Surgical Needle Research Articles

MAK Bends and MAK Stops: An Innovative Way to put Bends and Stops in NiTi Archwires

Introduction : It is difficult to bend NiTi wire because of its shape memory properties. Although prefabricated NiTi archwires, such as the Connecticut Intrusion Arch or utility archwire are available, there is no simple, economic method available to incorporate first or second order bends in NiTi wires. Similarly there is no simple, economic and reliable method available to place stops in NiTi archwires. A simple creative method of using sterile disposable surgical needle segments as archwire stops (Makhija, Abhishek, Kamna or MAK stops) and archwire bends (MAK bends) is demonstrated. These may be adapted as custom stops and bends in NiTi archwires for fabricating intrusion, extrusion, expansion and distalization archwires. Materials and methods: Fresh unused, sterile, disposable,18 to 23 gauge surgical needles are segmented using a diamond cutting disk to use as crimpable stops (MAK stops), stops of varying length may also be bent with optical pliers to incorporate bends in NiTi wires (MAK bends). Conclusion: MAK stops and MAK bends are simple, easy and an economical chairside method to incorporate a range of applications which, overcome some of issues with formability of NiTi wires.

A novel suture‐based method for efficient transplantation of stem cells

Advances in regenerative medicine have improved the potential of using cellular therapy for treating several diseases. However, the effectiveness of new cellular therapies is largely limited by low cell engraftment and inadequate localization. To improve on these limitations, we developed a novel delivery mechanism using cell-seeded biological sutures. We demonstrate the ability of cell-seeded biological sutures to efficiently implant human mesenchymal stem cells (hMSCs) to specific regions within the beating heart; a tissue known to have low cell retention and engraftment shortly after delivery. Cell-seeded biological sutures were developed by bundling discrete microthreads extruded from extracellular matrix proteins, attaching a surgical needle to the bundle and seeding the bundle with hMSCs. During cell preparation, hMSCs were loaded with quantum dot nanoparticles for cell tracking within the myocardium. Each biological suture contained an average of 5903 ± 1966 hMSCs/cm suture length. Delivery efficiency was evaluated by comparing cell-seeded biological suture implantation with intramyocardial (IM) cell injections (10,000 hMSCs in 35 μL) into the left ventricle of normal, noninfarcted rat hearts after 1 h. Delivery efficiency of hMSCs by biological sutures (63.6 ± 10.6%) was significantly higher than IM injection (11.8 ± 6.2%; p < 0.05). Cell-tracking analysis indicated suture-delivered hMSCs were found throughout the thickness of the ventricular myocardium: along the entire length of the biological suture track, localizing closely with native myocardium. These results suggest cell-seeded biological sutures can deliver cells to the heart more efficiently than conventional methods, demonstrating an effective delivery method for implanting cells in soft tissue.

Fluid Biopsy for Solid Tumors: A Patient’s Companion for Lifelong Characterization of Their Disease

Cancer is currently diagnosed and treated based on the results of a tissue biopsy of the primary tumor or a metastasis using invasive techniques such as surgical resection or needle biopsy. New technology for retrieving cancer cells from the circulation, developed in the last 5 years, has made it possible to obtain a 'fluid biopsy' from the bloodstream without the need for an invasive procedure. This technological development makes it possible to diagnose and manage cancer from a blood test rather than from a traditional biopsy. It also allows the repeated sampling of cancer cells from a patient, making it possible, in a practical manner, to interrogate the disease repeatedly in order to understand the mechanisms by which cancer cells evolve within a given individual. The ability to obtain cancer cells repeatedly also has the potential to substantially advance drug development by enabling early ex vivo validation of both targets and early-stage compounds, as well as creating new efficiencies in the drug development process during clinical trials.

A rare case of homicidal insecticide (organochloro compound) poisoning by intraperitoneal injection

We report a case of a 52-year-old businessman who was allegedly injected with organochloro compound (OC) in his abdomen by his business rivals by means of a surgical needle and a syringe. Homicide by OC injection via an intraperitoneal route has not been reported in the literature. Postmortem findings along with the toxicology report have been discussed particularly in view of the mode of poison administration with a review of literature.

