Octopus System Research Articles

Acute Total Hip Arthroplasty in Acetabular Fractures in the Elderly Using the Octopus System: Mid Term to Long Term Follow-Up

Patients older than 55 years presenting with acetabular fractures fulfilling the criteria for acute total hip arthroplasty (THA) were included. Cementless THA was done using the Octopus System and autologous bone grafting. 15 patients were available for latest follow up. The average follow-up was 81.5months (62–122months). Mean Harris Hip Score was 91.1. 10 patients were walking without any support while 5 were using a cane. There were no cases of acetabular or femoral component loosening. This method of treatment is promising in the older population as there is deficiency of bone stock which may lead to fixation failures. It is, therefore, worthwhile to recommend primary THA using the Octopus system in the successful management of selected types of acetabular fractures in the elderly.

The times they are a‐changin’: time to change glaucoma management

The times they are a‐changin’: time to change glaucoma management

Optimizing use of the octopus system for off-pump total arterial myocardial revascularization with the TY graft

Rapid developments in interventional cardiology for the treatment of coronary artery disease ask for further evolution of surgical revascularization techniques with improved short-term and long-term results. Off-pump bypass grafting, total arterial revascularization, and use of composite arterial grafts are innovative operative procedures that are already established in many centers. We describe our technique to combine all three procedures in a single operation.

Octopus

E-commerce would go bust without electronic cash payment systems, yet few of the dozens of systems introduced in various world markets over the last decade has been reliable enough to be embraced by large numbers. One exception is Hong Kong’s Octopus system. By mid-2001, nearly 70 percent of Hong Kong’s seven million residents used an Octopus card to make over six million daily transactions worth billions of dollars. Why is the Octopus card so successful when even e-cash systems backed by major credit card operators, including Mondex and Visa Cash, have struggled? This article explores what the Octopus experience can teach us about e-payment. Octopus, a smart card used in Hong Kong’s passenger transportation system, was born in June 1994 when the Mass Transit Railway Corporation (MTRC), the operator of the underground railway system in Hong Kong, persuaded four local public transportation operators of buses, ferries and mini-vans to form a joint venture company, Creative Star Limited (CS), to develop an automated fare collection system based on contactless smart cards. The fare collection contract, valued at U.S. $55 million, was awarded to ERG Australia Limited and its subsidiary AES Prodata, which subsequently awarded the contactless card portion of the contract to Sony and Mitsubishi Corporation in Japan. The contactless, rechargeable smart cards known as Octopus cards were introduced to the general public in September of 1997, as illustrated in Figure 1, which depicts the timeline of the development of Octopus. Card users can now use their cards in almost all modes of public transportation in Hong Kong and can recharge their cards up to H.K. $1,000 (about U.S. $130) in railway stations as well as in more than four hundred 7-Eleven convenience stores within the territory. Unlike slot-based cards that require the user to insert the card into a physical slot, the Octopus card is a proximity card; it can be read by operators without physical contact. All operators’ computer networks are linked to the CS Clearing House, which is responsible for revenue apportionment and fund transfer.

Conversion to off-pump coronary bypass without increased morbidity or change in practice

Background. This article examines the feasibility of complete conversion from conventional coronary artery operation to routine off-pump coronary bypass operation. Methods. Data on our first 285 off-pump procedures using the Octopus system (Medtronic Inc, Minneapolis, MN) represent our learning curve. This is a complete experience in coronary bypass surgery over 16 months. Results. The cohort was nonselected. All patients had at least two-vessel disease. Eight hundred seven grafts were performed (mean, 2.8 per patient) of which 647 grafts (84%) were arterial (mean, 2.3 per patient). One hundred seventy nine patients (63%) underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications were: mortality, 3 patients (1.5%); renal failure, 24 patients (8%); stroke, 2 patients (< 1%); and atrial fibrillation, 60 patients (21%). The morbidity data and frequency of arterial grafting did not differ from that of 355 patients who underwent coronary bypass operations in a preceding 18-month period. Conclusions. Complete shift from routine use of cardiopulmonary bypass to nonselective off-pump coronary bypass operation is possible with a low conversion rate and without an apparent increase in morbidity or change in technique. Whereas short-term safety and efficacy seem certain, studies of long-term outcome are necessary before the eventual role of off-pump coronary bypass in myocardial revascularization can be defined.

