Port Device Research Articles

Enhanced safety in central venous catheterization performed by Japanese board-certified pediatric surgeons: a retrospective single-center study.

Board certification by the Japanese Society of Pediatric Surgeons is awarded to pediatric surgeons with substantial surgical experience and academic achievement. However, to date, the surgical performance or outcomes of certified surgeons have not been reported. This study examined the relationship between board certification and surgical outcomes of central venous catheterization. This retrospective single-center study was conducted between April 2017 and May 2024. Patients were classified based on whether their procedures were performed by board-certified or non-certified surgeons, and their backgrounds and surgical outcomes were compared. In addition, multivariate analysis was performed to identify the factors associated with prolonged operative time. This study included 112 procedures: 26 performed by board-certified surgeons and 86 performed by non-certified surgeons. There were no significant differences in the age, sex, weight, or primary diagnosis between the groups; however, surgery-associated complications were significantly more common in the non-certified surgeon group than in the board-certified surgeon group (15.1% vs. 0%, P = 0.036). In addition, factors independently associated with a prolonged operative time included weight < 10kg, left-sided approach, implantable port device use, and < 7years of postgraduate experience for the surgeon. Board certification was associated with a significant reduction in surgery-associated complications during central venous catheterization.

Long-Term Survival Outcomes After Minimally Invasive Surgery for Ileal Neuroendocrine Tumors

BackgroundIleal neuroendocrine tumors (i-NETs) are characterized by their multifocality and bulky mesenteric mass. Having shown that minimally invasive surgery (MIS) utilizing a hand-access port device has favorable short-term outcomes and achieves the goals of surgery for i-NETs, we sought to analyze long-term survival outcomes of MIS.MethodsOne hundred and sixty-eight patients who underwent resection of primary i-NETs at a single institution between January 2007 and February 2023 were retrospectively studied. Patients were categorized into the MIS or open surgery cohorts on an intention-to-treat basis. Open surgery was selected mainly based on the need for hepatectomy or bulky mesenteric mass resection. Overall survival was analyzed using log-rank tests with propensity score matching (PSM) and Cox proportional hazards regression. PSM was performed to reduce standardized mean differences of the variables to <0.2.ResultsOverall, 129 (77%) patients underwent MIS and 39 (23%) underwent open surgery. Twenty-seven MIS patients were converted to an open procedure. The median follow-up time was 49 months (interquartile range 23–87 months). In the PSM cohorts, overall survival did not differ significantly between the MIS and open surgery cohorts {median 99 months (95% confidence interval [CI] 91–not applicable [NA]) vs. 103 months (95% CI 86–NA), p = 0.77; hazard ratio 0.87 (95% CI 0.33–2.2), p = 0.77}.ConclusionsMIS is an alternative to open surgery for i-NETs, achieving similar short- and long-term oncological outcomes. Bulky mesenteric mass and a plan for concurrent liver resection are potential criteria for open surgery.

Suture-Needle Management Device and Novel Port Configuration for Robotic Sacrocolpopexy.

Robot-assisted sacrocolpopexy (SCP) is a commonly performed procedure for the repair of apical pelvic organ prolapse; therefore, novel devices and techniques to improve safety and efficacy of this procedure should be explored. The objective of this study was to assess safety and efficacy of 8-mm trocar site for use of a disposable suture/needle management device (StitchKit; Origami Surgical, Madison, NJ) for robot-assisted SCP with a 4-arm configuration and no assistant port. This is a retrospective case series of patients undergoing robot-assisted SCP at a tertiary center from 2018 to 2021. All surgical procedures were performed using four 8-mm robotic trocars and StitchKit device. Our objective was to review all cases in which this technique was used to determine whether the approach resulted in a safely completed procedure and any complications or adverse events. Secondary objectives were to describe patient and operative characteristics. In total, 422 patients underwent robot-assisted SCP for pelvic organ prolapse. The mean age was 60 ± 10 years, and mean body mass index was 27 ± 6 (calculated as weight in kilograms divided by height in meters squared). Most patients had stage 3 prolapse (73%) and underwent concomitant hysterectomy (70%). Ninety-nine percent (n = 416) of cases were completed robotically. StitchKit was successfully inserted and removed in all robotic cases with correct needle counts. All patients had postoperative visits, and 80% followed up at 3 months. No umbilical/port site hernias, operative site infections, or adverse events were reported. Robot-assisted SCP can be performed safely using a 4-arm robotic configuration and suture kit device. This setup eliminates incisions greater than 8 mm and an assistant port, allowing for surgical efficiency without compromising patient outcomes.

