, Taek-Kyun; Park, Hyo-Joo; Lee, Sam-Jun; Yoo, Kyoung-Seok; Kang, Suh-Jung; Kwon, Se-Jeong; Shin, Mi-Ae; Kim, Hu-Nyun; Kahn, Hyung-Sik; Kim, Min-Jung; Kim, Tae-Young


    [Purpose] This study was designed to test the effects of the Assistant Chair-Desk System (ACDS), which can reduce the forward tilt of the neck and trunk and the level of fatigue during long lasting study in the sitting position. [Subjects] Fourteen middle school students and 14 college students of mixed gender participated in this study. [Methods] Fatigue level, the trapezius muscle, and the forward tilt angle of the head and trunk as well as distance factors were assessed before after using a normal chair-desk system (NCDS) and the ACDS for 120 minutes. [Results] There was an interaction effect in the angle and length of the neck from the sitting posture changes after 2 hours of studying using the NCDS and ACDS. There were also significant differences in the fatigue levels, hip joint angles and the lengths from the head according to the main effects of the chair-systems. [Conclusion] The studying position while using the ACDS was determined to prevent significant fatigue levels of the muscle and body, provide support to the head, by limiting the forward movement of the neck, and prevent forward tilt of the neck and trunk, by enabling the target point and gaze to be closer to the horizontal direction.

  16. Accuracy of Image-guided Surgical Systems at the Lateral Skull Base as Clinically Assessed Using Bone-Anchored Hearing Aid Posts as Surgical Targets (United States)

    Balachandran, Ramya; Fitzpatrick, J. Michael


    Objective Image-guided surgical (IGS) technology has been clinically available for over a decade. To date, no acceptable standard exists for reporting the accuracy of IGS systems, especially for lateral skull base applications. We present a validation method that uses the post from bone anchored hearing aid (BAHA) patients as a target. We then compare the accuracy of two IGS systems—one using laser skin-surface scanning (LSSS) and another using a non-invasive fiducial frame (FF) attached to patient via dental bite-block (DBB) for registration. Study design Prospective. Setting Tertiary referral center. Patients Six BAHA patients who had adequate dentition for creation of a DBB. Intervention(s) For each patient, a dental impression was obtained, and a customized DBB was made to hold a FF. Temporal bone CT scans were obtained with the patient wearing the DBB, FF, and a customized marker on the BAHA post. In a mock OR, CT scans were registered to operative anatomy using two methods: (a) LSSS, (b) FF. Main outcome measure(s) For each patient and each system, the position of the BAHA marker in the CT scan and in the mock OR (using optical measurement technology) were compared and the distances between them are reported to demonstrate accuracy. Results Accuracy (mean ± standard deviation) was 1.54 ± 0.63 mm for DBB registration and 3.21 ± 1.02 mm for LSSS registration. Conclusions An IGS system using FF registration is more accurate than one using LSSS (p = 0.03, two-sided Student's t-test). BAHA patients provide a unique patient population upon which IGS systems may be validated. PMID:18836389

  17. Validity for assisted hatching on pregnancy rate in assisted reproductive technology: analysis based on results of Japan Assisted Reproductive Technology Registry System 2010. (United States)

    Nakasuji, Takashi; Saito, Hidekazu; Araki, Ryuichiro; Nakaza, Aritoshi; Kuwahara, Akira; Ishihara, Osamu; Irahara, Minoru; Kubota, Toshiro; Yoshimura, Yasunori; Sakumoto, Tetsuro


    The aim of this study was to assess the efficacy of assisted hatching (AH) in assisted reproductive technology (ART) treatment. In this retrospective observational study, the data of patients who were registered in the National ART Registry System of Japan between January and December 2010 were analyzed. The descriptive statistics and validity of AH in fresh embryo transfer (ET) and frozen-thawed ET were assessed by using multiple logistic regression analyses. From a total of 105,450 single ET, 46,029 (43.7%) cycles underwent AH. A total of 9737 (21.3%) and 36,292 (60.9%) cycles underwent AH from 45,818 fresh single ET and 59,632 frozen-thawed single ET, respectively. In the fresh ET patients that underwent AH, the clinical pregnancy and live birth rate were significantly decreased in patients of all ages compared with that of the non-AH group. In the frozen-thawed ET patients, there was no significant difference in pregnancy and live birth rate between the AH group and the non-AH group. AH treatment was more frequently performed in frozen-thawed ET patients than in fresh ET patients, and in the blastocyst stage than in the early cleavage stage. A significantly decreased pregnancy and live birth rate was observed in the fresh ET patients who underwent AH. In the frozen-thawed ET patients who underwent AH, improvement in the clinical pregnancy and live birth rate was not observed. Further studies on the indication and application of AH in ART treatment are required. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  18. Effect of an office-based surgical safety system on patient outcomes. (United States)

    Rosenberg, Noah M; Urman, Richard D; Gallagher, Sean; Stenglein, John; Liu, Xiaoxia; Shapiro, Fred E


    To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications. We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plastic surgery practice with an already high standard of care. We recorded baseline, prechecklist rates for each checklist item and postoperative adverse outcomes via a retrospective chart review of 219 cases. After an education program and 30-day run-in period, a prospective, post-checklist implementation chart review was initiated (n = 184), with outcome data compared to the baseline. The total number of complications per 100 patients decreased from 15.1 to 2.72 after checklist implementation (P checklist was associated with a reduction in surgical complications in an office-based plastic surgery practice with an already high standard of care.

  19. Increasing compliance with the World Health Organization Surgical Safety Checklist-A regional health system's experience. (United States)

    Gitelis, Matthew E; Kaczynski, Adelaide; Shear, Torin; Deshur, Mark; Beig, Mohammad; Sefa, Meredith; Silverstein, Jonathan; Ujiki, Michael


    In 2009, NorthShore University HealthSystem adapted the World Health Organization Surgical Safety Checklist (SSC) at each of its 4 hospitals. Despite evidence that SSC reduces intraoperative mistakes and increase patient safety, compliance was found to be low with the paper form. In November 2013, NorthShore integrated the SSC into the electronic health record (EHR). The aim was to increase communication between operating room (OR) personnel and to encourage best practices during the natural workflow of surgeons, anesthesiologists, and nurses. The purpose of this study was to examine the impact of an electronic SSC on compliance and patient safety. An anonymous OR observer selected cases at random and evaluated the compliance rate before the rollout of the electronic SSC. In June 2014, an electronic audit was performed to assess the compliance rate. Random OR observations were also performed throughout the summer in 2014. Perioperative risk events, such as consent issues, incorrect counts, wrong site, and wrong procedure were compared before and after the electronic SSC rollout. A perception survey was also administered to NorthShore OR personnel. Compliance increased from 48% (n = 167) to 92% (n = 1,037; P health record. Surgeons (91% vs 97%; P safety. The World Health Organization SSC is a validated tool to increase patient safety and reduce intraoperative complications. The electronic SSC has demonstrated an increased compliance rate, a reduced number of risk events, and most OR personnel believe it will have a positive impact on patient safety. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Financial consequences of the implementation of a rapid response system on a surgical ward. (United States)

    Simmes, Friede; Schoonhoven, Lisette; Mintjes, Joke; Adang, Eddy; van der Hoeven, Johannes G


