Search results for: orthopaedic surgery

Authors: J. Bartnicka, J. A. Piedrabuena, R. Portilla, L. Moyano - Cuevas, J. B. Pagador, P. Augat, J. Tokarczyk, F. M. Sánchez Margallo

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Orthopaedic surgeries are characterized by a high degree of complexity. This is reflected by four main groups of resources: 1) surgical team which is consisted of people with different competencies, educational backgrounds and positions; 2) information and knowledge about medical and technical aspects of surgery; 3) medical equipment including surgical tools and materials; 4) space infrastructure which is important from an operating room layout point of view. These all components must be integrated and build a homogeneous organism for achieving an efficient and ergonomically correct surgical workflow. Taking this as a background, there was formulated a concept of international project, called “Online Vocational Training course on ergonomics for orthopaedic Minimally Invasive” (Train4OrthoMIS), which aim is to develop an e-learning tool available in 4 languages (English, Spanish, Polish and German). In the article, there is presented the first project research outcomes focused on three aspects: 1) ergonomic needs of surgeons who work in hospitals around different European countries, 2) the concept of structure of e-learning course, 3) the definition of tools and methods for knowledge assessment adjusted to users’ expectation.  The methodology was based on the expert panels and two types of surveys: 1) on training needs, 2) on evaluation and self-assessment preferences. The major findings of the study allowed describing the subjects of four training modules and learning sessions. According to peoples’ opinion there were defined most expected test methods which are single choice test and right after quizzes: “True or False” and “Link elements” The first project outcomes confirmed the necessity of creating a universal training tool for orthopaedic surgeons regardless of the country in which they work. Because of limited time that surgeons have, the e-learning course should be strictly adjusted to their expectation in order to be useful.

Keywords: International e-learning, ergonomics, orthopaedic surgery, Train4OrthoMIS.

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Authors: M. Regis, E. Marin, S. Fusi, M. Pressacco, L. Fedrizzi

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Electron Beam Melting (EBM) process was used to prepare porous scaffolds with controlled porosity to ensure optimal levels of osteointegration for different trabeculae sizes. Morphological characterization by means of SEM analyses was carried out to assess pore dimensions; tensile, compression and adhesion tests have been carried out to determine the mechanical behavior. The results indicate that EBM process allows the creation of regular and repeatable porous scaffolds. Mechanical properties greatly depend on pore dimension and on bulk-pore ratio. Adhesion resistance meets the normative requirements, and the overall performance of the produced structures is compatible with potential orthopaedic applications.

Keywords: Additive manufacturing, orthopaedic implants, osteointegration, trabecular structures

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Authors: Sangram A. Sathe, Neha A. Madgulkar, Shruti S. Raut, S. P. Wadkar

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Transforaminal lumbar interbody fusion (TLIF) surgeries have nowadays became popular for treatment of degenerated spinal disorders. The interbody fusion technique like TLIF maintains load bearing capacity of the spine and a suitable disc height. Currently many techniques have been introduced to cure Spondylolisthesis. This surgery provides greater rehabilitation of degenerative spines. While performing this TLIF surgery existing methods use guideway, which is a troublesome surgery technique as the use of two separate instruments is required to perform this surgery. This paper presents a concept which eliminates the use of guideway. This concept also eliminates problems that occur like reverting the cage. The concept discussed in this paper also gives high accuracy while performing surgery.

Keywords: Degenerative disc diseases, pedicle screw, spine, spondylolisthesis, transforaminal lumbar interbody fusion.