A review of 1,582 consecutive Octopus off-pump coronary bypass patients

Background. Off-pump coronary bypass may provide a safer form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in the increasingly complex patients being referred for operation. This study reviews the entire experience of the Medtronic Octopus System (Medtronic, Minneapolis, MN) for beating heart bypass from 7 surgeons. Demographics, operative procedures, early outcomes, and trends in usage were examined. Methods. Patients were selected for off-pump procedures by the individual surgeons. Data were entered prospectively into locally maintained databases and then collected for collation and analysis. Results. A total of 1,582 consecutive Octopus patients were entered, representing the entire Octopus experience of each surgeon. Proportions of off-pump procedures relative to standard bypass increased over time, as did the percentage of patients receiving three or more grafts, 24.6% in 1997 and 55.9% in 1999. A total of 3,653 anastomoses were performed, 1,905 to the left anterior descending system, 837 to the circumflex distribution, and 911 to the right coronary territory. Morbidity was low. Few patients required conversion to cardiopulmonary bypass (2.6%; 0.2% urgently). Permanent stroke occurred in 0.6% and myocardial infarction in 1.2%. Operative mortality was 1%. Conclusions. Octopus off-pump bypass was demonstrated to be a safe procedure with widening applicability. With experience surgeons tend to apply the system to increasing proportions of their patients and are able to revascularize all coronary territories.

Robotically assisted endoscopic coronary artery bypass procedures without cardiopulmonary bypass

Minimally invasive coronary artery surgical procedures still require a minithoracotomy or partial sternotomy for the coronary artery anastomosis. The clinical performance of manual endoscopic coronary artery grafting is extremely difficult and has not been published yet. For this reason, computer-assisted systems have been developed to facilitate endoscopic microsurgery. 1 This is the description of the first clinical use of the voice-controlled and computer-assisted system ZEUS (Computer Motion Inc, Goleta, Calif) for endoscopic coronary artery surgical procedures on the beating heart without cardiopulmonary bypass. Four patients (3 men and 1 woman, aged 44 to 64 years) with an isolated proximal stenosis of the left anterior descending (LAD) coronary artery were evaluated for the procedure. After approval by the local ethics committee, written informed consent was given by the patients. At surgery, 3 thoracoscopic ports (10 mm and 5 mm) were inserted in the left side of the chest. First, the left internal thoracic artery (LITA) was dissected endoscopically. After this, a small parasternal incision (4 cm) was made above the 5th intercostal space. The pericardium was incised through the minithoracotomy. The LAD was visualized and the Octopus system (Medtronic GmbH, Dusseldorf, Germany) was used for coronary artery stabilization. One stabilization pod was inserted through the incision and the second one through one of the thoracoscopic ports. The ZEUS Robotic Surgical System was used to perform an endoscopic graft anastomosis. This system consists of 3 interactive robotic arms placed at the operating table, a computer controller, and an ergonomically enhanced surgeon console. One robotic arm was used to position the endoscope by means of voice control, and the other 2 robotic arms manipulated the surgical instruments under the surgeon’s direct control. A 3-dimensional camera (Vista Cardiothoracic Systems Inc, Westborough, Mass) was inserted through the minithoracotomy. The 2 instrument controllers were inserted through 2 of the thoracoscopic ports

Less invasive, continuous hemodynamic monitoring during minimally invasive coronary surgery

