Search results for: Medical Surgical

Authors: A. Ruimi, S. Goyal, B. M. Nour

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Interactive web-based computer simulations are needed by the medical community to replicate the experience of surgical procedures as closely and realistically as possible without the need to practice on corpses, animals and/or plastic models. In this paper, we offer a review on current state of the research on simulations of surgical threads, identify future needs and present our proposed plans to meet them. Our goal is to create a physics-based simulator, which will predict the behavior of surgical thread when subjected to conditions commonly encountered during surgery. To that end, we will i) develop three dimensional finite element models based on the Cosserat theory of elasticity ii) test and feedback results with the medical community and iii) develop a web-based user interface to run/command our simulator and visualize the results. The impacts of our research are that i) it will contribute to the development of a new generation of training for medical school students and ii) the simulator will be useful to expert surgeons in developing new, better and less risky procedures.

Keywords: Cosserat rod-theory, FEM simulations, Modeling, Surgical thread.

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Authors: Rita C. Ramos

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Medical Surgical Nursing is one of the major subjects in nursing. This study examined the validity and reliability of the achievement examination utilizing the Classical Test Theory and Item Response Theory. The study answered the following objectives specifically : ( a) To establish the validity and reliability of the achievement examination utilizing Classical Test Theory and Item Response Theory ; ( b ) To determine the dimensionality measure of items and ( c ) to compare the item difficulty and item discrimination of the Medical Surgical Nursing Achievement examination using Classical Test Theory ( CTT ) and Item Response Theory ( IRT ). The developed instrument was administered to fourth year nursing students (N= 136) of a private university in Manila. The findings yielded the following results: The achievement examination is reliable both using CTT and IRT. The findings indicate person and item statistics from two frameworks are quite alike. The achievement examination formed a unidimensional construct.

Keywords: Achievement Examination, Item Response Theory, Medical Surgical, Nursing.

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Authors: Amany S. Youssef, Suzan A.M. El Feky, Samy A. El-Asser, Rasha A.M. Abd Allah

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Surgical site infections (SSIs) are the most common nosocomial infection in surgical patients resulting in significant increases in postoperative morbidity and mortality. The commonly causative bacteria developed resistance to virtually all antibiotics available. The aim of this study was to isolation and identification the most common bacteria that cause SSIs in Medical Research Institute, and to compare their sensitivity to selected group of antibiotics and natural products (garlic, oregano, olive, and Nigella sativa oils). The isolated pathogens collected from infected surgical wounds were identified, and their sensitivities to the antibiotics commonly available for clinical use, and also to the different concentrations of the used natural products were investigated. The results indicate to the potential therapeutic effect of the tested natural products in treatment of surgical wound infections.

Keywords: Surgical wounds, multi-resistant bacteria, bacterial sensitivity, natural oils.

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Authors: K. K. Saju, A. R. Reghuraj

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High reflectance of surgical instruments under bright light hinders the visual clarity during laparoscopic surgical procedures leading to loss of precision and device control and creates strain and undesired difficulties to surgeons. Majority of the surgical instruments are made of surgical grade steel. Instruments with a non reflective surface can enhance the visual clarity during precision surgeries. A conversion coating of black oxide has been successfully developed 410 grade surgical stainless steel .The characteristics of the developed coating suggests the application of this technique for developing 410 grade surgical instruments with minimal reflectance.

Keywords: Conversion coatings, 410 stainless steel, black oxide, reflectance.

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Authors: Abdulrahim Shamayleh

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In this work, the surgical theater of a local hospital in KSA was analyzed using simulation. The focus was on attempting to answer questions related to how many Operating Rooms (ORs) to open and to analyze the performance of the surgical theater in general and mainly the Post Anesthesia Care Unit (PACU) to assist making decisions regarding PACU staffing. The surgical theater consists of ten operating rooms and the PACU unit which has a maximum capacity of fifteen beds. Different sequencing rules to sequence the surgical cases were tested and the Longest Case First (LCF) were superior to others. The results of the different alternatives developed and tested can be used by the manager as a tool to plan and manage the OR and PACU

Keywords: Operating room, post anesthesia care unit, PACUstaffing, sequencing, healthcare

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Authors: J. Bartnicka

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Surgical team consists of variety types of medical specialists possessing different kind of knowledge, motivations, personalities or abilities. This together with poor knowledge transfer, lack of information and communication technologies (ICT) implementations in hospitals can cause protraction of patient care processes and even jeopardize patient safety. There is presented in the article the outcomes of studies on communication and workflow in surgical team in the background of different collaboration levels in healthcare system. As a result the five determinants of improving workflow and communication within surgical team were indicated as well as knowledge-based tools and supporting information technology were proposed.

