Surgical Drill Research Articles

Virtual Surgical Planning and 3D-Printed Guided Biopsy of Bilateral Lesions in the Mandible: A Case Report

Purpose: To report the use of virtual surgical planning and a 3D printed drill guide for the biopsy of mandibular lesions. Case report: A 38-year-old woman presented with two bilateral lesions in the mandibular body, in close proximity to the inferior alveolar nerve and the molar roots. An incisional biopsy was planned with coDiagnostiX software using the cone beam computed tomography DICOM files and a cast model that had been digitalized using a bench scanner (7series, Dental Wings, Quebec, Canada). A tooth-supported drill guide was produced by 3D printing with digital light processing technology (Moonray S, Sprintray, CA, USA). The surgical procedure was performed under local anesthesia. No complications were observed intraoperatively or during postoperative recovery. Conclusion: The use of an intraoperative surgical 3D-printed drill guide enables a smaller surgical procedure and more precise bone biopsies.

Effects of the technique and drill design used during the osteotomy on the thermal and histological stimulation

The objective of our in vivo study was to compare the effects of the osteotomy on the thermal alterations, the bone healing and count of polymorphonuclear cells, comparing the drill design (cylindrical or conical) using continuous or intermittent movement. Twelve rabbits were used, which were made four osteotomies (n = 2 per tibia) to simulate the surgical drilling sequence for the installation of a dental implant at 8 mm of length and regular diameter. Four groups were proposed: group G1, cylindrical drill with continuous movement; group G2, cylindrical drill with intermittent movement; group G3, conical drill with continuous movement; and, group G4, conical drill with intermittent movement. Thermal mean variation was 6.91 ± 1.4 °C in group 1, 4.30 ± 1.3 °C in group 2, 2.78 ± 0.6 °C in group 3, and 2.77 ± 0.7 °C in group 4. Whereas the mean area of new bone formation was 1.00 ± 0.3 mm2 in group 1, 1.48 ± 0.3 mm2 in group 2, 2.20 ± 0.4 mm2 in group 3, and 2.43 ± 0.4 mm2in group 4. The mean count of polymorphonuclear cells, in the group 1 was 62.4 ± 5.9 cells, group 2 was 50.7 ± 4.2 cells, group 3 was 44.4 ± 3.7 cells, and group 4 was 42.4 ± 3.7 cells. The conical drill sequence produced a significantly smaller increase in temperature during both techniques (continuous and intermittent), more effective new bone formation and a smaller number of polymorphonuclear cells. During the osteotomy for the installation of implants, the professional must take to consider the drill design to perform a less traumatic surgical technique, which can improve and facilitate the healing of peri-implant tissues.

Cranial Perforation Using an Optically-Enhanced Surgical Drill.

The design of mechanically clutched cranial perforators, used in craniotomy procedures, limits their performance under certain clinical conditions and can, in some cases, impose the risk of severe brain injury on patients undergoing the procedure. An additional safety mechanism could help in mitigating these risks. In this work, we examine the use of diffuse reflectance spectroscopy as a potential fallback mechanism for near real-time detection of the bone-brain boundary. Monte Carlo simulation of a two layer model with optical properties of bone and brain at 530 and 850nm resulted in a detectable change in diffuse reflectance signal when approaching the boundary. The simulated results were used to guide the development of an experimental drill control system, which was tested on 10 sheep craniums and yielded 88.1 % success rate in the detection of the approaching bone-brain boundary.

Infrared thermographic evaluation of temperature modifications induced during osteotomies performed with Er:YAG laser, piezosurgery and surgical drill – an animal study

Infrared thermographic evaluation of temperature modifications induced during osteotomies performed with Er:YAG laser, piezosurgery and surgical drill – an animal study

Medial Displacement Calcaneal Osteotomy: Loss of Correction with Varying Drilling Techniques

