High-definition Recording Research Articles

A better way to carry out a preseptal transconjunctival approach to the orbit

Introduction: The most common approaches taught in the United Kingdom to the orbital floor are subciliary, subtarsal, infraorbital rim and transconjunctival. Orbital floor fractures may be reached via 2 types of conjunctival approaches; the preseptal and post/retroseptal. Whilst the retroseptal approach offers a more direct and easier route to the orbital rim and floor, it is associated with a higher rate of lower lid complications compared to the preseptal approach. We will focus on the preseptal transconjunctival approach. Methods: A modified technique in Glasgow provides excellent exposure via a preseptal transconjunctival approach. The team will present a high definition recording of key steps to allow access to the orbital floor in a few minutes. Results: This approach is surgically similar in providing exposure and access, but aesthetically superior to other approaches and has minimal complications. There are limited disadvantages to transconjunctival preseptal approach, if performed meticulously with sound knowledge of anatomy of peri-orbital tissues. Conclusions: Although technically more demanding than the post/retroseptal approach, the preseptal approach enables a large and safe access to the entire orbital floor by passing through an anatomical bloodless plane. This approach can also be combined with a lateral canthotomy/cantholysis and with a medial caruncular transconjunctival incision, thus providing extended exposure of the entire orbit. Introduction: The most common approaches taught in the United Kingdom to the orbital floor are subciliary, subtarsal, infraorbital rim and transconjunctival. Orbital floor fractures may be reached via 2 types of conjunctival approaches; the preseptal and post/retroseptal. Whilst the retroseptal approach offers a more direct and easier route to the orbital rim and floor, it is associated with a higher rate of lower lid complications compared to the preseptal approach. We will focus on the preseptal transconjunctival approach. Methods: A modified technique in Glasgow provides excellent exposure via a preseptal transconjunctival approach. The team will present a high definition recording of key steps to allow access to the orbital floor in a few minutes. Results: This approach is surgically similar in providing exposure and access, but aesthetically superior to other approaches and has minimal complications. There are limited disadvantages to transconjunctival preseptal approach, if performed meticulously with sound knowledge of anatomy of peri-orbital tissues. Conclusions: Although technically more demanding than the post/retroseptal approach, the preseptal approach enables a large and safe access to the entire orbital floor by passing through an anatomical bloodless plane. This approach can also be combined with a lateral canthotomy/cantholysis and with a medial caruncular transconjunctival incision, thus providing extended exposure of the entire orbit.

A High-definition Recording Method of Electrocardiogram

In order to improve the clarity of ECG waveforms and the anti-interference ability of ECG acquisition under abnormal conditions, this study proposes a high-definition ECG recording method based on superimposed averaging algorithm. The results show that the proposed method can more clearly reflect the details of the ECG. Meanwhile, it has a significant inhibitory effect on EMG interference. As a result, the proposed method has a positive significance for improving the anti-interference ability of ECG equipment.

Simple Video-Based Spatiotemporal Gait Analysis Is Not Better than Subjective Visual Assessment of Lameness in Dogs

Abstract Introduction Visual gait analysis is prone to subjectivity, but objective analysis systems are not widely available to clinicians. Simple video analysis using high-definition recordings might enable identification of temporal or spatial variations that could permit objective and repeatable assessments of lameness in general practice. Methods Cohorts of normal and mildly to moderately lame dogs were filmed using a standardized protocol. Using freely available software, measurements of stance, swing and stride time were obtained, along with measurements of pelvic, shoulder, and head height for each limb. Symmetry ratios were calculated, and distributions of normal and lame dogs compared using Mann–Whitney U test and Kruskal–Wallis test. Results Recordings from 35 normal dogs were assessed along with 30 dogs with grade 1 to 3/5 lameness. While no consistent significant differences in temporal characteristics could be found, head height asymmetry was significantly different between lame and normal dogs (p = 0.003), with pairwise comparison showing this difference was restricted to forelimb-lame dogs (p = 0.03). Conclusion While potentially useful for patient records, use of video recordings at walking speeds for simple spatiotemporal gait analysis does not appear to offer clinically significant advantages over visual gait analysis in a typical clinical population of lame dogs.

American Wild: Digital Preservation for Changing Landscapes

The National Park Service represents the nation's largest initiative in landscape conservation and preservation. As both a material and cultural construct, national parks are living memorials to a uniquely American wilderness narrative. In celebration of the National Park Service Centennial, American Wild is a speculative proposal for digital landscape preservation. The project generates civic pride by connecting the distinctive architecture of the Washington, DC Metro to the national parks. Using ultra–high-definition recordings, videos of each park are individually projection-mapped at full scale. The memorial creates a timeline of the National Park Service's 100-year history that advocates for its next centennial.