Keywords: Knowledge transfer, absorption abilities, knowledge representation, information and communication technologies, cooperation.

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Authors: Siti Nor Zawani Ahmmad, Eileen Su Lee Ming, Yeong Che Fai, Fauzan Khairi bin Che Harun

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The increasingly sophisticated technologies have now been able to provide assistance for surgeons to improve surgical performance through various training programs. Equally important to learning skills is the assessment method as it determines the learning and technical proficiency of a trainee. A consistent and rigorous assessment system will ensure that trainees acquire the specific level of competency prior to certification. This paper reviews the methods currently in use for assessment of surgical skill and some modern techniques using computer-based measurements and virtual reality systems for more quantitative measurements

Keywords: assessment, surgical skill, checklist, global rating, virtual reality

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Authors: N. Khomarloo, F. Mousazadegan, M. Latifi, N. Hemmatinejad

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Recently, the utilization of reusable surgical gowns in order to decrease costs, environmental protection and enhance surgeon’s comfort is considered. One of the concerns in applying this kind of medical protective clothing is reduction of their resistance to bacterial penetration especially in wet state, after repeated laundering and sterilizing process. The purpose of this study is to investigate the effect of the laundering and sterilizing process on the reusable surgical gown’s resistance against bacterial wet penetration. To this end, penetration of Staphylococcus aureus bacteria in wet state after 70 washing and sterilizing cycles was evaluated on the two single-layer and three-layer reusable gowns. The outcomes reveal that up to 20 laundering and sterilizing cycles, protective property of samples improves due to fabric shrinkage, after that because of the fabric’s construction opening, the bacterial penetration increase. However, the three-layer gown presents higher protective performance comparing to the single-layer one.

Keywords: Reusable surgical gown, laundry, sterilization, wet bacterial penetration.

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Authors: G. Aloisio, L. T. De Paolis, A. De Mauro, A. Mongelli

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One of the essential requirements of a realistic surgical simulator is to reproduce haptic sensations due to the interactions in the virtual environment. However, the interaction need to be performed in real-time, since a delay between the user action and the system reaction reduces the immersion sensation. In this paper, a prototype of a coronary stent implant simulator is present; this system allows real-time interactions with an artery by means of a specific haptic device. To improve the realism of the simulation, the building of the virtual environment is based on real patients- images and a Web Portal is used to search in the geographically remote medical centres a virtual environment with specific features in terms of pathology or anatomy. The functional architecture of the system defines several Medical Centres in which virtual environments built from the real patients- images and related metadata with specific features in terms of pathology or anatomy are stored. The searched data are downloaded from the Medical Centre to the Training Centre provided with a specific haptic device and with the software necessary both to manage the interaction in the virtual environment. After the integration of the virtual environment in the simulation system it is possible to perform training on the specific surgical procedure.

Keywords: Medical Simulation, Web Portal, Virtual Reality.

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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: Katarzyna Mleczko

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Processes of production of innovative medical tools have interdisciplinary character. They consist of direct and indirect close cooperation of specialists of different scientific branches. The Knowledge they have seems to be important for undertaken design, construction and manufacturing processes. The Knowledge exchange between participants of these processes is therefore crucial for the final result, which are innovative medical products. The paper draws attention to the necessity of feedback from the end user to the designer / manufacturer of medical tools which will allow for more accurate understanding of user needs. The study describes prerequisites of production processes of innovative medical (surgical) tools including participants and category of knowledge resources occurring in these processes. They are the result of research in selected Polish organizations involved in the production of medical instruments and are the basis for further work on the development of knowledge sharing model in interdisciplinary teams geographically dispersed.

Keywords: Interdisciplinary production processes, knowledge exchange, knowledge sharing, medical tools, user-centered design.

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Authors: Saimir Heta, Kastriot Haxhirexha, Virtut Velmishi, Nevila Alliu, Ilma Robo