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Authors: Ramon Sancibrian, Carlos Redondo-Figuero, Maria C. Gutierrez-Diez, Esther G. Sarabia, Maria A. Benito-Gonzalez, Jose C. Manuel-Palazuelos

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In this paper, the design and evaluation of a handle for laparoscopic surgery is presented. The design of the handle is based on ergonomic principles and tries to avoid awkward postures for surgeons. The handle combines the so-called power-grip and accurate-grip in order to provide strength and accuracy in the performance of surgery. The handle is tested using both objective and subjective approaches. The objective approach uses motion capture techniques to obtain the angles of forearm, arm, wrist and hand. The muscular effort is obtained with electromyography electrodes. On the other hand, a subjective survey has been carried out using questionnaires. Results confirm that the handle is preferred by the majority of the surgeons.

Keywords: Laparoscopic Surgery, Ergonomics, Mechanical Design, Biomechanics.

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Authors: K. Bensafia, A. Mansour, G. Le Maillot, B. Clement, O. Reynet, P. Ariès, S. Haddab

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This paper presents a system designed for wireless acquisition, the recording of electrocardiogram (ECG) signals and the monitoring of the heart’s health during surgery. This wireless recording system allows us to visualize and monitor the state of the heart’s health during a surgery, even if the patient is moved from the operating theater to post anesthesia care unit. The acquired signal is transmitted via a Bluetooth unit to a PC where the data are displayed, stored and processed. To test the reliability of our system, a comparison between ECG signals processed by a conventional ECG monitoring system (Datex-Ohmeda) and by our wireless system is made. The comparison is based on the shape of the ECG signal, the duration of the QRS complex, the P and T waves, as well as the position of the ST segments with respect to the isoelectric line. The proposed system is presented and discussed. The results have confirmed that the use of Bluetooth during surgery does not affect the devices used and vice versa. Pre- and post-processing steps are briefly discussed. Experimental results are also provided.

Keywords: Electrocardiography, monitoring, surgery, wireless system.

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Authors: Maruf Yinka Kolawole, Jacob Olayiwola Aweda, Farasat Iqbal, Asif Ali, Sulaiman Abdulkareem

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Zinc is a non-ferrous metal with potential application in orthopaedic implant materials. However, its poor mechanical properties were major challenge to its application. Therefore, this paper studies the mechanical properties of biodegradable Zn-based alloy for biomedical application. Pure zinc powder with varying (0, 1, 2, 3 & 6) wt% of magnesium powders were ball milled using ball-to-powder ratio (B:P) of 10:1 at 350 rpm for 4 hours. The resulting milled powders were compacted and sintered at 300 MPa and 350 °C respectively. Microstructural, phase and mechanical properties analyses were performed following American standard of testing and measurement. The results show that magnesium has influence on the mechanical properties of zinc. The compressive strength, hardness and elastic modulus of 210 ± 8.878 MPa, 76 ± 5.707 HV and 45 ± 11.616 GPa respectively as obtained in Zn-2Mg alloy were optimum and meet the minimum requirement of biodegradable metal for orthopaedics application. These results indicate an increase of 111, 93 and 93% in compressive strength, hardness and elastic modulus respectively as compared to pure zinc. The increase in mechanical properties was adduced to effectiveness of compaction pressure and intermetallic phase formation within the matrix resulting in high dislocation density for improving strength. The study concluded that, Zn-2Mg alloy with optimum mechanical properties can therefore be considered a potential candidate for orthopaedic application.

Keywords: Biodegradable metal, biomedical application mechanical properties, powder metallurgy, zinc.

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Authors: M. Ovinis, D. Kerr, K. Bouazza-Marouf, M. Vloeberghs

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The use of machine vision to inspect the outcome of surgical tasks is investigated, with the aim of incorporating this approach in robotic surgery systems. Machine vision is a non-contact form of inspection i.e. no part of the vision system is in direct contact with the patient, and is therefore well suited for surgery where sterility is an important consideration,. As a proof-of-concept, three primary surgical tasks for a common neurosurgical procedure were inspected using machine vision. Experiments were performed on cadaveric pig heads to simulate the two possible outcomes i.e. satisfactory or unsatisfactory, for tasks involved in making a burr hole, namely incision, retraction, and drilling. We identify low level image features to distinguish the two outcomes, as well as report on results that validate our proposed approach. The potential of using machine vision in a surgical environment, and the challenges that must be addressed, are identified and discussed.

