Flexible Forceps Research Articles

Flexible Laparoscopic Forceps Manipulator Using Synchronous Belt Mechanism

In laparoscopic surgery, many problems are due to the poor degrees of freedom (DOF) of movement in controlling the forceps and laparoscopes. This paper proposes a new flexible laparoscopic forceps manipulator using synchronous belt drive mechanism, which consist of two miniaturized parts, synchronous belt drive mechanism enables independent bending procedure from-90° to 90° at the tip of forceps, and friction wheel mechanism which provides pivoting motion of forceps around incision hole on the abdomen. This mechanism is simple with high rigidity and can easily be miniaturized. The most remarkable characteristics of the prototype described in this paper are: 1) the casing diameter of the forceps is 5 mm; 2) with high rigidity and the repeatability positioning accuracy was 0.5o in bending motion; 3) pure mechanical structure with simple operation and low cost. This manipulator can solve the conflicts and blockings in laparoscopic surgery by switching back and forceps towards, meanwhile, it eliminates the surgical doctor’s fatigue and enhances the precision of surgery with higher effectiveness and safety as well.

Tracheobronchial Amyloidosis in a Patient With Sjogren Syndrome

Pulmonary amyloidosis in the setting of Sjogren syndrome is rare. It most commonly presents in form of multinodular disease with or without cysts formation. Amyloid plaques may also deposit in the airway submucosa, causing airway narrowing; the condition referred as "tracheobronchial amyloidosis" (TBA). Patients with this condition most commonly present with postobstructive pneumonia, wheezing, and occasionally hemoptysis. Endoscopic therapies, using flexible forceps with or without laser therapy is crucial to alleviate the obstruction and control the bleeding. Other therapeutic modalities such as external beam radiation has been shown to be promising; however, further data are still needed. To our knowledge, our patient is the first reported case of TBA in a setting of Sjogren syndrome.

A Novel Technique for Inferior Vena Cava Filter Extraction

Inferior vena cava (IVC) filters are used to protect against pulmonary embolism in high-risk patients. Whilst the insertion of retrievable IVC filters is gaining popularity, a proportion of such devices cannot be removed using standard techniques. We describe a novel approach for IVC filter removal that involves snaring the filter superiorly along with the use of flexible forceps or laser devices to dissect the filter struts from the caval wall. This technique has used to successfully treat three patients without complications in whom standard techniques failed.

Best management of ultra-small tracheobronchial foreign bodies in neonates

ObjectivesTo develop (1) a practical and comprehensive algorithm of instruments and techniques available to treat neonates with tracheobronchial foreign bodies, based on the patient's subglottic diameter and (2) primary and secondary prevention strategies for neonatal tracheobronchial foreign bodies. Methods(1) Analysis of the case of a severely premature infant who presented with the incidental radiological finding of a 2cm suction catheter tip, which, over a two week period, had migrated between her main bronchi; the foreign body was removed with a previously unreported combination of instruments: a 3French (F) flexible urological forceps through the side port of a 2.5mm rigid bronchoscope. (2) In vitro testing of typical foreign bodies and readily available endoscopic instruments. ResultsWe have developed a practical and comprehensive algorithm for the treatment of neonates with tracheobronchial foreign bodies, as well as primary and secondary prevention strategies. ConclusionsThe treatment algorithm and prevention strategies may reduce morbidity and mortality from neonatal tracheobronchial foreign bodies.

The vulnerable Indian one rupee coin

Coins are the most commonly ingested foreign body encountered in the pediatric population, with a peak incidence between 6 months and 3 years of age. Although some ingested coins may be aspirated, most coins pass through the alimentary tract without causing any complications. Coins in the esophagus causing symptoms require immediate removal. The management of asymptomatic coins has been a perplexing problem to the clinicians for decades. We recently managed an interesting case of an impacted Indian one rupee coin in the esophagus of a 13-year-old girl, by performing a simple yet novel technique, by using a conventional flexible endoscopic biopsy forceps. Further, reviewing the literature we inferred that the rounded, stainless steel Indian one rupee coin with a diameter of 25 mm, by itself seems to be vulnerable for impaction in the esophagus and therefore needs to be promptly addressed even if asymptomatic.

