Operator's Hand Research Articles

Evaluating salivary aerosol spread and contamination risks during dental procedures in an open-plan clinic

Saliva has been regarded as a potential transmission medium in dentistry. This study aims to investigate the dispersion of salivary aerosols on susceptible individuals and assess the resultant environmental contamination, focusing on field measurement during drilling procedures. To visualize salivary dispersion during dental procedures, a fluorescein solution was introduced into a dental manikin's mouth. Spectrofluorometry quantified the spatial-temporal distribution of salivary aerosols in the breathing zones of both the operator and the patient in the adjacent bay, along with environmental contamination. Aerosol particles from 0.5 to 20 μm in diameter were measured by an Aerodynamic Particle Sizer (APS). Fluorescence photography was used to evaluate the contamination on the operator's dominant hand. Employing High-volume evacuators (HVE) reduced fluorescence by 52% and peak concentration by 65%. Particle size distribution showed a substantial proportion of <1 μm particle number concentrations with a notable increase in fine particles during the operation. There was no significant difference in the contamination of the dominant hand regardless of whether the HVE was used or not (P = 0.839 > 0.05). Remarkably, the fingertips exhibited notable contamination (inner surface 0.11%, outer surface 0.13%). The results highlighted the potential transmission risk of patients' salivary to dental staff, emphasizing vital coordination between the HVE and dental instruments.

Development and evaluation of modified lead gloves to reduce hand radiation dose during interventional radiological procedures

We developed lead gloves that minimize radiation dose to the operator's hands during interventional radiological procedures and that do not impede the operator's surgical capabilities. Existing lead gloves can protect the operator's hands by shielding radiation, but use of such gloves may impair preception sensitivity, resulting in a reduction in the operator's surgical ability. Accordingly, in this study, we developed modified lead gloves that can reduce radiation dose while maintaining operator sensitivity during procedures by modifying the operator's main surgical finger area in existing lead gloves. To evaluate the performance of developed modified lead gloves, radiation was applied in surgical conditions without gloves and with surgical gloves, lead gloves, and modified lead gloves. The radiation dose was evaluated for each condition. When the modified lead gloves were worn, the degree of shielding was similar to when conventional lead gloves were worn. Based on these results, if the operator wears modified lead gloves during interventional radiological procedures, they will protect the hands from radiation while maintaining physical sensitivity in the hands.

Multimodal Robot Programming Interface Based On RGB-D Perception and Neural Scene Understanding Modules

In this paper, we propose a system for natural and intuitive interaction with the robot. Its purpose is to allow a person with no specialized knowledge and no training in robot programming to program a robotic arm.We utilize data from the RGB-D camera to segment the scene and detect objects. We also estimate the configuration of the operator's hand and the position of the visual marker to determine the intentions of the operator and the actions of the robot. To this end, we utilize trained neural networks and operations on the input point clouds. Also, voice commands are used to define or trigger the execution of the motion. Finally, we performed a set of experiments to show the properties of the proposed system.

Toward safer Human-Robot collaboration in MR environment

This paper presents a Mixed Reality (MR) approach to extend the Safe Move tool from ABB Robot Studio (RS) to view and intuitively edit the safety configuration, allowing the import of existing configurations and the export of modified ones to RS for certification by the expert. The added virtual sensor can detect the user's position allowing collision detection and avoidance. The robot's motion is not only adjusted to the safety zone in which the robot is but also to its relative position to the operator by monitoring in real-time positions of the operator's hands as well as head and triggering appropriate action in the robot.

Kontrolišite ruku robota putem praćenja ljudskih ruku zasnovano na viziji

In this paper, hand tracking based on computer vision is developed to control the movement of a SCARA robot arm. The robot arm will move according to the movement of the human hand. Instead of using buttons on the teach-pendant or a computer control program to move the robot arm, the robot can now be easily controlled and positioned quickly by the movement of the operator's hand. A SCARA robot arm with two rotation joints and one translation motion is constructed for the validation system. Two states of the hand are recognized for controlling the vacuum cup to grasp the products. Stepper motors drive the robot arm. Arduino Uno is used as the main controller for controlling the stepper motors. The handtracking is performed by using the MediaPipe Hands framework developed by Google. The coordinates of 21 hand landmarks are extracted for further processing. A program is written on a personal computer to process the image to get the position and state of the hand. This position is transformed into the rotation angles of the robot's joints. Then, the angles and state are sent to the Arduino board. The Arduino board creates pulse signals to rotate the stepper motors. The experimental results show that the robot's trajectory is close to the hand trajectory at a low speed.

