Accuracy Of Surgery Research Articles

Nine-grid Area Division Method: A New Ideal Bone Puncture Region for Percutaneous Vertebroplasty in Lumbar Spine.

Percutaneous vertebroplasty (PVP) is widely recognized as an efficacious intervention for alleviating low back pain resulting from osteoporotic vertebral compression fractures. The ideal bone puncture point is conventionally situated at the projection "left 10 points, right 2 points" of the pedicle in the lumbar spine. Determining the optimal bone puncture point represents a critical and complex challenge. The accuracy of percutaneous vertebroplasty (PVP) is primarily influenced by the proficiency of the operating surgeons and the utilization of multiple fluoroscopes during the conventional procedure. Incidences of puncture-related complications have been documented globally. In an effort to enhance the precision of the surgical technique and reduce the occurrence of puncture-related complications, our team applied the "Nine-grid Area Division Method" for PVP in the lumbar spine to modify the traditional procedure. There is potential to decrease the number of puncture times, the radiation exposure dosage, and the duration of surgical procedures. This protocol introduces the definition of the "Nine-grid Area Division Method" and describes the process of modeling target vertebrae DICOM imaging data within medical imaging processing software, simulating operations within a 3-D model, refining the 3-D model using reverse engineering production software, reconstructing the vertebral engineering model within 3-D modeling design software, and utilizing surgical data to determine safe entry regions for pedicle projection. By employing this methodology, surgeons can effectively identify appropriate puncture points with precision and ease, thereby reducing the intricacies associated with puncturing and enhancing the overall accuracy of surgical procedures.

Skin Staining After Injection of Superparamagnetic Iron Oxide for Sentinel Lymph Node Dissection: A Retrospective Study of Two Protocols for Injection and Long-Term Follow-Up.

Sentinel lymph node (SLN) dissection is a highly accurate surgical procedure allowing detection of lymph node invasion in patients with clinically negative axilla in early breast cancer. Superparamagnetic iron oxide (SPIO) is a marker used during SLN procedure, allowing the same detection rate as isotopes (Tc-99). A drawback of SPIO is skin staining that can occur around the injection site. The goal of this retrospective study was to assess the frequency of skin staining after oncological breast surgery with SPIO, and the impact of two different injection protocols on the rate of skin staining. Data from breast cancer patients undergoing magnetic tracer SLN detection (SLND) procedure in a single department between 2020 and 2022 was reviewed. Injection protocol P1 consisted of retro-areolar injection of Magtrace 0.8 mL. Injection protocol P2, consisted of retro-tumoral injection with 1 mL. Presence of skin staining was assessed at day 10 after surgery. The evolution and satisfaction of the patients was assessed at six and 12 months. In total 175 sentinel lymph node biopsy procedures were performed (P1: 141/P2: 34), consisting of breast conservative surgery (BCS) (P1: 70%/P2: 53%) or mastectomy (P1: 30%/P2: 47%) with SLN. SLN detection rate was 97.7%. Skin staining was reported in 23% and occurred more often after BCS (31.6%) compared to mastectomy (6.8%). When BCS was performed, peritumoral injection was associated with a decreased risk of skin staining compared with retro-areolar injection (22.2% vs. 33.3%, respectively). When present skin staining persisted for 12 months, but most of the patients described only a slight discomfort. The low rate of discoloration after mastectomy, as previously reported, can be explained by the removal of skin and glandular tissue in which the tracer accumulates. Less skin staining in P2 may be because of a shorter interval between injection and surgery and the removal of the excess of SPIO during the lumpectomy. SPIO injection is a safe surgical technique. After mastectomy, the rate of discoloration was low. Despite the persistent skin discoloration in 58.6% in our study, patient satisfaction was high. Deeper injection, reduced doses, massage of the injection site and peritumoral injection may reduce skin staining.

