Operator's Hand Research Articles

Recognition of Endovascular Manipulations using Recurrent Neural Networks.

The ability to accurately recognize elementary surgical gestures is a stepping stone to automated surgical assessment and surgical training. In this paper, a long short-term memory (LSTM) recurrent neural network is applied to the task of recognizing six typical manipulations in percutaneous coronary intervention (PCI). The manipulation mentioned above is referring to the atomic surgical operation, also called surgeme in many research. Instead of using the video data or kinematic data of surgical instruments, we propose to use the kinematic data of the operator's hand acquired by our wearable data glove to recognize the manipulations. To establish a baseline for comparison, a method based on Hidden Markov Model (HMM) is applied because HMM is frequently used in the tasks of surgical sequence learning. Two cross-validation schemes are used in our experiments, they both illustrate that our LSTM-based method far outperforms the HMM-based method. To our knowledge, this is the first paper to apply the LSTM recurrent neural network in the field of PCI.

Cranial Osteopathy: Obscurantism and Enlightenment.

The application of cranial osteopathic manipulative medicine (OMM) is always controversial in the literature. Primary respiration related to the movement of spheno-basilar synchondrosis in the adult goes against the knowledge of complete ossification that occurs at this articulation after the pubertal phase. The idea that the operator's hands can communicate with the meninges is difficult to accept. The anatomy shows us that the fascial system involves the meninges and that from the microcellular point of view there are no layers that divide one tissue from another. The backing of new sciences, such as quantum physics, suggest that cranial palpation allows the osteopath to come into contact with the meninges. Recent scientific evidence shows that meningeal afferents can affect extracranial areas and that the pericranial musculature itself is able to influence these afferents. The article highlights some reflections in support of cranial osteopathy, based on scientific information that could help the osteopath to improve clinical work.

Predictive Assessment of Operator's Hand Trajectory with the Copying Type of Control for Solution of the Inverse Dynamic Problem

The most important task of modern robotics is the development of robots to perform the work in potentially dangerous fields which can cause the risk to human health. Currently robotic systems can not become a full replacement for man for solving complex problems in a dynamic environment despite an active development of artificial intelligence technologies.
 The robots that implement the copying type of control or the so-called virtual presence of the operator are the most advanced for use in the nearest future. The principle of copying control is based on the motion capture of the remote operator and the formation of control signals for the robot’s drives. A tracking system or systems based on movement planning can be used to control the drives. The tracking systems are simpler, but systems based on motion planning allow to achieve more smooth motion and less wear on the parts of the control object. An artificial delay between the movements of the operator and the control object for necessary data collection is used to implement the control-based motion planning.
 The aim of research is a reduction of delay, which appears when controlling the anthropomorphic manipulator drives based on the solution of the inverse dynamic problem, when real time copying type of control is used . For motion path planning it is proposed to use forecast values of the generalized coordinates for manipulator. Based on the measured values of the generalized coordinates of the operator's hand, time series are formed and their prediction is performed. Predictive values of generalized coordinates are used in planning the anthropomorphic manipulator trajectory and solving the inverse dynamic problem. Prediction is based on linear regression with relatively low computational complexity, which is an important criterion for the system operation in the real time operation mode. The developed mathematical apparatus, based on prediction parameters and maximum permissible accelerations of the manipulator drives, allows to find a theoretical estimate of error values limits for planning the operator's hand trajectory using the proposed approach for specific tasks. The adequacy of the maximum theoretical value of the prediction error, as well as the prospects of the proposed approach for testing in practice is confirmed by the software simulation in Matlab environment.

Occupational exposure during endovascular aneurysm repair (EVAR) and aortoiliac percutaneous transluminal angioplasty (PTA) procedures.