Category:HindfootIntroduction/Purpose:Surgical correction of Stage 2 posterior tibial tendon dysfunction typically involves a combination of soft tissue and bony corrections, often including a medial displacement calcaneal osteotomy (MDCO). This osteotomy is often fixated utilizing two parallel screws; however, it remains unknown how much correction is lost based on various accepted drilling techniques for common fixation of this osteotomy. Our cadaveric study compares three different surgical drilling techniques, using two parallel cannulated screws for fixation, to best maintain desired translation of the MDCO.Methods:Fifteen above knee, fresh-frozen, matched pair cadaveric specimens (30 limbs) were randomized equally into three groups. Calcanealosteotomies were performed, followed by manual 10 mm medial translation of the tuberosity. Two parallel 2.5mm guide wires were advanced across the osteotomy site under fluoroscopy. The first group involved a ‘staggered’ drilling technique in which one guide wire was over drilled to the osteotomy site with a 4.5mm cannulated drill and then a 7.0 mm cannulated screw was placed across the osteotomy, followed by a second screw in similar fashion. The second, ‘simultaneous’ group consisted of over drilling both guide wires sequentially followed by placement of both screws. The third control group involved simultaneously over drilling only the near cortex, followed by placement of the 2 screws. Following screw fixation, the calcaneal tuberosity was manually translated in a lateral direction. The loss of correction was then marked and measured in millimeters.Results:All thirty cadaveric specimens underwent standard medializing calcaneal displacement osteotomy without significant variation, or complication. Loss of medialization was measured in millimeters following a manual lateral displacing force after the screw fixation of the osteotomy. The ‘simultaneous’ drilling group experienced the greatest loss of medial displacement with the mean loss of correction being 2.6 mm (range 1.37 - 3.48 mm) following manual lateral translation. The ‘staggered’ group showed an average loss of 1.16 mm (range 0.36 - 2.67 mm). The control group, that simply involved drilling of the near cortex, demonstrated the greatest maintenance of medial displacement with a mean loss of only 0.036 mm (range 0.01 - 0.06 mm).Conclusion:Our cadaveric study comparing three different drilling techniques for maintaining the intended correction following MDCO demonstrates that simultaneous over drilling of only the tuberosity near cortex prior to screw fixation was the most resistant to loss of medial displacement; whereas mean loss of correction with simultaneous drilling of both wires to the osteotomy resulted in the greatest loss of correction at an average of 26%.

Surgical fire in operating room- A meta synthesis

Operating rooms (ORs) are among the most vulnerable hospital wards to fire and burns. Patient burns are one of the unwanted events that can cause irreparable complications and even death. Therefore, the present study aimed to identify the factors affecting patient burns and propose strategies to prevent patient burns. The present study was a meta-synthesis systematic review. The keywords patient safety, Operating rooms safety, and safe surgery were searched on ProQuest, Ovid, Science Direct, and PubMed. English and Persian articles on fire and patient burns in ORs that were published before 2020 were included. Articles considered suitable by two researchers were analyzed through thematic analysis. Head and neck surgeries are more frequently prone to burns. The most common causes of burns in ORs include lasers, electrocautery, electroshocks, surgical drills, lamps, fiber optic, and warmers. Alcohol-based substances used to disinfect patients’ skin are the most important flammable materials in ORs.

Surgical Drill Bit Design and Thermomechanical Damage in Bone Drilling: A Review.

As drilling generates substantial bone thermomechanical damage due to inappropriate cutting tool selection, researchers have proposed various approaches to mitigate this problem. Among these, improving the drill bit design is one of the most feasible and economical solutions. The theory and applications in drill design have been progressing, and research has been published in various fields. However, pieces of information on drill design are dispersed, and no comprehensive review paper focusing on this topic. Systemizing this information is crucial and, therefore, the impetus of this review. Here, we review not only the state-of-the-art in drill bit designs-advances in surgical drill bit design-but also the influences of each drill bit geometries on bone damage. Also, this work provides future directions for this topic and guidelines for designing an improved surgical drill bit. The information in this paper would be useful as a one-stop document for clinicians, engineers, and researchers who require information related to the tool design in bone drilling surgery.

Rib osteotomy with the Nuss procedure for the repair of adult pectus excavatum.