IndoCyanine Green fluorescence guided resections in hepatobiliary surgery

Background: Fluorescence-guided surgery (FGS) has recently gained popularity as a promising technique for treating visceral, hepatobiliary, and pancreatic neoplasms. It involves using laser sources to illuminate injected substances that emit a fluorescence signal, guiding surgical procedures, and providing real-time visualization of otherwise undetectable structures. This review explores the advancements in hepatobiliary surgery using IndoCyanine Green (ICG) fluorescence guided resections. Methods: The review examined the use of FGS in identifying subcapsular liver tumors, millimetric hepatocellular carcinoma, intrahepatic cholangiocarcinoma, liver metastases, and various benign liver neoplasms. In addition, fluorescence cholangiography using ICG injection was explored to improve liver surgery's accuracy and safety. Results: The review found that ICG fluorescence-guided resections can potentially improve surgical outcomes by enhancing the accuracy and safety of procedures. The use of fluorescence cholangiography allows for the efficient identification of the bile ducts and helps surgeons avoid damaging critical structures during liver surgery. Conclusion: ICG fluorescence-guided resections represent a promising method for improving surgical outcomes and patient safety for visceral and hepatobiliary Surgery. It is a quick, easy, inexpensive, and safe device that can be used for various surgical applications. As imaging systems continue to improve, fluorescence imaging can become a widely used intraoperative navigation tool for open, laparoscopic, and robotic surgery.

Simulation of soft tissue deformation under physiological motion based on complementary dynamic method

Background and ObjectivePhysiological motions have a significant impact on soft tissue deformation and accuracy of surgical procedures, which is essential for realistic surgical simulation. While existing studies offer accurate simulation of soft tissue deformation, integrating physiological motions into deformation models of soft tissue remains a challenging task. MethodsThis paper introduces a novel deformation model, based on complementary dynamics, to animate soft tissue deformation under physiological motion. The finite element method is incorporated to accurately characterize the elastic behavior of the soft tissue. Mathematical models of physiological motion are utilized and the physiological effects are converted into displacements of a predefined set of handles within the soft tissue mesh. Complementary displacements derived from the inherent dynamics of the soft tissue are calculated, enabling the simulation of physiological motions and elastic behaviors in soft tissue deformation. ResultsExperiments were conducted to evaluate the performance and effectiveness of the proposed method in simulating soft tissue deformation under physiological motion. The simulation results show that the soft tissues exhibit physiological motion that corresponds to the rhythm of arterial pressure fluctuations, heartbeat or respiratory. Furthermore, the presented method exhibits stable performance compared with existing force-based methods. ConclusionsBoth elastic behaviors and physiological motions of soft tissue deformation can be governed by the proposed method. A high degree of realistic visualization is achieved for virtual surgery simulation.

Exploring New Horizons: Surgical Robots Supported by Artificial Intelligence

Artificial intelligence-assisted surgical robots combine the agility and accuracy of robotic systems with the cutting-edge capabilities of AI technology. These advanced surgical robots are made to help surgeons carry out difficult surgical procedures more precisely and effectively. Surgical robots with AI algorithms built in can analyse enormous volumes of patient data, make choices in real-time, and adjust to changing circumstances. The surgical process and patient safety could both be considerably improved by this technology. Several important advantages of surgical robots powered by AI include Enhanced Accuracy Surgical robots can make extremely precise motions with little error because of the capabilities of robotics and AI, leading to more accurate surgical procedures. During an operation, real-time decision-making AI algorithms can evaluate data from a variety of sources, including patient vitals, medical imaging, and surgical history, to give surgeons on-the-spot recommendations and insights. Artificial intelligence-driven surgical robots can automate tedious and repetitive activities, freeing surgeons to concentrate on more important choices and increasing operating room productivity. By analysing patient data and delivering individualized insights, AI can help surgeons with preoperative planning, resulting in better surgical approaches and outcomes. AI technology's sophisticated skills can assist in identifying potential dangers and difficulties during surgery, allowing surgeons to proactively address them and reduce unfavourable events.

Factors affecting sports participation after total hip arthroplasty.

The purpose of this study was to investigate the rate of return to sports after total hip arthroplasty (THA) in patients who regularly participate in sports and evaluate the factors that can affect the return to sports. In total, 165 patients who had been continuously participating in sports prior to surgery were included from a total of 401 patients who underwent THA from 2015 to 2018. The mean follow-up was 3.3 (range, 2-6) years. Demographics, medical history, surgical parameters, functional outcomes, and anxiety about complications at the final follow-up were compared between the patients who participated in the same sports as before surgery (S group) and those who could not (N group). The overall return to sports rate was 79% for 68 (41%) and 97 (59%) patients in the S and N groups, respectively. The most common sports that patients participated in post-operatively were walking (76 patients, 46%) and swimming (37 patients, 22%), followed by muscle training (25 patients, 15%). There were significant differences between the groups in the following patient factors: sex, primary disease, post-operative Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire outcome, and anxiety about falls and dislocation. In the evaluation of factors affecting return to sports using logistic regression analysis, male sex (odds ratio 3.66, 95% confidence interval 1.13-11.19, p = 0.029) and anxiety of dislocation (odds ratio 3.42, 95% confidence interval 1.58-7.42, p < 0.01) were extracted as independent risk factors. Careful patient guidance and rehabilitation, in addition to accurate surgical procedures, will improve patient participation in sports.

