Surgical Tools Research Articles

Imaging of aqueous outflow in health and glaucoma. Justifying the re-direction of aqueous.

A wave of less invasive surgical options that target or bypass the conventional aqueous outflow system has been incorporated into routine clinical practice to mitigate surgical risks associated with traditional glaucoma drainage surgery. A blanket surgical approach for open-angle glaucoma is unlikely to achieve the desired IOP reduction in an efficient or economical way. Developing a precise approach to selecting the most appropriate surgical tool for each patient is dependent upon understanding the complexities of the aqueous outflow system and how devices influence aqueous drainage. However, homoeostatic control of aqueous outflow in health and glaucoma remains poorly understood. Emerging imaging techniques have provided an opportunity to study aqueous outflow responses non-invasively in clinic settings. Haemoglobin Video Imaging (HVI) studies have demonstrated different patterns of aqueous outflow within the episcleral venous system in normal and glaucomatous eyes, as well as perioperatively after trabecular bypass surgery. Explanations for aqueous outflow patterns remain speculative until direct correlation with findings from Schlemm's canal and the trabecular meshwork are possible. The redirection of aqueous via targeted stent placement may only be justifiable once the role of the aqueous outflow system in IOP homoeostasis has been defined.

Non-navigated 2D intraoperative ultrasound: An unsophisticated surgical tool to achieve high standards of care in glioma surgery.

In an era characterized by rapid progression in neurosurgical technologies, traditional tools such as the non-navigated two-dimensional intraoperative ultrasound (nn-2D-IOUS) risk being overshadowed. Against this backdrop, this study endeavors to provide a comprehensive assessment of the clinical efficacy and surgical relevance of nn-2D-IOUS, specifically in the context of glioma resections. This retrospective study undertaken at a single center evaluated 99 consecutive, non-selected patients diagnosed with both high-grade and low-grade gliomas. The primary objective was to assess the proficiency of nn-2D-IOUS in generating satisfactory image quality, identifying residual tumor tissue, and its influence on the extent of resection. To validate these results, early postoperative MRI data served as the reference standard. The nn-2D-IOUS exhibited a high level of effectiveness, successfully generating good quality images in 79% of the patients evaluated. With a sensitivity rate of 68% and a perfect specificity of 100%, nn-2D-IOUS unequivocally demonstrated its utility in intraoperative residual tumor detection. Notably, when total tumor removal was the surgical objective, a resection exceeding 95% of the initial tumor volume was achieved in 86% of patients. Additionally, patients in whom residual tumor was not detected by nn-2D-IOUS, the mean volume of undetected tumor tissue was remarkably minimal, averaging at 0.29 cm3. Our study supports nn-2D-IOUS's invaluable role in glioma surgery. The results highlight the utility of traditional technologies for enhanced surgical outcomes, even when compared to advanced alternatives. This is particularly relevant for resource-constrained settings and emphasizes optimizing existing tools for efficient patient care. NCT05873946 - 24/05/2023 - Retrospectively registered.

Comparison of Outcome of Laparoscopic and Open Inguinal Hernioplasty

Objective: To determine the outcome of Open and laparoscopic Inguinal Hernioplasty. Study Design: Comparative prospective study. Place and Duration of Study: Department of Surgery Combined Military Hospital, Multan Pakistan, from Sep 2021 to Oct 2022. Methodology: One hundred patients were enrolled and divided into Group-A and Group-B based on a technique used. Patents with a working diagnosis of inguinal hernia aged 13 to 90 years were included in the study. The data was collectedbfrom the participants at one week and six months post-operatively. Results: The mean age of patients was 43.87±13.63 years. The mean operative time was 70.5±10.48 minutes. The mean hospital stay was 1.88±0.79 days. The median post-op pain at 0 hours was 2(2 – 1); at 6 hours was 4(6 – 3); at 12 hours was 5(5 – 4) and at 24 hours was 5(6-3). Conclusion: The laparoscopic surgical technique is a wonderful addition to the surgical tool kit of a surgeon. When performed by experienced persons, there is speedy recovery and reduced hospital stay with minimal morbidity and mortality. It is highly recommended for inguinal hernioplasty.