Keywords: Visual inspection, machine vision, robotic surgery.

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Authors: M. Mottaghi, F. Ghalichi, H. Badri Ghavifekr, H. Niroomand Oskui

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This paper presents design and characterization of a microaccelerometer designated for integration into cataract surgical probe to detect hardness of different eye tissues during cataract surgery. Soft posterior lens capsule of eye can be easily damaged in comparison with hard opaque lens since the surgeon can not see directly behind cutting needle during the surgery. Presence of microsensor helps the surgeon to avoid rupturing posterior lens capsule which if occurs leads to severe complications such as glaucoma, infection, or even blindness. The microsensor having overall dimensions of 480 μm x 395 μm is able to deliver significant capacitance variations during encountered vibration situations which makes it capable to distinguish between different types of tissue. Integration of electronic components on chip ensures high level of reliability and noise immunity while minimizes space and power requirements. Physical characteristics and results on performance testing, proves integration of microsensor as an effective tool to aid the surgeon during this procedure.

Keywords: Cataract surgery, MEMS, Microsensor, Phacoemulsification.

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Authors: Ege Can Onal, Enver Ersen, Meltem Elitas

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Laparoscopy is a surgical operation, well known as keyhole surgery. The operation is performed through small holes, hence, scars of a patient become much smaller, patients can recover in a short time and the hospital stay becomes shorter in comparison to an open surgery. Several tools are used at laparoscopic operations; among them, the laparoscope has a crucial role. It provides the vision during the operation, which will be the main focus in here. Since the operation area is very small, motion of the surgical tools might be limited in laparoscopic operations compared to traditional surgeries. To overcome this limitation, most of the laparoscopic tools have become more precise, dexterous, multi-functional or automated. Here, we present a robotic-assisted laparoscope that is controlled with pedals directly by a surgeon. Thus, the movement of the laparoscope might be controlled better, so there will not be a need to calibrate the camera during the operation. The need for an assistant that controls the movement of the laparoscope will be eliminated. The duration of the laparoscopic operation might be shorter since the surgeon will directly operate the camera.

Keywords: Laparoscope, laparoscopy, low-cost, minimally invasive surgery, robotic-assisted surgery.

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Authors: M. Ovinis, D. Kerr, K. Bouazza-Marouf, M. Vloeberghs

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In this paper, the feasibility of using machine vision to assess task completion in a surgical intervention is investigated, with the aim of incorporating vision based inspection in robotic surgery systems. The visually rich operative field presents a good environment for the development of automated visual inspection techniques in these systems, for a more comprehensive approach when performing a surgical task. As a proof of concept, machine vision techniques were used to distinguish the two possible outcomes i.e. satisfactory or unsatisfactory, of three primary surgical tasks involved in creating a burr hole in the skull, namely incision, retraction, and drilling. Encouraging results were obtained for the three tasks under consideration, which has been demonstrated by experiments on cadaveric pig heads. These findings are suggestive for the potential use of machine vision to validate successful task completion in robotic surgery systems. Finally, the potential of using machine vision in the operating theatre, and the challenges that must be addressed, are identified and discussed.

Keywords: Machine vision, robotic surgery, visual inspection.

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Authors: J. Bouchard, B. Prosperi, G. Bavre, M. Daudé, E. Jeandupeux

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Young patients suffering from Cerebral Palsy are facing difficult choices concerning heavy surgeries. Diagnosis settled by surgeons can be complex and on the other hand decision for patient about getting or not such a surgery involves important reflection effort. Proposed software combining prediction for surgeries and post surgery kinematic values, and from 3D model representing the patient is an innovative tool helpful for both patients and medicine professionals. Beginning with analysis and classification of kinematics values from Data Base extracted from gait analysis in 3 separated clusters, it is possible to determine close similarity between patients. Prediction surgery best adapted to improve a patient gait is then determined by operating a suitable preconditioned neural network. Finally, patient 3D modeling based on kinematic values analysis, is animated thanks to post surgery kinematic vectors characterizing the closest patient selected from patients clustering.