Multilevel Operation Strategy of a Vascular Interventional Robot System for Surgical Safety in Teleoperation

Remote-controlled vascular interventional robots have great potential for use in minimally invasive vascular surgeries in recent years due to their ability to reduce the occupational risk of surgeons and improve the stability and accuracy of surgical procedures. However, blood vessels will suffer from the damage caused by collision with medical instruments to some extent even though the surgeries are very successful. Moreover, when surgeons perform unsafe operations, the unsafe operations will not only seriously affect surgical safety (or even cause serious complications) but also restrict the continuity of operation. In this article, a multilevel concept for operating force is first introduced into surgical procedures as a reference for the choice and design of operation strategies. Based on this concept, a novel multilevel operation strategy is first proposed to reduce blood vessel damage, ensure surgical safety, and allow for continuous operation. This strategy can remind surgeons about the operative conditions in real-time, reduce collision to blood vessels, and eliminate unsafe operations online. A prototype was fabricated and calibrated through calibration experiments and the performance of the multilevel operation strategy was validated through <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vitro</i> and <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">ex vivo</i> experiments. Experimental results demonstrate the engineering effectiveness of the proposed method and motivate the need for further <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vivo</i> studies to evaluate improvement on surgical safety.

Implant-Supported Hybrid Prosthesis using All on Six Concept for Atrophic Ridges with Severe Gag Reflex: A Case Report

Aims: Edentulism is correlated to poor self-esteem and depression in both young and old individuals due to social rejection. For edentulous patients who are not interested in removable prosthesis, implant-supported fixed prosthesis might be an appropriate treatment modality. The aim of this case report is to rehabilitate the completely edentulous patient with severe gag reflex by maxillary implant supported hybrid prosthesis and mandibular conventional complete denture.&#x0D; Presentation of case: A 58 years old female patient had reported to the outpatient wing of department of prosthodontics with chief complaint of missing teeth in maxillary and mandibular arches. Patient had a history of severe gagging and discomfort with old denture. The treatment progresses as six implant placed and hybrid prosthesis was fabricated in maxillary arch and conventional complete denture was fabricated in mandibular arch and delivered to the patient.&#x0D; Discussion: Implant-supported complete arch rehabilitation can be accomplished with either a fixed or removable prosthesis. For a satisfactory outcome, proper patient selection, accurate surgical procedure, and meticulous prosthetic planning are required. Cement-retained implant restorations are becoming more popular because they are simple, aesthetic, and cost-effective. However, such restorations are hard to retrieve, and any residual cement in the soft tissue around the implant might cause peri-implant illness.&#x0D; Conclusion: A screw retained fixed prosthesis was planned for this patient in maxillary arch and conventional complete denture in mandibular arch which gave a successful outcome and avoid gag reflex.

Modern approaches to the surgical treatment of large full-thickness macular holes

Vitreoretinal surgery is an actively developing area of modern ophthalmic surgery. Intravitreal interventions in the central retina with large full-thickness macular holes deserve special attention. This article provides an overview of the scientific literature published in journals recommended by the Higher Attestation Commission, also presented in the scientific databases Scopus, PubMed, dedicated to modern techniques to the surgical treatment of large full-thickness macular holes. The main methods for closing defects in the macular area today are the use of various modifications of the inverted internal limiting membrane flap technique and the application of autologous platelet rich plasma in a macular hole. These techniques provide high anatomical and functional outcomes. Modifications of the inverted internal limiting membrane flap technique demonstrated effectiveness in such complex clinical situations as recurrent macular holes, concomitant high myopia, retinal detachment. Over the past 10 years, data on the use of autologous platelet-rich plasma for this group of patients appeared in the scientific literature. More accurate surgical procedures are required for the use of this technique compared with the standard methods, but this technique is applicable in all patients, does not require additional manipulations (blood sampling and centrifugation), additional equipment. Vitreoretinal interventions with the use of platelet-rich plasma are characterized by relative simplicity and ease of carrying out surgical procedures. However, it is important to consider the possibility of pseudouveitis development, the need for additional equipment. Since both of these methods demonstrate good anatomical results, the problem of choosing a technique in a particular clinical case remains. It was clear that the method of surgical intervention should be chosen, taking into account possible disadvantages and limitations to the method, as well as the skills of an ophthalmic surgeon. The lack of a unified approach to macular hole surgery encourages researchers to improve surgical techniques, develop and implement new modifications of surgical approaches.

