Left Tilt Research Articles

Oblique impingement of an ice particle on a water film

In the present study, we experimentally investigated the oblique impinging process of an ice particle on a water film. A parameter study of the impact velocity, impact angle, and water film thickness was carefully carried out. The results showed that three impact categories occurred, namely uprising liquid sheet, crown with a notch, and complete crown. The uprising liquid sheet only occurred in the case when the dimensionless water film thickness was 0.1, which appeared to be independent of the impact velocity and the impact angle. The crown with a notch only occurred in the case when the impact velocity was 23.0 m/s. The left tilt angles of uprising liquid sheet, crown with a notch, and complete crown all increased first and then decreased with the dimensionless time. Among the three experimental parameters investigated in the present study, the dimensionless water film thickness had the most significant effect on the evolutions of the left tilt angles. The dimensionless spreading lengths in x- and y-direction all increased with the increase in dimensionless water film thickness. In addition, the correlations of dimensionless spreading lengths in x- and y-direction were proposed. In addition, the lifetime of complete crown generally increased with the increase in the impact velocity and the dimensionless water film thickness. Within the scope of the present study, the dimensionless maximum height of uprising liquid sheet generally ranged from 3.0 to 3.5. When the impact angle was 30.0°, the dimensionless maximum height of the crown with a notch increased with the increasing dimensionless water film thickness. The present work not only provides a new insight into the study of the ice crystal icing but also offers effective support for the development of efficient anti/de-icing methods.

Frequency of Airway Complications with Modified Recovery Position versus Conventional Recovery position for Extubation after General Anaesthesia.

To compare the frequency of respiratory complications encountered in two different positions used for extubation i.e. conventional recovery position versus the modified recovery position (recovery position with 10-degree left tilt and head-down). Comparative study. Place and Duration of the Study: Department of Anaesthesia, Combine Military Hospital, Kohat, Pakistan, from April 2022 to March 2023. Two hundred patients scheduled for elective nose and throat surgeries were equally divided into two groups (Group C and Group M). Patients with history of bronchial asthma, chronic obstructive pulmonary disease (COPD), recent respiratory infection, and gastro-oesophageal reflux disease (GERD) were excluded from this study. Patients with more than two intubation attempts were also excluded. Group C patients were extubated in a conventional left lateral recovery position, whereas Group M patients were extubated in a modified recovery position with patient in a left lateral position with 10-degree head-down and 10-degree left tilt. All patients were observed for persistent coughing (coughing that lasted for at least 2 minutes after extubation), breath holding for 20 seconds or more, desaturation (oxygen saturation less than 90%), laryngospasm, need for reintubation, vomiting, and regurgitation. Frequency of airway complications was significantly higher in Group C as compared to Group M. In Group C, 18 (18%) out of hundred patients had complications compared to 6 (6%) patients only in Group M (p = 0.009). Extubation in a modified recovery position is associated with reduced frequency of airway complications as compared to the conventional recovery position. Airway complications, Extubation, Cough, Laryngospasm, Recovery position.

The Correlation Between Crawford Wedge and 15 ° Table Left Tilt on Hemodynamic Changes in Caesarean Section a Prospective Observational Study

The supine hypotensive syndrome occurs due to the gravid uterus compressing the inferior vena cava when a pregnant woman lies in a supine position, resulting in reduced central venous return also known as inferior vena cava compression. syndrome Supine hypotension syndrome results in signs of shock and by a decrease in maternal blood pressure. This may result in life-threatening complications in the mother and fetus. To reduce the incidence of supine hypotension syndrome, a few practices were recommended by authors in maternal positioning during Lower abdominal cesarean section (LSCS) surgeries'. Here in this study, we are comparing hemodynamic stability between Table left tilt and wedge under the right hip

Asuhan Keperawatan Pada Pasien Stroke Hemoragik Dengan Pemberian Intervensi Posisi Miring Kanan Kiri Terhadap Pencegahan Dekubitus

The background of this research is based on a brain disease, namely stroke. Stroke results in much higher mortality and morbidity. Viewed from the aspects of risk of death, high medical costs, decreased quality of life and increased prevalence, stroke has a broad impact. Apart from that, decubitus problems also arise in stroke sufferers due to prolonged pressure, the parts that experience bruising are the hips, buttocks, foot joints and heels. Based on a preliminary study conducted at the Tangerang Regency General Hospital, there were 89 patients with a diagnosis of stroke starting from 2022. Meanwhile, in the Cempaka room, it was found that during the assessment there was 1 case with a diagnosis of stroke on January 2 2024. The results of this research are effectiveness. right and left tilt positions in reducing pressure sores or decubitus in patients with stroke. The conclusion of this study is that the right and left side positions are non-pharmacological techniques for reducing pressure ulcers or decubitus and can be used in patients who experience problems with prolonged bed rest. The suggestion from this research is that intervention in right and left tilt positions can be carried out according to the 2021 PPNI SOP.