Keywords: Cerebral Palsy, Clustering, Crouch Gait, 3-D Modeling.

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Authors: Vikas Pandey, T. L. Joshy, Vyshak Vijayan, N. Babu

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A new and cost effective robotic device was designed for remote tele surgery using dual tone multi frequency technology (DTMF). Tele system with Dual Tone Multiple Frequency has a large capability in sending and receiving of data in hardware and software. The robot consists of DC motors for arm movements and it is controlled manually through a mobile phone through DTMF Technology. The system enables the surgeon from base station to send commands through mobile phone to the patient’s robotic system which includes two robotic arms that translate the input into actual instrument manipulation. A mobile phone attached to the microcontroller 8051 which can activate robot through relays. The Remote robot-assisted tele surgery eliminates geographic constraints for getting surgical expertise where it is needed and allows an expert surgeon to teach or proctor the performance of surgical technique by real-time intervention.

Keywords: Robot, Microcontroller, DTMF, Tele surgery.

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Authors: T. Kero, R. Söderberg, M. Andersson, L. Lindkvist

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Within dental-guided surgery, there has been a lack of analytical methods for optimizing the treatment of the rehabilitation concepts regarding geometrical variation. The purpose of this study is to find the source of the greatest geometrical variation contributor and sensitivity contributor with the help of virtual variation simulation of a dental drill- and implant-guided surgery process using a methodical approach. It is believed that lower geometrical variation will lead to better patient security and higher quality of dental drill- and implant-guided surgeries. It was found that the origin of the greatest contributor to the most variation, and hence where the foci should be set, in order to minimize geometrical variation was in the assembly category (surgery). This was also the category that was the most sensitive for geometrical variation.

Keywords: Variation Simulation, Process Optimization, Guided Surgeries, Dental Prosthesis.

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Authors: J. A. López, C.I. López, J.E. Olguín, C. Camargo, J. M. López

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The institutions seek to improve their performance and quality of service, so that their patients are satisfied. This research project aims, conduct a time study program in the area of gynecological surgery, to determine the current level of capacity and optimize the programming time in order to adequately respond to demand. The system is analyzed by waiting lines and uses the simulation using ARENA to evaluate proposals for improvement and optimization programming time each of the surgeries.

Keywords: Time study, waiting lines, reducing time, simulation.

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Authors: M. Ramezanifard, J. Dargahi, S. Najarian, N. Narayanan

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One of the major disadvantages of the minimally invasive surgery (MIS) is the lack of tactile feedback to the surgeon. In order to identify and avoid any damage to the grasped complex tissue by endoscopic graspers, it is important to measure the local softness of tissue during MIS. One way to display the measured softness to the surgeon is a graphical method. In this paper, a new tactile sensor has been reported. The tactile sensor consists of an array of four softness sensors, which are integrated into the jaws of a modified commercial endoscopic grasper. Each individual softness sensor consists of two piezoelectric polymer Polyvinylidene Fluoride (PVDF) films, which are positioned below a rigid and a compliant cylinder. The compliant cylinder is fabricated using a micro molding technique. The combination of output voltages from PVDF films is used to determine the softness of the grasped object. The theoretical analysis of the sensor is also presented. A method has been developed with the aim of reproducing the tactile softness to the surgeon by using a graphical method. In this approach, the proposed system, including the interfacing and the data acquisition card, receives signals from the array of softness sensors. After the signals are processed, the tactile information is displayed by means of a color coding method. It is shown that the degrees of softness of the grasped objects/tissues can be visually differentiated and displayed on a monitor.