An analysis on the effect of body tissues and surgical tools on workflow recognition in first person surgical videos.

Analysis of operative fields is expected to aid in estimating procedural workflow and evaluating surgeons' procedural skills by considering the temporal transitions during the progression of the surgery. This study aims to propose an automatic recognition system for the procedural workflow by employing machine learning techniques to identify and distinguish elements in the operative field, including body tissues such as fat, muscle, and dermis, along with surgical tools. We conducted annotations on approximately 908 first-person-view images of breast surgery to facilitate segmentation. The annotated images were used to train a pixel-level classifier based on Mask R-CNN. To assess the impact on procedural workflow recognition, we annotated an additional 43,007 images. The network, structured on the Transformer architecture, was then trained with surgical images incorporating masks for body tissues and surgical tools. The instance segmentation of each body tissue in the segmentation phase provided insights into the trend of area transitions for each tissue. Simultaneously, the spatial features of the surgical tools were effectively captured. In regard to the accuracy of procedural workflow recognition, accounting for body tissues led to an average improvement of 3 % over the baseline. Furthermore, the inclusion of surgical tools yielded an additional increase in accuracy by 4 % compared to the baseline. In this study, we revealed the contribution of the temporal transition of the body tissues and surgical tools spatial features to recognize procedural workflow in first-person-view surgical videos. Body tissues, especially in open surgery, can be a crucial element. This study suggests that further improvements can be achieved by accurately identifying surgical tools specific to each procedural workflow step.

Developing a phantom for simulating robotic-assisted complete mesocolic excision using 3D printing and medical imaging

BackgroundRobotic-assisted complete mesocolic excision is an advanced procedure mainly because of the great variability in anatomy. Phantoms can be used for simulation-based training and assessment of competency when learning new surgical procedures. However, no phantoms for robotic complete mesocolic excision have previously been described. This study aimed to develop an anatomically true-to-life phantom, which can be used for training with a robotic system situated in the clinical setting and can be used for the assessment of surgical competency.MethodsEstablished pathology and surgical assessment tools for complete mesocolic excision and specimens were used for the phantom development. Each assessment item was translated into an engineering development task and evaluated for relevance. Anatomical realism was obtained by extracting relevant organs from preoperative patient scans and 3D printing casting moulds for each organ. Each element of the phantom was evaluated by two experienced complete mesocolic excision surgeons without influencing each other’s answers and their feedback was used in an iterative process of prototype development and testing.ResultsIt was possible to integrate 35 out of 48 procedure-specific items from the surgical assessment tool and all elements from the pathological evaluation tool. By adding fluorophores to the mesocolic tissue, we developed an easy way to assess the integrity of the mesocolon using ultraviolet light. The phantom was built using silicone, is easy to store, and can be used in robotic systems designated for patient procedures as it does not contain animal-derived parts.ConclusionsThe newly developed phantom could be used for training and competency assessment for robotic-assisted complete mesocolic excision surgery in a simulated setting.

Endo-Surgical Force Feedback System Design for Virtual Reality Applications in Medical Planning