    Rapid response systems (RRSs) are recommended by the Institute for Healthcare Improvement and implemented worldwide. Our study on the effects of an RRS showed a non-significant decrease in cardiac arrest and/or unexpected death from 0.5% to 0.25%. Unplanned intensive care unit (ICU) admissions increased significantly from 2.5% to 4.2% without a decrease in APACHE II scores. In this study, we estimated the mean costs of an RRS per patient day and tested the hypothesis that admitting less severely ill patients to the ICU reduces costs. A cost analysis of an RRS on a surgical ward, including costs for implementation, a 1-day training programme for nurses, nursing time for extra vital signs observation, medical emergency team (MET) consults and differences in unplanned ICU days before and after RRS implementation. To test the hypothesis, we performed a scenario analysis with a mean APACHE II score of 14 points instead of the empirical 17.6 points for the unplanned ICU admissions, including 33% extra MET consults and 22% extra unplanned ICU admissions. Mean RRS costs were €26.87 per patient-day: implementation €0.33 (1%), training €0.90 (3%), nursing time spent on extended observation of vital signs €2.20 (8%), MET consults €0.57 (2%) and increased number of unplanned ICU days after RRS implementation €22.87 (85%). In the scenario analysis mean costs per patient-day were €10.18. The costs for extra unplanned ICU days were relatively high but the remaining RRS costs were relatively low. The 'APACHE II 14' scenario confirmed the hypothesis that costs for the number of unplanned ICU days can be reduced if less severely ill patients are referred to the ICU. Based upon these findings, our hospital stimulates earlier referral to the ICU, although further implementation strategies are needed to achieve these aims. © 2014 John Wiley & Sons, Ltd.

  1. DNA-assisted swarm control in a biomolecular motor system. (United States)

    Keya, Jakia Jannat; Suzuki, Ryuhei; Kabir, Arif Md Rashedul; Inoue, Daisuke; Asanuma, Hiroyuki; Sada, Kazuki; Hess, Henry; Kuzuya, Akinori; Kakugo, Akira


    In nature, swarming behavior has evolved repeatedly among motile organisms because it confers a variety of beneficial emergent properties. These include improved information gathering, protection from predators, and resource utilization. Some organisms, e.g., locusts, switch between solitary and swarm behavior in response to external stimuli. Aspects of swarming behavior have been demonstrated for motile supramolecular systems composed of biomolecular motors and cytoskeletal filaments, where cross-linkers induce large scale organization. The capabilities of such supramolecular systems may be further extended if the swarming behavior can be programmed and controlled. Here, we demonstrate that the swarming of DNA-functionalized microtubules (MTs) propelled by surface-adhered kinesin motors can be programmed and reversibly regulated by DNA signals. Emergent swarm behavior, such as translational and circular motion, can be selected by tuning the MT stiffness. Photoresponsive DNA containing azobenzene groups enables switching between solitary and swarm behavior in response to stimulation with visible or ultraviolet light.

  2. Development, implementation, and evaluation of a hybrid electronic medical record system specifically designed for a developing world surgical service. (United States)

    Laing, G L; Bruce, J L; Skinner, D L; Allorto, N L; Clarke, D L; Aldous, C


    The Pietermaritzburg Metropolitan Trauma Service previously successfully constructed and implemented an electronic surgical registry (ESR). This study reports on our attempts to expand and develop this concept into a multi-functional hybrid electronic medical record (HEMR) system for use in a tertiary level surgical service. This HEMR system was designed to incorporate the function and benefits of an ESR, an electronic medical record (EMR) system, and a clinical decision support system (CDSS). Formal ethical approval to maintain the HEMR system was obtained. Appropriate software was sourced to develop the project. The data model was designed as a relational database. Following the design and construction process, the HEMR file was launched on a secure server. This provided the benefits of access security and automated backups. A systematic training program was implemented for client training. The exercise of data capture was integrated into the process of clinical workflow, taking place at multiple points in time. Data were captured at the times of admission, operative intervention, endoscopic intervention, adverse events (morbidity), and the end of patient care (discharge, transfer, or death). A quarterly audit was performed 3 months after implementation of the HEMR system. The data were extracted and audited to assess their quality. A total of 1,114 patient entries were captured in the system. Compliance rates were in the order of 87-100 %, and client satisfaction rates were high. It is possible to construct and implement a unique, simple, cost-effective HEMR system in a developing world surgical service. This information system is unique in that it combines the discrete functions of an EMR system with an ESR and a CDSS. We identified a number of potential limitations and developed interventions to ameliorate them. This HEMR system provides the necessary platform for ongoing quality improvement programs and clinical research.

  3. Intelligent Robot-assisted Humanitarian Search and Rescue System

    Directory of Open Access Journals (Sweden)

    Henry Y. K. Lau


    Full Text Available The unprecedented scale and number of natural and man-made disasters in the past decade has urged international emergency search and rescue communities to seek for novel technology to enhance operation efficiency. Tele-operated search and rescue robots that can navigate deep into rubble to search for victims and to transfer critical field data back to the control console has gained much interest among emergency response institutions. In response to this need, a low-cost autonomous mini robot equipped with thermal sensor, accelerometer, sonar, pin-hole camera, microphone, ultra-bright LED and wireless communication module is developed to study the control of a group of decentralized mini search and rescue robots. The robot can navigate autonomously between voids to look for living body heat and can send back audio and video information to allow the operator to determine if the found object is a living human. This paper introduces the design and control of a low-cost robotic search and rescue system based on an immuno control framework developed for controlling decentralized systems. Design and development of the physical prototype and the immunity-based control system are described in this paper.

  4. Intelligent Robot-Assisted Humanitarian Search and Rescue System

    Directory of Open Access Journals (Sweden)

    Albert W. Y. Ko


    Full Text Available The unprecedented scale and number of natural and man-made disasters in the past decade has urged international emergency search and rescue communities to seek for novel technology to enhance operation efficiency. Tele-operated search and rescue robots that can navigate deep into rubble to search for victims and to transfer critical field data back to the control console has gained much interest among emergency response institutions. In response to this need, a low-cost autonomous mini robot equipped with thermal sensor, accelerometer, sonar, pin-hole camera, microphone, ultra-bright LED and wireless communication module is developed to study the control of a group of decentralized mini search and rescue robots. The robot can navigate autonomously between voids to look for living body heat and can send back audio and video information to allow the operator to determine if the found object is a living human. This paper introduces the design and control of a low-cost robotic search and rescue system based on an immuno control framework developed for controlling decentralized systems. Design and development of the physical prototype and the immunity-based control system are described in this paper.

  5. Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display. (United States)

    Chen, Xiaojun; Xu, Lu; Wang, Yiping; Wang, Huixiang; Wang, Fang; Zeng, Xiangsen; Wang, Qiugen; Egger, Jan


    The surgical navigation system has experienced tremendous development over the past decades for minimizing the risks and improving the precision of the surgery. Nowadays, Augmented Reality (AR)-based surgical navigation is a promising technology for clinical applications. In the AR system, virtual and actual reality are mixed, offering real-time, high-quality visualization of an extensive variety of information to the users (Moussa et al., 2012) [1]. For example, virtual anatomical structures such as soft tissues, blood vessels and nerves can be integrated with the real-world scenario in real time. In this study, an AR-based surgical navigation system (AR-SNS) is developed using an optical see-through HMD (head-mounted display), aiming at improving the safety and reliability of the surgery. With the use of this system, including the calibration of instruments, registration, and the calibration of HMD, the 3D virtual critical anatomical structures in the head-mounted display are aligned with the actual structures of patient in real-world scenario during the intra-operative motion tracking process. The accuracy verification experiment demonstrated that the mean distance and angular errors were respectively 0.809±0.05mm and 1.038°±0.05°, which was sufficient to meet the clinical requirements. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. New insights into the surgical anatomy of the esophagus

    NARCIS (Netherlands)

    Weijs, Teun J.; Ruurda, Jelle P.; Luyer, Michael D.P.; Cuesta, Miguel A.; van Hillegersberg, Richard; Bleys, Ronaldus L.A.W.