Verification of surgical factors affecting the efficiency of stone extraction with one-surgeon basketing technique using a f-URSL simulation model.

Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator's hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side.

Development of a synchronous motion-tracking and video capture tool for flexible ureteroscopy.

Hand/instrument motion-tracking in surgical simulation provides valuable data to improve psychomotor skills and can serve as a formative evaluation tool. Motion analysis has been well-studied in laparoscopic surgery; however, there are essentially no studies looking at motion-tracking for flexible ureteroscopy (fURS ), a common surgical procedure requiring hand dexterity and 3D spatial awareness. We aimed to design a synchronized motion-tracking and video capture system for fURS capable of collecting objective metrics for use in surgical skills training. Motion tracking of the ureteroscope was performed using a motion-tracking platform, inertial measurement units (IMUs), and an optical sensor. Position (x, y, z) and orientation (roll, pitch, yaw) of the ureteroscope handle, lever deflection, and translation of the scope insertion point were collected. Video capture of the operator's hands was collected with a Raspberry Pi camera. All peripherals were controlled on a Raspberry Pi 4 and synchronized to its system clock. Our system demonstrated good accuracy in detecting translation of the ureteroscope in the x- and y-axes, and yaw, pitch and roll of the ureteroscope at discrete orientations of 0, ±30, ±60, and ±90 degrees. Unique to fURS, deflection of the lever was captured by the difference in IMU static accelerations with good accuracy. The optical sensor detected translation of the ureteroscope at the insertion point with good precision and an average error of 5.51%. We successfully developed a motion-tracking and video-capture system capable of collecting motion-analysis parameters unique to fURS . Future studies will focus on establishing the construct validity of this tool.

Synchronized Control of Robotic Arm based on Virtual Reality and IMU Sensing

This study introduces a robotic control system that combines virtual reality integration and inertial measurement units (IMU) using mixed reality (MR) devices. The system integrates three main modules: (1) virtual reality (VR), which simulates remote reality by the Hololens2, (2) the wearable IMUs device, which captures the operator's hand movements; and (3) the robotic arm UR5, which is controlled by the user and the VR environment. The virtual and physical systems communicate via a Message Queuing Telemetry Transport (MQQT) communication architecture to establish communication between modules. To introduce a closed-loop control system for the robotic arm, model predictive control (MPC) was achieved with precise path planning to provide a flexible, intuitive, and reliable method to operate the remote-controlled manipulator. To validate the system integration and functions, two demonstrations were conducted: (a) the offline mode, where the VR module of the robotic arm was controlled by the IMUs device to check correctness, and (b) the online mode, where the control command was transferred to UR5 to complete a target mission via artificial potential field (APF) adjustment. The primary outcome of this study was the development of virtual and real industrial robotic arms to test the developed model in VR and shop floor labs.

Learning From Human Demonstrations for Wheel Mobile Manipulator: An Unscented Model Predictive Control Approach.

Industry 4.0 requires new production models to be more flexible and efficient, which means that robots should be capable of flexible skills to adapt to different production and processing tasks. Learning from demonstration (LfD) is considered as one of the promising ways for robots to obtain motion and manipulation skills from humans. In this article, a framework that enables a wheel mobile manipulator to learn skills from humans and complete the specified tasks in an unstructured environment is developed, including a high-level trajectory learning and a low-level trajectory tracking control. First, a modified dynamic movement primitives (DMPs) model is utilized to simultaneously learn the movement trajectories of a human operator's hand and body as reference trajectories for the mobile manipulator. Considering that the auxiliary model obtained by the nonlinear feedback is hard to accurately describe the behavior of mobile manipulator with the presence of uncertain parameters and disturbances, a novel model is established, and an unscented model predictive control (UMPC) strategy is then presented to solve the trajectory tracking control problem without violating the system constraints. Moreover, a sufficient condition guaranteeing the input to state practical stability (ISpS) of the system is obtained, and the upper bound of estimated error is also defined. Finally, the effectiveness of the proposed strategy is validated by three simulation experiments.

