Telesurgery Research Articles

Ultra-Mini Percutaneous Nephrolithotripsy and Retrograde Intrarenal Surgery in Treatment of Less than 2 cm Kidney Stones: Comparative Efficacy and Safety

Background. Renal stones of ≤ 2cm size occur most commonly, with several treatment options currently available that include remote shockwave lithotripsy, percutaneous nephrolithotripsy (PCNL) and retrograde intrarenal surgery (RIRS). The choice of treatment for ≤ 2 cm kidney stones remains a relevant and hotly debated issue.Aim. A study of the efficacy, safety, advantages and disadvantages of ultra-mini percutaneous nephrolithotripsy (ultra-mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of ≤ 2 cm kidney stones.Materials and methods. Treatment outcomes in urology patients of the Botkin Hospital were analysed retrospectively for years 2017–2022. The patients were divided between cohorts: cohort 1 consisted of patients who underwent ultra-mini PCNL; cohort 2 included 41 patients with RIRS.Results and discussion. The incidence of complete stone absence on the day after surgery was significantly higher in cohort 1 (39; 92.8 %) vs. 2 (33; 80.4 %). Mean operation time was significantly less in cohort 1 (55 [30–80] min) vs. 2 (78 [30–125] min). Mean hospital stay did not differ significantly between the cohorts: 3 (1–5) vs. 2.8 (2–4) days in cohorts 1 and 2, respectively. Haematuria was statistically more severe in cohort 1 (7 cases; 16.6 %) vs. 2 (4 cases; 9.7 %); mean postoperative haemoglobin decrease was also significantly higher in cohort 1 (11.6) vs. 2 (6.4 g/L).Conclusion. Both ultra-mini PCNL and RIRS are effective, safe and complementary procedures in treatment for ≤2 cm renal stones. Ultra-mini PCNL is more effective over RIRS in terms of single-intervention complete stone removal and shorter operation time, whereas the overall complications rate did not significantly differ between cohorts.

Challenges in threat modelling of new space systems: A teleoperation use-case

A growing number of adversaries are targeting space missions, and as such, there have been increasing academic and industrial efforts in identifying threats and risks through modelling techniques. In parallel, the research communities are collaborating to lower the entry barriers for space activities to deliver more innovative and cost-effective space missions. This evolution has been termed as New Space. However, this transformation of the space ecosystem has led to changes in the threat landscape, introducing new threat vectors and threat actors intent on compromising space systems and missions. As a result, it is expected that cyber threats could increase against space systems. Furthermore, teleoperation, a significant use case for building extraterrestrial habitats, has already been shown vulnerable in other domains as well. For example, teleoperated robots developed for remote surgery have been shown to be vulnerable to threats, such as malicious control due to an elevation-of-privilege attack. Threat modelling is a systematic and structured method to determine associated system vulnerabilities, possible attack entry points and vectors, and potential impacts on the system. In this work, we examine the efficacy of the de facto threat modelling methods such as STRIDE/DREAD in capturing highly adaptive security requirements and threats from a system-centric perspective for the teleoperation mission scenario. Understanding and protecting these hardware-software assets and their interaction in the mission is of foremost importance since security breaches threaten human safety across the broader New Space ecosystem. This research presents the limitations of existing threat modelling approaches in capturing hardware-software interaction in space systems, which is an open area for scientific enquiry. Moreover, research challenges are raised to improve the safety and security of the teleoperation mission. The output of this work can then be used to develop more appropriate threat modelling approaches to support security requirement engineering for different New Space mission scenarios.

A new soft tissue deformation model based on Runge-Kutta: Application in lung

Flexible body deformation model is the most critical research in the field of telemedicine, which decides whether the deformation process of tissues and organs can be simulated in real time and realistically. Basically, the improvement of model accuracy often means the loss of real-time performance. In order to effectively balance between accuracy and real-time performance, this paper proposes a new model, which uses the step-variable fourth-order Runge-Kutta method for the first time to solve the relationship problem between the external force and displacement of the nodes in the finite element deformation of the lung. To improve the real-time performance of the model, a one-stage solution optimization algorithm is proposed to optimize the step size selection problem. Finally, an accelerated two-level node update algorithm is proposed to further improve the real-time performance. A lung surgery simulation platform with 3DMax2020 and OpenGL4.5 is built to verify the accuracy, efficiency, realism and applicability of the model. Experimental results show that the proposed lung model can achieve real-world visual reproduction during remote surgery, and exceeds other 13 reference models in real-time performance, with natural deformation effect, high simulation accuracy, which is suitable for modeling normal lung and four types of lungs suffering from diseases.