Study on the Application Value of CT Thin-Layer Scan Data Assisted 3D Printing Technology in Hip and Knee Replacement.

To better study hip and knee replacement, 50 eligible hip and knee patients from March 2020 to April 2021 were selected. A 1 : 1 scale solid model was printed with CT thin-layer scanning data assisted by 3D printing technology to evaluate the ankle function of patients six months after surgery. The results showed that the 3D rapid prototyping time of the 1 : 1 fracture model in 50 patients was 3-4 hours. The operation time was 70–90 min, and the average operation time was 80 min. The actual application in operation was consistent with that in the simulation of the 3D printing model, after surgery, and there was no infection of incision soft tissue or loss of reduction in all 50 patients. CT thin-layer scan data aided 3D printing technology can help clinical hip and knee replacement simulation and planning, improving surgery's accuracy and safety.

On the microstructural origin of brain white matter hydraulic permeability

Brain microstructure plays a key role in driving the transport of drug molecules directly administered to the brain tissue, as in Convection-Enhanced Delivery procedures. The proposed research analyzes the hydraulic permeability of two white matter (WM) areas (corpus callosum and fornix) whose three-dimensional microstructure was reconstructed starting from the acquisition of electron microscopy images. We cut the two volumes with 20 equally spaced planes distributed along two perpendicular directions, and, on each plane, we computed the corresponding permeability vector. Then, we considered that the WM structure is mainly composed of elongated and parallel axons, and, using a principal component analysis, we defined two principal directions, parallel and perpendicular, with respect to the axons' main direction. The latter were used to define a reference frame onto which the permeability vectors were projected to finally obtain the permeability along the parallel and perpendicular directions. The results show a statistically significant difference between parallel and perpendicular permeability, with a ratio of about two in both the WM structures analyzed, thus demonstrating their anisotropic behavior. Moreover, we find a significant difference between permeability in corpus callosum and fornix, which suggests that the WM heterogeneity should also be considered when modeling drug transport in the brain. Our findings, which demonstrate and quantify the anisotropic and heterogeneous character of the WM, represent a fundamental contribution not only for drug-delivery modeling, but also for shedding light on the interstitial transport mechanisms in the extracellular space.

Patient Safety Reporting and Implementation during the Pandemic Covid 19

Introduction:The goal of this research was to determine the recording and implementation of patient safety during a pandemic.Materials and Methods: This study was conducted through in 2 phases. In the first phase, the design used is pre and post-design. The researchers analyzed patient safety reports from each treatment room. The data collected retrospectively were patient safety data in the patient safety recording 2019 and data in the 2020 report. The second part consisted of conducting structured interviews through focus group discussions held in two sessions, with five respondents in each session.Results: A total of 33 patient care units were included in this study. There were differences in the recording and reporting of patient safety before the pandemic and during the pandemic (P=0.001), there were differences in the implementation of patient identification (P= 0.026), there was a difference in effective communication (P= 0.040), while drug alertness was not significantly different (P= 0.970); there was a difference in the accuracy of surgical procedures (P= 0.016), there was a difference in infection prevention (P= 0.011), and prevention of falling risk (P= 0.001).Conclusion:There was a decrease in the number of recordings and reporting on patient safety because officers serving patients are more focused on the condition of patients with Covid-19. Nurses are faced with a new disease that raises concerns about transmission and the use of complete PPE so that voices are not heard. Recommendations for using research results as learning materials in policymaking.