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Background: Testicular rotation can occur at any age. The possibility to save the testicle is the fastest possible surgical intervention which is indicated by the presence of acute pain even at rest. The time element is more important to diagnose and proceed further with surgical intervention. Testicular damage is a consequence which mainly depends on the moment of onset of symptoms, at the time when the symptoms are diagnosed, the earliest action to be performed is surgical intervention. Sometimes medical tests are needed to confirm a diagnosis, or to help identify another cause for symptoms; for example, the urine test, that is used to check for infection, associated with the scrotal ultrasound test. Control of blood flow to the longitudinal supply vessels of the testicles is indicated. The sign that indicates testicular rotation is a reduction in blood flow. This is the element which is distinguished from ultrasound examination. Surgery may be needed to determine if the patient’s symptoms are caused by the rotation of the testis or any other condition. Discussion: As a surgical intervention of the emergency, the torsion of the test depends very much on the duration of the torsion, as the success in the life of the testicle depends on the fastest surgical intervention. From the previous clinic, it is noted that in any case presented to the pediatric patient diagnosed with testicular rotation, there is always a link with personal history that the patient refers to the presence of a previous episode of testicular trauma. Literature supports this fact very logically. Conclusions: Salvation without testicular atrophy depends closely on establishing the diagnosis of testicular rotation as soon as possible. Following the logic above, it can be said that the diagnosis for rotation should be performed as soon as possible, to avoid consequences that will not be favorable for the patient.

Keywords: Acute scrotum, testicular torsion, newborns, infants, clinical presentation.

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Authors: Kuniyasu Soda

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Surgical trauma seems to facilitate metastatic spread, although the underlying mechanisms are not known. Increased concentrations of polyamines (spermine and spermidine) in the blood seem to have associated with the enhanced malignant potential of cancer cells and decrease in anti-tumor immunity of cancer patients. In addition to de novo synthesis in rapidly growing cells such as normal regenerating cells and cancer cells, cells can take up polyamines from extra-cellular sources. We have shown that increased polyamine concentration results in decreases in cytokine production and expression of adhesion molecules involved in anti-tumor immunity, such as CD11a. And, immune cells in an environment with increased polyamine levels lose anti-tumor immune functions, such as lymphokine activated killer cell (LAK) activities. Because blood polyamine levels are increased in post-surgical patients, polyamine seems to have roles on post-traumatic tumor spread.

Keywords: Immune function, LAK, Polyamine, Surgical trauma.

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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: Nevila Alliu, Saimir Heta, Ilma Robo, Vera Ostreni

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Periodontitis as an oral pathology caused by specific bacterial flora functions as a focal infection for the onset and aggravation of arteriosclerosis. These two distant pathologies, since they affect organs at a distance from each other, communicate with each other with correlation at the level of markers of inflammation in the blood. Fluctuations in the level of fibrinogen in the blood, depending on the active or passive phase of the existing periodontitis, affect the promotion of arteriosclerosis. The study is of the brief communication article type with the aim to analyze the effect of non-surgical periodontal treatment on fluctuations in the level of fibrinogen in the blood. The reduction of fibrinogen's level in blood after non-surgical periodontal treatment of periodontitis in the patient's oral cavity, is a common consequence supported by literature sources. Also, the influence of a high amount of fibrinogen in blood on the occurrence of arteriosclerosis at the same patient, is also another important data that again rely on many sources of literature. Thromboembolism and arteriosclerosis, as risk factors expressed in clinical data, have temporary bacteremia in the blood, which can occur significantly and often between phases of non-surgical periodontal treatment of periodontitis, treatments performed with treatment phases and protocols of predetermined treatment. Arterial thromboembolism has a significant factor, such as high levels of fibrinogen in the blood, which are significantly reduced during the period of non-surgical periodontal treatment.

Keywords: Fibrinogen, refractory periodontitis, atherosclerosis, non-surgical, periodontal treatment.

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Authors: Giovanni Aloisio, Lucio T. De Paolis, Luciana Provenzano, Lucio Colizzi, Gianluca Pantile

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One of the essential requirements in order to have a realistic surgical simulator is real-time interaction by means of a haptic interface is. In fact, reproducing haptic sensations increases the realism of the simulation. However, the interaction need to be performed in real-time, since a delay between the user action and the system reaction reduces the user immersion. In this paper, we present a prototype of the coronary stent implant simulator developed in the HERMES Project; this system allows real-time interactions with a artery by means of a specific haptic device; thus the user can interactively navigate in a reconstructed artery and force feedback is produced when contact occurs between the artery walls and the medical instruments

Keywords: Collision Detection, Haptic Interface, Real-Time Interaction, Surgical Simulator.

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, antibiotic misuse, Iraq, prescribing.