Joint VNF Placement and Scheduling for Latency-Sensitive Services

Next-generation 6G networks are envisioned to be a key enabler for low-latency services (e.g., extended reality, remote surgery), which cannot be potentially realized by currently deployed networks. Network function virtualization (NFV) and software-defined networking (SDN) are going to continue playing their key role as two promising technologies in 6G to realize these services due to flexibility, agility, scalability, and cost-efficiency. Although NFV and SDN bring several benefits, provisioning latency-sensitive network services (NSs) in an NFV-based infrastructure remains a challenge, as they require stringent service deadlines. To efficiently meet such stringent service deadlines, VNF placement and scheduling need to be carried out jointly. Most of the existing studies tackle these two problems separately. In this paper, we study the joint VNF placement and scheduling problem for latency-sensitive NSs. We aim at optimally determining whether to place new VNFs or to reuse the already deployed VNFs to optimize profits while guaranteeing stringent deadlines. To solve the problem, we formulate it as an integer linear programming (ILP) problem. Due to its complexity, we also propose two efficient heuristics, namely, greedy-based and Tabu search-based algorithms to solve the problem. The simulation results show that our proposed algorithms achieve higher profits than the existing benchmarks.

Remote and rural surgery training and recruitment: a national attitudinal survey of Scottish surgical trainees.

Scotland's healthcare system includes six rural general hospitals (RGHs) which provide a full surgical service to the most remote and rural populations. Constraints of geography and finance, and population need, mean that local delivery of surgical services will be required for the foreseeable future. These RGHs face difficulties in recruiting suitably trained general surgeons. This study aimed to describe Scottish surgical trainees' attitudes towards training and working in remote and rural surgery, perceived barriers to recruitment and potential solutions. A survey was distributed in paper and electronic forms to all Scottish trainees in core surgery (early-stage trainees) and general surgery (later-stage trainees). The survey collected data describing demographics, life and career experiences, and attitudes towards training in remote and rural environments. Univariate and multivariate analyses of influences on interest in rural training and recruitment were carried out, and thematic analysis of free-text responses. There were 152 respondents (response rate 59%). Most (81%) felt that surgical training should be offered in rural environments and 43% were personally interested in some rural training. On multivariate analysis, interest in rural training was associated with being a core trainee (odds ratio (OR) 7.54, 95% confidence interval (CI) 2.79-22.76), and rural work experience following graduation (OR 5.12, 95%CI 1.85-15.39). Respondents stating that they were likely to work in a rural environment (9.2%), were more likely on multivariate analysis to be core trainees (OR 5.70, 95%CI 1.37-28.99) and to have previously lived in a rural location (OR 5.49, 95%CI 1.33-25.93). When trainees were asked for their views on how RGH jobs could be made more attractive, themes identified were as follows: increasing and improving training opportunities in RGHs, increasing the breadth of surgical training, optimising links with referral centres, and improving pay and conditions. This is the first study in a UK setting to describe the views of surgical trainees towards training and working in rural environments. There is substantial support and interest for rural surgical training among Scottish surgical trainees. A minority are interested in a rural surgical career, with interest more likely in core trainees and in those who have lived rurally. Increasing surgical training opportunities in rural environments and maximising medical school intake from rural areas may be important in addressing recruitment concerns.

Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue.

Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narrowband lines acting as bottlenecks. Therefore, verifying the effects on surgical performance and surgeon fatigue when communication lines dip below required bandwidths are important. To clarify the communication bandwidth environment effects on image transmission and operability when bandwidth is lower than surgical robot requirements, and to determine surgeon fatigue levels in suboptimal environments. Employing a newly developed surgical robot, a commercial IP-VPN line connected two hospitals 150 km apart. Thirteen surgical residents remotely performed a defined suturing procedure at 1-Gbps to 3-Mbps bandwidths. Communication delay, packet loss, time-to-task completion, forceps-movement distance, video degradation, and robot operability were evaluated before and after bandwidth changes. The Piper Fatigue Score-12 (PFS-12) was used to measure fatigue associated with surgeon performance. Roundtrip communication time for both 1-Gbps and 3-Mbps lines averaged 4 ms. Video transmission delay from camera to monitor was comparable, at 92 ms. Surgical robot signal transmission rate averaged 5.2 Mbps, so changing to 1-Gbps-3-Mbps lines resulted in significant packet loss. Surgeons perceived significant roughness, image distortion, diplopia, and degradation of 3D images (p = 0.009), but not changes in delay time or maneuverability. All surgeons could complete tasks, but objective measurement of task-completion time and forceps-travel distance were significantly prolonged (p = 0.013, p = 0,041). Additionally, PFS-12 showed post-procedure fatigue increase at both 1-Gbps and 3-Mbps. Fatigue increase was significant at 3-Mbps (p = 0.041). In remote surgery environments with less than the optimal bandwidth, even when delay time and operability are equivalent, reduced surgical performance occurs from video degradation from packet loss. This may cause increased surgeon fatigue.