Immunohistochemical detection of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 in formalin‐fixed breast carcinoma cell block preparations: Correlation of results to corresponding tissue block (needle core and excision) samples

Evaluation of ER, PR and Her 2 are routinely performed on breast carcinomas. For accurate detection of these markers, compliance with the ASCO/CAP guidelines is recommended. Our previous study showed that alcohol fixation did not affect ER results when alcohol-fixed cell block (CB) sections were compared to formalin-fixed tissue sections, while PR and Her2 showed less concordance. The aim of this study was to evaluate and to compare ER, PR and Her2 IHC results on formalin-fixed CB sections to those observed on subsequent surgical (needle core or resection) specimens (SS). Fifty cases of formalin fixed CB samples obtained from primary (18%) and metastatic (82%) breast carcinomas were studied, all of which had subsequent SS available. ER, PR, and Her2 IHC studies were done on all samples and results were compared. ER results on formalin-fixed CB samples showed excellent correlation with SS (correlation coefficient cc = 0.82). While there was minimal improvement in PR results (cc = 0.433), Her2 detection did not improve by formalin fixation (cc = 0.439). Formalin fixation for CB preparations does not significantly improve the already good detection of ER positive breast tumors. The concordance rate in PR and IHC results between formalin-fixed CB and SS samples showed improvement as compared with the alcohol-fixed CB results. However, there was no improvement in detection of Her2 overexpression by using formalin fixation on cytology specimens.

Sacrospinous Ligaments Anterior Apical Anchoring for Needle-guided Mesh is a Safe Option: A Cadaveric Study

To evaluate the feasibility and safety of using the sacro-spinous ligament (SSL) as a fixation point for anterior-apical pelvic floor compartment mesh implants. The apical support achieved with the sacro-spinous ligament mesh fixation is considered adequate, as it provides a high and stronger anchoring point. Even though, meshes for anterior pelvic floor reconstruction are traditionally anchored to the arcus tendineous fascia pelvis (ATFP). The authors presumed that fixing the anterior mesh to the sacro-spinous ligament instead of the ATFP is both feasible and safe. The present study evaluated the anatomical aspects and relations of a modified tissue passage with sacro-spinous fixation of the anterior apical mesh arms. In 5 embalmed female cadavers and 1 fresh female cadaver, the apical arms of the anterior needle-guided mesh were placed through the SSLs rather than through the ATFP, using a transgluteal approach. The distances between the mesh arms and the ureters and uterine arteries were measured. The minimal final distance between the mesh arms and the ureters or uterine arteries was 1.5 cm in the embalmed cadavers, but only 5 mm in the fresh cadaver. However, when analyzing the procedure carefully, it was noted that during dissection the ureters and arteries were pushed medially by the surgeon's finger, thus the operative procedure did not entail any real risk of injury to these structures. The introduced surgical needle caused no trauma to any adjacent cadaveric organs. Anterior pelvic floor meshes may be safely anchored to the SSL, thus potentially improving the apical support.

Electro Thermomechanical Behavior of a Smart Actuator for an Active Surgical Needle

A large and increasing number of cancer interventions, including both diagnosis and therapy, involve precise placement of needles. The challenge in most of the existing needle-based procedures is the safe and accurate navigation of the needle through tissue to the desired target. This challenge is due to lack of proper actuation of the needle (i.e., actuated from the proximal end, which is far away from the needle tip). To overcome this challenge, we propose to bend the needle using a smart actuator that applies bending forces on the needle body; thereby, improving the navigation of the needle. The smart actuator is designed with shape memory alloy (SMA) wires due to their unique properties such as superelasticity, shape memory effect, and biocompatibility. These wires, connected on the needle, can be heated with resistance heating to produce relatively large forces that can bend the needle. However, predicting the actuation forces is difficult due to their coupled thermomechanical effects. Therefore, this study will experimentally and numerically evaluate the feasibility of the SMA wires for the smart actuator.

A Novel Force Modeling Scheme for Needle Insertion Using Multiple Kalman Filters

In this paper, the interaction force between a surgical needle and soft tissue is studied. The force is modeled using a novel nonlinear dynamic model. Encouraged by the LuGre model for representing friction forces, the proposed model captures all stages of needle-tissue interaction, including puncture, cutting, and friction forces. An estimation algorithm for identifying the parameters of the model is presented. This online approach, which is based on sequential extended Kalman filtering, enables us to characterize the total contact force using an efficient mathematical model. The algorithm compares the axial force measured at the needle base with its expected value and then adapts the model parameters to represent the actual interaction force. While the nature of this problem is very complex, the use of multiple Kalman filters makes the system highly adaptable for capturing the force evolution during an interventional procedure in standard operating conditions. To evaluate the performance of our model, experiments were performed on artificial phantoms.