The purpose of this study was to determine the radiation exposure of primary interventionalist's different body parts during endovascular aneurysm repair (EVAR) procedures and aortoiliac percutaneous transluminal angioplasty (PTA) procedures and to evaluate the efficacy of a radioprotective drape. Occupational doses for 36 consecutive aortoiliac PTA procedures and 17 consecutive EVAR procedures were estimated using thermoluminescence dosimetry (TLD) chips (TLD-200, Hashaw, Solon, OH). Effective dose (ED) was calculated using the Niklason algorithm. For the evaluation of a 0.25mm Pb equivalent drape (Ecolab, Saint Paul, Minnesota, USA), experiments were performed using two physical anthropomorphic phantoms (Rando-Alderson Research Labs, CA, USA). Median ED for a typical EVAR and PTA procedure was 4.7 ± 1.4μSv and 4.4 ± 3.6μSv, respectively. The highest radiation doses were measured for the operator's hands in both procedures. Moreover, considerable doses were measured to the operator's head, eye lenses and thyroid. Due to the use of the drape, radiation exposure of primary operator's abdominal area, genitals, thyroid and eye lenses was reduced by an average of 59%, 60%, 65% and 59%, respectively. However, dose area product (DAP) and peak skin dose(PSD) were increased by 20% when part of the drape was placed into the X-ray field. During EVAR and PTA procedures, primary operator's organs are exposed to considerable radiation doses. Occupational radiation exposure can be reduced significantly with the proper use of a radioprotective drape.

US-Guided Biopsies: Overarching Principles.

Gathering synovial tissue from any swollen joint especially in early arthritis patients is critical for good quality research and to obtain further insight into the pathophysiology of inflammatory joint diseases. Multiplying biopsy sites is a challenge in terms of the techniques needed for each different joint but also in terms of safety and tolerability. It is important to provide the best care especially in very early arthritis patients who have only had the disease for a few months. This review discusses the minimal requirements applying to antiseptic techniques for the operator's hands, patient preparation, local anesthesia, and post-procedure care.

Robot-assisted surgery in gynecology

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Robot-assisted gynecologic surgery has grown exponentially since receiving Food and Drug Administration approval for use in gynecologic surgery in 2005. Robotic surgery has several major advantages, including three-dimensional visual magnification, articulation beyond normal manipulation, and the filtering of the operator's hand tremors. Therefore, robotic surgery is suitable for microsurgery, and it could be an alternative option for laparotomy. Robotic surgery has advantages, especially for suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased estimated blood loss, complication rates, and length of hospital stay. The advantages of robotic surgery help to overcome the limitations of laparoscopy, especially for complicated procedures in deep infiltrating endometriosis. Although extensive radical operations for deep infiltrating endometriosis of the bowel and urinary tract, such as segmental resections of the bladder, ureters, and bowel, were performed by laparotomy in the past, they are now performed more easily and more effectively using robotic techniques. In a recent systematic review and meta-analysis, robotic and laparoscopic sacrocolpopexy resulted in similar clinical outcomes, but robotic surgery was associated with a longer operation time and higher costs. Robotic and conventional laparoscopic hysterectomy show equivalent surgical and clinical outcomes. Compared to laparotomy, robotic gynecologic cancer surgery results in improved clinical outcomes and comparable oncologic outcomes. If robotic surgery is tailored in terms of patient selection, surgeon ability, and equipment availability, it could be a feasible option for highly advanced minimally invasive surgery.

AB031. Penile prosthesis implant and Peyronie’s disease: clinical outcomes and surgical challenges

Peyronie’s disease is often associated with loss of penile length and many men often complain of erectile dysfunction. Scientific advances in prosthesis design, device technologies and surgical techniques over the years have made penile prosthesis implant a more natural, durable and reliable device. Concurrent penile prosthesis implant with penile reconstructive surgery allows for penile length (and girth) restoration while at the same time, addresses underlying erectile issue in men with complex penile deformity and erection dysfunction. There is a need to centralize complex penile prosthesis implant surgery in expert hands to optimize surgical outcomes. Strict patient selection and counseling, judicious use of anti-microbial prophylaxis, and advanced surgical skills are paramount to ensure excellent outcome in this group of men.