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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: Jaydip M. Desai, Antonio Valdevit, Arthur Ritter

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Robotic surgery is used to enhance minimally invasive surgical procedure. It provides greater degree of freedom for surgical tools but lacks of haptic feedback system to provide sense of touch to the surgeon. Surgical robots work on master-slave operation, where user is a master and robotic arms are the slaves. Current, surgical robots provide precise control of the surgical tools, but heavily rely on visual feedback, which sometimes cause damage to the inner organs. The goal of this research was to design and develop a realtime Simulink based robotic system to study force feedback mechanism during instrument-object interaction. Setup includes three VelmexXSlide assembly (XYZ Stage) for three dimensional movement, an end effector assembly for forceps, electronic circuit for four strain gages, two Novint Falcon 3D gaming controllers, microcontroller board with linear actuators, MATLAB and Simulink toolboxes. Strain gages were calibrated using Imada Digital Force Gauge device and tested with a hard-core wire to measure instrument-object interaction in the range of 0-35N. Designed Simulink model successfully acquires 3D coordinates from two Novint Falcon controllers and transfer coordinates to the XYZ stage and forceps. Simulink model also reads strain gages signal through 10-bit analog to digital converter resolution of a microcontroller assembly in real time, converts voltage into force and feedback the output signals to the Novint Falcon controller for force feedback mechanism. Experimental setup allows user to change forward kinematics algorithms to achieve the best-desired movement of the XYZ stage and forceps. This project combines haptic technology with surgical robot to provide sense of touch to the user controlling forceps through machine-computer interface.

Keywords: Haptic feedback, MATLAB, Simulink, Strain Gage, Surgical Robot.

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Authors: Catherine A. Todd, Fazel Naghdy

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In this work a surgical simulator is produced which enables a training otologist to conduct a virtual, real-time prosthetic insertion. The simulator provides the Ear, Nose and Throat surgeon with real-time visual and haptic responses during virtual cochlear implantation into a 3D model of the human Scala Tympani (ST). The parametric model is derived from measured data as published in the literature and accounts for human morphological variance, such as differences in cochlear shape, enabling patient-specific pre- operative assessment. Haptic modeling techniques use real physical data and insertion force measurements, to develop a force model which mimics the physical behavior of an implant as it collides with the ST walls during an insertion. Output force profiles are acquired from the insertion studies conducted in the work, to validate the haptic model. The simulator provides the user with real-time, quantitative insertion force information and associated electrode position as user inserts the virtual implant into the ST model. The information provided by this study may also be of use to implant manufacturers for design enhancements as well as for training specialists in optimal force administration, using the simulator. The paper reports on the methods for anatomical modeling and haptic algorithm development, with focus on simulator design, development, optimization and validation. The techniques may be transferrable to other medical applications that involve prosthetic device insertions where user vision is obstructed.

Keywords: Haptic modeling, medical device insertion, real-time visualization of prosthetic implantation, surgical simulation.

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Authors: L. Siva Rama Krishna, Sriram Venkatesh, M. Sastish Kumar, M. Uma Maheswara Chary

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Rapid Prototyping (RP) is a technology that produces models and prototype parts from 3D CAD model data, CT/MRI scan data, and model data created from 3D object digitizing systems. There are several RP process like Stereolithography (SLA), Solid Ground Curing (SGC), Selective Laser Sintering (SLS), Fused Deposition Modeling (FDM), 3D Printing (3DP) among them SLS and FDM RP processes are used to fabricate pattern of custom cranial implant. RP technology is useful in engineering and biomedical application. This is helpful in engineering for product design, tooling and manufacture etc. RP biomedical applications are design and development of medical devices, instruments, prosthetics and implantation; it is also helpful in planning complex surgical operation. The traditional approach limits the full appreciation of various bony structure movements and therefore the custom implants produced are difficult to measure the anatomy of parts and analyze the changes in facial appearances accurately. Cranioplasty surgery is a surgical correction of a defect in cranial bone by implanting a metal or plastic replacement to restore the missing part. This paper aims to do a comparative study on the dimensional error of CAD and SLS RP Models for reconstruction of cranial defect by comparing the virtual CAD with the physical RP model of a cranial defect.

Keywords: Rapid Prototyping, Selective Laser Sintering, Cranial defect, Dimensional Error.

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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: Sharan Badiger, Prema T. Akkasaligar

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Medical imaging technology has experienced a dramatic change in the last few years. Medical imaging refers to the techniques and processes used to create images of the human body (or parts thereof) for various clinical purposes such as medical procedures and diagnosis or medical science including the study of normal anatomy and function. With the growth of computers and image technology, medical imaging has greatly influenced the medical field. The diagnosis of a health problem is now highly dependent on the quality and the credibility of the image analysis. This paper deals with the various aspects and types of medical imaging.

Keywords: Computed Tomography, Echocardiography, Medical Imaging, Magnetic Resonance, Ultrasound Imaging.