    Implementation of (robot assisted) minimally invasive esophagectomy and increased knowledge of the relation between the autonomic nervous system and the immune response have led to new insights regarding the surgical anatomy of the esophagus. First, two layers of connective tissue were identified;

  7. Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery. (United States)

    Catanuto, Giuseppe; Pappalardo, Francesco; Rocco, Nicola; Leotta, Marco; Ursino, Venera; Chiodini, Paolo; Buggi, Federico; Folli, Secondo; Catalano, Francesca; Nava, Maurizio B


    The increased complexity of the decisional process in breast cancer surgery is well documented. With this study we aimed to create a software tool able to assist patients and surgeons in taking proper decisions. We hypothesized that the endpoints of breast cancer surgery could be addressed combining a set of decisional drivers. We created a decision support system software tool (DSS) and an interactive decision tree. A formal analysis estimated the information gain derived from each feature in the process. We tested the DSS on 52 patients and we analyzed the concordance of decisions obtained by different users and between the DSS suggestions and the actual surgery. We also tested the ability of the system to prevent post breast conservation deformities. The information gain revealed that patients preferences are the root of our decision tree. An observed concordance respectively of 0.98 and 0.88 was reported when the DSS was used twice by an expert operator or by a newly trained operator vs. an expert one. The observed concordance between the DSS suggestion and the actual decision was 0.69. A significantly higher incidence of post breast conservation defects was reported among patients who did not follow the DSS decision (Type III of Fitoussi, N = 4; 33.3%, p = 0.004). The DSS decisions can be reproduced by operators with different experience. The concordance between suggestions and actual decision is quite low, however the DSS is able to prevent post- breast conservation deformities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. PLAN-IT - Scheduling assistant for solar system exploration

    International Nuclear Information System (INIS)

    Dias, W. C.; Henricks, J. A.; Wong, J. C.; California Institute of Technology, Pasadena)


    A frame-based expert scheduling system shell, PLAN-IT, is developed for spacecraft scheduling in the Request Integration Phase, using the Comet Rendezvous Asteroid Flyby (CRAF) mission as a development base. Basic, structured, and expert scheduling techniques are reviewed. Data elements such as activity representation and resource conflict representation are discussed. Resource constraints include minimum and maximum separation times between activities, percentage of time pointed at specific targets, and separation time between targeted intervals of a given activity. The different scheduling technique categories and the rationale for their selection are also considered. 13 references

  9. Electron-assisted magnetization tunneling in single spin systems (United States)

    Balashov, Timofey; Karlewski, Christian; Märkl, Tobias; Schön, Gerd; Wulfhekel, Wulf


    Magnetic excitations of single atoms on surfaces have been widely studied experimentally in the past decade. Lately, systems with unprecedented magnetic stability started to emerge. Here, we present a general theoretical investigation of the stability of rare-earth magnetic atoms exposed to crystal or ligand fields of various symmetry and to exchange scattering with an electron bath. By analyzing the properties of the atomic wave function, we show that certain combinations of symmetry and total angular momentum are inherently stable against first or even higher-order interactions with electrons. Further, we investigate the effect of an external magnetic field on the magnetic stability.

  10. Driver assistance systems - status and future prospects; Fahrerassistenzsysteme fuer Nutzfahrzeuge - Stand und Ausblick

    Energy Technology Data Exchange (ETDEWEB)

    Hipp, E.; Schaller, K.V. [MAN Nutzfahrzeuge AG, Muenchen (Germany)


    Driver assistance systems help the driver in his work. The demand for such systems will be determined by the marked increase in traffic on our roads and also the growing requirements on drivers of commercial vehicles. These systems are basically understood to be systems which assist navigation, the selection and retention of driving values and the stabilisation with regard to the vehicle and its surroundings. They include - Adaptive cruise control, - stop and go systems, - vehicle to vehicle communication, - lane guard system, - turn-off assistance. New approaches to ease the driver's burden, improve traffic flow and safety will be discussed and - as far as possible - assessed. Their use, acceptance and legal questions are to be presented against a background of long-term evaluation, system limits and functional transparency. (orig.) [German] Fahrerassistenzsysteme helfen dem Fahrer bei seinen Aufgaben. Die deutlichen Veraenderungen im Verkehrsgeschehen auf unseren Strassen aber auch die gestiegenen Anforderungen an den Fahrer von Nutzfahrzeugen werden die Nachfrage nach solchen Systemen bestimmen. Grundsaetzlich werden hier Systeme verstanden, die assistieren bei der Navigation, der Wahl und Einhaltung der Fuehrungsgroessen und bei der Stabilisierung im Umfeld von Fahrzeug und von Fahrumgebung. Betrachtet werden - Adaptive Cruise Control, - Stop and Go-Systeme, - Fahrzeug-Fahrzeug Kommunikation, - Lane Guard System, - Abbiegeassistenz und weiterfuehrende, - Telematiksysteme. Neue Ansaetze, die zur Entlastung des Fahrers, zu Verbesserungen im Verkehrsfluss und der Fahrsicherheit fuehren werden diskutiert und - soweit moeglich - bewertet. Nutzung, Akzeptanz, rechtliche Fragen sollen vor dem Hintergrund von Langzeitbewertung, Systemgrenzen und Funktionstransparenz dargestellt werden. (orig.)

  11. Prevention of Surgical Malpractice Claims by Use of a Surgical Safety Checklist

    NARCIS (Netherlands)

    de Vries, Eefje N.; Eikens-Jansen, Manon P.; Hamersma, Alice M.; Smorenburg, Susanne M.; Gouma, Dirk J.; Boermeester, Marja A.


    Objective: To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist. Background: Surgical disciplines are overrepresented in the distribution of adverse events. The recently described multidisciplinary SURgical PAtient Safety System

  12. [The system of health assistants in Shaanxi during the Republican period]. (United States)

    Zhang, Ruibin


    To tackle plague, in the 21st year of the Republic of China (1932), the government of Shaanxi province, established the "Shaanxi Department of Epidemic Prevention" and set up health assistant system at the grassroots level. As the main promoter and executor of rural epidemic prevention, the health assistants played a significant role in the formation of public health knowledge propaganda, the formation of public health idea, public environmental hygiene investigation and popularization of health and epidemic prevention work. Health assistant system, as the initiation of modern Shaanxi health, marking the gradual moving forward to its modernization, exerting a positive role and, at the same time, demonstrating that the development of modern public health needs the improvement of comprehensive national strength and the simultaneous construction of political civilization.

  13. Computer-assisted system for the reconstruction of shattered objects (United States)

    Cooper, Frederick A.; Brenningmeyer, Todd


    Reconstruction for forensic purposes of shattered or otherwise damaged objects has been a painstaking, if not impossible, undertaking. The forensic crime scientist and the archaeologist share this challenge. A pilot project, funded by the National Institute of Justice experimented with several avenues of approach to this problem of reassembly by using the 627 fragmented pieces of a pane of glass from a crime scene. I was approached by staff members of the Forensic Laboratory of the Minnesota Bureau of Criminal Apprehension because I was developing a means to restore a Greek Bronze Age wall painting (ca. 1350 B.C.E.) fragmented into 4750 pieces and a Greek temple (ca. 150 B.C.E.) demolished by vandals about 1500 years ago, leaving behind 1485 stone blocks, 1-3 tons each. The challenge was to develop an automated method to rapidly and effectively analyze a quantity of fragments of like kind separated one from the other and from the original object by violence and other means. The project established a set of mathematically and graphically definable characteristics held by the glass sherds which allowed for the making of joins between pieces. Preparation included the formulation of inventory check-sheets and a barcode label system with a unique identifier for each piece based on a x,y,z grid system. The next step involved experimentation with an array of proprietary GIS, SQL, and CAD software alternatives for the processing of data. In the end we settled on maximum likelihood analysis of SQL filtered results. This and shape indices were complied using ArcView and the scripting language, Avenue, products of ESRI, Redlands, California.