A Novel Technique for Hand-Assisted Laparoscopy in Difficult Nephrectomies-Is One Hand Better Than Two? A Single-Centre, Single-Surgeon Series.

Laparoscopic radical nephrectomy is the standard of care for T1 renal tumors and nowadays being used for T2 or higher tumors, resulting in higher the conversion rates. To bridge this gap, the hand-assisted laparoscopy (HAL) method was introduced. Even now, in the robotic era, this HAL approach continues to find importance in urology, especially in the most challenging cases, albeit, with a relatively low usage rate due to the cost involved and availability of hand port devices. Here, we report a case series using a novel modification of the HAL nephrectomy (HALN) technique when open conversion is needed. From a prospective database, we retrospectively analyzed the data of Six patients who underwent HALN at the All India Institute of Medical Sciences between January 2019 and December 2022. Indications for surgery included both malignant and benign renal disease. Four surgeries were performed on the right side while two were performed on the left. Five patients underwent a HALN for renal cell carcinoma (RCC) and 1 for a benign non-functioning kidney. In our series, all the cases with RCC had were T2a or higher. Our case series shows that HALN is technically safe, effective, and a great adjunct to conventional laparoscopy. The ingenious use of a surgical glove as a hand port is an easy-to-make-and- use device in such challenging surgeries.

Practical use of the central venous access port for contrast-enhanced CT: comparison with peripheral intravenous access regarding enhancement and safety

To evaluate the efficacy of using the central venous (CV) port compared with peripheral intravenous access for contrast-material injection for contrast enhancement during the portal venous phase. Patients were divided into three groups: CV delay, CV routine, and peripheral access (PA) groups. Patients in the CV delay group underwent injection in the arm-down position with an additional delay, while those in the CV routine and PA groups underwent injections with the routine injection protocol for portal venous phase imaging. Contrast enhancement was evaluated by measuring the mean radiodensity (Hounsfield units) values for the aortic arch, abdominal aorta, inferior vena cava, portal vein, and spleen. The peak injection pressure was recorded and compared among the three groups. No complications related to power injection were observed during 119 contrast-material injections performed using the CV port device. The CV delay group showed significantly lower radiodensity values than the PA group (165.7±20.1 versus 181±19 HU [p<0.01] for the portal vein); however, no significant differences in mean radiodensity values were observed between the CV routine and PA groups (p>0.05). The median peak injection pressure was 73.5, 67, and 47 psi in the CV delay, CV routine, and PA groups, respectively (p<0.01). The CV port can be used for safe contrast-material injection while maintaining contrast enhancement on portal venous phase comparable to that achieved with peripheral intravenous access.

Subcutaneous Venous Access Device (Port) Placement and Methods of Dealing with Complications that Develop During the Procedure

Subcutaneous Venous Access Device (Port) Placement and Methods of Dealing with Complications that Develop During the Procedure

Aerosol and surface contamination assessment of a novel ventilated infectious aerosol containment device.

Healthcare personnels (HCPs) are at risk of respiratory infectious diseases during patient care activities. HCPs rely primarily on personal protective equipment to prevent pathogen exposures, but there is a need to develop alternative, or complementary control strategies, including engineering controls. The objective of this study was to evaluate the ability of the 3 designs (denoted D1A, D1B, and D2) of the University of Utah Containment Ventilation for Exposure Reduction (U-COVER), a protective barrier enclosure device to contain respirable aerosols when placed over a simulated patient. The 2 primary performance metrics were the percent reduction in: (i) the concentration of respirable aerosols in the simulated breathing zone of an HCP, and (ii) surface contamination outside the device, which were tested using salt aerosols and fluorescein aerosols, respectively. Briefly, salt or fluorescein aerosols were generated as though expelled by a prone patient under 3 conditions: (i) no device (control), (ii) with the device but without exhaust ventilation, and (iii) with the device with exhaust ventilation. Device D2 was also tested under simulated use conditions, in which cardboard "arms" were placed inside the device ports. All 3 device designs showed the ability to reduce particle concentrations in the simulated HCP breathing zone and on surfaces by >99% with exhaust ventilation compared to the control condition. Without exhaust ventilation, device performance was lower and highly variable. Under simulated use conditions, device D2 reduced particle concentrations in the simulated HCP breathing zone by ≥91% and on surfaces by >99% relative to control for all combinations of "arms" tested. The U-COVER device demonstrates excellent aerosol containment and warrants further testing with dynamic simulated or actual use conditions.