For the Nuss procedure in adult patients with pectus excavatum, sufficient sternal elevation is difficult due to the rigid chest wall. To solve the problem, we present a novel rib osteotomy procedure. From the skin incisions on the lateral chest which are the common approach for the Nuss procedure, a surgical drill is used to incise bilateral anterior half of the rib cortex after installing the pectus bars. Osteotomy is done on the ribs next to the points where the bars penetrate the intercostal muscle. After making rib osteotomy, the ribs bend spontaneously like greenstick fracture. Elevation of the stiff anterior chest wall can be achieved by this procedure. Rib osteotomy is also beneficial for pain relief due to the reduction of the strain to the ribs. It could be expected that regression after bar removal is avoided.

Usefulness of a high-speed surgical air drill in pubectomy during delayed anastomotic urethroplasty for pelvic fracture urethral injury.

Pubectomy is an ancillary technique used to increase exposure of the disrupted urethra and reduce anastomotic tension, which can be difficult for inexperienced surgeons. The objective of the present study was to illustrate the use of an air drill enabling delicate and precise bone resection in pubectomy for delayed anastomotic urethroplasty for pelvic fracture urethral injury. Between 2009 and 2019, 88 male patients underwent delayed anastomotic urethroplasty with pubectomy for pelvic fracture urethral injury. A total of 73 procedures used a high-speed surgical air drill (HiLAN HS; Aesculap, Tuttlingen, Germany) equipped with a short-hand piece. Operative time and blood loss in the air drill patient group (group1) were compared with that of patients who underwent pubectomy using a rongeur and/or gouge (group2, n=15). In 65 group1 patients, urethroplasty was carried out using the perineal approach, with partial inferior pubectomy. Eight group1 patients, whose proximal urethral end was displaced upward superior to the upper edge of pubis, underwent urethroplasty using the perineal and abdominal approach, with a superior partial pubectomy and supracrural urethral rerouting. No difficulty was encountered using the air drill in any of the cases. There was no significant difference in median operative time between the groups (group1 256min vs group2 228min; P=0.31). The median blood loss in group1 was significantly lower than group2 (149mL vs 453mL; P<0.0001). Surgical air drills might facilitate pubectomy in patients undergoing delayed anastomotic urethroplasty for pelvic fracture urethral injury. This tool offers the advantage of a delicate bone resection with reduced blood loss.

Effects of temperature increase during surgical drilling in acrylic resin.

Acrylic resin is employed for drilling bone biomodels. Since drilling causes temperature rise, the mechanical properties of thermoplastic acrylic resin can be altered, consequently affecting drilling properties. However, it is currently unclear how this temperature increase impacts drilling. This study reports the effects of temperature rise on both mechanical and drilling properties through experiments in which acrylic resin is drilled under machining conditions employed in surgical operations. Drilling tests were performed using a surgical drill on medical acrylic resin under dry conditions to observe generated cutting chips and measure drilling properties such as torque, drilling time, and temperature rise. Dynamic mechanical analysis measurements were performed to consider temperature effects. According to the morphological classification of the cutting chips, the drilling process is divided into three phases corresponding with the generation of cylindrical helix, waved, and rounded nubby chips respectively. During drilling, the temperature of the chips can exceed the glass transition temperature (100∘C) resulting in decreased viscoelasticity, which is associated with decreased torque. While drilling acrylic resin under surgical machining conditions, increasing temperature can decrease torque and morphologically change cutting chips due to the decrease in mechanical properties above the glass transition temperature.

Bioimpedance Sensing Surgical Drill - Computational Modelling and Experimental Validation.

Surgical drilling to fixate dental implants is associated with high risk of injury to the inferior alveolar nerve (IAN) and the maxillary sinus. Current common practice is to use pre-operative radiographs to plan and drill with no real-time feedback of drill tip position with respect to these critical structures. Real-time proximity sensing of the IAN and maxillary sinus by measuring the electrical impedance properties of tissues, directly from the drill tip, while drilling may reduce and eventually eliminate this risk. Sensing impedance to detect tissue boundaries needs sensor geometry optimization for maximum detection distance. We have created a finite element method (FEM) based simulation platform that yields accurately impedances for different conductivities, frequencies and sensor geometries.