  14. Cosmetic and aesthetic skin photosurgery using a computer-assisted CO2 laser-scanning system (United States)

    Dutu, Doru C. A.; Dumitras, Dan C.; Nedelcu, Ioan; Ghetie, Sergiu D.


    Since the first application of CO2 laser in skin photosurgery, various techniques such as laser pulsing, beam scanning and computer-assisted laser pulse generator have been introduced for the purpose of reducing tissue carbonization and thermal necrosis. Using a quite simple XY optical scanner equipped with two galvanometric driven mirrors and an appropriate software to process the scanning data and control the interaction time and energy density in the scanned area, we have obtained a device which can improve CO2 laser application in cosmetic and aesthetic surgery. The opto-mechanical CO2 laser scanner based on two total reflecting flat mirrors placed at 90 degree(s) in respect to the XY scanning directions and independently driven through a magnetic field provides a linear movement of the incident laser beam in the operating field. A DA converter supplied with scanning data by the software enables a scanning with linearity better than 1% for a maximum angular deviation of 20 degree(s). Because the scanning quality of the laser beam in the operating field is given not only by the displacement function of the two mirrors, but also by the beam characteristics in the focal plane and the cross distribution in the laser beam, the surgeon can control through software either the scanning field dimensions or the distance between two consecutive points of the vertically and/or horizontally sweep line. The development of computer-assisted surgical scanning techniques will help control the surgical laser, to create either a reproducible incision with a controlled depth or a controlled incision pattern with minimal incision width, a long desired facility for plastic surgery, neurosurgery, ENT and dentistry.

  15. The 'Lumbar Fusion Outcome Score' (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain. (United States)

    Mattei, Tobias A; Rehman, Azeem A; Teles, Alisson R; Aldag, Jean C; Dinh, Dzung H; McCall, Todd D


    In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes - as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI) - were evaluated pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (including bone scan/99mTc scintigraphy increased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification) which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3 months and continuing up to 1 year of follow-up. In conclusion,  LUFOS has been devised as a new practical and surgically oriented grading system based on simple key parameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axial LBP.

  16. The ventricular system of the brain: a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations. (United States)

    Mortazavi, M M; Adeeb, N; Griessenauer, C J; Sheikh, H; Shahidi, S; Tubbs, R I; Tubbs, R S


    The cerebral ventricles have been recognized since ancient medical history. Their true function started to be realized more than a thousand years later. Their anatomy and function are extremely important in the neurosurgical panorama. The literature was searched for articles and textbooks of different topics related to the history, anatomy, physiology, histology, embryology and surgical considerations of the brain ventricles. Herein, we summarize the literature about the cerebral ventricular system.

  17. Robot-Assisted Airway Support: A Simulated Case (United States)

    Tighe, Patrick J.; Badiyan, S. J.; Luria, I.; Lampotang, S.; Parekattil, S.


    Recent advances in telemedicine and robotically assisted telesurgery may offer advanced surgical care for the geographically remote patient. Similar advances in tele-anesthesia will be necessary to optimize perioperative care for these patients. Although many preliminary investigations into tele-anesthesia are underway, none involves remote performance of anesthesia-related procedures. Here we describe simulated robotically assisted fiberoptic intubations using an airway simulation mannequin. Both oral and nasal approaches to fiberoptic intubation were successful, but presented unique opportunities and challenges inherent to the robot’s design. Robotically assisted airway management is feasible using multipurpose surgical robotic systems. PMID:20870983

  18. Experimental study of a photovoltaic solar-assisted heat-pump/heat-pipe system

    International Nuclear Information System (INIS)

    Fu, H.D.; Pei, G.; Ji, J.; Long, H.; Zhang, T.; Chow, T.T.


    A practical design for a heat pump with heat-pipe photovoltaic/thermal (PV/T) collectors is presented. The hybrid system is called the photovoltaic solar-assisted heat-pump/heat-pipe (PV-SAHP/HP) system. To focus on both actual demand and energy savings, the PV-SAHP/HP system was designed to be capable of operating in three different modes, namely, the heat-pipe, solar-assisted heat pump, and air-source heat-pump modes. Based on solar radiation, the system operates in an optimal mode. A series of experiments were conducted in Hong Kong to study the performance of the system when operating in the heat-pipe and the solar-assisted heat-pump modes. Moreover, energy and exergy analyses were used to investigate the total PV/T performance of the system. - Highlights: ► A novel PV-SAHP/HP system with three different operating modes was proposed. ► Performance of the PV-SAHP/HP system was studied experimentally. ► A optimal operating mode of the PV-SAHP/HP system was suggested in this paper.

  19. Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years

    Directory of Open Access Journals (Sweden)

    Kyo Chul Koo


    Conclusions: RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. Patients who are unable to accept the risk of adjuvant therapy and its side effects or incontinence should be deterred from surgical treatment, and other options such as radiation therapy could be an alternative.

  20. MAS: Malware Analysis System Based on Hardware-Assisted Virtualization Technology (United States)

    Kim, Taehyoung; Kim, Inhyuk; Min, Changwoo; Eom, Young Ik

    There are many analysis techniques in order to analyze malicious codes. However, recently malicious codes often evade detection using stealthy obfuscation techniques, and attack computing systems. We propose an enhanced dynamic binary instrumentation using hardware-assisted virtualization technology. As a machine-level analyzer, our system can be isolated from almost the whole threats of malware, and provides single step analysis environment. Proposed system also supports rapid system call analysis environment. We implement our malware analysis system (referred as MAS) on the KVM hypervisor with Intel VT-x virtualization support. Our experiments with benchmarks show that the proposed system provides efficient analysis environment with low overhead.

  1. 76 FR 15321 - SEDASYS Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Inc.'s, Petition... (United States)


    ...] SEDASYS Computer-Assisted Personalized Sedation System; Ethicon Endo-Surgery, Inc.'s, Petition for Review... denial of premarket approval for its SEDASYS computer-assisted personalized sedation system (SEDASYS system). ADDRESSES: Submissions related to the petition should be filed with the Division of Dockets...

  2. An integrated knowledge system for wind tunnel testing - Project Engineers' Intelligent Assistant (United States)

    Lo, Ching F.; Shi, George Z.; Hoyt, W. A.; Steinle, Frank W., Jr.


    The Project Engineers' Intelligent Assistant (PEIA) is an integrated knowledge system developed using artificial intelligence technology, including hypertext, expert systems, and dynamic user interfaces. This system integrates documents, engineering codes, databases, and knowledge from domain experts into an enriched hypermedia environment and was designed to assist project engineers in planning and conducting wind tunnel tests. PEIA is a modular system which consists of an intelligent user-interface, seven modules and an integrated tool facility. Hypermedia technology is discussed and the seven PEIA modules are described. System maintenance and updating is very easy due to the modular structure and the integrated tool facility provides user access to commercial software shells for documentation, reporting, or database updating. PEIA is expected to provide project engineers with technical information, increase efficiency and productivity, and provide a realistic tool for personnel training.

  3. Promoting Contextual Vocabulary Learning through an Adaptive Computer-Assisted EFL Reading System (United States)

    Wang, Y.-H.