Performance Visualization of Southbound Interface in Software Defined Networking

Software Defined Networking (SDN) makes Internet network configuration easier by separating the control plane and data plane. The control plane on the controller has information on network devices in the data plane and centrally control these devices. One of the controllers in SDN being developed is the Open Network Operating System (ONOS). ONOS provides interfaces such as Representational State Transfer (REST) Application Programming Interface (API). The ONOS core REST API provides some information from the network connected to it, such as devices, statistics, and the information in JSON file. The primary objective of this study is to develop an interface that simplifies performance monitoring through graphical representation. This involves testing the visualization with various topologies and conducting a comparative analysis of the visualization results across these topologies. The creation of the interface entails presenting statistical data, available in the form of a JSON file from the ONOS controller via the REST API, on the web interface in graphical format. The resulting visualization generates a graph that aligns with the performance characteristics of each topology, reflecting device details, ports, and additional parameters such as the count of sent and received packets, as well as sent and received bytes. The performance visualization outcomes specific to each topology are consistent with the number of connections and are prominently displayed on the web interface. Additionally, this research evaluates network throughput and bandwidth by sending ICMP packet and iperf tests across each topology. Among all the openflow tests performed on various network topologies, it was observed that the tree topology exhibited the lowest network capacity utilization, followed by the leaf-spine topology, and finally the ring topology.

A Novel Port to Facilitate Magnetic Hyperthermia Therapy for Glioma.

High-grade gliomas (HGG) are the most common primary brain malignancy and continue to be associated with a dismal prognosis (median survival rate of 15-18 months) with standard of care therapy. Magnetic hyperthermia therapy (MHT) is an emerging intervention that leverages the ferromagnetic properties of magnetic iron-oxide nanoparticles (MIONPs) to target cancer cells that are otherwise left behind after resection. We report a novel port device to facilitate localization, delivery, and temperature measurement of MIONPs within a target lesion for MHT therapy. We conducted an in-depth literature and intellectual property review to define specifications of the conceived port device. After setting the design parameters, a thorough collaboration with neurological surgeons guided the iterative modeling process. A prototype was developed using Fusion 360 (Autodesk, San Rafael, CA) and printed on a Form 3 printer (Formlabs, Medford, MA) in Durable resin. The prototype was then tested in a phantom skull printed on a Pro-Jet 660Pro 3D printer (3D Systems, Rock Hill, SC) and a brain model based on mechanical and electrochemical properties of native brain tissue. This phantom underwent MHT heating tests using an alternating magnetic field (AMF) sequence based on current MHT workflow. Successful localization, delivery, and temperature measurement were demonstrated. The purpose of this study was twofold: first, to create and validate the procedural framework for a novel device, providing the groundwork for an upcoming comprehensive animal trial and second, to elucidate a cooperative approach between engineers and clinicians that propels advancements in medical innovation.

Health-related quality of life in patients with solid tumors receiving implantable venous access ports for chemotherapy: A prospective randomized controlled trial