Virtual reality (VR) applications for surgical planning and mentoring are currently becoming more widespread. Within these fields of applications, haptic systems are crucial to help the understanding of the feedback provided by the tissue during the interaction with the surgical tool. The accuracy of the VR scenario is related to many aspects, among them the ability of the haptic device to provide the force feedback and thus the adoption of proper characterization and modeling of the soft tissue behavior during deformation. This paper presents the current development concerning a VR environment to be equipped with a force feedback haptic device to simulate and experience clamping in colorectal surgery. The reaction at the clamp handle is provided starting from a FEA of the contact between the surgical tool and the tissue, coupled with the kinematic analysis of the mechanism. Connecting the virtual scenario to a microcontroller board, the reaction force is applied to the the haptic device, shaped as a clamping tool handle, so that the user may experience the tissue impedence during clamping. By simulations made through Simscape, a concept is evaluated according to some simulation paths that involve common scenarios of the virtual reality experience (such as collision, partial or total clamping operation). The novelty of the research regards the system design oriented to increase the accuracy of the soft tissue material behaviour through a preliminary off-line dedicated FEA investigation. Through Simulink simulations, the system design is verified so that the VR system set-up may be carried out. The results highlighted: (a) a good correspondence among the theoretical study of the reference kinematism that the haptic device must reproduce; (b) the implementation of a bilinear material model, derived off-line from FEA, is suitable to capture hyperelastic and geometric non-linearities of the soft tissue; (c) the feasibility of the open loop haptic control in accordance to the explored kinematism. The final goal of the research is to propose a system design approach able to tune the VR experince for teaching and mentoring through a in-house set-up easy to be tailored.

NeuroIGN: Explainable Multimodal Image-Guided System for Precise Brain Tumor Surgery.

Precise neurosurgical guidance is critical for successful brain surgeries and plays a vital role in all phases of image-guided neurosurgery (IGN). Neuronavigation software enables real-time tracking of surgical tools, ensuring their presentation with high precision in relation to a virtual patient model. Therefore, this work focuses on the development of a novel multimodal IGN system, leveraging deep learning and explainable AI to enhance brain tumor surgery outcomes. The study establishes the clinical and technical requirements of the system for brain tumor surgeries. NeuroIGN adopts a modular architecture, including brain tumor segmentation, patient registration, and explainable output prediction, and integrates open-source packages into an interactive neuronavigational display. The NeuroIGN system components underwent validation and evaluation in both laboratory and simulated operating room (OR) settings. Experimental results demonstrated its accuracy in tumor segmentation and the success of ExplainAI in increasing the trust of medical professionals in deep learning. The proposed system was successfully assembled and set up within 11min in a pre-clinical OR setting with a tracking accuracy of 0.5 (± 0.1) mm. NeuroIGN was also evaluated as highly useful, with a high frame rate (19 FPS) and real-time ultrasound imaging capabilities. In conclusion, this paper describes not only the development of an open-source multimodal IGN system but also demonstrates the innovative application of deep learning and explainable AI algorithms in enhancing neuronavigation for brain tumor surgeries. By seamlessly integrating pre- and intra-operative patient image data with cutting-edge interventional devices, our experiments underscore the potential for deep learning models to improve the surgical treatment of brain tumors and long-term post-operative outcomes.

Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation.

To quantify the environmental impact of standard direct laryngoscopy surgery and model the environmental benefit of three feasible alternative scenarios that meet safe decontamination reprocessing requirements. This is a life cycle assessment (LCA) modeling study. Yale-New Haven Hospital (YNHH), a 1541-bed tertiary medical center in New Haven, Connecticut, USA. We performed cradle-to-grave LCA of DLS at Yale New Haven Hospital in 2022, including global warming potential (GWP), water consumption, and fine particulate matter formation. Three alternative scenarios were modeled: disinfecting surgical tools using high-level disinfection rather than steam sterilization, substituting non-sterile for sterile gloves and gowns; and reducing surgical towel and drape sizes by 30%. Changes in disinfection practices would decrease procedure GWP by 11% in each environmental impact category. Substituting non-sterile gowns and gloves reduced GWP by 15%, with nominal changes to water consumption. Linen size reduction resulted in 28% less procedure-related water consumption. Together, a nearly 30% reduction across all environmental impact categories could be achieved. Not exceeding minimum Center for Disease Control (CDC) decontamination standards for reusable devices and optimizing non-sterile consumable materials could dramatically reduce healthcare-associated emissions without compromising safety, thereby minimizing the negative consequences of hospital operations to environmental and human health. Findings extend to other non-sterile surgical procedures. NA Laryngoscope, 134:3206-3214, 2024.