    The study developed an adaptive computer-assisted reading system and investigated its effect on promoting English as a foreign language learner-readers' contextual vocabulary learning performance. Seventy Taiwanese college students were assigned to two reading groups. Participants in the customised reading group read online English texts, each of…

  4. The development of ground unmanned vehicles, driver assistance systems and components according to patent publications (United States)

    Saykin, A. M.; Tuktakiev, G. S.; Zhuravlev, A. V.; Zaitseva, E. P.


    The paper contains the analysis of the main trends in the patenting of ground unmanned vehicles, driver assistance systems (ADAS) and unmanned vehicle components abroad during the period from 2010 to 2016. The conclusion was made that the intensity of their patenting abroad increased.

  5. The Utilization of a Computer Assisted Guidance System in Academic Advising (United States)

    Pfautz, Charles Van Vleck


    Computer assisted guidance systems may adapt well to various models of academic advising, and they have the ability to address the challenge of meeting the diverse advising needs of community college students without sacrificing the integrity of academic advising (Fowkes & McWhirter, 2007). The purpose of this qualitative case study was to assess…

  6. Enhancing the Delivery of Supplemental Nutrition Assistance Program Education through Geographic Information Systems (United States)

    Stone, Matthew


    The Network for a Healthy California (Network) employs a Geographic Information System (GIS) to identify the target audience and plan program activities because GIS is a powerful tool for assisting in data integration and planning. This paper describes common uses of GIS by Network contractors as well as demonstrating the possibilities of GIS as a…

  7. Adaptive object placement for augmented reality use in driver assistance systems


    Bordes, Lucie; Breckon, Toby P.; Katramados, Ioannis; Kheyrollahi, Alireza


    We present an approach for adaptive object placement for Augmented Reality (AR) use in driver assistance systems. Combined vanishing point and road surface detection enable the real-time adaptive emplacement of AR objects within a drivers' natural field of view for on-road information display. This work combines both automotive vision and multimedia production aspects of real-time visual engineering.

  8. Development of advanced driver assistance systems with vehicle hardware-in-the-loop simulations

    NARCIS (Netherlands)

    Gietelink, O.J.; Ploeg, J.; Schutter,; Verhaegen, M.


    This paper presents a new method for the design and validation of advanced driver assistance systems (ADASs). With vehicle hardware-in-the-loop (VEHIL) simulations, the development process, and more specifically the validation phase, of intelligent vehicles is carried out safer, cheaper, and is more

  9. Audio Cues to Assist Visual Search in Robotic System Operator Control Unit Displays (United States)


    Christopher C. Stachowiak , and Michael A. Lattin ARL-TR-3632 December 2005 Approved for...Assist Visual Search in Robotic System Operator Control Unit Displays Ellen C. Haas, Ramakrishna S. Pillalamarri, Christopher C. Stachowiak , and...5e. TASK NUMBER 6. AUTHOR(S) Ellen C. Haas, Ramakrishna S. Pillalamarri, Christopher C. Stachowiak , and Michael A. Lattin (all of ARL

  10. Vision based Traffic Sign Detection and Analysis for Intelligent Driver Assistance Systems

    DEFF Research Database (Denmark)

    Møgelmose, Andreas; Trivedi, Mohan M.; Moeslund, Thomas B.


    In this paper, we provide a survey of the traffic sign detection literature, detailing detection systems for Traffic Sign Recognition (TSR) for driver assistance. We separately describe the contributions of recent works to the various stages inherent in traffic sign detection: segmentation, featu...... research, including integration of context and localization. We also introduce a new public database containing US traffic signs...

  11. Advanced driver assistance system: Road sign identification using VIAPIX system and a correlation technique (United States)

    Ouerhani, Y.; Alfalou, A.; Desthieux, M.; Brosseau, C.


    We present a three-step approach based on the commercial VIAPIX® module for road traffic sign recognition and identification. Firstly, detection in a scene of all objects having characteristics of traffic signs is performed. This is followed by a first-level recognition based on correlation which consists in making a comparison between each detected object with a set of reference images of a database. Finally, a second level of identification allows us to confirm or correct the previous identification. In this study, we perform a correlation-based analysis by combining and adapting the Vander Lugt correlator with the nonlinear joint transformation correlator (JTC). Of particular significance, this approach permits to make a reliable decision on road traffic sign identification. We further discuss a robust scheme allowing us to track a detected road traffic sign in a video sequence for the purpose of increasing the decision performance of our system. This approach can have broad practical applications in the maintenance and rehabilitation of transportation infrastructure, or for drive assistance.

  12. Evaluation of negative pressure vacuum-assisted system in acute and chronic wounds closure: our experience. (United States)

    Chiummariello, S; Guarro, G; Pica, A; Alfano, C


    Negative-pressure therapy or vacuum-assisted closure (VAC) has been used in clinical applications since the 1940's and has increased in popularity over the past decade. This dressing technique consists of an open cell foam dressing put into the wound cavity, a vacuum pump produces a negative pressure and an adhesive drape. A controlled sub atmospheric pressure from 75 to 150 mmHg is applied. The vacuum-assisted closure has been applied by many clinicians to chronic wounds in humans; however it cannot be used as a replacement for surgical debridement. The initial treatment for every contaminated wound should be the necrosectomy. The VAC therapy has a complementary function and the range of its indications includes pressure sores, stasis ulcers, chronic wounds such as diabetic foot ulcers, post traumatic and post operative wounds, infected wounds such as necrotizing fasciitis or sternal wounds, soft-tissue injuries, bone exposed injuries, abdominal open wounds and for securing a skin graft. We describe our experience with the VAC dressing used to manage acute and chronic wounds in a series of 135 patients, with excellent results together with satisfaction of the patients.

  13. Brakes, brake control and driver assistance systems function, regulation and components

    CERN Document Server


    Braking systems have been continuously developed and improved throughout the last years. Major milestones were the introduction of antilock braking system (ABS) and electronic stability program. This reference book provides a detailed description of braking components and how they interact in electronic braking systems. Contents Motor vehicle safety.- Basic principles of vehicle dynamics.- Car braking systems.- Car braking-system components.- Wheel brakes.- Antilock breaking systems.- Traction control system.- Electronic stability program.- Automatic brake functions.- Hydraulic modulator.- Sensors for brake control.- Sensotronic brake control.- Active steering.- Occupant protection systems.- Driver assistance systems.- Adaptive cruise control.- Parking systems.- Instrumentation.- Orientation methods.- Navigation systems.- Workshop technology. The target groups Motor-vehicle technicians in education and vocational training Master-mechanics and technicians in garage-workshops Teachers and lecturers in vocation...

  14. Robot-assisted biopsies in a high-field MRI system. First clinical results

    International Nuclear Information System (INIS)

    Schell, B.; Eichler, K.; Mack, M.G.; Mueller, C.; Kerl, J.M.; Beeres, M.; Thalhammer, A.; Vogl, T.J.; Zangos, S.; Czerny, C.