A preliminary quantification of the clinical gesture during vacuum assisted delivery on a training dummy

BackgroundThe vacuum assisted delivery represents, in France, the most used operative vaginal delivery technique. The purpose was to provide a preliminar quantification of the operator's hand kinematics while performing a vacuum assisted delivery. MethodsA group of 21 participants composed of 12 trainees and 9 obstetricians were recorded performing a vacuum assisted delivery on a training dummy, the matching fetal presentation was a left occiput anterior position. FindingsThe mean movement was composed of a first phase corresponding to a descendant pull, followed by an ascendant finish of the gesture. No significative difference were found between the trainees and the obstetricians' mean gesture. InterpretationThis is the first quantification of the clinical gesture associated with the vacuum assisted delivery.

Colorectal Surgery: Single Tertiary Center Experience

Objectives: Laparoscopic approach is nowadays being used widely for the treatment of various surgical diseases in many centers, but it has not considered as the gold standard in colorectal surgery yet.The aim of this study was to examine and compare the postoperative clinical and oncological outcomes of laparoscopic and open colorectal surgery in the light of literatüre. Methods: 526 patients who had colorectal cancer surgery in our clinic in between May 2015 and March 2023 were enrolled in this retrospective comparative study. Patients treated with open surgery were included in Group 1 (OS group) and ones treated laparoscopically includedin Group 2 (LS group). Demographics (age,sex), types of operations, ASA scores, evaluation of resected specimen, dissected lymph nodes, T invasion of tumors in groups, postoperative complications, operation time and hospital stay times and short-term morbidity and mortality were noted and compared with each other. Results: Patients in LS group had less blood loss compared with those in OS group (median 80 mL (range 0-1300) vs 155 mL (0–2000),p&lt;0•0001), although laparoscopic surgery lasted longer than did open surgery (p&lt;0•0001). The patients who underwent the laparoscopic surgery showed faster recovery then those who underwent open surgery, regarding first passing bowel gas (p=0.045), time of first bowel motion (p=0.04), time to resume normal diet (p=0.041), and time to ambulate independently (p=0.037). Hospital stay time was significantly shorter in Laparoscopy group (p&lt;0.001). Oncological satisfaction of resection as assessed by number of removed lymph nodes, distal resection margin did not differ between groups (p=0.564, p=0.698). Although wound infection was significantly higher in OS group (p&lt;0.001), other morbidity parameters and mortality after colectomy did not differ between two groups. Conclusion: Laparoscopic colorectal surgery gives satisfactory outcomes as compared to open surgery in many aspects such as clinical and oncological outcomes and early recovery. Considering the short-term outcomes of the present study, laparoscopic colorectal surgery in experienced hands seems to be safe and feasible for the treatment of the colorectal cancers.

Software system of automatic identification and distributed storage of patient medical data

Due to the rapid development of information technologies, informatization in the medical industry is essential. The main component of electronic health care is medical information systems designed for the accumulation, processing, analysis and transmis-sion of medical data. In the medical field, specialized software products are used to per-form diagnostic studies, process the results of laboratory tests, and make decisions at the stage of establishing a diagnosis. The use of mobile devices in medical information systems is developing. However, the degree of automation of processes in the provision of medical services and the protection of the personal and medical data of patients is still insufficient. The purpose of the research is to create a basic architecture of a software system that would simplify the process of developing software for automated input, processing, search and confidential patient access to their medical data in a medical information system based on multi-color barcoding of information using mobile devices. The architecture of the software system is proposed, in which, based on the princi-ples of distribution, anonymization, and data ownership, a patient can provide access to medical personnel to their medical data by reading a multi-color interference-resistant barcode from one smartphone (patient’s) by the camera of another smartphone (doctor’s). It is shown that in order to ensure the reliability of such transmission, it is neces-sary to use an interference-resistant barcode, which would ensure the integrity of the data in the conditions of possible distortion of the barcode image (change in lighting, scanning angle, trembling of the operator's hand, blurring or skewing of the image, etc.). The use of mobile devices for the barcode method of transmission and processing of data allows providing the protected electronic co-operating of a patient and a doctor both directly and remotely. It guarantees high reliability and confidentiality of the ex-change of data. The proposed technical solutions make it possible to improve the quality of medi-cal care and strengthen the protection of the patient's medical data.