PS01.052: OUR STANDARD PROCEDURE IN LAPAROSCOPIC NISSEN FUNDOPLICATION FOR GERD PATIENTS

Abstract Background Laparoscopic techniques in anti-reflux surgery for GERD patients are still considered complicated by many surgeons. We have established our simple procedure. Methods: SURGICAL PROCEDURE Setting Our 5-trocar setting with patients is as follows: 12 mm trocar just below the navel (A), 5 mm trocar at the upper right abdomen for pulling up lateral segment of the liver, 5 mm trocar at the upper right abdomen, 12 mm trocar at the upper left abdomen (B), 5 mm trocar at the middle left abdomen (C). Step 1 Under laparoscopic view, left part of the lesser omentum was cut with preserving the hepatic branch of vagus nerve. The right crus of the diaphragma has been dissected free from the soft tissue around the stomach. In this step the fascia of the right crus should be preserved and the soft tissue should not been damaged to avoid unnecessary bleeding. After cutting the peritoneum just inside the right crus, the soft tissue was dissected bluntly to left side. Then the inside margin of the left crus of the diaphragma was recognized from right side. In this part, laparoscope: trocar (A), the assistant: trocar (B), the operator's right hand: trocar (C). Step 2 The branches of left gastroepiploic vessels and the short gastric vessels were divided. The left crus of the diaphragma was exposed and the window at the posterior side of the abdominal esophagus was widely opened. In this part, laparoscope: trocar (A) at the beginning of dividing left gastroepiploic vessels, trocar (B) when dividing short gastric vessels. Step 3 The both crus are sutured with interrupted stitches to reduce the hiatus. From the right side, the fundus of the stomach is grasped through the widely opened window behind the abdominal esophagus. Then the fundus of the stomach is pulled to obtain a 360 degree ‘stomach-wrap’ around the abdominal esophagus. Using 2–0 non-absorbable braided suture, stitches are placed between both gastric flaps. Results We have performed this procedure in 90 cases. The mean operation time of recent 20 cases was 90 min. Conclusion We have established our standard anti-reflux surgery procedure with less bleeding and less operative time. Disclosure All authors have declared no conflicts of interest.

The Method for Determining the Relative Positions of the Operator's Arm for Master-Slave Teleoperation of Anthropomorphic Manipulator

The aim of the article is to increase the accuracy of the capture of the operator's arm for the master-slave teleoperation anthropomorphic manipulator. As the master device, a mechanical system is considered, the links of which are parallel to the operator's arm. The Cartesian coordinates of the shoulder joint, carpal joint and the operator's hand, are determined by solving the direct kinematics problem through the Denavite-Hartenberg representation. A new geometrical method for solving the inverse kinematics problem for determining the Cartesian coordinates of the elbow joint is proposed. The proposed method provides an accurate determining of the position of the operator's arm for the considered master device. The low computational complexity of the geometric method makes it possible to use it in real-time systems. The value of the research is determined by the urgency of the problem of the accuracy of master-slave teleoperation.

Comparison of Magnesium Sulfate and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine in Infraclavicular Brachial Plexus Block.

Background:Magnesium sulfate and dexmedetomidine were used as adjuvants to local anesthesia to improve the quality of regional anesthesia.Aims:The aim of this study is to evaluate and compare the effects of magnesium sulfate and dexmedetomidine when added to ropivacaine on the quality of infraclavicular brachial plexus block (BPB).Settings and Design:This was a prospective randomized double-blinded controlled study.Patients and Methods:A total of 105 adult patients undergoing surgery in hands, wrist, and forearm using infraclavicular BPB were randomly assigned into three groups. Ultrasound-guided infraclavicular BPB was performed using 35 ml ropivacaine 0.5% diluted with 4 ml normal saline 0.9%. Magnesium sulfate 150 mg and dexmedetomidine 100 μg were added in the magnesium sulfate group and dexmedetomidine group, respectively. Duration of analgesia, onset times and durations of sensory block (SB) and motor block (MB), patient's satisfaction, and complications were recorded.Statistical Analysis:Statistical software SPSS 16 was used for statistical analysis.Results:Dexmedetomidine and magnesium sulfate provided longer duration of analgesia and lesser consumption of postoperative rescue analgesia than the control group (P = 0. 000); dexmedetomidine provided the longest duration of analgesia versus control and magnesium sulfate groups (P = 0.000). Dexmedetomidine provided the quickest onset times and the longest durations of both SB and MB than control and magnesium sulfate groups (P = 0.000). Dexmedetomidine group had higher incidences of bradycardia and hypotension.Conclusions:Magnesium sulfate or dexmedetomidine is a useful adjuvant to ropivacaine for infraclavicular BPB in lengthening the duration of analgesia. Dexmedetomidine provided quicker onset and longer duration of both SB and MB and longer duration of analgesia with lesser consumption of postoperative rescue analgesia; however, it showed a higher incidence of intraoperative hypotension and bradycardia than magnesium sulfate.