Keywords: Minimally invasive surgery, Robotic surgery, Sensor, Softness, Tactile.

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Authors: Ayat E. Ali, Christeen R. Aziz, Merna A. Helmy, Mohammed M. Malek, Sherif H. El-Gohary

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Goal: Purpose of the project was to make a plastic surgery prediction by using pre-operative images for the plastic surgeries’ patients and to show this prediction on a screen to compare between the current case and the appearance after the surgery. Methods: To this aim, we implemented a software which used data from the internet for facial skin diseases, skin burns, pre-and post-images for plastic surgeries then the post- surgical prediction is done by using K-nearest neighbor (KNN). So we designed and fabricated a smart mirror divided into two parts a screen and a reflective mirror so patient's pre- and post-appearance will be showed at the same time. Results: We worked on some skin diseases like vitiligo, skin burns and wrinkles. We classified the three degrees of burns using KNN classifier with accuracy 60%. We also succeeded in segmenting the area of vitiligo. Our future work will include working on more skin diseases, classify them and give a prediction for the look after the surgery. Also we will go deeper into facial deformities and plastic surgeries like nose reshaping and face slim down. Conclusion: Our project will give a prediction relates strongly to the real look after surgery and decrease different diagnoses among doctors. Significance: The mirror may have broad societal appeal as it will make the distance between patient's satisfaction and the medical standards smaller.

Keywords: K-nearest neighbor, face detection, vitiligo, bone deformity.

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Authors: Dean J. Callaghan, Mark M. McGrath

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Sensorized instruments that accurately measure the interaction forces (between biological tissue and instrument endeffector) during surgical procedures offer surgeons a greater sense of immersion during minimally invasive robotic surgery. Although there is ongoing research into force measurement involving surgical graspers little corresponding effort has been carried out on the measurement of forces between scissor blades and tissue. This paper presents the design and development of a force measurement test apparatus, which will serve as a sensor characterization and evaluation platform. The primary aim of the experiments is to ascertain whether the system can differentiate between tissue samples with differing mechanical properties in a reliable, repeatable manner. Force-angular displacement curves highlight trends in the cutting process as well the forces generated along the blade during a cutting procedure. Future applications of the test equipment will involve the assessment of new direct force sensing technologies for telerobotic surgery.

Keywords: Force measurement, minimally invasive surgery, scissor blades, tissue cutting.

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Authors: Hakan Işık, Esra Saraçoğlu

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In this study, a comparison of two control methods, Proportional Control (PC) and Fuzzy Logic Control (FLC), which have been used to develop an ideal thermoelectric renal hypothermia system in order to use in renal surgery, has been carried out. Since the most important issues in long-lasting parenchymatous renal surgery are to provide an operation medium free of blood and to prevent renal dysfunction in the postoperative period, control of the temperature has become very important in renal surgery. The final product is seriously affected from the changes in temperature, therefore, it is necessary to reach some desired temperature points quickly and avoid large overshoot. PIC16F877 microcontroller has been used as controller for both of these two methods. Each control method can simply ensure extra renal hypothermia in the targeted way. But investigation of advantages and disadvantages of every control method to each other is aimed and carried out by the experimental implementations. Shortly, investigation of the most appropriate method to use for development of system and that can be applied to people safely in the future, has been performed. In this sense, experimental results show that fuzzy logic control gives out more reliable responses and efficient performance.