Power analysis of robotic medical drill with different control approaches

Increasing the efficiency of the systems used in surgical operations has become an important issue. Especially in orthopedic surgery, many surgical systems and instruments are used to reduce the workload of surgeons and increase the success of the operation. Surgical drills, which are one of these systems used in orthopedic surgery, are used in operations such as drilling, cutting and carving in various interventions. Cases such as drill sensitivity and stability are critical to operational success and patient health. In this study, an orthopedic drill design that can be added to a linear motion module or a 6-axis robot manipulator has been realized. Linear Quadratic Regulator (LQR), which is one of the optimal controller methods, Proportional Integral (PI) Controller, which is one of the classical controller methods and Model Predictive Controller (MPC) systems from modern controller systems are designed to perform speed control task of the surgical drill. A drill integrated into the robot manipulator for a constant drilling speed of 120 rad/sec and a robot manipulator were used to provide constant feed rate (1 mm/s) and to drill holes at constant intervals during the drilling experiments. Power analysis is performed in real-time in bone drilling operations for three controllers. Current, and voltage information during drilling are recorded simultaneously in the experimental setup. In particular, it has been observed that the power signal and the force information of the bone in different layers are proportional.

Effects of rotary ultrasonic bone drilling on cutting force and temperature in the human bones.

Efficacy and outcomes of osteosynthesis depend on various factors including types of injury and repair, host factors, characteristics of implant materials and type of implantation. One of the most important host factors appears to be the extent of bone damage due to the mechanical force and thermal injury which are produced at cutting site during bone drilling. The temperature above the critical temperature (47 °C) produces thermal osteonecrosis in the bones. In the present work, experimental investigations were performed to determine the effect of drilling parameters (rotational speed, feed rate and drill diameter) and techniques (conventional surgical bone drilling and rotary ultrasonic bone drilling) on cutting force and temperature generated during bone drilling. The drilling experiments were performed by a newly developed bone drilling machine on different types of human bones (femur, tibia and fibula) having different biological structure and mechanical behaviour. The bone samples were procured from male cadavers with the age of second to fourth decades. The results revealed that there was a significant difference (p < 0.05) in cutting force and temperature rise for rotary ultrasonic bone drilling and conventional surgical bone drilling. The cutting force obtained in rotary ultrasonic bone drilling was 30%-40%, whereas temperature generated was 50%-55% lesser than conventional surgical bone drilling process for drilling in all types of bones. It was also found that the cutting force increased with increasing feed rate, drill diameter and decrease in rotational speed, whereas increasing rotational speed, drill diameter and feed rate resulted in higher heat generation during bone drilling. Both the techniques revealed that the axial cutting force and the temperature rise were significantly higher in femur and tibia compared with the fibula for all combinations of process parameters.

1750-P: Effects of Melatonin on the Insulin Signaling and Inflammatory Pathway of Rats with Apical Periodontitis

Background: Apical periodontitis (PEA) is oral inflammation related to the increase of proinflammatory cytokines that may act locally and systemically. PEA in rats has been shown to cause insulin resistance (IR) and impaired insulin signal. Melatonin (MEL) is known to improve IR. We hypothesized that administration of MEL in PEA rats may prevent the IR found in these animals. Therefore, the aim of this study was to verify, in rats with PEA, the effects of MEL on: IR; the insulin and inflammatory pathways; TNF-α levels. Methodology: Seventy-two Wistar rats (60 days of age) were distributed into: control (CN); CN+MEL (CNMEL); PEA; PEA+MEL (PEAMEL). PEAs were induced in the first and second upper and lower molars of the right side using a surgical drill. Following PEA induction, MEL (5 mg/kg) was administered orally (drinking water) for 60 days. At the end of treatment were analyzed: 1) HOMA-IR; 2) TNF-α levels; 3) phosphorylation status of pp185 tyrosine, Akt serine and IKKα/β in soleus (SM) and extensor digitorum longus (EDL) muscles. Statistical analysis was performed by analysis of variance (ANOVA) followed by Bonferroni test (p&amp;lt;0.05). Results: HOMA-IR and TNF-α were higher in the PEA group than in the other groups (HOMA-IR: CN: 2.49 ± 0.24; PEA: 3.57 ± 0.24; CNMEL: 2.17 ± 0.13; PEAMEL: 2.57 ± 0.09 - TNF-α: CN: 8.56 ± 0.84; PEA: 13.42 ± 0.86; CNMEL: 9.21 ± 0.83; PEAMEL: 8.62 ± 0.42). The phosphorylation status of pp185 tyrosine and Akt serine was lower in the PEA group compared to the CN group in SM. Administration of MEL in the PEAMEL group increased the phosphorylation of both proteins. No statistical differences in these parameters were observed between the groups in the EDL muscle. Higher IKKα/β phosphorylation was observed in the PEA group compared to the other groups in both tissues. Conclusions: PEA promoted IR, increased TNF-α levels, impaired insulin signal in SM and inflammatory pathway activation in SM and EDL. Administration of MEL only prevented changes in insulin signal in MS. Disclosure D.H. Sumida: None. Funding Fundação de Amparo a Pesquisa do Estado de São Paulo (2018/23346-3, 2019/18589-7); São Paulo State University