    Purpose: The purpose of this study was to examine the clinical use of MR-guided biopsies in patients with suspicious lesions using a new MR-compatible assistance system in a high-field MR system. Materials and Methods: Six patients with suspicious focal lesions in various anatomic regions underwent percutanous biopsy in a high-field MR system (1.5 T, Magnetom Espree, Siemens) using a new MR-compatible assistance system (Innomotion). The procedures were planned and guided using T1-weighted FLASH and TrueFISP sequences. A servopneumatic drive then moved the guiding arm automatically to the insertion point. An MRI compatible 15G biopsy system (Somatex) was introduced by a physician guided by the needle holder and multiple biopsies were performed using the coaxial technique. The feasibility, duration of the intervention and biopsy findings were analyzed. Results: The proposed new system allows accurate punctures in a high-field MR system. The assistance device did not interfere with the image quality, and guided the needle virtually exactly as planned. Histological examination could be conducted on every patient. The lesion was malignant in four cases, and an infectious etiology was diagnosed for the two remaining lesions. Regarding the differentiation of anatomical and pathological structures and position monitoring of the insertion needle, TrueFISP images are to be given preference. The average intervention time was 41 minutes. Lesions up to 15.4 cm beneath the skin surface were punctured. Conclusion: The proposed MR-guided assistance system can be successfully utilized in a high-field MR system for accurate punctures of even deep lesions in various anatomic regions. (orig.)

  15. System performance and economic analysis of solar-assisted cooling/heating system

    KAUST Repository

    Huang, B.J.


    The long-term system simulation and economic analysis of solar-assisted cooling/heating system (SACH-2) was carried out in order to find an economical design. The solar heat driven ejector cooling system (ECS) is used to provide part of the cooling load to reduce the energy consumption of the air conditioner installed as the base-load cooler. A standard SACH-2 system for cooling load 3.5. kW (1. RT) and daily cooling time 10 h is used for case study. The cooling performance is assumed only in summer seasons from May to October. In winter season from November to April, only heat is supplied. Two installation locations (Taipei and Tainan) were examined.It was found from the cooling performance simulation that in order to save 50% energy of the air conditioner, the required solar collector area is 40m2 in Taipei and 31m2 in Tainan, for COPj=0.2. If the solar collector area is designed as 20m2, the solar ejector cooling system will supply about 17-26% cooling load in Taipei in summer season and about 21-27% cooling load in Tainan. Simulation for long-term performance including cooling in summer (May-October) and hot water supply in winter (November-April) was carried out to determine the monthly-average energy savings. The corresponding daily hot water supply (with 40°C temperature rise of water) for 20m2 solar collector area is 616-858L/day in Tainan and 304-533L/day in Taipei.The economic analysis shows that the payback time of SACH-2 decreases with increasing cooling capacity. The payback time is 4.8. years in Tainan and 6.2. years in Taipei when the cooling capacity >10. RT. If the ECS is treated as an additional device used as a protective equipment to avoid overheating of solar collectors and to convert the excess solar heat in summer into cooling to reduce the energy consumption of air conditioner, the payback time is less than 3 years for cooling capacity larger than 3. RT. © 2011 Elsevier Ltd.

  16. Computer assisted radiology and surgery. CARS 2010

    International Nuclear Information System (INIS)



    The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

  17. Computer assisted radiology and surgery. CARS 2010

    Energy Technology Data Exchange (ETDEWEB)



    The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

  18. Successful Pregnancy Following Assisted Reproduction in Woman With Systemic Lupus Erythematosus and Hypertension: A Case Report. (United States)

    de Macedo, José Fernando; de Macedo, Gustavo Capinzaiki; Campos, Luciana Aparecida; Baltatu, Ovidiu Constantin


    Patients with systemic lupus erythematosus have a poor prognosis of pregnancy, since it is associated with significant maternal and fetal morbidity, including spontaneous miscarriage, pre-eclampsia, intrauterine growth restriction, fetal death and pre-term delivery. We report a case with successful pregnancy in a patient with systemic lupus erythematosus and hypertension. A 39-year-old nulliparous woman presented with systemic lupus erythematosus with antinuclear and antiphospholipid antibodies, hypertension and recurrent pregnancy loss presented for assisted reproduction. The patient responded well to enoxaparin and prednisone during both assisted reproduction and prenatal treatment. This case report indicates that prescription of immunosuppressant and blood thinners can be safely recommended throughout the whole prenatal period in patients with systemic lupus erythematosus. Enoxaparin and prednisone may be prescribed concurrently during pregnancy.

  19. Autonomic nervous system function, child behavior, and maternal sensitivity in three-year-old children with surgically corrected transposition. (United States)

    Harrison, Tondi M


    Explore relationships among autonomic nervous system (ANS) function, child behavior, and maternal sensitivity in three-year-old children with surgically corrected transposition of the great arteries (TGA) and in children healthy at birth. Children surviving complex congenital heart defects are at risk for behavior problems. ANS function is associated with behavior and with maternal sensitivity. Child ANS function (heart rate variability) and maternal sensitivity (Parent-Child Early Relational Assessment) were measured during a challenging task. Mother completed the Child Behavior Checklist. Data were analyzed descriptively and graphically. Children with TGA had less responsive autonomic function and more behavior problems than healthy children. Autonomic function improved with more maternal sensitivity. Alterations in ANS function may continue years after surgical correction in children with TGA, potentially impacting behavioral regulation. Maternal sensitivity may be associated with ANS function in this population. Continued research on relationships among ANS function, child behavior, and maternal sensitivity is warranted. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Supervised and dynamic neuro-fuzzy systems to classify physiological responses in robot-assisted neurorehabilitation. (United States)

    Lledó, Luis D; Badesa, Francisco J; Almonacid, Miguel; Cano-Izquierdo, José M; Sabater-Navarro, José M; Fernández, Eduardo; Garcia-Aracil, Nicolás


    This paper presents the application of an Adaptive Resonance Theory (ART) based on neural networks combined with Fuzzy Logic systems to classify physiological reactions of subjects performing robot-assisted rehabilitation therapies. First, the theoretical background of a neuro-fuzzy classifier called S-dFasArt is presented. Then, the methodology and experimental protocols to perform a robot-assisted neurorehabilitation task are described. Our results show that the combination of the dynamic nature of S-dFasArt classifier with a supervisory module are very robust and suggest that this methodology could be very useful to take into account emotional states in robot-assisted environments and help to enhance and better understand human-robot interactions.

  1. Supervised and dynamic neuro-fuzzy systems to classify physiological responses in robot-assisted neurorehabilitation.

    Directory of Open Access Journals (Sweden)

    Luis D Lledó

    Full Text Available This paper presents the application of an Adaptive Resonance Theory (ART based on neural networks combined with Fuzzy Logic systems to classify physiological reactions of subjects performing robot-assisted rehabilitation therapies. First, the theoretical background of a neuro-fuzzy classifier called S-dFasArt is presented. Then, the methodology and experimental protocols to perform a robot-assisted neurorehabilitation task are described. Our results show that the combination of the dynamic nature of S-dFasArt classifier with a supervisory module are very robust and suggest that this methodology could be very useful to take into account emotional states in robot-assisted environments and help to enhance and better understand human-robot interactions.

  2. Self Assistive Technology for Disabled People – Voice Controlled Wheel Chair and Home Automation System

    Directory of Open Access Journals (Sweden)

    R. Puviarasi


    Full Text Available This paper describes the design of an innovative and low cost self-assistive technology that is used to facilitate the control of a wheelchair and home appliances by using advanced voice commands of the disabled people. This proposed system will provide an alternative to the physically challenged people with quadriplegics who is permanently unable to move their limbs (but who is able to speak and hear and elderly people in controlling the motion of the wheelchair and home appliances using their voices to lead an independent, confident and enjoyable life. The performance of this microcontroller based and voice integrated design is evaluated in terms of accuracy and velocity in various environments. The results show that it could be part of an assistive technology for the disabled persons without any third person’s assistance.