Simulação humana digital na concepção de postos de trabalho: estudo comparativo de casos

Este artigo apresenta como a ferramenta computacional de Modelagem e Simulação Humana contextualizada pela Análise Ergonômica do Trabalho (AET) e pela análise da Atividade Futura Possível pode auxiliar nos processos de projeto de postos de trabalho. São analisados dois estudos de caso nos quais a Simulação Humana foi empregada com auxílio do software Jack. O primeiro estudo aborda a concepção de um balcão de atendimento em uma empresa pública de serviços postais. O segundo apresenta o desenvolvimento de uma estação de trabalho de abastecimento de agulhas cirúrgicas em uma empresa de manufatura de produtos relacionados às áreas de saúde e higiene. A partir dos resultados dos estudos de caso, são explicitadas as contribuições e desafios da utilização dessa tecnologia em projetos visando equacionar as questões de saúde e produtividade. O uso da simulação integrada ao processo de intervenção da AET permitiu melhorar a antecipação das futuras atividades prováveis das novas situações de trabalho e auxiliou a integração e comunicação dos atores envolvidos nesses processos sociais.

519 ロボットを用いた外科運針動作のモデル化 : 第1報,刺入点を基点とする運針法の提案

519 ロボットを用いた外科運針動作のモデル化 : 第1報,刺入点を基点とする運針法の提案

520 ロボットを用いた外科運針動作のモデル化 : 第2報,刺入点を基点とした運針法における組織損傷の解析

520 ロボットを用いた外科運針動作のモデル化 : 第2報,刺入点を基点とした運針法における組織損傷の解析

Characterization of ultrasound elevation beamwidth artifacts for prostate brachytherapy needle insertion

Ultrasound elevation beamwidth leads to image artifacts and uncertainties in localizing objects (such as a surgical needle) in ultrasound images. The authors examined the clinical significance of errors caused by elevation beamwidth artifacts and imaging parameters in needle insertion procedures. Beveled prostate brachytherapy needles were inserted through all holes of a grid template under real-time transrectal ultrasound (TRUS) guidance. The needle tip position as indicated by the TRUS image was compared to their observed physical location. A new device was developed to measure the ultrasound elevation beamwidth. Imaging parameters of the TRUS scanner have direct impact on the localization error ranging from 0.5 up to 4 mm. The smallest localization error was observed laterally close to the center of the grid template and axially within the beam's focal zone. Largest localization error occurs laterally around both sides of the grid template and axially within the beam's far field. The authors also found that the localization errors vary with both lateral and elevation offsets. The authors found properly adjusting the TRUS imaging settings to lower the ultrasound gain and power effectively minimized the appearance of elevation beamwidth artifacts and in turn reduced the localization errors of the needle tip.

The Retained Surgical Specimen, an Unappreciated Retained Foreign Object

A retained foreign object is a preventable surgical error and has typically been considered a surgical instrument, needle, or sponge. A new retained surgical object is a retained surgical specimen (RSS). This case study outlines the nature of the RSS, the paradigm shift that has led to this becoming a new healthcare error, and steps to prevent this new type of retained object from occurring.