PurposeImplantable venous access ports are widely used in patients receiving chemotherapy, but there is still scarce evidence about any patient-reported outcome measures. This prospective randomized controlled trial examined the impact on patients’ quality-of-life following the placement of an implantable port device for long-term chemotherapy treatment. MethodA total of 120 chemotherapy naïve adult outpatients scheduled to receive chemotherapy (duration ≥12 weeks) for solid tissue tumors in a single academic oncology unit were randomly allocated (n = 60 in each arm) between radiologically guided insertion of an implantable venous access port (PORT arm) or standard repeated peripheral venous access (Control arm). Health-related quality-of-life scores (HRQoL) were assessed with the EQ-5D-5L and the oncology-specific EORTC QLQ-C30 (version 3.0) questionnaires at baseline, 3- and 6-months post randomization. Non-parametric tests were applied and differences between medians (Δ) are reported because of skewed-left HRQoL data. ResultsBaseline clinical and demographic characteristics were well balanced between the two groups. There were no complications during insertion and no infection or device failure in the PORT subjects through the 6-month follow-up. The functional and symptom scales of the EORTC QLQ-C30 questionnaire were similar between both study arms at all time intervals. The EORTC QLQ-C30 global health status was significantly improved in the PORT subjects both at 3 months (Δ: 8.3 out of 100; P = 0.04) and 6 months follow-up (Δ: 16.7 out of 100; P = 0.003). Changes in EQ-5D-5L scores were significantly improved at 6 months in the PORT arm compared to control (Δ: 0.074 out of 1; P = 0.01). ConclusionsImplantable venous access ports may confer significantly improved patient-reported quality-of-life benefits in patients receiving chemotherapy for solid tissue tumors.

Parenteral nutrition overview: the role of the nurse and equipment

Parenteral nutrition is the intravenous provision of nutrition, made up of a mixture of components. It is for patients where conditions, such as intestinal failure, short bowel syndrome or bowel obstruction, are present and necessiate additional nutrition to meet patients’ needs and avoid malnutrition. Parenteral nutrition can be life-preserving for patients. There are four main types of central intravenous catheters that deliver these nutrients: an implantable port device, a tunnelled central venous catheter, a non-tunnelled central venous catheter and a peripherally-inserted central catheter. The three main bag types that contain of bags that contain these nutrients: pre-made, multi-chamber and bespoke. This article outlines the importance and involvement of nurses in the parenteral nutrition process, including the selection and administration of parenteral equipment, as well as presenting a summary of parenteral catheters and bags, their safety and evidence-based efficacy.

Ultra-Broadband Integrated Optical Filters Based on Adiabatic Optimization of Coupled Waveguides

Broadband spectral filters are highly sought-after in many integrated photonics applications such as ultra-broadband wavelength division multiplexing, multi-band spectroscopy, and broadband sensing. In this study, we present the design, simulation, and experimental demonstration of compact and ultra-broadband silicon photonic filters with adiabatic waveguides. We first develop an optimization algorithm for coupled adiabatic waveguide structures, and use it to design individual, single-cutoff spectral filters. These single-cutoff filters are 1×2 port devices that optimally separate a broadband signal into short-pass and long-pass outputs, within a specified device length. We control the power roll-off and extinction ratio in these filters using the adiabaticity parameter. Both outputs of the filters operate in transmission, making it possible to cascade multiple filters in different configurations. Taking advantage of this flexibility, we cascade two filters with different cutoff wavelengths on-chip, and experimentally demonstrate band-pass operation. The independent and flexible design of these band edges enables filters with bandwidths well over 100 nm. Experimentally, we demonstrate band-pass filters with passbands ranging from 6.4 nm up to 96.6 nm. Our devices achieve flat-band transmission in all three of the short-pass, band-pass, and long-pass outputs with less than 1.5 dB insertion loss and extinction ratios of over 15 dB. These ultra-broadband filters can enable new capabilities for multi-band integrated photonics in communications, spectroscopy, and sensing applications.

Randomized controlled trial assessing intubation time with and without an aerosol biocontainment device

Introduction: The emergence of the coronavirus disease 2019 (COVID-19) pandemic renewed interest in infectious aerosols and methods to reduce risk of airborne respiratory pathogen transmission. This has led to the development of novel aerosol protective devices for which clinical and aerosol protective features have not been fully characterized. The relative efficacy of these devices for use during airway procedures has not been assessed in randomized controlled trials. Materials and Methods: We recruited anesthesiology attendings, residents, and certified registered nurse anesthetists to perform intubations with an aerosol biocontainment device (ABCD). Thirty-seven patients undergoing procedures requiring intubation in the operating room were recruited and randomized (2:1) to intubation with (25) or without (12) the ABCD. Primary endpoints were time to secure the airway and adverse events. Secondary endpoints were a number of intubation attempts, access to the patient and airway equipment through the device ports, user assessment of ABCD function and technical burden, and patient experience in the ABCD. Results: Intubation time with the ABCD (46 s) was not significantly different compared to intubation without the ABCD (37 s; P=0.06). There were 3 adverse events with the ABCD (1 claustrophobia, 2 unanticipated difficult airways) that required device removal for intubation. In general, patients tolerated the device well and ABCD users felt the device functioned as intended but increased the technical burden associated with intubation. Discussion: It is feasible to use an aerosol protective device for intubation. The introduction of novel devices into high acuity airway procedures should be approached with caution and should account for the risk mitigation gained from the device balanced against the increased procedural complexity and potential safety risks associated with restricted access to the airway.