  3. Assisted Living Systems for Elderly and Disabled People: A Short Review

    Directory of Open Access Journals (Sweden)

    Ivo Iliev


    Full Text Available The number of elderly people living alone in their homes is permanently growing in the whole western world. Because of the deteriorating capabilities to sense and interact with the environment, such as memory, eye sight, hearing and mobility, the ageing populations often live with significantly degraded life quality. Many also suffer from chronic diseases that require medical treatment and periodical examinations. Different Assisted Living Systems have been proposed to cope with the problems. The goal is to enable the elderly people to live longer in their preferred environment, to enhance the quality of their live and to reduce the expenses of the public health care. The Assisted Living Systems are based on a lot of sensors, actuators and multimedia equipment, providing for the autonomy of people and assisting them in carrying out their daily activities together with available interaction with remote relatives and friends. The applied approaches and implementations are specific that limit the dissemination of the results between the object oriented groups. Besides, most of the projects require considerable funding for implementation. For the time being and especially for some countries with lower Gross Domestic Product, the efforts may be directed to creation of low-cost assistive systems performing some basic tasks, related to the need and health status of the living alone adults or disabled people, e.g. automatic fall detection and signalization, as well as instantaneous monitoring the photo-pletismographic signals together with permanently available communication interface between the caregiver and the user.

  4. Improving manual skills in persons with disabilities (PWD) through a multimodal assistance system. (United States)

    Covarrubias, Mario; Gatti, Elia; Bordegoni, Monica; Cugini, Umberto; Mansutti, Alessandro


    In this research work, we present a Multimodal Guidance System (MGS) whose aim is to provide dynamic assistance to persons with disabilities (PWD) while performing manual activities such as drawing, coloring in and foam-cutting tasks. The MGS provides robotic assistance in the execution of 2D tasks through haptic and sound interactions. Haptic technology provides the virtual path of 2D shapes through the point-based approach, while sound technology provides audio feedback inputs related to the hand's velocity while sketching and filling or cutting operations. By combining this Multimodal System with the haptic assistance, we have created a new approach with possible applications to such diverse fields as physical rehabilitation, scientific investigation of sensorimotor learning and assessment of hand movements in PWD. The MGS has been tested by people with specific disorders affecting coordination, such as Down syndrome and developmental disabilities, under the supervision of their teachers and care assistants inside their learning environment. A Graphic User Interface has been designed for teachers and care assistants in order to provide training during the test sessions. Our results provide conclusive evidence that the effect of using the MGS increases the accuracy in the tasks operations. The Multimodal Guidance System (MGS) is an interface that offers haptic and sound feedback while performing manual tasks. Several studies demonstrated that the haptic guidance systems can help people in recovering cognitive function at different levels of complexity and impairment. The applications supported by our device could also have an important role in supporting physical therapist and cognitive psychologist in helping patients to recover motor and visuo-spatial abilities.

  5. Cloud-assisted mutual authentication and privacy preservation protocol for telecare medical information systems. (United States)

    Li, Chun-Ta; Shih, Dong-Her; Wang, Chun-Cheng


     With the rapid development of wireless communication technologies and the growing prevalence of smart devices, telecare medical information system (TMIS) allows patients to receive medical treatments from the doctors via Internet technology without visiting hospitals in person. By adopting mobile device, cloud-assisted platform and wireless body area network, the patients can collect their physiological conditions and upload them to medical cloud via their mobile devices, enabling caregivers or doctors to provide patients with appropriate treatments at anytime and anywhere. In order to protect the medical privacy of the patient and guarantee reliability of the system, before accessing the TMIS, all system participants must be authenticated.  Mohit et al. recently suggested a lightweight authentication protocol for cloud-based health care system. They claimed their protocol ensures resilience of all well-known security attacks and has several important features such as mutual authentication and patient anonymity. In this paper, we demonstrate that Mohit et al.'s authentication protocol has various security flaws and we further introduce an enhanced version of their protocol for cloud-assisted TMIS, which can ensure patient anonymity and patient unlinkability and prevent the security threats of report revelation and report forgery attacks.  The security analysis proves that our enhanced protocol is secure against various known attacks as well as found in Mohit et al.'s protocol. Compared with existing related protocols, our enhanced protocol keeps the merits of all desirable security requirements and also maintains the efficiency in terms of computation costs for cloud-assisted TMIS.  We propose a more secure mutual authentication and privacy preservation protocol for cloud-assisted TMIS, which fixes the mentioned security weaknesses found in Mohit et al.'s protocol. According to our analysis, our authentication protocol satisfies most functionality features

  6. Efficacy of Local and Systemic Antimicrobials in the Non-Surgical Treatment of Smokers With Chronic Periodontitis: A Systematic Review. (United States)

    Chambrone, Leandro; Vargas, Miguel; Arboleda, Silie; Serna, Maritza; Guerrero, Marcela; de Sousa, Jose; Lafaurie, Gloria Inés


    The aim of this systematic review is to evaluate whether use of local or systemic antimicrobials would improve clinical results of non-surgical periodontal therapy for smokers with chronic periodontitis (CP). Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and The Cochrane Central Register of Controlled Trials were searched up to and including March 2016. Randomized clinical trials of duration of at least 6 months were included if they reported on treatment of smokers (≥10 cigarettes per day for minimum 12 months) with CP with non-surgical periodontal therapy either alone or associated with local or systemic antimicrobials. Random-effects meta-analyses were undertaken to evaluate mean differences in probing depth (PD) and clinical attachment level (CAL). Of 108 potentially eligible articles, seven were included. Most individual studies (75%) testing locally delivered antibiotics reported that smokers benefited from this treatment approach. Pooled estimates found additional PD reduction of 0.81 mm (P = 0.01) and CAL gain of 0.91 mm (P = 0.01) at sites with baseline PD ≥5 mm. Conversely, meta-analysis on systemic use of antimicrobials failed to detect significant differences in mean changes from baseline, and only one trial supported their use. In smokers with CP, adjunctive use of local antimicrobials improved efficacy of non-surgical periodontal therapy in reducing PD and improving CAL at sites presenting PD ≥5 mm before treatment. Current evidence does not demonstrate similar gains when scaling and root planing plus systemic antimicrobial/antibiotics were associated with therapy.

  7. Enhanced Recovery After Surgery Program Implementation in 2 Surgical Populations in an Integrated Health Care Delivery System. (United States)

    Liu, Vincent X; Rosas, Efren; Hwang, Judith; Cain, Eric; Foss-Durant, Anne; Clopp, Molly; Huang, Mengfei; Lee, Derrick C; Mustille, Alex; Kipnis, Patricia; Parodi, Stephen


    Novel approaches to perioperative surgical care focus on optimizing nutrition, mobility, and pain management to minimize adverse events after surgical procedures. To evaluate the outcomes of an enhanced recovery after surgery (ERAS) program among 2 target populations: patients undergoing elective colorectal resection and patients undergoing emergency hip fracture repair. A pre-post difference-in-differences study before and after ERAS implementation in the target populations compared with contemporaneous surgical comparator groups (patients undergoing elective gastrointestinal surgery and emergency orthopedic surgery). Implementation began in February and March 2014 and concluded by the end of 2014 at 20 medical centers within the Kaiser Permanente Northern California integrated health care delivery system. A multifaceted ERAS program designed with a particular focus on perioperative pain management, mobility, nutrition, and patient engagement. The primary outcome was hospital length of stay. Secondary outcomes included hospital mortality, home discharge, 30-day readmission rates, and complication rates. The study included a total of 3768 patients undergoing elective colorectal resection (mean [SD] age, 62.7 [14.1] years; 1812 [48.1%] male) and 5002 patients undergoing emergency hip fracture repair (mean [SD] age, 79.5 [11.8] years; 1586 [31.7%] male). Comparator surgical patients included 5556 patients undergoing elective gastrointestinal surgery and 1523 patients undergoing emergency orthopedic surgery. Most process metrics had significantly greater changes in the ERAS target populations after implementation compared with comparator surgical populations, including those for ambulation, nutrition, and opioid use. Hospital length of stay and postoperative complication rates were also significantly lower among ERAS target populations after implementation. The rate ratios for postoperative complications were 0.68 (95% CI, 0.46-0.99; P = .04) for patients