Improving breast cancer care through a regional quality collaborative

Regional collaborative organizations provide an effective structure for improving the quality of surgical care. With low complication rates and a long latency between surgical care and outcomes such as survival and local recurrence, quality measurement in breast cancer surgery is ideally suited to process measures. Diagnostic biopsy technique for breast cancer diagnosis is measurable and amenable to change at the provider level. We present initial results from our analysis of institutional variation in surgical and core needle biopsy use within a regional breast cancer quality collaborative. Established in 2006, the Michigan Breast Oncology Quality Initiative (MiBOQI) consists of 18 hospitals collecting data on breast cancer care using the National Comprehensive Cancer Centers Network (NCCN) Oncology Outcomes Database Project platform to analyze and compare breast cancer practices and outcomes amongst member institutions. Institutional review board approval is obtained at each site. Data are submitted electronically to the NCCN and analyzed for concordance with practice guidelines. Aggregate and blinded data are shared with project directors and institutions at collaborative meetings, and ongoing practice patterns are observed for change. We analyzed variation in breast biopsy technique for initial cancer diagnosis over time and between institutions. Diagnostic biopsies were categorized as core needle, surgical excisional, surgical incisional, and other surgical biopsy. Procedural data for 8,066 patients treated for breast cancer between November 1, 2006 and December 31, 2009 were analyzed. The mean patient age was 59.5 years (range, 25.4-90.0 years). Within MiBOQI, 21% of patients underwent surgical biopsy for initial diagnosis. The percentage of patients undergoing surgical biopsy ranged from 8% to 37%, and the majority of surgical biopsies were classified as excisional biopsies. Patients with ductal carcinoma in situ were more likely to undergo surgical biopsy compared to those with invasive cancer (30.4% vs 17.8%; P < .001). There was no association between biopsy type and patient age, race, or comorbidity. Data on biopsy technique were shared with site project directors and a target surgical biopsy rate of <15% was chosen by consensus. Site project directors disseminated the data to their institutions and developed action plans for provider and patient education. Over the study period, the percentage of cases undergoing surgical biopsy for the entire MiBOQI collaborative decreased from 21% to 15% (P < .001). The regional quality collaborative model can be used to collect, analyze, and disseminate surgical breast care quality data to organizations and treating physicians. These data can be used to describe patterns of care and make comparisons over time and between organizations. These data can also be used to set regional quality standards and provide an avenue for physician-led quality improvement.

Finding a Lost Needle in Laparoscopic Surgery

A lost needle during laparoscopic surgery is an uncommon major surgical problem. Finding and retrieval can be a challenge, whereas failure to do so carry potentially serious clinical and medicolegal implications. This study aims to investigate the application of a new device to retrieve lost needles intraoperatively compared with traditional management. A literature search was performed to locate articles on lost surgical needles associated with laparoscopic surgery. A laparoscopic magnet was designed and tested based on a case report and an animal experiment. The laparoscopic magnet was a fast and safe method for retrieval of lost surgical needles during laparoscopic surgery. Lost needles during laparoscopic surgery can be located and retrieved by various methods. We found the laparoscopic magnet to be the safest and most efficient way of retrieving lost needles intraoperatively.

Detection of electric treeing of solid dielectrics with the method of acoustic emission

The paper presents results of research of electrical treeing of solid dielectrics with the method of acoustic emission (AE). The study was performed with an alternating voltage of 50 Hz in the range up to 21 kV (RMS) on methyl polymethacrylate or crosslinked polyethylene samples. They were of cuboidal shape of the dimensions 25 × 10 × 4 mm. One of the cuboid sample walls of the dimensions 25 × 4 mm was covered with a conducting paint. On the opposite wall, a surgical needle of T-25 type was screwed. The distance between the electrodes (the needle and the wall covered with a conducting paint) was in the range 0.5–2.0 mm. Registered signals were denoised with wavelet transformation method and then there were analyzed. The following parameters were analyzed: a sum and rate of acoustic emission counting, a sum and rate of acoustic emission events, RMS value of the electric signal leaving the converter. Spectrum and spectrogram were also analyzed. It was found that AE signals are generated during electrical treeing of solid dielectrics. Values of chosen parameters increased their values when the process begins. There are also some dominant frequencies ranges, different for different kinds of dielectrics, connected with the treeing.

The effect of surgical preparation technique on the bacterial load of surgical needles and suture material used during strabismus surgery

To investigate the effectiveness of 3 surgical preparation techniques in decreasing bacterial contamination of needles and suture material during strabismus surgery. Consecutive patients requiring 2-muscle strabismus surgery were randomized into 1 of 3 groups. In Group A, patients' periocular skin and bulbar conjunctivae underwent preparation with 5% povidone-iodine; the drape was placed without regard to eyebrows; and an open wire-loop lid speculum was used. Group B patients underwent the same preparation as Group A patients; however, the eyelashes and eyebrows were scrubbed with 5% povidone-iodine on cotton tip applicators, and the drape was placed to exclude the eyebrows from the surgical field. Group C patients underwent the same preparation as Group B patients; however, a bladed lid speculum was used during surgery to exclude some of the eyelashes from the surgical field. After the procedure, all needles and suture materials were sent separately for aerobic culture. The data were analyzed for differences in contamination rates between the groups. Of 77 patients, 24 (31.4%) had either a needle and/or suture contaminant. Groups A, B, and C had mean contamination rates of 29.6%, 34.6%, and 29.2%, respectively. There was no significant statistical variation in contamination among the 3 groups. The most common organism identified was a coagulase-negative staphylococcus strain. More meticulous sterile preparation of the surgical field did not result in a meaningful reduction in suture or needle contamination rates during strabismus surgery.