Time-resolved fluorescence and diffuse reflectance for lung squamous carcinoma margin detection.

A major challenge in non-small cell lung cancer surgery is the occurrence of positive tumor margins. This may lead to the need for additional surgeries and has been linked to poor patient prognosis. This study aims to develop an in vivo surgical tool that can differentiate cancerous from noncancerous lung tissue at the margin. A time-resolved fluorescence and diffuse reflectance bimodal device was used to measure the lifetime, spectra, and intensities of endogenous fluorophores as well as optical properties of lung tissue. The tumor and fibrotic tissue data, each containing 36 samples, was obtained from patients who underwent surgical removal of lung tissue after being diagnosed with squamous carcinoma but before any other treatment was administered. The normal lung tissue data were obtained from nine normal tissue samples. The results show a statistically significant difference between cancerous and noncancerous tissue. The results also show a difference in metabolic related optical properties between fibrotic and normal lung tissue samples. This work demonstrates the feasibility of a device that can differentiate cancerous and noncancerous lung tissue for patients diagnosed with squamous cell carcinoma.

Usefulness of Robotic Stereotactic Assistance (ROSA®) Device for Stereoelectroencephalography Electrode Implantation: A Systematic Review and Meta-analysis.

The aim of this study was to systematically review and meta-analyze the efficiency and safety of using the Robotic Stereotactic Assistance (ROSA®) device (Zimmer Biomet; Warsaw, IN, USA) for stereoelectroencephalography (SEEG) electrode implantation in patients with drug-resistant epilepsy. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was carried out. Overall, 855 nonduplicate relevant articles were determined, and 15 of them were selected for analysis. The benefits of the ROSA® device use in terms of electrode placement accuracy, as well as operative time length, perioperative complications, and seizure outcomes, were evaluated. Studies that were included reported on a total of 11,257 SEEG electrode implantations. The limited number of comparative studies hindered the comprehensive evaluation of the electrode implantation accuracy. Compared with frame-based or navigation-assisted techniques, ROSA®-assisted SEEG electrode implantation provided significant benefits for reduction of both overall operative time (mean difference [MD], -63.45 min; 95% confidence interval [CI] from -88.73 to -38.17 min; P < 0.00001) and operative time per implanted electrode (MD, -8.79 min; 95% CI from -14.37 to -3.21 min; P = 0.002). No significant differences existed in perioperative complications and seizure outcomes after the application of the ROSA® device and other techniques for electrode implantation. To conclude, the available evidence shows that the ROSA® device is an effective and safe surgical tool for trajectory-guided SEEG electrode implantation in patients with drug-resistant epilepsy, offering benefits for saving operative time and neither increasing the risk of perioperative complications nor negatively impacting seizure outcomes.

The Sonopet iQ® Ultrasonic Bone Aspirator in Craniofacial Surgery: A Scoping Review and Qualitative Analysis

Background: The Sonopet iQ® Ultrasonic Aspirator is a surgical tool used for the fragmentation and emulsification of bone and soft tissue. Ultrasonic vibrations emulsify bone with cited benefits of decreased damage to surrounding soft tissue and minimal heat dispersion. Despite these potential benefits, there is a paucity of published articles on the safety and efficacy of the Sonopet® in the setting of craniofacial surgery. Methods: In accordance with PRISMA guidelines, MEDLINE and Pubmed were searched for articles that studied use of the Sonopet® for osteotomies in the craniofacial setting. Studies exclusively investigating soft tissue aspiration were excluded. Results: Out of 61 articles discovered, 22 met inclusion criteria and discussed a total of 816 patients. Of the 22 articles, there were 8 retrospective chart reviews, 7 case series, 5 cadaver models, and 2 case reports. Studies spanned multiple disciplines including otolaryngology, ophthalmology, craniofacial surgery, neurosurgery, and oral and maxillofacial surgery. Despite its frequent use in orthognathic and cranial vault remodeling surgery, only 4 studies described its use in these fields. The most commonly cited benefits of the Sonopet® were enhanced ergonomics and safety, discussed in 20 of the included studies. Eighteen studies claimed the Sonopet® was safer to use in surgically tight spaces compared to traditional drills. Four studies found decreased bone dust generation by the Sonopet® compared to conventional cutting devices. No studies reported an increase in postoperative complications due to the device. The most commonly cited disadvantage was the cost of the device, however, the majority of authors believed the benefits of the device outweighed the increase in cost. Conclusions: There is a dearth of research investigating the use of the Sonopet® in craniofacial surgery. Available studies emphasize the ergonomic and safety benefits of the Sonopet® and encourage expanded use of the device despite its cost.