Comparison of Pressure Pulsation Characteristics of Francis Turbine with Different Draft Tube Arrangement Direction

Hydroelectric power generation is an important clean energy source, and the stability of water turbine operation determines the quality of hydro energy utilization. For hydro turbines, the layout direction of the draft tube is often only considered from a structural perspective, ignoring the hydrodynamic characteristics. This study adopts the computational fluid dynamics method and verifies the effectiveness of numerical simulation with experimental results, analyzing the influence of asymmetric draft tube layout direction on pressure pulsation of mixed flow turbine. The results show that under different working conditions, there is basically no difference in efficiency corresponding to different inclined directions of the draft tube, and the relative difference in performance values is less than 1%. From the perspective of internal flow, the working condition has a greater impact on the flow, and the draft tube tilt has a smaller impact. Under strong swirling flow conditions in the draft tube, the variational mode decomposition of pressure fluctuation is carried out. Research has found 7 characteristic frequency bands including 140 Hz, 80–90 Hz, 40–46 Hz, 5.5–6.5 Hz, 2.5–3 Hz, 1.67 Hz, and <1 Hz. The frequency of the dominant mode corresponding to the left tilt is higher, while the amplitude of the runner frequency is slightly lower. In general, left tilt is not only more suitable for unit layout but also has a better effect on draft tube pressure fluctuation, which is worthy of application in engineering.

OGBN V02 Robotic common bile duct clearance

Abstract Background A 44-yar old male patient presented with painful obstructive jaundice and bilirubin of 127 μmol/L. A Contrast Enhanced Computed Tomography (CECT) revealed dilated biliary tree as a result of obstructing stone in the proximal common bile duct (CBD). The patient underwent an Endoscopic Retrograde CholangioPancreatography (ERCP) and sphincterotomy which demonstrated pus in the bile duct, but also a stone impacted in the common hepatic duct which could not be extracted endoscopically. Therefore, a 7Fr pigtail stent was inserted. Subsequently, he was discharged home and re-admitted for an elective robotic cholecystectomy and bile duct clearance 6 weeks later. Methods Robotic CBD clearance was performed using DaVinciXi system, a 12mm Airseal and four 8mm robotic ports. The patient was supine with split legs(15 degrees), in reverse Trendelenburg position and left tilt. The CBD was dissected out, the anterior duct wall was delineated and longitudinal choledochotomy was carried out. A large stone was extracted through the choledochotomy site followed by removal of stent. Subsequently, a cholangioscopy was performed using a single-use flexible ureteroscope and no further stone disease was identified proximally or distally. Following this, a bile duct closure was performed using 4-0 Polydioxanone interrupted sutures and SutureCut Needle Driver. Results There were no intra- or post-operative complications. The patient made an excellent recovery from robotic common bile duct clearance and was discharged home less than 24 hours post procedure. Conclusions This video presentation highlights the technical aspects of robotic common bile duct clearance and demonstrates that the robotic system allows for accurate dissection and precise suturing which could reduce the risk of bile duct stricture.