A novel suturing technique for filtering glaucoma surgery: the accordion suture.

To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure (IOP). Description of 'the accordion suture' technique for mitomycin C augmented trabeculectomy. In cases of postoperative high IOP, pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges. By means of this technique, the scleral flap opens up in an "accordion" manner, thus preventing flap obstruction and providing adequate aqueous flow. Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma. Mean age of the subjects was 67.42±8.21y and female/male ratio was 4/4. Mean preoperative IOP was 37±7.48 mm Hg. Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications. The scleral flap closure is performed with three separate sutures; initially, our accordion suture through the center of the flap, and two releasable sutures on both corners. All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture, without any complications. The average traction time was 3.5±0wk postoperatively. The mean postoperative IOP was 11.37±2.72 mm Hg. No suture related complications were observed. This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.

The Effect of Alcohol-Based Hand Sanitizer Vapors on Evidential Breath Alcohol Test Results.

This study was undertaken to determine if the application of alcohol-based hand sanitizers (ABHSs) to the hands of a breath test operator will affect the results obtained on evidential breath alcohol instruments (EBTs). This study obtained breath samples on three different EBTs immediately after application of either gel or foam ABHS to the operator's hands. A small, but significant, number of initial analyses (13 of 130, 10%) resulted in positive breath alcohol concentrations, while 41 samples (31.5%) resulted in a status code. These status codes were caused by ethanol vapors either in the room air or their inhalation by the subject, thereby causing a mouth alcohol effect. Replicate subject samples did not yield any consecutive positive numeric results. As ABHS application can cause a transitory mouth alcohol effect via inhalation of ABHS vapors, EBT operators should forego the use of ABHS in the 15min preceding subject testing.

Postplacental intrauterine device expulsion by 12 weeks: a prospective cohort study

An intrauterine device placed immediately following a delivery can serve as an effective and safe contraceptive strategy in the postpartum period. There is limited evidence that the levonorgestrel intrauterine system may have a higher rate of expulsion compared to the copper intrauterine device; however, rates of expulsion for these 2 intrauterine device types have not been compared directly. We sought to compare expulsion rates by 12 weeks' postpartum for the levonorgestrel intrauterine system and copper intrauterine device. We enrolled women who received postplacental intrauterine devices at 2 urban hospitals. Eligible women were ≥18 years old, English- or Spanish-speaking, with singleton vaginal delivery at ≥35 weeks' gestation. Intrauterine devices were inserted within 10 minutes of placental delivery by trained providers using ring forceps or the operator's hand. Intrauterine device location was evaluated via abdominal ultrasound at 24-48 hours' postpartum, and via transvaginal ultrasound 6 and 12 weeks later, categorizing position of the intrauterine device at the fundus, below the fundus but above the internal os, any part of the intrauterine device below the internal os (partial expulsion), or no intrauterine device visualized. Outcomes included intrauterine device expulsion and method continuation. We used multivariable logistic regression to identify factors associated with expulsion. We enrolled 123 women ages 18-40 years. Of these, 68 (55%) initiated levonorgestrel intrauterine system and 55 (45%) initiated copper intrauterine device. Groups were similar except more copper intrauterine device users were Hispanic (66% vs 38%) and fewer were primiparous (16% vs 31%). Among the 96 (78%) with 12-week follow-up, expulsion was higher for levonorgestrel intrauterine system users (21/55 or 38%) than for copper intrauterine device users (8/41 or 20%) (odds ratio, 2.55; 95% confidence interval, 0.99-6.55; P= .05). At 24 hours' postpartum, there was no significant difference in median distance from the intrauterine device to the fundus between intrauterine device types or between those who did or did not experience expulsion. Of expulsions, 86% occurred ≤6 weeks' postpartum. All complete expulsions were clinically identified, but of the partial expulsions, only 4/10 (40%) were clinically suspected prior to ultrasound. The only independent predictor of expulsion was intrauterine device type. Including reinsertions, intrauterine device use at 12 weeks was not significantly different for levonorgestrel intrauterine system and copper intrauterine device users (80% vs 93%; P= .14). Women initiating postplacental levonorgestrel intrauterine system are more likely to experience complete expulsion than those initiating copper intrauterine device. Using sonographic criteria results in higher expulsion rates than previously reported. It is unclear if such high expulsion rates would be identified following standard clinical practice.