“One-stop shop” spectral imaging for rapid on-site diagnosis of lung cancer: a future concept in nano-oncology

BackgroundThere are currently many techniques and devices available for the diagnosis of lung cancer. However, rapid on-site diagnosis is essential for early-stage lung cancer, and in the current work we investigated a new diagnostic illumination nanotechnology.MethodsTissue samples were obtained from lymph nodes, cancerous tissue, and abnormal intrapulmonary lesions at our interventional pulmonary suites. The following diagnostic techniques were used to obtain the samples: endobronchial ultrasound bronchoscopy; flexible bronchoscopy; and rigid bronchoscopy. Flexible and rigid forceps were used because several of the patients were intubated using a rigid bronchoscope. In total, 30 tissue specimens from 30 patients were prepared. CytoViva® illumination nanotechnology was subsequently applied to each of the biopsy tissue slides.ResultsA spectral library was created for adenocarcinoma, epidermal growth factor receptor mutation-positive adenocarcinoma, squamous cell carcinoma, usual interstitial pneumonitis, non-specific interstitial pneumonitis, typical carcinoid tumor, sarcoidosis, idiopathic pulmonary fibrosis, small cell neuroendocrine carcinoma, thymoma, epithelioid and sarcomatoid mesothelioma, cryptogenic organizing pneumonia, malt cell lymphoma, and Wegener’s granulomatosis.ConclusionThe CytoViva software, once it had created a specific spectral library for each entity, was able to identify the same disease again in subsequent paired sets of slides of the same disease. Further evaluation of this technique could make this illumination nanotechnology an efficient rapid on-site diagnostic tool.

Temporary Endobronchial Embolization with Silicone Spigots for Moderate Hemoptysis: A Retrospective Study

Background: The management of airway bleeding is generally performed in an emergency to prevent hypoxemia and lung flooding. When the bleeding arises from peripheral lesions that are not visible endoscopically, bronchoscopic options have limited curative intents. Endobronchial embolization using silicone spigots (EESS) is a novel approach. Objectives: We analyzed the efficacy and safety of EESS in a retrospective study. Methods: We retrospectively reviewed charts of patients referred to our center for moderate hemoptysis (MH) who underwent EESS. Successful management is defined as immediate bleeding cessation. Results: From December 2008 to January 2012, 9 patients were treated with EESS in our endoscopy unit. The MH originated from the left upper lobe in 4 cases, the right upper lobe in 3 cases and the right middle lobe and left lower lobe in 1 case each. Thirteen spigots were inserted. The success rate was 78%. Of the 9 patients, 7 were referred to interventional radiology for bronchial artery embolization, with a success rate of 86%, and 2 were referred for thoracic surgery. One patient had EESS as definitive treatment; the silicone spigots were bronchoscopically removed after a median of 4 days in 6 of the remaining 8 patients. Only 2 patients had hemoptysis recurrence after a median follow-up of 107 days (ranging from 13 to 1,017 days). None of the patients died from hemoptysis. Conclusion: EESS is an original, temporary technique that requires only a flexible bronchoscope and biopsy forceps for placement and removal. EESS ensures airway protection while waiting for definitive management.

Laparoscopic Intersphincteric Resection With a SILS Port for Very Low Rectal Cancer

Since intersphincteric resection (ISR) for rectal cancer was established in the 1990 s, this technique has been applied to very low rectal cancer. This procedure requires advanced techniques for anorectal surgery. However, it is indicated only for early lesions and should be as minimally invasive as possible. We describe a minimally invasive ISR with a single-incision laparoscopic surgery (SILS) port. Our case involves a 59-year-old man with hemorrhage from the rectum. Pathologic examination of the transanally resected specimen revealed that the tumor had invaded into the deeper submucosa. To minimize surgical incisions, a SILS port was utilized in place of a 10- and a 5-mm trocar. The SILS port was inserted through a 2.5 cm transverse incision in the right lower abdomen, where a diverting stoma would be created. Two flexible or straight forceps introduced through this port afforded an easier dissection of the rectum to the levator ani muscle, and transanal dissection of the internal sphincter was performed in the standard manner to connect with the abdominal dissection. The only postoperative incision other than a stoma and surgical drain was one 10-mm incision above the umbilicus. Our technique of ISR with the SILS port is a useful clinical application of minimally invasive surgery.