Neural mechanism of activity spread in the cat motor cortex and its relation to the intrinsic connectivity

Motor cortical points are linked by intrinsic horizontal connections having a recurrent network topology. However, it is not known whether neural activity can propagate over the area covered by these intrinsic connections and whether there are spatial anisotropies of synaptic strength, as opposed to synaptic density. Moreover, the mechanisms by which activity spreads have yet to be determined. To address these issues, an 8 × 8 microelectrode array was inserted in the forelimb area of the cat motor cortex (MCx). The centre of the array had a laser etched hole ∼500 μm in diameter. A microiontophoretic pipette, with a tip diameter of 2-3 μm, containing bicuculline methiodide (BIC) was inserted in the hole and driven to a depth of 1200-1400 μm from the cortical surface. BIC was ejected for ∼2min from the tip of the micropipette with positive direct current ranging between 20 and 40 nA in different experiments. This produced spontaneous nearly periodic bursts (0.2-1.0 Hz) of multi-unit activity in a radius of about 400 μm from the tip of the micropipette. The bursts of neural activity spread at a velocity of 0.11-0.24 ms⁻¹ (mean=0.14 mm ms⁻¹, SD=0.05)with decreasing amplitude.The area activated was on average 7.22 mm² (SD=0.91 mm²), or ∼92% of the area covered by the recording array. The mode of propagation was determined to occur by progressive recruitment of cortical territory, driven by a central locus of activity of some 400 μm in radius. Thus, activity did not propagate as a wave. Transection of the connections between the thalamus and MCx did not significantly alter the propagation velocity or the size of the recruited area, demonstrating that the bursts spread along the routes of intrinsic cortical connectivity. These experiments demonstrate that neural activity initiated within a small motor cortical locus (≤ 400 μm in radius) can recruit a relatively large neighbourhood in which a variety of muscles acting at several forelimb joints are represented. These results support the hypothesis that the MCx controls the forelimb musculature in an integrated and anticipatory manner based on a recurrent network topology

Neurosensory tissue morphology with intraoperative optical fiber probe in aqueous medium

In this work, the author has demonstrated cross-sectional imaging of a retina of an ex vivo fish sample using a common path frequency domain optical coherence tomography at 0.8 μm range. It has been introduced that an integrated surgical hypodermic needle fiber probe can stabilize the flexible glass optical fiber and provides a close proximity to the specimen for intraoperative image guiding. In addition, the light source characteristics were matched to the common path interferometer while operating in the aqueous medium (saline solution), in order to mimic the in vivo condition, in that it shows greater bandwidth and shorter center wavelength for larger input current or output power to sustain the appropriate level of coherence reference peak by the partial reflection at the glass fiber probe interface.

Ophthalmic practice health hazards among ophthalmologists in a resource–limited setting

Objective To determine ophthalmic practice health hazards among ophthalmologists in a resource-limited setting. Methods The study was conducted through a cross-sectional survey of 53 ophthalmologists' experiences on ophthalmic practice health hazards using semi-structured questionnaire. Results Most practitioners felt eye surgical procedures 40 (75.5%) and examination of eye patients (62.3%) were potentially hazardous to practitioners and, 49 (92.5%) thought clerking was not. Most, 92.5% had experienced patients' halitosis/cough during ophthalmoscopy and, 77.4% experienced hand smeared with patients' eye discharges/tears. Important health hazards experiences included, having contacted systemic diseases (5.7%) and infective eye diseases (18.9%), knife cut during surgical procedure (7.6%), needle pricks (49.1%) and hand smeared with patients' blood (49.1%). Others were neck pain at ophthalmoscopy (35.9%), blurred vision at retinoscopy (20.8%) and hoarseness while performing visual acuities (1.9%). Conclusions Eye practitioners are exposed to hazards in their practice including potentially life threatening ones. Necessary precautions at work, use of hazard free ophthalmic equipment and working conditions would reduce hazards in ophthalmic practice.