Assessment of the radial and ulnar arteries hemodynamic changes by ultrasound in patients with primary palmar hyperhidrosis after thoracic sympathetic block

Objective: To evaluate the value of radial and ulnar arteries hemodynamic changes by ultrasound in patients with primary palmar hyperhidrosis after thoracic sympathetic block. Methods: This was a prospective study, from January 2016 to September 2016, 23 patients with primary palmar hyperhidrosis were admitted to the First Hospital of Jiaxing City, Zhejiang Province, 92 arteries of these patients who underwent thoracic sympathetic block were enrolled into this study. Diameters, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the radial and ulnar arteries were examined one day before and after the operation by color Doppler ultrasound. Spectral waveforms of these arteries were observed, and palms temperature (T), oxygen saturation (SpO(2)), perfusion index (PI) were also measured. Diameters, PSV, EDV, RI, T, SpO(2) and PI of the patients with PH were compared before and after the surgery. The effect of operation was also evaluated. Results: Before surgery, diameters and EDV of the radial and ulnar arteries of the patients with PH were(2.12±0.36) mm, (1.50±0.32) mm, (4.90±1.84) cm/s, (4.71±1.65) cm/s, respectively, after surgery, the diameter of the RA, UA and EDV were (2.45±0.54) mm, (1.87±0.44) mm, (9.37±1.69) cm/s and (9.12±1.54) cm/s, which were significantly increased.Before surgery, RI of the RA and UA of the patients were (0.85±0.05), (0.97±0.07) , respectively, after surgery, RI of the RA and UA were (0.57±0.04), (0.64±0.09), respectively, which were significantly decreased after surgery. The difference was statistically significant (t=-5.23, -2.33, -19.80, -14.68, 3.31, 3.48, all P<0.01). Before surgery, PSV of the RA and UA of the patients were (46.38±15.12) cm/s, (45.60±14.88) cm/s , respectively, after surgery, PSV of the RA and UA were (46.93±16.02) cm/s, (46.19±15.30) cm/s , respectively. The difference was not statistically significant (t=-0.23, -1.39, all P>0.05). Before surgery, T, SpO(2) and PI of the patients were(29.7±1.04) ℃, (93.24±2.23) %, (1.11±0.13) % , respectively, after surgery, T, SpO(2) and PI of the patients were (35.09±1.21) ℃, (98.10±1.34) %, (4.77±1.22)% , respectively. The difference was statistically significant (t=-20.174, -1.140, -23.601, all P<0.05). The symptoms of hyperhidrosis of the patients were disappeared immediately after the surgery in both hands. All of the patients were cured within 3 months and there was no severe complications. Conclusion: Thoracic sympathetic block increase Diameters and EDV but decrease RI of the radial and ulnar arteries of the patients with PH and increase the palms temperature. Artery diameters, EDV, and RI measured by ultrasound can be used as parameters to evaluate the effect of thoracic sympathetic block in patients with PH. It's objective, non-invasive and convenient.

Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing.

This study aims at experimentally determining the incidence and extent of liquid releases onto the operator's hands and into the work environment during common nursing operations involving infusions. A sequence of operations related to the preparation and administration of infusions was conducted by three subjects for 15 times each using fluorescein marked infusion solutions and two different infusion sets (standard set vs. safety-optimized set). Unintended release of liquid was quantified by glove and surface wipe sampling and HPLC/FD analysis of the samples. Operations concerning the disposal of infusions were also part of the study. In over 90% of the simulations, a release of infusion solution was observed in a standard workflow, comprising priming and decapping the infusion set, connecting it to a peripheral intravenous (IV) cannula, and detaching it again. Based on median values (229 vs. 26μl), the release of infusion solution was about ninefold higher when using the non-optimized standard infusion set. During decapping, a hand contamination was found in a majority of cases. The handling of infusions may involve a risk of nurses' exposure to active agents by release of infusion solution into the work environment. According to our results with different infusion sets, exposure risks can be reduced technically and by appropriate handling. Nevertheless, hand contaminations found for both sets emphasize the necessity for additional measures such as more consistent use of protective gloves.