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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: Hamidreza Hoshyarmanesh, Hosein Madieh, Sanju Lama, Yaser Maddahi, Garnette R. Sutherland, Kourosh Zareinia

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This paper illustrates the concept of an algorithm to register specified markers on the neuroArm surgical manipulators, an image-guided MR-compatible tele-operated robot for microsurgery and stereotaxy. Two range-finding algorithms, namely time-of-flight and phase-shift, are evaluated for registration and supervisory control. The time-of-flight approach is implemented in a semi-field experiment to determine the precise position of a tiny retro-reflective moving object. The moving object simulates a surgical tool tip. The tool is a target that would be connected to the neuroArm end-effector during surgery inside the magnet bore of the MR imaging system. In order to apply flight approach, a 905-nm pulsed laser diode and an avalanche photodiode are utilized as the transmitter and receiver, respectively. For the experiment, a high frequency time to digital converter was designed using a field-programmable gate arrays. In the phase-shift approach, a continuous green laser beam with a wavelength of 530 nm was used as the transmitter. Results showed that a positioning error of 0.1 mm occurred when the scanner-target point distance was set in the range of 2.5 to 3 meters. The effectiveness of this non-contact approach exhibited that the method could be employed as an alternative for conventional mechanical registration arm. Furthermore, the approach is not limited by physical contact and extension of joint angles.

Keywords: 3D laser scanner, intraoperative MR imaging, neuroArm, real time registration, robot-assisted surgery, supervisory control.

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Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

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Bile spillage occurs frequently during laparoscopic cholecystectomy, yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visit, with subsequent readmission and additional procedures. Thus, this study sought to examine whether bile spillage is indeed associated with increased risk of postoperative wound infections after laparoscopic cholecystectomy. We hypothesize that patients who experience bile spillage (BS) during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per Center for disease control and prevention (CDC) defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and absent in the rest i.e., 92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in non-bile spillage cases SSI was found in 8 cases (8.7%). However, it was statistically not significant (p value > 0.05). 11 (92%) cases were superficial SSI and one was organ-space infection. No mortality or 30-day readmission was found in our study period. Spillage of gallbladder content does not lead to an increase in SSIs. However, as the rate of SSI is still higher, surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage, thorough peritoneal irrigation with normal saline should be done.

Keywords: Biliary spillage, organ space infection, Laparoscopic cholecystectomy, surgical site infection.

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Authors: Saimir Heta, Ilma Robo, Nevila Alliu, Tea Meta

Abstract:

Background: Plasma levels of inflammatory markers are the expression of the infectious wastes of existing periodontitis, as well as of existing inflammation everywhere in the body. Materials and Methods: The study consists of the clinical part of the measurement of inflammatory markers of 23 patients diagnosed with chronic periodontitis and the recording of parental periodontal parameters of patient periodontal status: hemorrhage index and probe values, before and 7-10 days after non-surgical periodontal treatment. Results: The level of fibrinogen drops according to the categorization of disease progression, active and passive, with the biggest % (18%-30%) at the fluctuation 10-20 mg/d. Fluctuations in fibrinogen level according to the age of patients in the range 0-10 mg/dL under 40 years and over 40 years was 13%-26%, in the range 10-20 mg/dL was 26%-22%, in the 20-40 mg/dL was 9%-4%. Conclusions: Non-surgical periodontal treatment significantly reduces the level of non-inflammatory markers in the blood. Oral health significantly reduces the potential source for periodontal bacteria, with the potential of promoting thromboembolism, through interaction between thrombocytes.

Keywords: Chronic periodontitis, atherosclerosis, risk factor, inflammatory markers.

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Authors: Pei-Ti Chen, Ren-Hua Kung, Ming –Yi Huang , Fuu-Diing Chen, Lei Pei

Abstract:

Medical Tourism is a new development in Taiwan recently. The willingness and barriers of potential tourists from China to participate medical tourism are studied. A questionnaire survey is conducted and the SPSS software is used to analyze data. The results show that under one fifth of respondents express full medical tourism participation willingness. Among travel barriers toward medical tourism, “insufficient information of medical tourism trip", “not enough time", “no companion", “worrying about unsatisfied itinerary." are perceived the most important barriers.

Keywords: medical tourism, travel barriers, participation willingness

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

Abstract:

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: Hsing-Yi Kao, Der-Ming Liou

Abstract:

Transferring patient information between medical care sites is necessary to deliver better patient care and to reduce medical cost. So developing of electronic medical records is an important trend for the world.The Continuity of Care Document (CCD) is product of collaboration between CDA and CCR standards. In this study, we will develop a system to generate medical records with entry level based on CCD template module.

Keywords: Continuity Care Document, medical record, entrylevel

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