Intraoperative Shortening of Aneurysm Clips: Revisiting an Old Technique in a New Era

It can sometimes be challenging to find a suitable clip to treat an unusual aneurysm, or when the surrounding anatomy is unusual, especially in resource-limited environments. We describe a method to modify aneurysm clips based on the method originated by Sugita etal in 1985. Herein clip modification (Clip-Mod) is used to treat anatomically difficult anterior communicating artery aneurysms. The Department of Neurological Surgery database was reviewed to find aneurysm patients treated using modified aneurysm clips. Clip-Mod was performed during surgery by shortening the tines of titanium aneurysm clips by abrasion applied from the side of a standard 3-mm surgical diamond drill bit under constant irrigation. Note that the thickness of the tines and the clip spring were not modified or contacted by the drill. Four cases used modified aneurysm clips, from 648 total clip-treated aneurysms (0.6%) by 2 surgeons over a 14-year period. Three patients presented with subarachnoid hemorrhages that were determined to be due to anterior communicating artery aneurysms. One patient presented with an incidental unruptured anterior communicating artery aneurysm. All 4 patients were treated with 3-mm titanium clips shortened intraoperatively to 1- to 2-mm lengths, to achieve aneurysm obliteration without stenosing parent or perforating vessels. All 4 patients have done well clinically with no reoccurrences after 2-6 years' follow-up, which included angiographic evaluation. The use of this "Clip-Mod" technique thus appears useful for anterior communicating artery aneurysms. Clip-Mod could also be considered for treating other aneurysms when the "perfect" length clip is not available.

In Vitro Study on Bone Heating during Drilling of the Implant Site: Material, Design and Wear of the Surgical Drill.

Objective: An in vitro study was made to compare mean thermal variation according to the material, design and wear of the surgical drills used during dental implant site preparation. Material and methods: Three study groups (stainless steel drills with straight blades; diamond-like carbon-coated drills with straight blades; and diamond-like carbon-coated drills with twisted blades) were tested to compare material, design and wear of the surgical drill in terms of overall mean values (complete sequence of drills) and specific mean values (each drill separately). The groups comprised four drills: initial, pilot, progressive and final drill. Implant site configuration was performed through an intermittent and gradual drilling technique without irrigation at 800 rpm in standardized synthetic blocks. Maximum axial loading of two kilograms was controlled by an automatic press. Each surgical drill was submitted to 50 drillings and was sterilized every five uses. A thermographic camera analyzed the mean thermal changes. The software-controlled automatic press kept systematic drilling, axial loading and operational speed constant without any human intervention. Student’s t-test, ANOVA and multiple linear regression models were performed. The level of significance was 5% (p = 0.05). Results: The overall mean comparison between the stainless steel and diamond-like carbon-coated materials showed no statistically significant differences (p > 0.05), though specific mean comparison showed statistically significant differences between the drills of the different groups (p < 0.05). The twisted blades exhibited less overall and specific mean thermal variation than straight blades for the progressive and final drills (p < 0.01). In addition, the initial and pilot drills showed a greater mean thermal change than the progressive and final drills. The mean thermal variation was seen to increase during the 50 drillings. Conclusions: Within the limitations of this study, it can be concluded that the drill material did not significantly influence the overall mean thermal variation except for the pilot drill. The drill design affected overall and specific mean thermal variation since the twisted blades heated less than the straight blades. The initial and pilot drills increased the specific mean thermal variation with respect to the progressive and final drills. In addition, all drills in each group produced a gradual increase in mean temperature during the 50 drillings.