Should Current Laws Be Revised to Address Occupational Hazards Caused by Hand-Tool Size Mismatch Among Surgeons?

This Viewpoint discusses the challenges faced by surgeons with a smaller hand size—and women in particular—when using surgical tools designed for larger hands and explores potential legal remedies to address these challenges.

3D and 4D printing of biomedical materials: current trends, challenges, and future outlook

Three-dimensional (3D) and four-dimensional (4D) printing have emerged as the next-generation fabrication technologies, covering a broad spectrum of areas, including construction, medicine, transportation, and textiles. 3D printing, also known as additive manufacturing (AM), allows the fabrication of complex structures with high precision via a layer-by-layer addition of various materials. On the other hand, 4D printing technology enables printing smart materials that can alter their shape, properties, and functions upon a stimulus, such as solvent, radiation, heat, pH, magnetism, current, pressure, and relative humidity (RH). Myriad of biomedical materials (BMMs) currently serve in many biomedical engineering fields aiding patients’ needs and expanding their life-span. 3D printing of BMMs provides geometries that are impossible via conventional processing techniques, while 4D printing yields dynamic BMMs, which are intended to be in long-term contact with biological systems owing to their time-dependent stimuli responsiveness. This review comprehensively covers the most recent technological advances in 3D and 4D printing towards fabricating BMMs for tissue engineering, drug delivery, surgical and diagnostic tools, and implants and prosthetics. In addition, the challenges and gaps of 3D and 4D printed BMMs, along with their future outlook, are also extensively discussed. The current review also addresses the scarcity in the literature on the composition, properties, and performances of 3D and 4D printed BMMs in medical applications and their pros and cons. Moreover, the content presented would be immensely beneficial for material scientists, chemists, and engineers engaged in AM manufacturing and clinicians in the biomedical field. Graphical abstract. 3D and 4D printing towards biomedical applications

A Simple Procedure of Fascia-Fat Grafting and Blepharoplasty as a Single-Stage Procedure for the Correction of Sunken Eyelids in Vietnamese Population.

Upper sunken eyelids, which are characterized by the hollowness of the upper eyelids, often cause a poor aesthetic appearance. Herein, we present a simplified technique using fascia-fat grafts for volume augmentation combined with blepharoplasty as a single-stage procedure. From January 2021 to December 2021, 30 patients with sunken eyelids visiting our clinic for hollow eyelid treatment underwent a fascia-fat grafting derived from the inguinal crease combined with simultaneous eyelid reconstruction. A modified classification of sunken eyelids that was more suitable for the Asian population was proposed. Postoperatively, edema and ptosis were transient and addressed thanks to proper massage and compresses. Two cases had scar fibers leading to a slight tension of upper eyelids at 6-month follow-up. This event was addressed by triamcinolone acetonide injections at 4-6-week intervals with satisfactory results. The orbital volume of all patients was satisfying and stable up to 12 months after the surgery. The satisfaction rate was 100% and 88.8% in group 1 and group 2, respectively, at 12-month follow-up. Fascia-fat grafting combined with blepharoplasty as a single-stage procedure was a simplified method that did not require varied types of surgical tools but brought satisfactory results. This method facilitated the routine procedure and eased surgeons in the clinical practices.