COVID-19: Reshaping Medical Tourism through Artificial Intelligence (AI) and Robotics

The tourism and travel sector is a large and thriving industry, with almost 5 billion international tourist arrivals recorded in 2019, with an annual growth of 4% on the previous year. Yet it suffered a major downturn, globally due to Covid 19. Since the concept of healthcare has existed, humans have been willing to travel to access it. From the spas of the ancient Sumerians, Greeks, and Romans, to the supposed curative properties of alpine and seaside health resorts in early modern Europe, the idea of traveling long distances for health reasons, and marketing destinations for that purpose, is certainly nothing new However, lately, medical tourism has been growing due to the low-cost treatment, Specialization of medical agencies, hospitals, and medical professionals in the host countries. This type of tourism was valued at USD 16.761 million in 2018, and it is expected to reach USD 27,247.6 million by 2024. However, the appearance of COVID 19 has completely changed the tourism sector, where a loss of USD 910 billion to USD 1.2 trillion from export revenues from tourism was reported Moreover, the different types of Tourism and travel industry are taking advantage of Artificial intelligence (AI) in order to perform a variety of administrative and customer service tasks. For medical tourism the development of these technologies (AI, robotic, and so on) play a key role in supporting the medical agencies in connecting physicians and prospective medical tourists. In addition to make it more feasible and credible option for patients, respond to questions and provide valuable information to customers, and allows to reduce the time would be impossible for humans. Furthermore, international remote surgeries will allow various clinical centers to pool their expertise and offer remote surgeries from a central operating theatre that is convenient to access for patients and persuade patients to invest in the local economy. Keywords: Medical Tourism, COVID-19, AI, Robotics.

Tele-assessment of bandwidth limitation for remote robotics surgery

PurposeWe investigated the communication bandwidth (CB) limitation for remote robotics surgery (RRS) using hinotori™ (Medicaroid, Kobe, Japan).MethodsThe operating rooms of the Hokkaido University Hospital and Kyushu University Hospital were connected using the Science Information NETwork (SINET). The minimum required CB for the RRS was verified by decreasing the CB from 500 to 100 Mbps. Ten surgeons were tested on a task (intracorporeal suturing) at different levels of video compression (VC) (VC1: 120 Mbps, VC2: 40 Mbps, VC3: 20 Mbps) with the minimum required CB, and assessed based on the task completion time, Global Evaluative Assessment of Robotic Skills (GEARS), and System and Piper Fatigue Scale-12 (PFS-12).ResultsPacket loss was observed at 3–7% and image degradation was observed at 145 Mbps CB. The task performance with VC1 was significantly worse than that with VC2 and VC3 according to the task completion time (VC1 vs VC2, P = 0.032; VC1 vs. VC3, P = 0.032), GEARS (VC1 vs VC2; P = 0.029, VC1 vs VC3; P = 0.031), and PFS-12 (VC1 vs. VC2; P = 0.032, VC1 vs. VC3; P = 0.032) with 145 Mbps.ConclusionOur findings provide evidence that RRS using hinotori™ requires a CB ≥ 150 Mbps. We also found that when there is insufficient CB, RRS can be continued by compressing the image.