  8. Membrane contactor assisted water extraction system for separating hydrogen peroxide from a working solution, and method thereof (United States)

    Snyder, Seth W [Lincolnwood, IL; Lin, Yupo J [Naperville, IL; Hestekin', Jamie A [Fayetteville, AR; Henry, Michael P [Batavia, IL; Pujado, Peter [Kildeer, IL; Oroskar, Anil [Oak Brook, IL; Kulprathipanja, Santi [Inverness, IL; Randhava, Sarabjit [Evanston, IL


    The present invention relates to a membrane contactor assisted extraction system and method for extracting a single phase species from multi-phase working solutions. More specifically one preferred embodiment of the invention relates to a method and system for membrane contactor assisted water (MCAWE) extraction of hydrogen peroxide (H.sub.2O.sub.2) from a working solution.

  9. Cost analysis of new and retrofit hot-air type solar assisted heating systems (United States)

    Stewart, R. D.; Hawkins, B. J.


    A detailed cost analysis/cost improvement study was performed on two Department of Energy/National Aeronautics and Space Administration operational test sites to determine actual costs and potential cost improvements of new and retrofit hot air type, solar assisted heating and hot water systems for single family sized structures. This analysis concentrated on the first cost of a system which included procurement, installation, and integration of a solar assisted heating and hot water system on a new or retrofit basis; it also provided several cost projections which can be used as inputs to payback analyses, depending upon the degree of optimism or future improvements assumed. Cost definitions were developed for five categories of cost, and preliminary estimates were developed for each. The costing methodology, approach, and results together with several candidate low cost designs are described.

  10. Association of Surgical Treatment, Systemic Therapy, and Survival in Patients With Abdominal Visceral Melanoma Metastases, 1965-2014: Relevance of Surgical Cure in the Era of Modern Systemic Therapy. (United States)

    Deutsch, Gary B; Flaherty, Devin C; Kirchoff, Daniel D; Bailey, Mariel; Vitug, Sarah; Foshag, Leland J; Faries, Mark B; Bilchik, Anton J


    Systemic therapy for metastatic melanoma has evolved rapidly during the last decade, and patient treatment has become more complex. To evaluate the survival benefit achieved through surgical resection of melanoma metastatic to the abdominal viscera in patients treated in the modern treatment environment. This retrospective review of the institutional melanoma database from the John Wayne Cancer Institute at Providence St Johns Health Center, a tertiary-level melanoma referral center, included 1623 patients with melanoma diagnosed as having potentially resectable abdominal metastases before (1969-2003) and after (2004-2014) advances in systemic therapy. Overall survival (OS). Of the 1623 patients identified in the database with abdominal melanoma metastases, 1097 were men (67.6%), and the mean (SD) age was 54.6 (14.6) years. Of the patients with metastatic melanoma, 1623 (320 [19.7%] in the 2004-2014 period) had abdominal metastases, including 336 (20.7%) with metastases in the gastrointestinal tract, 697 (42.9%) in the liver, 138 (8.5%) in the adrenal glands, 38 (2.3%) in the pancreas, 109 (6.7%) in the spleen, and 305 (18.8%) with multiple sites. Median OS was superior in surgical (n = 392; 18.0 months) vs nonsurgical (n = 1231; 7.0 months) patients (P treatment with metastasectomy (HR, 0.59; 95% CI, 0.46-0.74; P treatment era did not significantly affect outcomes (HR, 0.82; 95% CI, 0.67-1.02; P = .15). Overall, patients with gastrointestinal tract metastases undergoing complete, curative resection derived the greatest benefit, with a median OS of 64 months. To our knowledge, this series is the largest single-institution experience with abdominal melanoma metastases, demonstrating that surgical resection remains an important treatment consideration even in the systemic treatment era.

  11. State-of-the-art Versus Time-triggered Object Tracking in Advanced Driver Assistance Systems

    Directory of Open Access Journals (Sweden)

    Moritz Koplin


    Full Text Available Most state-of-the-art driver assistance systems cannot guarantee that real-time images of object states are updated within a given time interval, because the object state observations are typically sampled by uncontrolled sensors and transmitted via an indeterministic bus system such as CAN. To overcome this shortcoming, a paradigm shift toward time-triggered advanced driver assistance systems based on a deterministic bus system, such as FlexRay, is under discussion. In order to prove the feasibility of this paradigm shift, this paper develops different models of a state-of-the-art and a time-triggered advanced driver assistance system based on multi-sensor object tracking and compares them with regard to their mean performance. The results show that while the state-of-the-art model is advantageous in scenarios with low process noise, it is outmatched by the time-triggered model in the case of high process noise, i.e., in complex situations with high dynamic.

  12. In vivo intra-operative breast tumor margin detection using a portable OCT system with a handheld surgical imaging probe (United States)

    Erickson-Bhatt, Sarah J.; Nolan, Ryan; Shemonski, Nathan D.; Adie, Steven G.; Putney, Jeffrey; Darga, Donald; McCormick, Daniel T.; Cittadine, Andrew; Marjanovic, Marina; Chaney, Eric J.; Monroy, Guillermo L.; South, Fredrick; Carney, P. Scott; Cradock, Kimberly A.; Liu, Z. George; Ray, Partha S.; Boppart, Stephen A.


    Breast-conserving surgery is a frequent option for women with stage I and II breast cancer, and with radiation treatment, can be as effective as a mastectomy. However, adequate margin detection remains a challenge, and too often additional surgeries are required. Optical coherence tomography (OCT) provides a potential method for real-time, high-resolution imaging of breast tissue during surgery. Intra-operative OCT imaging of excised breast tissues has been previously demonstrated by several groups. In this study, a novel handheld surgical probe-based OCT system is introduced, which was used by the surgeon to image in vivo, within the tumor cavity, and immediately following tumor removal in order to detect the presence of any remaining cancer. Following resection, study investigators imaged the excised tissue with the same probe for comparison. We present OCT images obtained from over 15 patients during lumpectomy and mastectomy surgeries. Images were compared to post-operative histopathology for diagnosis. OCT images with micron scale resolution show areas of heterogeneity and disorganized features indicative of malignancy, compared to more uniform regions of normal tissue. Video-rate acquisition shows the inside of the tumor cavity as the surgeon sweeps the probe along the walls of the surgical cavity. This demonstrates the potential of OCT for real-time assessment of surgical tumor margins and for reducing the unacceptably high re-operation rate for breast cancer patients.

  13. Optical augmented reality assisted navigation system for neurosurgery teaching and planning (United States)

    Wu, Hui-Qun; Geng, Xing-Yun; Wang, Li; Zhang, Yuan-Peng; Jiang, Kui; Tang, Le-Min; Zhou, Guo-Min; Dong, Jian-Cheng


    This paper proposed a convenient navigation system for neurosurgeon's pre-operative planning and teaching with augmented reality (AR) technique, which maps the three-dimensional reconstructed virtual anatomy structures onto a skull model. This system included two parts, a virtual reality system and a skull model scence. In our experiment, a 73 year old right-handed man initially diagnosed with astrocytoma was selected as an example to vertif