Promoting surgical smoke management in a pediatric operating room: a best practice implementation project.

The routine use of heat-producing tools in the perioperative setting generates surgical smoke. Surgical smoke poses a known health hazard for perioperative staff working in the operating room. The objective of this best practice project was to promote evidence-based practices regarding surgical plume management in a pediatric operating room. This project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding surgical smoke management in a pediatric operating room. Seven audit criteria representing best-practice recommendations were used. A baseline audit was conducted, followed by the implementation of multiple strategies developed by the key stakeholders. The project was finalized with a follow-up audit to determine any changes in compliance with best-practice recommendations. Baseline audit data indicated an average of 41% compliance with best practices across all audit criteria, revealing the need for significant improvement in five of the seven criteria. Three barriers were identified and strategies were implemented, including the development and implementation of an educational module and a surgical smoke exposure risk assessment tool. Follow-up audits showed an overall improvement of 30% among five of the seven audit criteria. This project yielded improvements with best practices for surgical smoke management in the perioperative setting. However, additional work is required to ensure the sustainability of best practices in this setting.

Realization and Control of Robotic Injection Prototype With Instantaneous Remote Center of Motion Mechanism.

Although there have been studies conducted on the instantaneous remote center of motion (RCM) mechanism, the general closed-loop control method has not been studied. Thus, this article fills that gap and employs the advantages of this mechanism to develop a novel injection system. The injection prototype involves the instantaneous RCM mechanism, insertion unit and injection unit. The RCM system is investigated in the presence of time-varying axial stiffness of the screw drive and underactuated case. For safe interaction, compliance control is designed in the insertion system. The stability of all separate systems is investigated with the bounded parameter variation rate. The injection prototype and a robot end-effector were then combined to perform injection. Our RCM prototype can achieve a large workspace, and its control effectiveness was verified by multiple frameworks and comparison with previous studies. Compliance-controlled insertion can achieve accurate depth regulation and zero-impedance control for manually operating the needle. With the help of three-dimensional reconstruction and hand/eye calibration, the manipulator can guide the injection prototype to a proper pose for injection of a face model. The injection prototype was successfully designed. The effectiveness of the whole control system was verified by simulations and experiments. The particular robotic injection task can be performed by the prototype. This article provides alternative schemes for developing an instantaneous RCM system, screw drive-based surgical tool, and robotic insertion with small needles.

How to exploit Augmented Reality (AR) technology in patient customized surgical tools: a focus on osteotomies

In orthopedic surgery and maxillofacial there is a growing use of augmented reality (AR) as a technology to increase the visual perception of the surgeon in the operating room. The objective of this review is to analyze the state of the art in the use of AR for osteotomies, highlighting the advantages and the most-known open issues to be addressed in the future research. Scopus, Web of Science, Pubmed and IEEE Xplore databases have been explored with a keyword search, setting the time limits from January 2017 to January 2023, inclusive. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines has been used in this review, focusing on anatomical districts, real-virtual environment interaction, advantaged and limitations of existing AR-based applications. 49 articles met the inclusion criteria and have been selected in the final analysis. For the sake of clarity, works have been grouped according to the anatomical district, but also the real-virtual environment interaction methodology was reported, as well as information regarding accuracy assessment. A Quality Function Deployment (QFD) has been used to assess the AR-based solutions with regards to the more traditional freehand (FH) and Patient Specific Template (PST) approaches. Finally, some suggestions to foster the AR-based solution adoption in osteotomies treatment have been drawn, considering the highlighted advantages and limitations of this technology. The AR resulted to meet the surgeons’ needs more than other traditional approaches. Among the emerged advantages, AR can lead to a better surgical field accessibility, more flexible solutions and lower the management effort. Nonetheless, future research should address some well-known issues, among which the calibration time, the robustness of the tracking, and the HMDs discomfort.

Research on ultrasonic bone cutting mechanism based on extended finite element method.