PO-631-01 TELEROBOTIC CARDIAC CATHETER ABLATION IN A RURAL HOSPITAL: A PROOF-OF-CONCEPT SIMULATION STUDY

Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the US and worldwide. Advancements in telecommunication, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings. The purpose of this study was to pilot test a system and methods to explore remote surgery in a rural community hospital setting using a novel telerobotic catheter ablation platform. Telerobotic System: We assembled a portable pre-clinical telerobotic catheter ablation system from commercial-grade components using 3rd party vendors. A Plexiglas case housed a 3-dimensionally printed cardiac model and simulated vasculature to represent the patient. Finally, we used a proprietary telerobotic cloud service and an off-the-shelf VR headset to allow a remote operator to perform the simulated telerobotic operations. Simulations: We carried out eight simulations with an experienced operator in Chicago, IL, and the Operating room (OR) team at Ocean Beach Hospital, a rural community hospital in Ilwaco, WA. OR team members were assigned to one of two simulation scenarios: loss of network connection or cardiac perforation with subsequent life-threatening tamponade physiology. Ethnographic Study: Two ethnographers observed and recorded each simulation via two stationary cameras in the rural hospital OR. The ethnographers also conducted semi-structured and focus group interviews. Interviews and observations suggested that rural OR teams could readily adapt to the telesurgery context. However, team perceptions of communication and emergency management were significantly impacted during simulated network failure with loss of contact with the remote operator. Most participants believed the team would have been more responsive to the challenges had they received formal training or had prior experience with the procedure. We demonstrate feasibility of a system and methods for the study of specialty telerobotic surgery in a rural hospital OR setting.

Cloud computing-enabled IIOT system for neurosurgical simulation using augmented reality data access

In recent years, statistics have indicated that the number of patients with malignant brain tumors has increased sharply. However, most surgeons still perform surgical training using the traditional autopsy and prosthesis model, which encounters many problems, such as insufficient corpse resources, low efficiency, and high cost. With the advent of the 5G era, a wide range of Industrial Internet of Things (IIOT) applications have been developed. Virtual Reality (VR) and Augmented Reality (AR) technologies that emerged with 5G are developing rapidly for intelligent medical training. To address the challenges encountered during neurosurgery training, and combining with cloud computing, in this paper, a highly immersive AR-based brain tumor neurosurgery remote collaborative virtual surgery training system is developed, in which a VR simulator is embedded. The system enables real-time remote surgery training interaction through 5G transmission. Six experts and 18 novices were invited to participate in the experiment to verify the system. Subsequently, the two simulators were evaluated using face and construction validation methods. The results obtained by training the novices 50 times were further analyzed using the Learning Curve-Cumulative Sum (LC-CUSUM) evaluation method to validate the effectiveness of the two simulators. The results of the face and content validation demonstrated that the AR simulator in the system was superior to the VR simulator in terms of vision and scene authenticity, and had a better effect on the improvement of surgical skills. Moreover, the surgical training scheme proposed in this paper is effective, and the remote collaborative training effect of the system is ideal.

Osmotic Message-Oriented Middleware for Internet of Things

IoT is a trending computational concept that converts almost everything in modern life into a smart thing in various innovational and outstanding approaches. Smart homes, connected cities, autonomous vehicles, industrial automation, and smart healthcare that allows doctors to perform a patient examination and enable executing a remote surgery are now applicable through the smart connected things. Moreover, the recent IoT analytics report expects the universal number of connected IoT things to grow by 9%, to 12.3 billion operating terminals. It is expected that there will be more than 27 billion IoT live connections by 2025. In this paper, we present osmotic message-oriented middleware, introducing an end-to-end IoT platform to federate the dynamic orchestration process of resources across different heterogeneous types of devices belonging to physical and virtual infrastructures (e.g., edge, fog, and cloud layers); the orchestration process follows the osmotic computing concepts represented as the self-adaptive MAPE-K model, which maintains/adopts itself on the runtime through feedback loops from the provisioning engine, which collects the node’s hardware and software performance matrices. Accordingly, the orchestration process utilizes the optimized dynamic Hungarian algorithm to solve the MELs’ assignment problem based on the vibrant runtime provisioning data. The implemented middleware prototype is tested on both simulated and real-life environments to validate the architecture hypothesis of running an efficient, robust, elastic, and cost-efficient end-to-end osmotic IoT ecosystem, which unlocks a new implementation model for the IoT numerous domains.

Remote vascular interventional surgery robotics: a literature review.

Vascular interventional doctors are exposed to radiation hazards during surgery and endure high work intensity. Remote vascular interventional surgery robotics is a hot research field, in which researchers aim to not only protect the health of interventional doctors, but to also improve surgical accuracy and efficiency. However, the current vascular interventional robots have numerous shortcomings, such as poor haptic feedback, few compatible surgeries and instruments, and cumbersome maintenance and operational procedures. Nevertheless, vascular interventional surgery combined with robotics provides more cutting-edge directions, such as Internet remote surgery combined with 5G network technology and the application of artificial intelligence in surgical procedures. To summarize the developmental status and key technical points of intravascular interventional surgical robotics research, we performed a systematic literature search to retrieve original articles related to remote vascular interventional surgery robotics published up to December 2020. This review, which includes 113 articles published in English, introduces the mechanical and structural characteristics of various aspects of vascular interventional surgical robotics, discusses the current key features of vascular interventional surgical robotics in force sensing, haptic feedback, and control methods, and summarizes current frontiers in autonomous surgery, long-distance robotic telesurgery, and magnetic resonance imaging (MRI)-compatible structures. On the basis of summarizing the current research status of remote vascular interventional surgery robotics, we aim to propose a variety of prospects for future robotic systems.