Background. Minimally invasive coronary surgery has gained more and more clinical acceptance. A clear contrast to the minimally invasive idea is the highly invasive pulmonary artery catheter used for hemodynamic monitoring during the operation. We evaluated a less invasive device which calculates cardiac output (CO) and hemodynamics based on arterial pulse-contour analysis. Methods. In 20 patients revascularized by the off-pump technique with the octopus system, agreement of CO by pulse-contour was compared to pulmonary arterial and femoral arterial thermodilution and hemodynamic alterations during the operation were recorded. Pulse-contour CO is computed by measuring the area under the arterial pressure waveform and dividing it by aortic impedance. Aortic impedance is determined by an arterial thermodilution at the onset of the system. Results. Correlation of pulmonary arterial and arterial thermodilution CO to pulse-contour CO was 0.91 and 0.90 respectively (both p < 0.01). Coefficients of variations were 6.2% and 6.7%. The bias was 0.1 L per minute and standard deviations were 0.42 L per minute and 0.55 L per minute. Hemodynamic changes during the operations were seen mainly during the distal anastomosis of the first diagonal branch; only slight changes occurred during the anastomosis of the left anterior descending coronary artery. Conclusions. Arterial pulse-contour analysis is easy to use and minimally invasive, thus qualifies as a reliable routine monitoring tool during minimally invasive coronary surgery with tissue stabilizers.

A two-year, three institution experience with the Medtronic Octopus: systematic off-pump surgery

Background. The popularity of beating heart coronary artery bypass (CAB) has grown with the development of mechanical stabilizers. Multicenter study offers an opportunity to examine methods and risk relating to this practice. Methods. The experience since March 1997, utilizing both the original Medtronic Octopus system and the second-generation, retractor-mounted, Octopus II for beating heart CAB (Medtronic, Inc, Minneapolis, MN), was retrospectively reviewed at three institutions. Results. Four hundred fifty-six patients completed Octopus CAB (Medtronic, Inc), performed through left thoracotomy (54), partial (33), or full (374) sternotomy, and epigastric (3) incisions with an average of 1.9 grafts/patient. Morbidities were reviewed: transfusion (20.6%), reoperation for bleeding (1.0%), atrial fibrillation (13.3%), completed stroke (0.2%), perioperative myocardial infarction (0.8%), and new intraaortic balloon pump (IABP) (0.4%), without episodes of deep sternal infection or renal failure. The mortality rate (0.32%), when compared to the Society of Thoracic Surgeons’ (STS)-predicted mortality (1.37% and 2.36%) at two institutions, was significantly less ( p < 0.05). Twelve nonurgent and one urgent conversion to cardiopulmonary bypass occurred. Six patients have required reintervention on bypassed vessels. Conclusions. To facilitate lateral and inferior wall grafting, a variety of techniques were utilized, including positioning, sternal and pericardial mobilization, and a new pericardial-based sling retractor, all designed to improve exposure while maintaining hemodynamic stability. The Octopus devices were safely applied with low morbidity and mortality utilizing varied operative approaches at three institutions.

Automatische Perimetrie des zentralen Gesichtsfeldes bei Erkrankungen der Makula

We developed a program for testing the central 12 degrees of the visual field with a spatial resolution of 1.6 degrees that was easy to operate. The program was designed for the Octopus computer-perimeter and created by means of the SARGON-utility. Our way of examining differed slightly from the standard Octopus procedure. We tested 16 normal eyes and 13 eyes of patients with various diseases of the central retina. Our normal values of differential threshold sensitivities were about 1.8 dB below the normal values of the Octopus system. Sensitivity and specificity of the program were nearly identical irrespective of using our normal values or the Octopus normal values for the calculation of the above mentioned parameters. Sensitivity was 84.6%, specificity 87.5%. The ability of the program to correctly localize retinal defects was shown. The program was designed for follow-up of patients having undergone paramacular lasercoagulation.

Influence of Lens Opacities on Visual Field Indices

This report presents the results of a study designed to verify the influence of lens opacities on the visual field indices. Four age-matched groups of subjects were considered: healthy volunteers, glaucomatous patients without lens opacities, cataractous patients without glaucoma and glaucomatous patients with lens opacities. The quantification of lens opacities was performed with the Lens Opacity Meter 701 instrument. The visual field indices were obtained automatically from the G1 program of the Octopus system. The statistical analysis of the results (coefficient of correlation) has shown that only the visual field indices that correspond to uniform and diffuse loss of light sensitivity were influenced by the presence of cataract. On the contrary, the visual field indices that indicate local irregularities of the threshold were not significantly influenced by the presence of lens opacities.