C-Clamp Technique: A Retrospective Review of a Novel Technique to Prevent Bladder Injury in Retropubic Midurethral Slings

ABSTRACT The original technique for mesh midurethral sling, which utilized a retropubic approach for sling placement, also recognized a risk of simultaneous iatrogenic bladder injury. While synthetic mesh midurethral slings have the criterion standard for SUI treatment, there is still no available technique that entirely eliminates the risk of bladder injury at the time of implantation. The retropubic approach holds a 0.7% to 34% rate of bladder injury. Some providers still opt for the transobturator approach because of a perceived decreased risk of intraoperative bladder perforation. This article describes the “C-clamp technique,” a method directly addressing the perceived key causes of bladder injury via the retropubic approach. This study aimed to determine bladder injury rates upon surgical implantation of retropubic synthetic mesh midurethral sling by 1 provider using the C-clamp technique. The article provides step-by-step instructions for this technique, as well as a link to a video (https://links.lww.com/FPMRS/A362). Briefly, the technique involves use of a deflecting catheter guide in steep Trendelenburg, “clamping” the pubis with the operator's nondominant hand to decrease the retropubic distance, and using the nondominant thumb on the inner curve of the trocar to guide the trocar passage toward the nondominant finger tips and suprapubic exit through the skin. This retrospective review identified 201 bottom-up retropubic synthetic mesh midurethral slings placed using the C-clamp technique between April 2012 and June 2022. General data collected included average age (51 years), average weight (46–139 kg), average body mass index (BMI, 15–57 kg/m2), and a range of prior surgical procedures and concomitant procedures. Approximately 15% of patients had a history of prior retropubic urethropexy or some form of midurethral sling. There were no lower urinary tract injuries in the entire cohort. Strengths of this study include its description of the C-clamp technique, the extremes and range of data points included within the study, and the 10-year range of the study. Limitations include its retrospective nature, the single surgeon provider, the vast majority of slings used produced by 1 manufacturer, and limited comprehensive data collection. Using data from 201 consecutive bottom-up synthetic mesh midurethral sling outcomes during a 10-year span, the authors argue that this technique addresses key anatomic issues contributing to bladder and urethral injury during placement of such slings, with a promising ability to eliminate bladder and urethral injury. Favorable data in a larger number of patients and by multiple providers could provide further support to this technique and support retropubic sling as a preferred method of midurethral sling.

Wrist autonomy based on upper-limb synergy: a pilot study.

Incorporating an electrically powered wrist can largely improve the dexterity of a prosthetic hand when grasping various objects; however, it also intensifies the difficulty of the hand's operation due to the introduction of extra degrees of freedom (DOFs). The mechanism of multi-joint synergy in human body movements provides a new sight to solve this problem. In this paper, focusing on four typical manipulation activities of daily life (ADLs), 10 upper-limb joint angles were collected and analyzed first to verify the existence of synergy. Then, a linear regression model was established to predict the wrist rotation angle from the shoulder and elbow joints, which can be directly used as a control reference for achieving wrist autonomy. For both healthy and amputee subjects, experimental platforms were established and control tests were conducted, wherein the task completion time and compensatory movement during the four ADLs were evaluated. The results show that our synergy-based wrist autonomy method can effectively improve the completion efficiency of multiple ADLs without increasing the control complexity. Also, it can significantly reduce the compensatory movements of multiple joints compared to traditional prostheses using an idle wrist.