The Effect of Kinesthetic and Artificial Tactile Noise and Variability on Stiffness Perception.

Robot-assisted minimally invasive surgeries (RAMIS) have many benefits. A disadvantage, however, is the lack of haptic feedback. Haptic feedback is comprised of kinesthetic and tactile information, and we use both to form stiffness perception. Applying both kinesthetic and tactile feedback can enable more precise feedback than kinesthetic feedback alone. However, during remote surgeries, haptic noises and variations can be present. Therefore, toward designing haptic feedback for RAMIS, it is important to understand the effect of haptic manipulations on stiffness perception. We assessed the effect of two manipulations using stiffness discrimination tasks in which participants received force feedback and artificial skin stretch. In Experiment 1, we added sinusoidal noise to the artificial tactile signal, and found that the noise did not affect participants' stiffness perception or uncertainty. In Experiment 2, we varied either the kinesthetic or the artificial tactile information between consecutive interactions with an object. We found that the both forms of variability did not affect stiffness perception, but kinesthetic variability increased participants' uncertainty. We show that haptic feedback, comprised of force feedback and artificial skin stretch, provides robust haptic information even in the presence of noise and variability, and hence can potentially be both beneficial and viable in RAMIS.

Leveraging 5G technology for robotic surgery and cancer care.

BackgroundThe field of robotic surgery has seen significant advancements in the past few years and it has been adopted in many large hospitals in the United States and worldwide as a standard for various procedures in recent years. However, the location of many hospitals in urban areas and a lack of surgical expertise in the rural areas could lead to increased travel time and treatment delays for patients in need of robotic surgical management, including cancer patients. The fifth generation (5G) networks have been deployed by various telecom companies in multiple countries worldwide. Our aim is to update the readers about the novel technology and the current scenario of surgical procedures performed using 5G technology. In this article, we also discuss how the technology could aid cancer patients requiring surgical management, the future perspectives, the potential challenges, and the limitations, which would need to overcome prior to widespread real‐life use of the technology for cancer care.Recent findingsThe expansion of 5G technology has enabled some countries to conduct remote surgical procedures, tele‐mentored and real‐time interactive procedures on animal models, cadavers, and humans, demonstrating that 5G networks could offer a potential solution to previously experienced latency and reliability hurdles during the remote surgeries performed in the 2000s.ConclusionNew technological advancements could serve as a ground for emerging novel therapeutic applications. While limitations and challenges related to the 5G infrastructure, cost, compatibility, and security exist; researching to overcome the limitations and comprehend the potential benefits of integrating the technology into practice would be imminent before widespread clinical use. Remote and tele‐mentored 5G‐powered procedures could offer a new tool in improving the care of patients requiring robotic surgical management such as prostate cancer patients.

Remote telesurgery in humans: a systematic review.

Since the conception of robotic surgery, remote telesurgery has been a dream upon which incredible technological advances haven been built. Despite the considerable enthusiasm for, there have been few published studies of remote telesurgery on humans. We performed a systematic review of the English literature (PubMed, EMbase, Inspec & Compendex and Web of Science) to report studies of remote telesurgery in humans. Keywords included telesurgery, remote surgery, long-distance surgery, and telerobotics. Subjects had to be human (live patients or cadavers). The operating surgeon had to be remote from the patient, separated by more than one kilometer. The article had to explicitly report the use of a long-distance telerobotic technique. Articles that focused on telepresence or tele-mentoring were excluded. The study included eight articles published from 2001 to 2020. One manuscript (1 subject) described remote surgery on a cadaver model, and the other seven were on live humans (72 subjects). Procedure types included percutaneous, endovascular, laparoscopic, and transoral. Communication methods varied, with the first report using a telephone line and the most recent studies using a 5G network. Six of the studies reported signal latency as a single value and it ranged from 28ms to 280ms. Few studies have described remote telesurgery in humans, and there is considerable variability in robotic and communication methods. Future efforts should work to improve reporting of signal latency and follow careful research methodology.