Overcoming Redundancy in Solution of the Inverse Kinematics Problem for a Vehicle Operator's Hand

Overcoming Redundancy in Solution of the Inverse Kinematics Problem for a Vehicle Operator's Hand

The Development of Motion Capture System Based on Kinect Sensor and Bluetooth-Gloves

The article describes a motion capture system based on the Kinect sensor and an original hand motion reading device – Bluetooth Gloves. It is used for operator's hand tracking including finger bending. A gyroscope assisted by an accelerometer measures the slope angles in relation to the axis of the sensor system while rotary potentiometers define the finger bending angles. The resulting trajectory data is translated into AR-600E robot movements. Data transmission is performed by means of Bluetooth interface. Software that reads telemetry from the Kinect Sensor and Bluetooth Gloves is developed using C++ and LabVIEW programming languages. Graphic User Interface and System architecture are given below.

Human motion caption with vision and inertial sensors for hand/arm robot teleoperation

The multi-fingered robot hand has much attention in various fields. Many robot hands have been proposed so far. A teleoperation system for the hand/arm robot allows intuitive manipulation of the hand/arm robot. This paper deals with a motion capture system for controlling the hand/arm robot remotel y. Here, we use vision and inertial sensors simultaneously in order to detect the position and the posture of an operator's arm and hand.

Temporarily Blocking the Uterine Artery to Dig Out a Diffused Adenomyosis Lesion Treated Laparoscopically

Study ObjectiveTo show the tips and tricks of a simpler technique for temporary blocking of the uterine artery in laparoscopic resection of a diffuse adenomyosis lesion to make the procedure more efficient and reproducible. DesignThis study is designed to be a step-by-step explanation of the technique using videos and pictures (Canadian Task Force classification III). SettingChangzhou Maternal and Child Health Hospital, Changzhou, China. PatientsThree patients (age 39-42 years, 41±1.73) were diagnosed with diffuse adenomyosis with severe secondary dysmenorrhea willing to reserve the uterus and a poor response to medical management. Gynecologic examination revealed that the uteri sizes were 9 to 14 weeks. Transvaginal ultrasonography revealed that the lesions were 4 to 7 cm in size. InterventionsLaparoscopic resection of the diffuse adenomyosis lesion was conducted after temporary blocking of the uterine artery with a rubber belt. Measurements and Main ResultsThe traditional methods for injecting diluted vasopressin in the myometrium around the affected area and a half-life period of 30 minutes were used. Many adenomyosis patients with severe dysmenorrhea and menometrorrhagia have a large lesion; thus, the operating time is longer. The maximum dose of vasopressin is 20 units daily, and hypertensive patients have a contraindication. We made an incision of the broad ligament of the avascular area near the uterine artery and pulled the rubber pressure pulse ligation tightly through to temporarily block the uterine artery without vasopressin completely through the laparoscopic resection of the diffuse adenomyosis lesion. Intraoperative blood loss was only 120 to 230 mL. In this video, we show a simpler technique for temporarily blocking the uterine artery in laparoscopic resection of diffuse adenomyosis with a stepwise expiation. A levonorgestrel-releasing intrauterine system (Mirena; Bayer, Leverkusen, Germany) was placed in the uterus from the vagina immediately after surgery. At the 3-25 month (10.67±12.42) follow-up, visual analog scale scores were obviously reduced, and the menstrual quantity and amenorrhea dramatically declined after the surgery. All patients had no recurrence and no Mirena loss as assessed by vaginal ultrasound and the visual analog scale [1]. Estrogen was maintained at the normal level after 3 months. This study was approved by the Institutional Review Board of the Changzhou Maternal and Child Health Hospital Affiliated to Nanjing Medical University. ConclusionThe incidence of adenomyosis is a newer trend that is being used in patients with a poor response to medical management of uterine lesions and large lesions in China. Using the rubber belt to temporarily block the uterine artery in laparoscopic resection of the diffuse adenomyosis lesion offers the possibility of the rubber belt being effective, safe, and reproducible. Minimally invasive surgery in expert hands is the preferred solution of an increasing number of patients after drug treatment failure.

External Cephalic Version: Some Tricks of the Trade.

External Cephalic Version: Some Tricks of the Trade.