OGBN V03 Robotic choledochoduodenostomy for benign common bile duct stricture

Abstract Background A 54-year-old male patient was referred with benign distal common bile duct (CBD) stricture secondary to chronic pancreatitis. He had multiple admissions with recurrent cholangitis requiring numerous Endoscopic Retrograde CholangioPancreatographies (ERCPs) and stent exchanges including SpyGlass procedure which did not demonstrate evidence of malignancy. His quality of life was poor due to debilitating pain and recurrent hospital admissions so he was offered elective choldechoduodenostomy aiming to bypass the bile duct stricture, but also allowing continued endoscopic surveillance. Methods A robotic choledochoduodenostomy was performed using the DaVinciXi system, a 12mm Airseal and four 8mm robotic ports. The patient was supine with split legs(15degrees) in reverse Trendelenburg position with a slight left tilt. Initially, robotic cholecystectomy was carried out following which the CBD was dissected and its anterior wall delineated. The duodenum was kocherised to allow sufficient mobility for anastomosis. Subsequently, a longitudinal choledochotomy was performed and a metal stent was extracted. Then, an enterotomy was made perpendicularly to the choledochotomy. A choledochoduodenostomy was performed using continuous 4-0-V-Loc sutures for posterior wall and 4-0-PDS continuous sutures for anterior wall. Results The post-operative period was uncomplicated. The patient experienced minimal pain after procedure and was discharged home on post-operative day 2. He was reviewed in outpatient clinic 6 weeks after, and reported he had successfully discontinued all regular opiates and benzodiazepines previously used for pain control. Conclusions A robotic choledochoduodenostomy is an excellent alternative for the treatment of benign bile duct strictures in patients with recurrent cholangitis requiring repeated stent exchanges. Moreover, it has the advantage of continued endoscopic surveillance which is not possible with traditional hepatico-jejunostomy.

Effect of left tilt of operating table during elective caesarean section on maternal haemodynamics and vasopressor requirement.

Objective: To compare the effects of left tilt of operating table on maternal hemodynamics and vasopressor requirement in contrast to supine position during caesarean section. Study Design: Comparative Analytical Study. Setting: District Head Quarter Hospital, Rawalpindi. Period: December 2021 to February 2022. Material & Methods: A total of 38 participants were included by the lottery method of randomization into the two groups according to the inclusion and exclusion criteria: supine group and left tilt group. For Supine Group, spinal anesthesia was administered in the sitting position, and then supine position was maintained. For Left tilt group, spinal anesthesia was administered in the sitting position and was then maintained in the supine position until the full anesthetic effect was achieved, and the table was tilted 15 °to the left. The Systolic and the diastolic blood pressures were noted at regular intervals. Data were entered and analyzed using SPSS version 25. Results: The results showed that systolic blood pressure decreased significantly in the supine group (F= 16.65, p< 0.000) compared to the left-tilted group (F= 2.1, p= 0.12). Intraoperative phenylephrine was required by four out of 20 participants in the supine group after 10 and 15 minutes, of out 2/20 participants after 20 minutes and out of 6/18 participants after 30 minutes. None of the participants in the left-tilt group required intraoperative phenylephrine. Conclusion: The left tilted position of the operating table is better than the supine position in terms of maternal hemodynamics and vasopressor requirement during Caesarean section.

Mobilization of Stroke Patients to Prevent Decubitus: A Systematic Review

Stroke is a disease or nerve disorder that occurs suddenly due to impaired blood flow to the brain. Stroke is known to cause various complications including the occurrence of decubitus wounds. Decubitus is one of the most frequent complications experienced by stroke patients. One of the therapies that can be given to prevent these complications is to take mobilization actions. The purpose of this literature review has been to analyze the provision of mobilization measures in stroke patients to prevent decubitus. The search method uses the Mendeley, PubMed, and Google Scholar databases between 2017 and 2021, with the keyword "Mobilization and Patient Stroke and Pressure Sores" obtained from 100 journals, from the Mendeley 82, PubMed 1 and Google Scholar 17 databases, then from these 100 journals a selection was made and 5 articles were obtained that can be reviewed according to the inclusion criteria. Results and Discussion of a review of literature review in 5 articles stated that mobilization measures can prevent decubitus in stroke patients. Mobilization can facilitate circulatory circulation, maintain muscle tone, and maintain and increase joint range of motion. Mobilization can be given to stroke patients with mobilization actions in the form of changes in the right tilt position, left tilt, and changes in tilt position 30 degrees. This position change can be done every 2 hours. The conclusions and recommendations of this literature review suggest that the administration of mobilizing measures is effective in preventing the occurrence of decubitus in stroke patients. For this reason, this research recommendation is that patients with bed rest be mobilized and given olive oil smears.

Penerapan Evidence Based Practice Nursing (EBPN) Modifikasi Miring Kiri dan Miring Kanan Menurunkan Back Pain Post Percutaneous Coronary Intervention

This study aims to apply the identification of left and right oblique modifications to reduce back pain after percutaneous coronary intervention based on the results of Evidence-Based Practice Nursing (EBPN) research. The research method used is a case study. The case study in this innovative design is a case study by applying research results in identifying left and right oblique modifications to reduce back pain post-percutaneous coronary intervention. The results showed that adjusting the correct oblique and left diagonal positions was carried out after two hours of cardiac catheterization, namely for 30 minutes (15 minutes in the correct oblique position and 15 minutes in the left oblique position). In conclusion, giving accurate diagonal left oblique work is carried out in patients who experience post PCI back pain at the time of the study, having a pain scale of 5. After being given intervention, the pain scale is reduced to 3.
 