Healing Hands: The Tactile Internet in Future Tele-Healthcare.

In the early 2020s, the coronavirus pandemic brought the notion of remotely connected care to the general population across the globe. Oftentimes, the timely provisioning of access to and the implementation of affordable care are drivers behind tele-healthcare initiatives. Tele-healthcare has already garnered significant momentum in research and implementations in the years preceding the worldwide challenge of 2020, supported by the emerging capabilities of communication networks. The Tactile Internet (TI) with human-in-the-loop is one of those developments, leading to the democratization of skills and expertise that will significantly impact the long-term developments of the provisioning of care. However, significant challenges remain that require today’s communication networks to adapt to support the ultra-low latency required. The resulting latency challenge necessitates trans-disciplinary research efforts combining psychophysiological as well as technological solutions to achieve one millisecond and below round-trip times. The objective of this paper is to provide an overview of the benefits enabled by solving this network latency reduction challenge by employing state-of-the-art Time-Sensitive Networking (TSN) devices in a testbed, realizing the service differentiation required for the multi-modal human-machine interface. With completely new types of services and use cases resulting from the TI, we describe the potential impacts on remote surgery and remote rehabilitation as examples, with a focus on the future of tele-healthcare in rural settings.

Communication Requirements in 5G-Enabled Healthcare Applications: Review and Considerations.

Fifth generation (5G) mobile communication technology can enable novel healthcare applications and augment existing ones. However, 5G-enabled healthcare applications demand diverse technical requirements for radio communication. Knowledge of these requirements is important for developers, network providers, and regulatory authorities in the healthcare sector to facilitate safe and effective healthcare. In this paper, we review, identify, describe, and compare the requirements for communication key performance indicators in relevant healthcare use cases, including remote robotic-assisted surgery, connected ambulance, wearable and implantable devices, and service robotics for assisted living, with a focus on quantitative requirements. We also compare 5G-healthcare requirements with the current state of 5G capabilities. Finally, we identify gaps in the existing literature and highlight considerations for this space.

An Isomorphic Interactive Device for the Interventional Surgical Robot after In Vivo Study.

Interventional surgical robots are widely used in neurosurgery to improve surgeons’ working environment and surgical safety. Based on the actual operational needs of surgeons’ feedback during preliminary in vivo experiments, this paper proposed an isomorphic interactive master controller for the master–slave interventional surgical robot. The isomorphic design of the controller allows surgeons to utilize their surgical skills during remote interventional surgeries. The controller uses the catheter and guidewire as the operating handle, the same as during actual surgeries. The collaborative operational structure design and the working methods followed the clinical operational skills. The linear force feedback and torque feedback devices were designed to improve the safety of surgeries under remote operating conditions. An eccentric force compensation was conducted to achieve accurate force feedback. Several experiments were carried out, such as calibration experiments, master–slave control performance evaluation experiments, and operation comparison experiments on the novel and previously used controllers. The experimental results show that the proposed controller can perform complex operations in remote surgery applications and has the potential for further animal experiment evaluations.

Barium Granulomatosis: A Rare Cause of Obstruction after Remote Bariatric Surgery and a Cautionary Tale of Contrast Selection with Surgical and Pathologic Correlation

Francis G. Celii, Jessica Burris, Richard J. Hausner, Curtis J. Wray, Naveen Manisundaram, Chakradhar Thupili and Varaha S. Tammisetti Bariatric weight loss procedures have dramatically increased in recent years, but are not without significant complications, including post-procedural leakage.

The Game's Afoot: a Patient-Centered Care Case Study on a Lower Extremity Bone Bruise without Trauma

This case report follows a right-handed 26-year-old female with a past medical history of schizoaffective disorder, patellofemoral syndrome, De Quervain's tendonitis, and remote foot surgery with acute onset debilitating foot pain from initial presentation at an urgent care facility to her eventual return to work. Special attention is drawn to physical exam findings, natural history, differential diagnosis, clinical pearls, and details on the legal responsibility of physicians. This case study hopes to provide a framework for how physicians and other providers can help patients as they navigate the harsh realities of the healthcare system and provide some key clinical pearls to ensure that the patient is kept front and center in the minds of those providing the necessary healthcare for the patient’s providing the necessary healthcare for the patient’s psychiatric, social, and physical needs. Keywords: Orthopaedics, Bruised Bone, Patient-Centered Care, Diagnostic Work Up, RICE