Keywords: renal hypothermia, renal cooling, temperature control, proportional control fuzzy logic control

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Authors: Beibei Han, Yong-Jin Yoon, Muhammad Hamidullah, Angel Tsu-Hui Lin, Woo-Tae Park

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This paper presents the design of a ring-shaped tri-axial fore sensor that can be incorporated into the tip of a guidewire for use in minimally invasive surgery (MIS). The designed sensor comprises a ring-shaped structure located at the center of four cantilever beams. The ringdesign allows surgical tools to be easily passed through which largely simplified the integration process. Silicon nanowires (SiNWs) are used aspiezoresistive sensing elementsembeddedon the four cantilevers of the sensor to detect the resistance change caused by the applied load.An integration scheme with new designed guidewire tip structure having two coils at the distal end is presented. Finite element modeling has been employed in the sensor design to find the maximum stress location in order to put the SiNWs at the high stress regions to obtain maximum output. A maximum applicable force of 5 mN is found from modeling. The interaction mechanism between the designed sensor and a steel wire has been modeled by FEM. A linear relationship between the applied load on the steel wire and the induced stress on the SiNWs were observed.

Keywords: Triaxial MEMS force sensor, Ring shape, Silicon Nanowire, Minimally invasive surgery.

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Authors: Elnaz Afshari, Siamak Najarian

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Having considered tactile sensing and palpation of a surgeon in order to detect kidney stone during open surgery; we present the 2D model of nephrolithiasis (two dimensional model of kidney containing a simulated stone). The effects of stone existence that appear on the surface of kidney (because of exerting mechanical load) are determined. Using Finite element method, it is illustrated that the created stress patterns on the surface of kidney and stress graphs not only show existence of stone inside kidney, but also show its exact location.

Keywords: Nephrolithiasis, Minimally Invasive Surgery, Artificial Tactile Sensing, Finite Element Method.

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Authors: Rassoli Aisa, Abrishami Movahhed Arezu, Faturaee Nasser, Seddighi Amir Saeed, Shafigh Mohammad

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Cardiovascular diseases are one of the most common causes of mortality in developed countries. Coronary artery abnormalities and carotid artery stenosis, also known as silent death, are among these diseases. One of the treatment methods for these diseases is to create a deviatory pathway to conduct blood into the heart through a bypass surgery. The saphenous vein is usually used in this surgery to create the deviatory pathway. Unfortunately, a re-surgery will be necessary after some years due to ignoring the disagreement of mechanical properties of graft tissue and/or applied prostheses with those of host tissue. The objective of the present study is to clarify the viscoelastic behavior of human saphenous tissue. The stress relaxation tests in circumferential and longitudinal direction were done in this vein by exerting 20% and 50% strains. Considering the stress relaxation curves obtained from stress relaxation tests and the coefficients of the standard solid model, it was demonstrated that the saphenous vein has a non-linear viscoelastic behavior. Thereafter, the fitting with Fung’s quasilinear viscoelastic (QLV) model was performed based on stress relaxation time curves. Finally, the coefficients of Fung’s QLV model, which models the behavior of saphenous tissue very well, were presented.

Keywords: Fung’s quasilinear viscoelastic (QLV) model, strain rate, stress relaxation test, uniaxial tensile test, viscoelastic behavior.

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Authors: Nora Taleb, Sellami Mokhtar, Michel Simonet

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This work concerns the evolution and the maintenance of an ontological resource in relation with the evolution of the corpus of texts from which it had been built. The knowledge forming a text corpus, especially in dynamic domains, is in continuous evolution. When a change in the corpus occurs, the domain ontology must evolve accordingly. Most methods manage ontology evolution independently from the corpus from which it is built; in addition, they treat evolution just as a process of knowledge addition, not considering other knowledge changes. We propose a methodology for managing an evolving ontology from a text corpus that evolves over time, while preserving the consistency and the persistence of this ontology. Our methodology is based on the changes made on the corpus to reflect the evolution of the considered domain - augmented surgery in our case. In this context, the results of text mining techniques, as well as the ARCHONTE method slightly modified, are used to support the evolution process.