Longitudinal and Turning Manual Operation Control for a Force Sensorless Power-Assisted Transport Cart

In this paper, we propose manual operation control for a force-sensorless power-assisted transport cart used for transportation in a factory. The magnitude and direction of the hand force applied by the operator were estimated according to the cart body sway. Based on the estimated force, the control input not only for the longitudinal but also for turning movements per the operator's intention can be obtained by using the proposed power-assist control algorithm. Our proposed method does not require a force sensor to detect the operator's hand force. Furthermore, the operator can intuitively operate the cart manually by applying hand force from any direction around the cart body. The proposed power-assist control scheme was implemented in a transport cart we developed. The experimental results obtained using the transport cart demonstrate the feasibility of the proposed manual operation control method.

Investigations of hand transmitted vibrations and associated health risks in load haul dumper operators based on different components of a work cycle

Load Haul Dumpers (LHDs) are operated in underground mines to transport ore/waste rock under extreme conditions. The operating conditions of the LHDs make the operators susceptible to occupational vibration exposure, including Hand Transmitted Vibrations (HTVs). To date, no research literature is available concerning the evaluation of HTVs based on different components of the LHD work cycle. In the present research study, HTV data were collected by mounting a hand strap on tri-axial accelerometer to the operator's hand in contact with the steering device of the LHDs. Frequency-weighted root mean square (WRMs) acceleration values for all the three measurement axes were collected during different components of the LHD work cycle, namely mucking, loaded travel, unloading, and empty travel. High vibration responses were recorded during the mucking operations, followed by empty hauling. Out of the eight LHDs considered for the study, three LHDs had total daily vibration values A(8) more than that of the stipulated Exposure Action Values (EAV) of 2.5 m/s2, the highest recorded being 2.9 m/s2 in the LHD designated L-6. Health risk assessment was carried out based on EU Directive 2002 and ISO 5349:2001, which showed that operators of three LHDs were at risk of developing health issues such as finger blanching within 12 years of their work life. Strategies to mitigate HTVs should focus on the component of the work cycle and the dominant axis of vibration along with the total daily vibration magnitudes. Operating the LHDs using remote controls during mucking can significantly reduce the total vibration magnitude within daily exposure limits.

Extended Control with Hybrid Gaze-BCI for Multi-Robot System under Hands-occupied Dual-tasking.

Currently there still remains a critical need of human involvements for multi-robot system (MRS) to successfully perform their missions in real-world applications, and the hand-controller has been commonly used for the operator to input MRS control commands. However, in more challenging scenarios involving concurrent MRS control and system monitoring tasks, where the operator's both hands are busy, the hand-controller alone is inadequate for effective human-MRS interaction. To this end, our study takes a first step toward a multimodal interface by extending the hand-controller with a hands-free input based on gaze and brain-computer interface (BCI), i.e., a hybrid gaze-BCI. Specifically, the velocity control function is still designated to the hand-controller that excels at inputting continuous velocity commands for MRS, while the formation control function is realized with a more intuitive hybrid gaze-BCI, rather than with the hand-controller via a less natural mapping. In a dual-task experimental paradigm that simulated the hands-occupied manipulation condition in real-world applications, operators achieved improved performance for controlling simulated MRS (average formation inputting accuracy increases 3%, average finishing time decreases 5 s), reduced cognitive load (average reaction time for secondary task decreases 0.32 s) and perceived workload (average rating score decreases 15.84) with the hand-controller extended by the hybrid gaze-BCI, over those with the hand-controller alone. These findings reveal the potential of the hands-free hybrid gaze-BCI to extend the traditional manual MRS input devices for creating a more operator-friendly interface, in challenging hands-occupied dual-tasking scenarios.