ARTIFICIAL INTELLIGENCE, VIRTUAL REALITY AND ROBOTICS IN COLORECTAL SURGERY USING MASTER-CLASS TECHNOLOGICAL INNOVATIONS

ARTIFICIAL INTELLIGENCE, VIRTUAL REALITY AND ROBOTICS IN COLORECTAL SURGERY USING MASTER-CLASS TECHNOLOGICAL INNOVATIONS

Medial Patellofemoral Ligament Reconstruction Using FiberTape and Knotless SwiveLock Anchors

Medial patellofemoral ligament (MPFL) reconstruction usually involves hamstring autografts and is associated with donor-site morbidity. Excellent short-term results with MPFL reconstruction using synthetic materials have been reported. Although synthetics do not sacrifice autologous tissues, their material properties are significantly different from those of biological tissues. Therefore, accurate surgical procedures are required to achieve excellent results. The purpose of this report was to describe our surgical method for MPFL reconstruction using FiberTape and knotless SwiveLock anchors.

The Mako ™ robotic arm-assisted total hip arthroplasty using direct anterior approach: surgical technique, skills and pitfals.

In the last decades many innovations have improved the hip replacement and the hip reconstruction surgery such as the introduction of the robotic-arm assisted surgery associated with the direct anterior approach (DAA). This surgical approach for total hip arthroplasty (THA) is growing in popularity and its effectiveness has been demonstrated to improve patients’ outcomes, especially regarding more accurate implant placement, less post operative pain, faster recovery and lower of prosthesis dislocation risk. The robotic-arm assisted surgery is another really great innovation for the orthopedic surgeons. It allows to create a patient-specific THA pre-operative planning and to perform a much more accurate surgical procedure. This article outlines authors’ surgical technique of performing accurate pre-operative planning and robotic-assisted THA using direct anterior approach based on the experience of 534 patients and to discuss details of this technique. (www.actabiomedica.it)

Three-dimensional orbital wall modeling using paranasal sinus segmentation

PurposeThree-dimensional orbital wall modeling is a time-consuming process because of the presence of pseudoforamina. We developed an automated three-dimensional modeling software to characterize the orbital wall, and evaluated it using data from fracture patients. MethodsWe first characterized the air and face regions using multiphase segmentation; the sinuses were segmented by applying morphological operations to air regions. Pseudoforamina of the orbital wall were offset with the segmented sinuses. Finally, the three-dimensional facial bone model, with orbital wall, was reconstructed from the segmented images. ResultsTen computed tomography data sets were used to evaluate the proposed method. Results were compared with those obtained using the active contour model and manual segmentation. The process took 31.7 ± 8.0 s, which was 30–60 times faster than other methods. The average distances between surfaces obtained with the proposed method and those obtained with manual segmentation (normal side: 0.20 ± 0.06 mm; fractured side: 0.28 ± 0.10 mm) were approximately half those obtained using the active contour model. ConclusionsThree-dimensional orbital wall models, which were very similar to the manually segmented models, were archived within 1 min using the developed software, regardless of fracture presence. The proposed method might improve the safety and accuracy of surgical procedures.

Potential Role of Carbon Nanoparticles in Guiding Central Neck Dissection and Protecting Parathyroid Glands in Patients with Papillary Thyroid Cancer

Background: Carbon nanoparticle (CN) suspensions have been widely used as lymph node tracers in cancers. Here, CN suspension was successfully applied to lymph node dissection. Objective: This study aimed to evaluate the role of CN suspension in identifying lymph nodes and preserving the parathyroid in patients with papillary thyroid cancer (PTC). Method: A total of 96 PTC patients were divided into a CN group (n = 46) and a control group (n = 50). All patients underwent total thyroidectomy with central lymph node dissection from 2014 to 2015. Results: The number of lymph nodes removed in the CN group and the control group was 9.6±2.4 and 7.8±2.2, respectively, and the number of dissected lymph nodes identified as &lt;5 mm in both groups was 4.4±1.3 and 2.4±1.4, respectively. These results were significantly different between the two groups (P &lt; 0.05). However, the number of metastatic lymph nodes was similar in the two groups. In addition, the results further revealed that the level of serum parathyroid hormone (PTH) was significantly lower in the control group than in the CN group on postoperative day 1 and week 1 (P &lt; 0.05), but similar outcomes were observed at postoperative month 1. Conclusion: CN suspension plays an important role in accurately identifying lymph nodes and protecting parathyroid glands. The clinical utilization of CN suspension could increase the accuracy of surgery programs and protect parathyroid function.