Cervical Pedicle Screw Insertion Using O-Arm-Based 3D Navigation: Technical Advancement to Improve Accuracy of Screws

This study aimed to report the technical advancement to improve the accuracy of cervical pedicle screw (CPS) placement using O-arm-based 3D navigation. Sixty-four patients who underwent CPS using O-arm in the spine level of C2 to C7 between June 2013 and February 2020 were involved. In the first phase, a reference frame was placed onto the spinous process of the cranial vertebrae and used it at a maximum of 3 vertebral levels. The navigation guide sleeve was used to drill a screw hole. In the second phase, a reference frame that can hold 3 vertebrae was introduced. In the third phase, a drill guide sleeve to minimize bending of the drill tip was developed. In the fourth phase, navigated surgical drill was introduced. Screw accuracy was assessed using Neo classification: grade (G) 0, no perforation; G1, perforation <2 mm; G2, perforation 2-4 mm; and G3, perforation >4 mm. Mean age at surgery was 67 (19-88) years. A total of 317 CPSs were inserted. In total, 83 screws were inserted in the first phase, 60 in the second phase, 87 in the third phase, and 87 in the fourth phase. The total proportion of malpositioning was 3.8% (12/317 screws) and all were G1; 6.0% (5/83 screws) in the first phase, 8.3% (5/60 screws) in the second phase, 1.2% (1/87 screws) in the third phase, and 1.2% (1/87 screws) in the fourth phase (P < 0.05). O-arm use improved CPS placement accuracy with the advancement of techniques and instruments.

V06-09 USEFULNESS OF HIGH-SPEED SURGICAL AIR DRILL IN PARTIAL PUBECTOMY DURING DELAYED ANASTOMOTIC URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURY

You have accessJournal of UrologyLower-Tract Reconstruction I: Sling/ Sphincter/ Penile & Urethral Reconstruction (V06)1 Apr 2020V06-09 USEFULNESS OF HIGH-SPEED SURGICAL AIR DRILL IN PARTIAL PUBECTOMY DURING DELAYED ANASTOMOTIC URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURY Akio Horiguchi*, Kenichiro Ojima, Masayuki Shinchi, Yusuke Hirano, Koetsu Hamamoto, Keiichi Lto, Tomohiko Asano, and Ryuichi Azuma Akio Horiguchi*Akio Horiguchi* More articles by this author , Kenichiro OjimaKenichiro Ojima More articles by this author , Masayuki ShinchiMasayuki Shinchi More articles by this author , Yusuke HiranoYusuke Hirano More articles by this author , Koetsu HamamotoKoetsu Hamamoto More articles by this author , Keiichi LtoKeiichi Lto More articles by this author , Tomohiko AsanoTomohiko Asano More articles by this author , and Ryuichi AzumaRyuichi Azuma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000885.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial pubectomy is an ancillary technique used in delayed anastomotic urethroplasty for pelvic fracture urethral injury (PFUI). This procedure widens the exposure of the disrupted urethra, and reduces anastomotic tension by shortening the urethral gap. Use of a less traumatic device for a pubectomy is optimal to avoid excessive bleeding from the venous plexus, located just behind the pubic symphysis. Surgical air drills enable delicate, precise bone resection and are widely used in spinal surgery. This video highlights our experience using an air drill in partial pubectomies for PFUI. METHODS: Between 2009 and 2019, 88 male patients underwent delayed anastomotic urethroplasty, with partial pubectomy for PFUI; performed by one surgeon (AH). Seventy-Three (83%) procedures used a high-speed surgical air drill (HiLAN HS®, Aesculap) equipped with a short, light hand piece. Operative time and blood loss in the air drill patient group (group 1) were compared with those patients who underwent pubectomy using rongeur and/or gouge in our early experience (group 2, n = 15, 17%). RESULTS: The median age was 37 years (IQR 23 to 55 years), the median urethral gap length on urethrogram was 25 mm (IQR 19 to 35 mm). In 65 of 73 (89%) patients, urethroplasty was performed via a perineal approach, with inferior partial pubectomy. After mobilizing the bulbar urethra and retracting split corporal bodies laterally, the inferior pubis was scraped by the drill using diamond burrs. In 8 (11%) patients whose proximal urethral end was displaced upward, superior to the upper border of pubic symphysis, urethroplasty was performed via a perineal and abdominal approach, with a superior partial pubectomy and supracrural urethral rerouting. After mobilizing the bulbar urethra via the perineal approach and making a lower abdominal incision extending over the pubic symphysis, a bony channel at the superior surface of the pubis was created by the drill. No difficulty was encountered in using the air drill in any of the cases. The surface of the pubic bone scraped by the air drill was flat; no sharp bony spikes remained. There was no significant difference in median operative time between the groups (256 minutes in group 1 vs. 228 minutes in group 2, p = 0.31). The median blood loss in group 1 (149 ml) was significantly smaller than that in group 2 (453 ml, p < 0.0001). CONCLUSIONS: Surgical air drills may be suitable for pubectomies even in amateur hands, and offer the advantage of delicate bone resection with reduced blood loss. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e558-e558 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akio Horiguchi* More articles by this author Kenichiro Ojima More articles by this author Masayuki Shinchi More articles by this author Yusuke Hirano More articles by this author Koetsu Hamamoto More articles by this author Keiichi Lto More articles by this author Tomohiko Asano More articles by this author Ryuichi Azuma More articles by this author Expand All Advertisement PDF downloadLoading ...