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

To determine the success rate of flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. This was a retrospective study of all adult patients (over 18 years of age) with foreign body aspiration submitted to bronchoscopy between January of 2009 and January of 2011 at the University of São Paulo School of Medicine Hospital das Clínicas, located in São Paulo, Brazil. The study sample comprised 40 adult patients, with a mean age of 52 years (range, 18-88 years). The median time of permanence of the foreign body in the airway was 15 days (range, 12 h to 10 years). All of the patients first underwent diagnostic flexible bronchoscopy. Foreign bodies were successfully removed with flexible bronchoscopy in 33 (82.5%) of the patients. In 1 patient, a metal object lodged in the distal bronchial tree required the use of fluoroscopy. Six patients (15%) required rigid bronchoscopy due to tracheal foreign body-induced dyspnea, in 2, and because the foreign body was too large for the flexible forceps, in 4. Bronchoscopy failed in 1 patient, who therefore required surgical bronchotomy. Although rigid bronchoscopy is considered the gold standard for the removal of foreign bodies from the airways, our experience showed that flexible bronchoscopy can be safely and effectively used in the diagnosis and treatment of stable adult patients.

Upper urinary tract biopsy: an old device for a new approach

The authors sought to evaluate the feasibility, diagnostic accuracy and safety of urological biopsy performed using a flexible alligator forceps. Twenty-seven patients with suspected urothelial malignancy underwent retrograde biopsy using a 7-F biopsy forceps (Cordis, Miami, FL, USA). Mild sedation was guaranteed by an anaesthesiologist. The final diagnosis was confirmed by cytohistological data and subsequently by pathology findings at surgery. Lesions with benign histopathology were closely monitored for at least 12 months. The technical success rate was 92.6%. The high diagnostic accuracy was related to the positive correspondence between histological outcomes and surgical results or follow-up observations. As regards sample site, the procedure was less successful in calyceal lesions than in lesions located in the upper urinary tract, with a technical success of 71.43%. Twenty patients had asymptomatic haematuria in the early hours after the procedure; ten of them had mild dysuria. No one require medication, and no major complications occurred. Urological forceps biopsy is a safe and easy procedure. It provides a relatively high level of accuracy in the diagnosis of lesions of the upper urinary tract.

Research and Development of Biomechanical Robot for Medical Operation

In the surgical operation, the research and development of the surgical robot that has both safety and effectiveness is needed in consideration of the physical mental strain decrease of the surgeon and the patient. Through the observation of the motion of fish, it has been found that fish swim efficiently using flexibility of pliable fins, giving the actuator the name of flexible oscillating fin propulsion system. The author proposed the application to the realm of healing the elastic vibration wing promotion system. The flexible forceps robot for the surgical operation of a vibrating flexible fin promotion system application was developed.

Removal of Foreign Bodies from Esophagus with Flexible Endoscope - A Case Report

To present a case of impacted artificial denture in esophagus and its removal by flexible endoscope. A 28year old male presented with history of ingesting his denture 2h back. It was removed by flexible endoscope and flexible fibre optic forceps. Though rigid endoscopic removal of foreign body is safe and effective, but often requires general anaesthesia. The flexible fibre optic endoscopic removal, which can be done under local anaesthesia in outpatient department is a suitable alternative.