Robotic Pelvic Exenteration (Cystoprostatectomy and Combined Abdominoperineal Resection) with Double-Barreled Wet Colostomy

Introduction: Patients with locally advanced pelvic carcinoma or severe radiation sequelae may be managed with pelvic exenteration, which requires both fecal and urinary diversion. Double-barreled wet colostomy (DBWC) represents a simultaneous diversion through a single ostomy as opposed to a separate terminal colostomy and urostomy.1–4 This has been described through an open approach; however, literature on the technique and safety of a robotic approach is scarce. This video shows a combined robotic cystoprostatectomy and abdominoperineal resection with creation of a DBWC for locally recurrent prostate cancer with rectal invasion. Materials and Methods: Using a high-definition recording system and iMovie software, we created a video of our technique for robotic cystoprostatectomy and abdomnioperineal resection with creation of a DBWC using the Surgical Intuitive Da Vinci Xi robot. Lithotomy position is used to access the perineum. Four robotic and one assistant port are placed allowing access to the descending colon and pelvic structures. Key steps include (1) mobilizing the sigmoid colon and rectum from the pelvic sidewall and brim to the splenic flexure; (2) bowel transection at the mid descending colon; (3) bilateral pelvic lymph node dissection (PLND), beginning at the bifurcation of the aorta and including the common iliac vessels, external iliac obturator, and hypogastric lymph nodes, including the triangle of Marcille; (4) transecting the bladder pedicles; (5) dropping the bladder and entering the space of Retzius; (6) dissecting the endopelvic fascia and lateral prostate; (7) transecting the dorsal vein complex and urethra; (8) dissecting the posterior plane of the rectum along the sacrum; (9) en bloc removal of the specimen through the perineal incision; (10) creating a ureteroenteric anastomosis with double J ureteral stents placement in the urinary reservoir; and (11) wet colostomy site creation 10–15 cm from the colonic suture line and brought up to the skin. Results: The operative time was 480 min (60 min abdominoperineal resection) and estimated blood loss was 250 mL. The final pathology report demonstrated a pT4N1 Gleason 9 prostate cancer and invasion of the rectum, bladder, and pelvic wall. Postoperatively, the DBWC functioned well, without complications of ascending pyelonephritis or electrolyte imbalance. At 6 months follow-up, the PSA is undetectable on leuprolide and the creatinine level is 1.4 (baseline of 1.0). Conclusions: This video presents an initial experience with robotic cystoprostatectomy and abdominoperineal resection with creation of a DBWC. Robotic pelvic exenteration and DBWC are feasible and safe for locally advanced pelvic malignancies. The dissection allows excision of the bladder, prostate, sigmoid colon, rectum, and anus en bloc while performing an extensive PLND. The open DBWC literature demonstrates shorter operative time and decreased blood loss and length of stay than separate ostomies. The most common complications include ascending pyelonephritis in 7–16% of cases as well as case reports of metabolic disturbances. Our early follow-up shows good functional outcomes without complications. Patients most likely to benefit from this procedure are those seeking greater ease of care and those patients with a higher risk of fistula as there is no need for further bowel anastomoses. No competing financial interests exist. Runtime of video: 8 mins 14 secs

The role of membrane-inner retina adherence in predicting simultaneous internal limiting membrane peeling during idiopathic epiretinal membrane surgery.

PurposeTo correlate the frequency and extent of simultaneous inadvertent internal limiting membrane (ILM) peeling during idiopathic epiretinal membrane (ERM) removal with characteristics of ERM adherence demonstrated on pre-operative spectral domain optical coherence tomography (SD-OCT).Patients and methodsThis is a prospective, observational, case series of patients undergoing pars plana vitrectomy for idiopathic ERM. Inner retina-ERM adhesion was categorized as focal, broad or complete in five anatomic locations at macular area based on preoperative SD-OCT findings. The extent of spontaneous ILM peeling was quantified on a scale 0-100% in each of the aforementioned anatomic locations by the operating surgeons who were masked to the OCT characteristics. All operations were recorded with a high definition recording system and the area of simultaneous ILM peel was quantified by a second masked observer. The final extent of spontaneous ILM peel was calculated as the average of the two scores.ResultsThirty consecutive subjects who underwent surgery for idiopathic ERM were included in the study. Evidence of simultaneous ILM peeling was identified in 80.3% of individuals. With regards to the type of ERM-macula adhesion, inadvertent ILM peel was observed in 70% of the patients who pre-operatively showed complete adhesion, in 43% with broad adhesion and in only 21% with focal adhesion (P<0.001). The extent of the spontaneous ILM peel during removal of ERM was also significantly dependent on the type of ERM-inner retina adhesion. Total simultaneous ILM peel was observed in 59% of locations with complete ERM-macula adhesion but only in 22% and 7% of locations with broad and focal adhesion respectively (P<0.001).ConclusionsSimultaneous ILM peel is a frequent occurrence during ERM surgery, especially when there is complete or broad ERM adherence to the macula. The type of ERM-inner retina adhesion represents a valid predictor of the extent of simultaneous ILM peel during removal of ERM. Thorough evaluation of preoperative OCT may be a useful tool in determining a safer, more simplistic strategy in ERM surgery.