Quantification of mechanical properties in long-term in vivo used silicone catheter lines according to DIN 10555-3

BackgroundTotally implantable central venous access port devices are crucial for intravenous application of chemotherapeutics and long-term therapy for chronic disease. Common complications include thrombosis and device fracture related to altered material properties through exposure in situ. This study exhibits whether uniaxial tensile properties (DIN 10555–3) of in vivo used catheters prove inferior to unused catheters. Material and methods5 unused, originally packed silicone catheters were cut into 6 segments of 50 mm: 3 segments each were cleaned via cleaning solution (n = 15) while 3 segments were left unattended (n = 15). Distal segments (50 mm) of long-term in vivo used silicone catheters were cleaned before testing (n = 33). Overall mechanical behavior was tested in a custom-made self-centering, torsion free carrier. Maximum force stress at failure, strain at failure and Young's modulus were determined and statistically analyzed. FindingsUnused catheters showed no significant difference in testing. in vivo used catheters exhibited 20% lower maximal force than unused catheters (p < 0.001), strain at break (p 〈0,001), and 7% higher elastic modulus (p = 0.004; power: 0.845). Due to a constant cross section area, stress at failure was proportional to maximum force (p < 0.001). Relation between determined parameters and dwell times was non-significant. InterpretationIn vivo long-term used silicone catheters showed significantly lower ultimate strength than unused ones. It is likely that in situ altering changes the mechanical properties of catheters and may potentially lead to failure.

Use of direct fluorescein sodium lymphography for thoracic duct identification in a dog with idiopathic chylothorax

AbstractA 2‐year‐6‐month‐old, female, neutered Greyhound was diagnosed with idiopathic chylothorax. Surgery was performed, which included thoracic duct ligation, subtotal pericardectomy, total right caudal lung lobectomy, chyli cisterna ablation and pleural port device placement. Fluorescein sodium was injected into a mesenteric lymph node through a right paracostal laparotomy for colourisation of the different branches of the thoracic duct to assist in identification. A sterile ultraviolet torch (LED 395 nm) was used to activate the fluorescent yellow‐green signal, enabling visual assessment of the thoracic duct and its branches. Finally, the different branches were ligated using haemovascular clips. Success of the thoracic duct ligation was assessed by contrast fluoroscopy. The dog recovered well from the surgery, but was euthanased without investigation 4 weeks after the procedure due to anorexia, diarrhoea and abdominal pain. This is the first report of thoracic duct ligation for idiopathic chylothorax in a dog using fluorescein sodium as a fluorophore to help with the identification of all the thoracic duct branches.

S – and T– Matrix Formulations for 2–Port Devices

We present the S– and T–matrix formulations of device characteristic for a 2–port device. We demonstrate that while the S–matrix formulation is intuitive and corresponds to physical quantities, the T–matrix formulation is better when it comes to handling multiple devices in series. We then compute the translation from S–matrix to T–matrix formulations and vice–versa.

Human Machine Interface System for Filling and Capping Process

In this research, bottle filling and capping processes are performed simultaneously in the pharmaceutical factory by using the PC based human machine interface (HMI) control system. In the traditional method of bottle filling process, the bottles are placed onto a conveyor and only one bottle is filled at a time. So, this method is time consuming and expensive as wide working place and many human labors is required. In this research, the proposed design can solve this problem without any complex control by using the HMI automation control system. The monitoring and running conditions in the packaging system are shown on the monitor of computer by using the composed of Visual Basic.Net and Mikro C. It also includes the volume of medical powder is limited by changing the size of filling funnel which is set up of shutter at the top and bottom of funnel. The entire system is more flexible and time saving. A prototype is implemented by using the DC motor, sensing devices; limit switches, peripheral interface controller (PIC) device and serial port communication. These control systems is very flexible, cost effective, space efficient and reduce complexity. PC based HMI control is used for monitoring the process.