Calibration and Registration of a Freehand Video-Guided Surgical Drill for Orthopaedic Trauma.

Pelvic trauma surgical procedures rely heavily on guidance with 2D fluoroscopy views for navigation in complex bone corridors. This "fluoro-hunting" paradigm results in extended radiation exposure and possible suboptimal guidewire placement from limited visualization of the fractures site with overlapped anatomy in 2D fluoroscopy. A novel computer vision-based navigation system for freehand guidewire insertion is proposed. The navigation framework is compatible with the rapid workflow in trauma surgery and bridges the gap between intraoperative fluoroscopy and preoperative CT images. The system uses a drill-mounted camera to detect and track poses of simple multimodality (optical/radiographic) markers for registration of the drill axis to fluoroscopy and, in turn, to CT. Surgical navigation is achieved with real-time display of the drill axis position on fluoroscopy views and, optionally, in 3D on the preoperative CT. The camera was corrected for lens distortion effects and calibrated for 3D pose estimation. Custom marker jigs were constructed to calibrate the drill axis and tooltip with respect to the camera frame. A testing platform for evaluation of the navigation system was developed, including a robotic arm for precise, repeatable, placement of the drill. Experiments were conducted for hand-eye calibration between the drill-mounted camera and the robot using the Park and Martin solver. Experiments using checkerboard calibration demonstrated subpixel accuracy [-0.01 ± 0.23 px] for camera distortion correction. The drill axis was calibrated using a cylindrical model and demonstrated sub-mm accuracy [0.14 ± 0.70 mm] and sub-degree angular deviation.

An in-vitro study of temperature rise during rotary ultrasonic bone drilling of human bone

Temperature rise in surgical bone drilling is an important factor that leads to death of the bone cells, known as Osteonecrosis, and results into poor osteosynthesis i.e. implant failure. The present work aims to study the temperature rise during bone drilling by a recently developed operation theatre (OT) compatible machine. The temperature during the drilling process was recorded from K-type thermocouple devices, which were embedded in the human tibial bone at four different positions (at 0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm) from the drilling site. Comparative study revealed that rotary ultrasonic bone drilling (RUBD) technique produced lesser temperature (40 – 50%) than conventional drilling on human tibia. Statistical model was developed to predict the temperature rise in RUBD process using response surface methodology (RSM), and the optimum parameters were determined using Genetic Algorithm. Analysis of variance (ANOVA) was carried out at a confidence interval of 95 percent (α = 0.05) to determine the influence of various drilling parameters such as rotational speed, feed rate, drill diameter and abrasive particle size on temperature rise. It was observed that the rotational speed was responsible for the maximum temperature rise (51.8%) followed by drill diameter (18.8%), and abrasive particle size (14.3%); whereas, the feed rate contributed minimal (4%) temperature rise.