Cavernous Redirection of Venous Drainage after Partial Transvenous Coil Occlusion of a Sigmoid Sinus dAVF: Coil Mass Retrieval with Flexible Cysto-Urethroscopy Grasping Forceps

We describe the case of a patient who presented with ocular symptoms (chemosis, proptosis, increased intra-ocular pressure, impaired visual acuity) eight months after the transvenous coil occlusion of an ipsilateral sigmoid sinus dural arteriovenous fistula (dAVF). Digital substraction angiography revealed a partial occlusion of the left sigmoid sinus with coils. Since the connection from the sigmoid sinus to the internal jugular vein was obliterated by coils without interrupting the arteriovenous shunt, the venous drainage was redirected into the inferior petrosal sinus, the cavernous sinus and the superior ophthalmic vein. The transjugular access to the inferior petrosal sinus was obstructed by a large coil mass in the jugular bulb. Several attempts to remove these coils with an Alligator retrieval device and a goose neck snare failed. The coil mass was withdrawn via a direct access to the internal jugular vein using flexible cysto-urethroscopy grasping forceps, an urological device designed for the removal of kidney stones. After establishing anterograde drainage, the now accessible inferior petrosal sinus was occluded with fibered coils and the dAVF was completely obliterated. The ocular symptoms resolved within ten days.

Single-port Retrieval of Peritoneal Foreign Body Using SILS Port

Foreign body retrieval surgery sometimes does not need excision and reconstruction of the gastrointestinal tract. To avoid unnecessarily large incisions is now feasible for such retrieval surgery. We report herein a case of a patient who underwent retrieval surgery with a single-incision laparoscopic surgery (SILS) to minimize surgical incision. Our case concerns a 72-year-old female with a 3 cm length needle incidentally discovered as a peritoneal foreign body without any apparent symptoms. Retrieval was performed safely with SILS port inserted through a 2.5 cm transverse incision below the umbilicus. Two flexible forceps introduced through the SILS port offer easy operation for retrieving foreign bodies even if dissection or other surgical maneuvers are required. Our technique of abdominal foreign body retrieval with the SILS port is a useful clinical application of minimally invasive surgery for such cases.

Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection

Zenker's diverticulum (ZD) is the most common diverticulum of the upper gastrointestinal tract. Various flexible endoscopic techniques have been used for division of the septum. However, the learning curve associated with these techniques might be difficult to overcome given the overall rarity of this condition. This can lead either to complications or to potential recurrence of symptoms. The authors hypothesized that a flexible bipolar hemostasis forceps developed for natural orifice translumenal surgery (NOTES) procedures would facilitate precise endoscopic diverticulotomy and simultaneously enable sealing of divided tissue edges. Because the pharyngeal diverticulum (PD) in the pig is comparable with a human ZD, this nonsurvival model was used to perform endoscopic diverticulotomy using two energy technologies. The PD septum was dissected with either a flexible and a rotating bipolar forceps (n = 5) or with standard needleknife cautery (NK; n = 3). The feasibility and safety of the two technologies were compared. In contrast to NK myotomy, the bipolar forceps could easily be readjusted before any tissue dissection in all (5/5) interventions, and energy was applied only on the tissue to be divided. Tissue bonding at the edges of the septum was observed in all cases. The monopolar energy in NK dissection made precise and centered division of the septum difficult to achieve and did not bond the edges of the septum. One perforation occurred with NK (1/3). The flexible bipolar forceps used for Zenker's diverticulotomy is appealing due to its ease of application and potential to coaptate mucomuscular tissue edges. Although further evaluation with a survival model is necessary, it also seems to be a safer approach than NK. This novel tool could facilitate performance of surgical endoscopists and may make flexible endoscopy the preferred method for Zenker's ablation.

Tracheal Diverticulum

Tracheal diverticulum is a rarely encountered entity, usually discovered incidentally as an outpouching at the right side on radiography or computed tomography (CT). We present the case of a male patient with a tracheal diverticulum detected during a work-up for hemoptysis. His thoracic CT scan showed a sac formation on the right dorsolateral wall of the trachea. Flexible bronchoscopy showed a collapsed entrance to the diverticulum, which could be opened by flexible forceps. The mucosal lining of the diverticulum seemed normal, without retained secretions or blood. Although with limited clinical consequences, tracheal diverticulum must be kept in mind as a reservoir for secretions that may cause infection, and also hemoptysis if infected.