Assessing Instrument Usage Patterns in Multiple Long Duration Colorectal Surgical Proceduresto Categorise Decisions Made by Surgeons and Elicit Specific Design Needs

The aims of this study are twofold: firstly to apply a method of categorizing surgical instrument use during long duration laparoscopic procedures, and secondly to validate this method by applying it to multiple instances of a single procedure. Case studies were performed on several separate high definition recordings of laparoscopic sigmoid colectomy procedures to assess the actions performed by the surgeon. The Observer XT V11.0(Noldus 2011) software package was used to study specific instrument usage, the actions associated with each instrument, idle behavior time and instrument changeover times. The Observer XT V11.0 software package was an effective method of categorizing the actions during the procedure. The data from the case studies indicated that for this specific right handed operator, the right hand led the procedure, using the most instruments and separate actions. The left hand provided support through actions such as grasping and maneuvering only. The most used instrument was the suction/irrigation instrument, followed by the grasping instruments. Key operations such as stapling/dissecting occupied the least amount of time. More time was spent maneuvering the internal anatomy than mobilizing the sigmoid colon or creating an anastomosis or stoma. Once the actions of each hand during each procedure were categorized, high level statistical analyses were applied to the data. It was necessary to perform these analyses to normalize the data as each part of the laparoscopic sigmoid colectomy procedure utilized different instruments for different durations. The future applications of this work lie in the innovation of new instruments or approaches to laparoscopic surgery. In these case studies, more time was spent navigating to the surgery site than performing the mobilization of the colon. There would appear to be a previously unmet clinical need to innovate new approaches to this type of surgery to shorten the duration of the surgery while preserving or improving the clinical outcome for the patient. More case studies are needed to confirm the validity of this claim.

NYU Technique for Robot-Assisted Boari Flap

Introduction and Objective: Robot-assisted laparoscopic techniques are being adopted by urologists for reconstruction of the upper urinary tract. Specifically, this technique is being increasingly used to manage complex ureteral strictures. In this video, we demonstrate the use of robotic technology to repair a proximal ureteral stricture utilizing a boari flap. Methods: Utilizing all of the principles of open surgery, we created a minimally invasive technique to perform a robot-assisted boari flap. Using a high-definition recording system and iMovie software with narrative and annotative editing, we created a video outlining the pertinent steps of this procedure. We review and present our data from a retrospectively collected cohort of patients undergoing robot-assisted ureteral reimplant. Results: Between 2005 and 2012, we performed a total of 23 robot-assisted ureteral reimplants of which 13% were boari flaps. Average age was 65. There were 11 females and 12 males. Average body mass index (BMI) was 27.4. Of the 23, 11 were right reimplants, 12 were left-sided, none were bilateral and 10 had previous repairs. Average operative time was 271.4 minutes. Average length of stay (LOS) was 2.3 days. There were 3 complications—a lower extremity neuropathy secondary to positioning, a stent migration, and an inadvertent enteromy. Average follow-up was 6.4 months. Symptom resolution as assessed by radiology was 94.7% and clinical symptom resolution at most recent follow up was 100%. Conclusion: The use of robot-assisted surgery provides a safe, reproducible, and durable technique to manage even the most complex upper urinary reconstructive procedures. This video illustrates many of the advantages provided by the use of robotics and how the open surgical technique can be reproduced in a minimally invasive environment. No competing financial interests exist. Runtime of video: 7 mins 31 secs

Application of Laser to Digital Printing. High Definition Image Printed by Laser Thermal Transfer.

For development of computer-to-plate direct exposure system, it is necessary to develop a dry and high definition recording process connected to the computer system. In the wax melt-type laser thermal transfer printing, the laser diode irradiation is absorbed as heat in the thermal transfer ribbon that results in local melting and transfer of the ink to the receiving sheet. In this research, the ink image was transferred to the paper and an aluminum plate by laser heating technology for making the high definition image and offset printing plate directly. The fundamental characteristics such as the shape of printed pixel, printing energy and optimization of printing condition were discussed in the melt-type thermal printing by laser heating.