Port first vs. Tip first: does difference in portacath insertion techniques reduce complication rates.

Accurate placement of central venous access devices is important to avoid complications such as infection, thrombosis and migration. This audit aims to determine if there is a difference in complication rates and accuracy of tip position between two different intravenous jugular (IVJ) port device insertion techniques: fixation of port first (PF) versus tip first (TF). Patients who underwent port device insertions from 2019 to 2021 at the Cairns Hospital were identified from the Australia Vascular Audit database. The primary outcome of accurate catheter tip placement (based on radiological criteria), secondary outcomes of line infection, thrombosis and other outcomes such as removal rates were gathered and compared between the 2 groups of port first (PF) versus tip first (TF) insertion. Two-hundred and twenty-seven patients underwent port device insertions during the period of interest. 98 (43.2%) patients had a PF insertion technique and 129 (56.8%) had a TF insertion technique. In the PF group, 81.6% (P< 0.05) of lines were accurately placed compared to 69.8% (P< 0.05) in the TF group. The line related thrombosis rate was 1% (P< 0.05) in the PF group compared to 6.2% (P< 0.05) in the TF group. Rate of line infections in the PF group was 5.1% (P= 0.92) compared to 6.2% (P= 0.92) in the TF group. The port first technique for IVJ port device placement was associated with higher accuracy and lower thrombosis rates and this was statistically significant. Further studies should involve larger multicentre populations to compare results between practitioners.

Technical Aspects of Using a Second Magnetic Grasper to Improve the Surgical Field in Single Port Revisional Bariatric Surgery.

The future of minimally invasive surgery in revisional surgery is experiencing changes with new equipment such as the magnetic assistance that can be used with single port devices in order to perform an incisionless surgery (Luengas R, Galindo J, Castro M, et al. Surg Obes Relat Dis. 2021;17(1):147-152). Magnetic assistance through an auxiliary grasper with two internal magnets serves beyond liver retraction in different steps of the surgery improving the surgical field by obtaining a better visualization and triangulation. Expose the feasibility of using two internal magnetic graspers by single port performing a conversion surgery of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). A 36-year-old female patient underwent a SG in 2015 and consults in 2021 because of severe GERD with a 33-point GERD-HRQL score. She has preoperative evaluation for a conversion surgery from SG to RYGB. Using a single port device through the umbilicus, an additional 5mm trocar was placed in the left side of the abdomen. Two internal magnets were introduced through the umbilicus, and they were controlled by two external magnets placed over the abdomen with an articulated arm. The first magnet was used for liver retraction and the second one to perform both anastomoses, close the intermesenteric and Petersen defect, acting as an auxiliary grasper. The ethical committee approval was obtained through an informed consent from the participant included in the study.

Effect of the Design Parameters of the Combustion Chamber on the Efficiency of a Thermal Oxidizer

Carbon monoxide is often produced during the incomplete combustion of volatile organic carbon compounds in industry. In the combustion chamber for oxidizing carbon monoxide emissions, a penta-coaxial port device can be used to improve the process of mixing the fuel and oxidizer. In this study, the conjugate heat transfer analysis was conducted by solving both Reynolds-averaged Navier–Stokes equations with the eddy dissipation model and solid heat conduction equation in the wall using Fluent 2019R2 to simulate the reaction flow of a volatile organic carbon compound burner and heat transfer of the stack insulation layer. The mass fractions of the O2, CO2, and CO gases; the temperature; and the velocity distribution in a combustion chamber were computed to investigate how various design parameters of the combustor, including air inlet size and stack height, and air inflow conditions affected the combustion performance. Results show that the size of the air inlet had only a minor effect on combustion efficiency and that the airstream forced by a fan significantly enhanced the combustion performance. In particular, increasing the height of the stack from 2 m to 4 m greatly increased combustion efficiency from 63% to 94%, with a 50% increase in the incoming air flow rate by natural convection, which demonstrates the importance of stack height in combustor design.