Surgical resection of a massive residual retroperitoneal mass after chemotherapy for a paratesticular rhabdomyosarcoma: a case report

IntroductionParatesticular rhabdomyosarcoma is a rare and aggressive mesenchymal tumor, accounting for only 7% of all rhabdomyosarcomas. It is mainly encountered in children and adolescents. The standard treatment consists of radical orchidectomy with negative surgical margins. However, chemotherapy is recommended to control retroperitoneal micrometastasis. The place of surgery for progressive retroperitoneal lymph node metastases remains controversial. We present a case of paratesticular rhabdomyosarcoma with progressive retroperitoneal lymph node metastases treated with surgery.Case reportWe report a case of a 17-year-old North African male with no particular medical history who presented with a left scrotal mass that had been evolving for several months. Beta-human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase were normal. Scrotal ultrasonography revealed the presence of a 6 cm heterogeneous hypoechogenic tissular mass with cystic areas adherent to the left scrotal wall, which was thickened in some places and vascularized by color Doppler. It exerted a mass effect on the homolateral testicle, which was of average volume. The thoracic–abdominal–pelvic computed tomography scan showed the presence of suspicious paraaortic lymph nodes. The most voluminous one measured 16 × 23 mm2. A left orchidectomy was performed. The final pathology report revealed an 8 cm paratesticular rhabdomyosarcoma of the embryonic type that displaced the testicle without invading it. Without going beyond it, it infiltrated the epididymis, the rete testis, and the albuginea. The surgical margin at the level of the spermatic cord was free. The patient had adjuvant chemotherapy (ifosfamide, vincristine, and dactinomycin). The patient had a challenging paraaortic lymph node dissection since the mass enlaced the left ureter and renal vessels. On histological examination, the paraaortic lymph nodes were metastatic.ConclusionRhabdomyosarcoma is an aggressive malignancy with high metastatic potential. Therefore, only an accurate diagnosis and early treatment can ensure better survival. Surgery in expert hands seems to be a good option for progressive retroperitoneal nodes. However, further studies are needed to determine the place of surgery in this setting.

From One Hand to Multiple Hands: Imitation Learning for Dexterous Manipulation From Single-Camera Teleoperation

We propose to perform imitation learning for dexterous manipulation with multi-finger robot hand from human demonstrations, and transfer the policy to the real robot hand. We introduce a novel single-camera teleoperation system to collect the 3D demonstrations efficiently with only an iPad and a computer. One key contribution of our system is that we construct a customized robot hand for each user in the simulator, which is a manipulator resembling the same structure of the operator's hand. It provides an intuitive interface and avoid unstable human-robot hand retargeting for data collection, leading to large-scale and high quality data. Once the data is collected, the customized robot hand trajectories can be converted to different specified robot hands (models that are manufactured) to generate training demonstrations. With imitation learning using our data, we show large improvement over baselines with multiple complex manipulation tasks. Importantly, we show our learned policy is significantly more robust when transferring to the real robot.

Treatment of Prolactinoma.

Prolactinomas are the commonest form of pituitary neuroendocrine tumor (PitNET), representing approximately half of such tumors. Dopamine agonists (DAs) have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line. The aim of this review is to examine the historical and modern management of prolactinomas, including medical therapy with DAs, transsphenoidal surgery, and multimodality therapy for the treatment of aggressive prolactinomas and metastatic PitNETs, with an emphasis on the efficacy, safety, and future directions of current therapeutic modalities. DAs have been the mainstay of prolactinoma management since the 1970s, initially with bromocriptine and more recently with cabergoline. Cabergoline normalizes prolactin in up to 85% of patients and causes tumor shrinkage in up to 80%. Primary surgical resection of microprolactinomas and enclosed macroprolactinomas performed by experienced pituitary neurosurgeons have similar remission rates to cabergoline. Aggressive prolactinomas and metastatic PitNETS should receive multimodality therapy including high dose cabergoline, surgery, radiation therapy (preferably using stereotactic radiosurgery where suitable), and temozolomide. DAs remain a reliable mode of therapy for most prolactinomas but results from transsphenoidal surgery in expert hands have improved considerably over the last one to two decades. Surgery should be strongly considered as primary therapy, particularly in the setting of microprolactinomas, non-invasive macroprolactinomas, or prior to attempting pregnancy, and has an important role in the management of DA resistant and aggressive prolactinomas.