Percutaneous and Transureteral Biopsies of Renal Papillae: Safe and Appropriate Procedures for In Vivo Histologic Analysis in Stone Formers

According to the Randall plaque theory, urinary crystals may attach to focal interstitial deposits of calcium phosphate (CaP), localized in the tip of the renal papillae. The aim of this prospective study was to evaluate the feasibility and safety of papillary biopsy, performed during ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL), to obtain, in vivo, appropriate samples to investigate interstitial CaP deposits that represent Randall's plaques precursors. Twenty-eight patients who were affected by recurrent renal stones, 13 males and 15 females, with a median age of 42.5 years (range 17-76 y), underwent rigid and/or flexible URS (8 patients) or PCNLs (20 patients). In all cases, endoscopic biopsies from renal papillae were performed. Papillary samples were obtained by means of 3F or 4F cup biopsy forceps if semirigid and flexible ureterorenoscopes were used. During percutaneous procedures, with rigid and flexible instruments, 5F or 10F cup forceps were used. The same pathologist analyzed all the histologic specimens. All patients underwent successful biopsy procedures. The quality of the obtained tissue allowed for an accurate histochemical analysis in 27 of 28 (96.4%) biopsies. One biopsy was inadequate because of some important regressive phenomena. No specific complications had to be attributed to biopsy procedures. Percutaneous or transureteral biopsies of renal papillae resulted in being safe and appropriate procedures to obtain papillary samples to identify the presence of interstitial calcium deposits. In the light of the low number of inadequate biopsies, it can be concluded that no difference was found between the percutaneous and transureteral bioptic approach.

9I-15 柔軟把持可能な手術鉗子ロボットの開発とモデル解析(GS-3 医療システムとデバイス)

9I-15 柔軟把持可能な手術鉗子ロボットの開発とモデル解析(GS-3 医療システムとデバイス)

Prospective Controlled Animal Study on Biopsy Sampling with New Flexible Cryoprobes versus Forceps: Evaluation of Biopsy Size, Histological Quality and Bleeding Risk

Background: Cryoextraction is a procedure used for the recanalization of obstructed airways caused by visible exophytic endobronchial tumor. Biopsy samples obtained by this technique have been shown to be useful for histological assessment. Objectives: The aim of the present animal study was to systematically evaluate biopsy size, histological quality and bleeding risk after cryobiopsy with new, flexible cryoprobes in comparison with forceps biopsy, serving as the gold standard. Methods: Biopsies were obtained from anesthetized pigs with the flexible bronchoscopy technique, and evaluated histologically with respect to their size and quality. Bleeding frequency, bleeding duration and histological changes in the biopsy bed were also recorded. Results: Cryobiopsies were significantly larger than forceps biopsies. The size of cryobiopsies was dependent on the freezing time. The histological quality of the cryobiopsy specimenswas not impaired by the freezing process, whereas forceps biopsies showed typical crush artifacts. Despite the larger defects left in the tracheobronchial system after cryobiopsy, bleeding frequency and duration were not higher compared to forceps biopsy. Conclusions: Since cryobiopsy sampling is not associated with a higher bleeding risk compared with forceps biopsy, this new biopsy technique offers – in addition to a good specimen quality – a safe and valuable tool with the potential of improving the outcome of diagnostic endoscopy.

Design and Manipulation of a Suction-Based Micro Robot for Moving in the Abdominal Cavity

In NOTES (Natural Orifice Translumenal Endoscopic Surgery), the path from the surgeon's fingertip to targeted sites is much longer than that of usual laparoscopic operations. Therefore, manipulation of forceps in NOTES is much more difficult, which increases the burden on surgeons. The aim of this study is to develop a micro mobile robot that can move in the abdominal cavity to guide flexible forceps and/or a camera to targeted sites. In order to achieve stable movements and surgery support actions, we proposed using the peritoneum (abdominal wall) as the surface for moving in the abdominal cavity. Moreover, we devised a robot system that relies on two suckers to attach to the peritoneum and a cable-driven mechanism to realize the relative movement of the two suckers, by which 3-d.o.f. movements could be realized. After examining adhesion of the suckers employed, we built a prototype robot. We verified that, hanging upside-down on the surface of a vinyl surface, the robot could move in different directions. Moreover, the load-bearing ability of the robot was also confirmed. From the results of the experiments, we showed the potential of using the robot as a surgery support for NOTES.