Keywords: Corpus, Evolution, Ontology

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Authors: Elnaz Afshari, Siamak Najarian, Naser Simforoosh, Siamak Hajizadeh Farkoush

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Minimally invasive surgery (MIS) is now being widely used as a preferred choice for various types of operations. The need to detect various tactile properties, justifies the key role of tactile sensing that is currently missing in MIS. In this regard, Laparoscopy is one of the methods of minimally invasive surgery that can be used in kidney stone removal surgeries. At this moment, determination of the exact location of stone during laparoscopy is one of the limitations of this method that no scientific solution has been found for so far. Artificial tactile sensing is a new method for obtaining the characteristics of a hard object embedded in a soft tissue. Artificial palpation is an important application of artificial tactile sensing that can be used in different types of surgeries. In this study, a new method for determining the exact location of stone during laparoscopy is presented. In the present study, the effects of stone existence on the surface of kidney were investigated using conceptual 3D model of kidney containing a simulated stone. Having imitated palpation and modeled it conceptually, indications of stone existence that appear on the surface of kidney were determined. A number of different cases were created and solved by the software and using stress distribution contours and stress graphs, it is illustrated that the created stress patterns on the surface of kidney show not only the existence of stone inside, but also its exact location. So three-dimensional analysis leads to a novel method of predicting the exact location of stone and can be directly applied to the incorporation of tactile sensing in artificial palpation, helping surgeons in non-invasive procedures.

Keywords: Kidney Stone, Laparoscopic Surgery, Artificial Tactile Sensing, Finite Element Method.

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Authors: Ahmad Atieh, Masoud Kalantari, Roozbeh Ahmadi, Javad Dargahi, Muthukumaran Packirisamy, Mehrdad Hosseini Zadeh

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The present paper presents a finite element model and analysis for the interaction between a piezoresistive tactile sensor and biological tissues. The tactile sensor is proposed for use in minimally invasive surgery to deliver tactile information of biological tissues to surgeons. The proposed sensor measures the relative hardness of soft contact objects as well as the contact force. Silicone rubbers were used as the phantom of biological tissues. Finite element analysis of the silicone rubbers and the mechanical structure of the sensor were performed using COMSOL Multiphysics (v3.4) environment. The simulation results verify the capability of the sensor to be used to differentiate between different kinds of silicone rubber materials.

Keywords: finite element analysis, minimally invasive surgery, Neo-Hookean hyperelastic materials, tactile sensor.

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Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

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Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG, MACCEs, quality of life, total arterial revascularization.

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Authors: Angelica I. Aviles, Pilar Sobrevilla, Alicia Casals

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Compensating physiological motion in the context of minimally invasive cardiac surgery has become an attractive issue since it outperforms traditional cardiac procedures offering remarkable benefits. Owing to space restrictions, computer vision techniques have proven to be the most practical and suitable solution. However, the lack of robustness and efficiency of existing methods make physiological motion compensation an open and challenging problem. This work focusses on increasing robustness and efficiency via exploration of the classes of 1−and 2−regularized optimization, emphasizing the use of explicit regularization. Both approaches are based on natural features of the heart using intensity information. Results pointed out the 1−regularized optimization class as the best since it offered the shortest computational cost, the smallest average error and it proved to work even under complex deformations.

Keywords: Motion Compensation, Optimization, Regularization, Beating Heart Surgery, Ill-posed problem.

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Authors: Dae Gon Woo, Chang Yong Ko, Tae Woo Lee, Han Sung Kim, Beob Yi Lee

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In the present study, changes of morphology and mechanical characteristics in the lumbar vertebrae of the ovariectomised (OVX) rat were investigated. In previous researches, there were many studies about morphology like volume fraction and trabecular thickness based on Micro - Computed Tomography (Micro - CT). However, detecting and tracking long-term changes in the trabecular bone of the lumbar vertebrae for the OVX rat were few. For this study, one female Sprague-Dawley rat was used: an OVX rat. The 4th Lumbar of the OVX rat was subjected to in-vivo micro-CT. Detecting and tracking long-term changes could be investigated in the trabecular bone of the lumbar vertebrae for an OVX rat using in-vivo micro-CT. An OVX rat was scanned at week 0 (just before surgery), at week 4, at week 8, week 16, week 22 and week 56 after surgery. Finite element (FE) analysis was used to investigate mechanical characteristics of the lumbar vertebrae for an OVX rat. When the OVX rat (at week 56) was compared with the OVX rat (at week 0), volume fraction was decreased by 80% and effective modulus was decreased by 75%.