 Keywords: PCI, PJK, Right and Left Tilt Position

The Effect Of Maternity Position On The Length Of Labor Time During The Active Phase Of Primigravida

Normal delivery is the process of fetal discharge and ari-ari in mothers with full-term pregnancy at the time of delivery, the mother needs special support in determining the position of labor because she has not had previous experience, especially in primigravida mothers. The choice of labor position is very important for the mother because the position can provide comfort and can facilitate the progress of labor. The purpose of this study was to determine the influence of both variables, namely the position of labor and the length of labor. Observational analytical research method with post test approach with design two experiments, a sample of 26 people consisting of 2 groups, 13 people in squatting and standing position groups and 13 people sitting middle position and left tilt with accidental sampling techniques, research in RB Cahaya 2 Lubuk Pakam, data collection using partograph sheets, data results tested with Simple t test. The results showed that there was an influence of Maternity Position on the length of labor time during the active phase of Primigravida with a p-value 0,00. It is recommended to all mothers who give birth to be able to choose the right position so that labor can take place smoothly and it is also recommended to husbands and health workers to support the positions of mothers who will give birth.

Evaluation of the linear and volumetric measuring changes in different positions in CBCT.

The effect of head position on reproducibility of volumetric measurements on Cone-beam computed tomography (CBCT) scans has not been evaluated before. Thus, this study aimed to assess the changes in linear and volumetric measurements on CBCT scans in different positions of the respective object. In this experimental study, 16 balls were placed in containers and underwent CBCT in neutral position and 8 different altered positions. The horizontal and vertical diameters of each ball were measured by OnDemand software while the volume of each ball was quantified by ITK-Snap software. The reproducibility of linear and volumetric measurements in nine different positions was analyzed by the Cronbach's α. Paired t-test was applied to analyze the difference in volumetric and linear measurements of the balls in the anterior and posterior halves of the scans in neutral position versus the upward and downward tilts, and right and left halves of the scans in neutral position versus the right and left tilts. The Cronbach's α was found to be .982 and .933 for volumetric and linear measurements, respectively, indicating high reproducibility of the measurements. No significant difference was noted in the mean linear measurements on CBCT scans at different positions compared with neutral position. In volumetric measurements, maximum difference between neutral and the other positions was less than 1%. CBCT is a reliable modality for linear and volumetric measurements in different positions.

Short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy in the treatment of gallbladder cancer and its effects on median survival time and postoperative complications.

To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into 2 groups: the control group (n = 61, LC + bile duct T-tube drainage) and experimental group (n = 60, LC + CJ). The perioperative indicators, short-term efficacy, median survival time, postoperative complications and immune stress response were compared between the 2 groups of patients before and after propensity score matching. The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in the experimental group were no different from those in the control group (P > .05), but the hospital stay was shorter than that in the control group (P < .05). There was no difference in the effective rate of treatment and median survival time between the 2 groups (P > .05). The total incidence rate of complications in the experimental group at 14 days after surgery was lower than that in the control group (P < .05). Day 3 after surgery, the levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) of the experimental group were higher than those of the control group (P < .05), while the level of C-reactive protein (CRP) was lower than that of the control group (P < .05). Compared with bile duct T-tube drainage, LC + CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the 2 is similar, which can be promoted in clinical practice.

Measures of Spatial Orientation: Spatial Bias Analogs in Visual and Haptic Tasks.

The primary sensory modality for probing spatial orientation can vary among psychophysical tasks. In the subjective visual vertical (SVV) task, a visual stimulus is used to measure perceived vertical orientation, while a haptic stimulus is used in the subjective haptic vertical (SHV) task. Here we examined disparity in SHV and SVV task results and asked whether it could be related to biases in probing different spatial estimates by each task. Forty-two healthy volunteers (mean ± SD age, 25 ± 10 years; 19 females; 21 left handed) were recruited. The effect of a task to measure spatial orientation was calculated as the difference between SHV and SVV values, and with the head upright and tilted 20° laterally. There was a task bias regardless of head position related to hand use in the haptic task but not handedness (mean head upright ± SEM: left hand, −3.7 ± 1.1°; right hand, 7.9 ± 1.0°). When this task bias was subtracted out, there was a similar spatial bias using each hand in the SHV task that was also comparable to the SVV task (mean head with left tilt: left hand, 3.9 ± 0.7°; right hand, 4.4 ± 0.7°; SVV, 4.9 ± 0.7°; mean head with right tilt: left hand, −4.6 ± 0.9°; right hand, −4.6 ± 0.8°; SVV, −4.7 ± 1.0°). These findings show that the disparity in visual and haptic measures of spatial orientation is primarily related to a modality-specific bias, and once the effect of hand use is removed from the haptic measurements, the spatial bias becomes comparable to the visual task.