The research on the crack propagation mechanism of bone has important research significance and clinical medical value for the selection of cutting parameters and the development of new surgical tools. In this paper, an extended finite element method (X-FEM) model of ultrasonic bone cutting considering microstructure was developed to further study the ultrasonic bone cutting mechanism and to quantitatively analyze the effects of cutting direction, ultrasonic parameters, and cutting parameters on the mechanism of ultrasonic bone cutting crack propagation. The results show that ultrasonic bone cutting is essentially a controlled crack propagation process, in which brittle crack and fatigue crack are the main crack propagation mechanisms. In order to improve the efficiency of ultrasonic bone cutting, large amplitude and high-frequency ultrasonic vibration are preferred. Compared with the other two cutting directions, the crack propagation deflection angle in the transverse cutting direction is the largest, resulting in the worst cutting surface. Therefore, in the path planning of orthopedic surgical robots, the transverse cutting direction should be avoided as much as possible. Frequency only has a significant effect on the crack propagation rate and has a positive correlation. There is a positive correlation between the deflection angle, propagation length, propagation rate, and amplitude, which provides the possibility to control the direction and length of crack propagation by controlling the amplitude of ultrasonic. The feed speed is much lower than the ultrasonic vibration speed, which makes the influence of ultrasonic vibration speed on the crack propagation characteristics dominant. The X-FEM model of ultrasonic bone cutting provides an effective method for selecting reasonable machining parameters of orthopedic robot and optimize the design of ultrasonic osteotome.

Fiberbots: Robotic fibers for high-precision minimally invasive surgery.

Precise manipulation of flexible surgical tools is crucial in minimally invasive surgical procedures, necessitating a miniature and flexible robotic probe that can precisely direct the surgical instruments. In this work, we developed a polymer-based robotic fiber with a thermal actuation mechanism by local heating along the sides of a single fiber. The fiber robot was fabricated by highly scalable fiber drawing technology using common low-cost materials. This low-profile (below 2 millimeters in diameter) robotic fiber exhibits remarkable motion precision (below 50 micrometers) and repeatability. We developed control algorithms coupling the robot with endoscopic instruments, demonstrating high-resolution in situ molecular and morphological tissue mapping. We assess its practicality and safety during in vivo laparoscopic surgery on a porcine model. High-precision motion of the fiber robot delivered endoscopically facilitates the effective use of cellular-level intraoperative tissue identification and ablation technologies, potentially enabling precise removal of cancer in challenging surgical sites.

Clinically relevant morphometric analysis of pterygopalatine fossa and its volumetric relationship with adjacent paranasal sinuses: a CT-based study.

This study aimed to perform morphometric measurements of the pterygopalatine fossa (PPF), the transition zone to critical neurovascular structures. The second aim was to investigate the relationship between the volumes of the PPF and the paranasal sinuses and the effect of nasal septum deviation (NSD) types on all these measurements. We performed PPF's morphometry and all volume measurements on the CT images of 260 patients (130 male and 130 female, age range 18-79). All volumetric measurements and the angle between foramen rotundum (FR) and pterygomaxillary fissure (PMF) were significantly higher in males than females. In contrast, the distance between sphenopalatine foramen (SPF) and PMF was considerably higher in females than in males. The PPF volume, the distance between the pterygoid canal (PC) and maxillary sinus, and the angle between FR and PMF were significantly higher on the right side than on the left. In contrast, the angle between PC and SPF and between greater palatine canal and PPF were considerably higher on the left side than on the right. The angle between PC and SPF decreased markedly with age. Only sphenoidal sinus volume was significantly smaller on the same side as the septal deviation. There was no correlation between PPF volume with maxillary and sphenoid sinus volumes from adjacent paranasal sinuses. Volumetric and morphometric data obtained from PPF and paranasal sinuses can aid clinicians in diagnosing and treating patients by guiding them in selecting the right surgical approach or tools, especially in endoscopic procedures.