Virtual Surgical Planning Using Stereolithographic Models for Segmental Mandibular Resection with Limited Extraoral Skin Incision versus Traditional Surgical Protocols

Purpose: To evaluate, both clinically and radiographically the usage of stereolithographic model with limited extraoral skin incision versus the traditional method using dry mandibles in preoperative adaptation of locking reconstruction plate for lateral mandibular continuity defects in delayed type mandibular reconstruction. Materials and methods: Sixteen patients were randomly classified into two equal groups; in which group I was the control (traditional method) and group II was the study group (new method). Group (I): 8 patients with mandibular lesions indicated for segmental mandibular resections via intraoral approach and a wide extraoral incision assisted with preoperative adaptation of the reconstruction plate on dry mandible and refined intraoperatively with the use of a plastic template. Group (II): 8 patients with mandibular lesions indicated for segmental mandibular resections via intraoral approach and with very limited extraoral incision assisted with preoperative adaptation of the reconstruction plate on the patient`s stereolithographic model. Results: The operation time, plate bending and adaptation time, the intraoperative blood loss, scar visibility, TMJ dysfunction, facial asymmetry, accurate plate adaptation, proper plate angulation, and plate over-extension especially in the proximal segment beyond the sigmoid notch, all were with statistically significant differences between both groups with better results always found in group II patients. However, no cases of tumor recurrence, plate exposure, or abnormal condylar position were recorded at the last follow up visit (6 months) in both groups. Conclusion: The use of the patient`s 3-D steriolithographic model for virtual surgical planning for segmental mandibular resection with limited skin incision has several advantages over the traditionally used method. It improves reconstruction of form and function, decreases operating room time and complications and enhances the capability to perform more accurate surgical procedures.

Study of the morphometric variations of the neural arch in the lumbar vertebrae in adult human skeleton of North Indian population

Measurement of human vertebral geometry is important for accurate surgical procedures. The aim of this study is to measure the neural ach shape from L1 to L5. All Lumbar dry vertebrae (N = 150) of 30 individuals is measured and analyzed by gender. A Digital Vernier Caliper is used to measure the dimensions of the spinous (SP) and transverse (TP) processes, vertebral canal (VC), laminae, and isthmus. Most of the parameters are greater in males. Isthmus length decreases from L1 to L5 vertebrae in males with left side length greater than that of right in the lumbar region. In lumbar vertebrae transverse process length is increasing from L1 (17.83 mm) to L3 (22.58 mm) then decreasing till L5 (18.70 mm) with right side length more than the left side at L1 to L5. Vertebral Superior Canal Width (VSCW) is increasing more than Vertebral Superior Canal length (VSCL) in lumbar vertebrae. The difference of width and length is increasing from L1 (5.65 mm) to L5 (9.28 mm). The shape of vertebral canal is oval in lumbar vertebrae. In conclusion, the neural arch is systematically asymmetrical and dynamic in shape along the lumbar spine.

Quantification of the stress generated by the endoscopic movement in the brain parenchyma during intra ventricular surgical procedure

Endoscopy is increasingly used for intra ventricular surgeries such as hydrocephalus and tumor removal (Miwa et al. 2015 Miwa T, Hayashi N, Endo S, Ohira T. 2015. Neuroendoscopic biopsy and the treatment of tumor-associated hydrocephalus of the ventricular and paraventricular region in pediatric patients: a nationwide study in Japan. Neurosurg Rev.[Crossref], [PubMed], [Web of Science ®], , [Google Scholar]). Robotic based surgeries are more and more developed to control the trajectory and the movement of the endoscope and then to enhance the accuracy of surgical procedures and to reduce post-operative issues. The use of computer- aided robot is then well-suited to accurately reach ventricles cavities through the brain parenchyma and to minimize cerebral damage caused by the movement of the endoscope. On a mechanical point of view, moderate and severe traumatic brain injury (TBI) had a 50% risk to locally occur when Von Mises stress respectively exceeds 18 and 38 kPa (Willinger & Baumgartner 2003 Willinger R, Baumgartner D. 2003. Human head tolerance limits to specific injury mechanisms. Int J Crashworthiness.[Taylor & Francis Online], , [Google Scholar]). The purpose of this study was to assess the Von Mises stress generated in the brain by the endoscopic movement.