Keywords: OVX rats, Trabecular bone, In-vivo Micro-CT, FE analysis

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Authors: Irfan Z. Qureshi, Fareeha A., Wajid A. Khan

Abstract:

Human amniotic membrane (HAM) is a useful biological material for the reconstruction of damaged ocular surface. The processing and preservation of HAM is critical to prevent the patients undergoing amniotic membrane transplant (AMT) from cross infections. For HAM preparation human placenta is obtained after an elective cesarean delivery. Before collection, the donor is screened for seronegativity of HCV, Hbs Ag, HIV and Syphilis. After collection, placenta is washed in balanced salt solution (BSS) in sterile environment. Amniotic membrane is then separated from the placenta as well as chorion while keeping the preparation in BSS. Scrapping of HAM is then carried out manually until all the debris is removed and clear transparent membrane is acquired. Nitrocellulose membrane filters are then placed on the stromal side of HAM, cut around the edges with little membrane folded towards other side making it easy to separate during surgery. HAM is finally stored in solution of glycerine and Dulbecco-s Modified Eagle Medium (DMEM) in 1:1 ratio containing antibiotics. The capped borosil vials containing HAM are kept at -80°C until use. This vial is thawed to room temperature and opened under sterile operation theatre conditions at the time of surgery.

Keywords: HAM, AMT, ocular transplant

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Authors: M. Gooroochurn, M. Ovinis, D. Kerr, K. Bouazza-Marouf, M. Vloeberghs

Abstract:

A registration framework for image-guided robotic surgery is proposed for three emergency neurosurgical procedures, namely Intracranial Pressure (ICP) Monitoring, External Ventricular Drainage (EVD) and evacuation of a Chronic Subdural Haematoma (CSDH). The registration paradigm uses CT and white light as modalities. This paper presents two simulation studies for a preliminary evaluation of the registration protocol: (1) The loci of the Target Registration Error (TRE) in the patient-s axial, coronal and sagittal views were simulated based on a Fiducial Localisation Error (FLE) of 5 mm and (2) Simulation of the actual framework using projected views from a surface rendered CT model to represent white light images of the patient. Craniofacial features were employed as the registration basis to map the CT space onto the simulated intraoperative space. Photogrammetry experiments on an artificial skull were also performed to benchmark the results obtained from the second simulation. The results of both simulations show that the proposed protocol can provide a 5mm accuracy for these neurosurgical procedures.

Keywords: Image-guided Surgery, Multimodality Registration, Photogrammetry, Preoperative to Intraoperative Registration.

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Authors: Chang, Chun-Lang, Liu, Chun-Kai

Abstract:

This study, for its research subjects, uses patients who had undergone total knee replacement surgery from the database of the National Health Insurance Administration. Through the review of literatures and the interviews with physicians, important factors are selected after careful screening. Then using Cross Entropy Method, Genetic Algorithm Logistic Regression, and Particle Swarm Optimization, the weight of each factor is calculated and obtained. In the meantime, Excel VBA and Case Based Reasoning are combined and adopted to evaluate the system. Results show no significant difference found through Genetic Algorithm Logistic Regression and Particle Swarm Optimization with over 97% accuracy in both methods. Both ROC areas are above 0.87. This study can provide critical reference to medical personnel as clinical assessment to effectively enhance medical care quality and efficiency, prevent unnecessary waste, and provide practical advantages to resource allocation to medical institutes.

Keywords: Total knee replacement, Case Based Reasoning, Cross Entropy Method, Genetic Algorithm Logistic Regression, Particle Swarm Optimization.

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