Persiapan dan Posisi Ibu dalam Persalinan

Childbirth is a vulnerable period for a woman who experiences pregnancy in her life cycle. The labor process is prone to experiencing various complications, one of the things that is naturally felt by maternity is the comfort and well-being of her body in dealing with labor contractions so that a comfortable position is needed for the mother to face her delivery without complications. Mother's preparation in labor is by choosing a position in labor. There are several positions in the labor process, namely left tilt, right side lying, semi sitting/semi fowler, lithotomy, squatting, knee chest. The purpose of this service is to provide education for mothers in dealing with childbirth, it requires preparation and knowledge related to the ideal position in childbirth that is safe, comfortable and healthy for mothers and their babies. The method used in this counseling is a demonstration of the delivery position. Based on the results of the activity, 15 pregnant women in the work area of ​​the Pattingalloang Public Health Center participated in the counseling activities.

Incidence of Spinal Anesthesia Induced Severe Hypotension among the Pregnant Women Undergoing Cesarean Section at Muhima Hospital

BackgroundThe spinal induced severe hypotension is frequently reported during cesarean section; the literature counts 70% of severe hypotension following spinal anesthesia for cesarean section. This complication is thought to be serious and even fatal, when not well managed; however, in Rwanda, we have a limited data about that spinal induced life-threatening complication. ObjectivesTo determine the incidence and factors associated with spinal anesthesia induced severe hypotension during caesarian section at Muhima hospital.MethodologyThe study was cross-sectional, descriptive and analytical in design. The study population was the pregnant women scheduled for cesarean section, and a sample size of 108 was used. A self-developed questionnaire was used as data collection tool. ResultsForty percent of participants’ experienced spinal anesthesia induced severe hypotension; while preloading, left tilt position and infusion of ephedrine, were associated with lower incidence of severe hypotension.ConclusionThe incidence of spinal induced severe hypotension is high, however, preloading; left lateral position and co-infusion of ephedrine were found to protect the participants from spinal induced severe hypotension. Therefore, these techniques should be promoted.&#x0D; Rwanda J Med Health Sci 2022;5(1):62-70

Facial Asymmetry in Children With Unilateral Congenital Ptosis.

To analyze facial asymmetry in children with unilateral congenital ptosis. This is a retrospective review of pediatric patients undergoing ptosis repair between January 1, 2017, and December 31, 2020. Charts were reviewed to ensure a diagnosis of idiopathic unilateral congenital ptosis. Sex, age, laterality, margin to reflex distance 1, levator function, and surgical intervention were collected.Clear preoperative photos without head turn were included. Using the ImageJ software ( nih.gov ), landmarks of the periorbital region, midface, and lower face were marked, and measurements between these landmarks were taken.Two-tailed Student t tests were used to compare measurements between the ptotic and non-ptotic sides. Relationships between different measurements on the same side of the face were analyzed using paired-variable regressions. Forty-four patients with unilateral congenital ptosis were included. The surgical management consisted of Mullerectomy in 9 of 44 (20%), levator resection in 15 of 44 (34%), and frontalis suspension in 20 of 44 (46%) patients. The side of the face with blepharoptosis was found to more often have smaller margin to reflex distance 1 ( p &lt; 0.001), smaller margin to reflex distance 2 ( p &lt; 0.005), smaller horizontal palpebral fissure ( p &lt; 0.05), shorter midface height ( p &lt; 0.001), and a more inferiorly displaced lateral canthus (canthal angle, p &lt; 0.001) relative to the non-ptotic side of the face. The mean head tilt of patients with right sided ptosis (1.37° right tilt) was statistically significantly different from those with left sided ptosis (0.85° left tilt; p = 0.04). In children with unilateral congenital ptosis, the ptotic side of the face was found to be the nondominant side of the face. Patients were also found to have ipsilateral head tilt.

Visuospatial orientation: Differential effects of head and body positions

To orientate in space, the brain must integrate sensory information that encodes the position of the body with the visual cues from the surrounding environment. In this process, the extent of reliance on visual information is known as the visual dependence. Here, we asked whether the relative positions of the head and body can modulate such visual dependence (VD). We used the effect of optokinetic stimulation (30°/s) on subjective visual vertical (SVV) to quantify VD as the average optokinetic-induced SVV bias in clockwise and counter-clockwise directions. The VD bias was measured in eight subjects with a head-on-body tilt (HBT) where only the head was tilted on the body, and also with a whole-body tilt (WBT) where the head and body were tilted together. The VD bias with HBT of 20° was in the same direction of the head tilt position (left tilt VD −1.35 ± 0.1.2°; right VD 1.60 ± 0.9°), whereas the VD bias with WBT of 20° was in a direction away from the body tilt position (left tilt VD 2.5 ± 1.1°; right tilt VD −2.1 ± 0.9°). These findings show differential effects of relative head and body positions on visual cue integration, a process which could facilitate optimal interaction with the surrounding environment for spatial orientation.

Comparison of the Effect of Intrathecal Hyperbaric 0.5% Bupivacaine Alone and With Addition of Dexemedetomidine on First Analgesic Request in Post-Operative Care Unit Following Elective Cesarean Section

Spinal anesthesia has been considered preferred method of anesthesia for patients undergoing elective cesarean sections. Dexmedetomidine (DXM) is relatively a newer drug in Pakistan as compared to conventional used drug i.e. Bupivacaine (BPV) and that’s why the local data regarding its efficacy in cesarean section is lacking. Objective: To compare the mean duration of spinal anasthesia between hyperbaric bupivacaine 0.5% alone versus hyperbaric bupivacaine 0.5% with dexmedetomidine on first analgesic request for women undergoing elective cesarean section under subarachnoid block Methods: Spinal anesthesia was performed in the sitting position under sterile conditions with 25G pencil point needle. After successful intra thecal injection, patient was placed in the supine position with left tilt. The cases in Group A received hyperbaric 0.5% BPV (2.25ml) with 5ug DXM (0.25ml) and those in Group B received only 0.5% BPV (2.25ml) with 0.25ml normal saline under full aseptic measures. These patients underwent cesarean section and were assessed in post-operative time after every 30 minutes to first request of analgesia which were given if there was pain of 4 or more on visual analogue scale. Results: In Group A, mean and SDs for duration of analgesia was 359.73+8.021 minutes. In Group B, mean and SDs for duration of analgesia was 182.30+7.720 minutes Conclusions: In this study, hyperbaric bupivacaine 0.5% with DXM in spinal anesthesia for patients undergoing caesarean section significantly prolonged the duration of analgesia

An Ergonomic Neuroendoscopic Instrument Handle Design using 3D Printing.

Minimally invasive neurosurgery poses several challenges to surgeons due to constrained working environment, and its implications on the surgical outcome are an area of growing concern. The instrument handle design directly affects surgeon's performance, and the conventional ring handle causes ergonomic discomfort. The aim of this study was to design and validate a palm grasping-based ergonomic handle for skull-base neuroendoscopic instruments. The handle was designed based on the palm grasping technique and to naturally match the contours of hand. The ergonomic handle was fabricated and assembled with the end-effector of biopsy forceps. Fifteen participants with no experience of neuroendoscopic procedures validated the ergonomic handle. During data collection, participants performed the ring transfer task on straight, right tilt (+30°) and left tilt (-30°) of activity plates of neuro-endo-trainer (NET) with 0° and 30° endoscopes. Feedback from participants indicated that there was significant improvement in degree of discomfort in performing the task on straight (P = 0.006) and tilted plate (P = 0.001) and degree of pain (0.0001) using the ergonomic handle. Furthermore, video analysis of the performed task shows that there was statistical improvement in hitting events (P = 0.001, P = 0.04), tugging events (P = 0.00001, P = 0.00001,) and picking attempts (P = 0.04, P = 0.0004) on straight and tilted plates, respectively. There was reduction in ring drop, jerk, and average moving time, but results were not significant. The subjective validation of ergonomic handle by neurosurgeons shows that the designed handle offers ergonomic advantages. Objective validation by video analysis shows that the ergonomic handle results in better task performance on NET surgical trainer.