Traction Device Research Articles

Effects of traction methods in inexperienced endoscopists during colorectal endoscopic submucosal dissection

Background colorectal endoscopic submucosal dissection (ESD) remains a technical challenge, but traction devices show promise in making this procedure easier. However, the efficacy of traction techniques for colorectal ESD is still unknown for inexperienced endoscopists. Methods We selected 400 patients who underwent colorectal ESD performed by four inexperienced endoscopists. Each patient in the traction-assisted ESD (TA-ESD) group was matched to a patient in the conventional ESD (C-ESD) group according to propensity scores. Results One-to-one propensity score-matching analysis created 87 matched pairs. The self-completion rate in the TA-ESD group is significantly higher than that in the C-ESD group (100% [87/87] vs. 92% [80/87], p < 0.001). The median resection speed was significantly faster in the TA-ESD group than that in the C-ESD group (27 mm2/min [IQR, 19.5–47.3] vs.18 mm2/min [IQR, 13.5–33.8], p < 0.001) and the procedure time in the TA-ESD group was significantly shorter than that in the C-ESD group (33 min [IQR, 27–47] vs.53 min [IQR, 38–73], p < 0.001). However, the histologic complete resection rate was not significantly different between the TA-ESD and C-ESD groups (93.1% [6/87]) vs. 96.6% [3/87], p < 0.1888, respectively). The en bloc resection rate (96.6%) and perforation rate (4.6%) were equivalent between the TA-ESD group and the C-ESD group. Conclusion Traction techniques seem to improve resection speed and self-completion rate of colorectal ESD for inexperienced endoscopists.

Successful hemostasis of multiple parapapillary diverticular hemorrhage by clip-with-rubber-band traction technique at the descending duodenum.

Various traction devices and techniques have been used to facilitate endoscopic submucosal dissection by creating a clear field of vision and allowing dissections to be performed more quickly and safely [1]. Here, we report successful endoscopic hemostasis of parapapillary diverticular hemorrhage by the clip-with-rubber-band traction technique at the descending duodenum.

Use of a traction device facilitates opening of the pocket during the pocket-creation method of gastric endoscopic submucosal dissection.

The pocket-creation method (PCM) is a strategy to achieve safe and high quality endoscopic submucosal dissection (ESD) throughout the alimentary tract [1] [2] [3] [4]. While the pocket is being created, the PCM enables endoscopists to effectively apply traction and countertraction using the tip of the hood alone. In this phase, the PCM can be considered a traction method; however, because stabilization of the endoscope tip and traction force gradually reduces while the pocket is being opened, it may become difficult and time-consuming. Particularly during gastric ESD, it is difficult to change the patient’s position and, as a result, it may not be possible to use gravity effectively, depending on the location of the lesion. We devised a new strategy for the PCM using traction devices when opening the pocket during gastric ESD ([Fig. 1]), as we have reported in the past for colorectal ESD [5].

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review.

ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.

Endoscopic submucosal dissection of a gigantic gastric polyp aided by a novel retraction device and complicated by upper esophageal sphincter laceration during retrieval

Video 1Endoscopic submucosal dissection of a sizeable gastric polyp with a short and broad stalk assisted by a novel traction device.

Design of a New Type of Bowl Plug and Its Disassembling Device

In order to solve the problem that bowl plug and cylinder hole cavity are difficult to disassemble due to interference fit. Through designing a new type of bowl plug and its disassembly device, the disassembly device is connected with the new bowl plug by the matching shaft, and through the fixing of the support plate and the support frame, the bowl plug can be easily disassembled under the action of the automatic traction device, so as to save manpower and improve work efficiency.

Research on Dynamic Modeling Measurement and Control of Cable Traction Devices for Electro-Optical Unmanned Systems

In order to realize the high-precision variable direction cable control of the electro-optical unmanned system in non-electromagnetic remote control, a cable traction device measurement and control with characteristics of variable direction traction, rapid installation, and lightweight portability were proposed. Fan-shaped connect rod mechanism and U-shaped groove fixed pulley group were added to it, which can realize multi-direction traction without derailment on the basis of the cable limit and alleviate the cable fracture caused by mechanical wear. Introducing Euler transformation and analyzing the dynamics of the cable, the whole operation process, and the tension detection model was established. A Kalman Filter traction planning method was proposed to solve the problems of inertia delay and emergency stop of the unmanned vehicles after a sudden direction change. In order to verify the effectiveness, an experimental platform for the cable traction system of a 50kg wheeled and 150kg tracked unmanned system was built for simulation and experimental testing. The results show that the cable system has good dynamic variable traction, which can meet the multi-terrain control ability of an electro-optical unmanned system in a complex field environment.

Impact of Traction Direction in Traction-Assisted Gastric Endoscopic Submucosal Dissection (with Videos)

BackgroundThe impact of traction direction in traction-assisted gastric endoscopic submucosal dissection (ESD) has not been adequately investigated. A clip with line (CWL) is a classical single-directional traction device. In contrast, a spring and loop with clip (SLC; S–O clip) is a newly developed multidirectional traction device.AimsTo investigate the impact of traction direction in gastric ESD by comparing the procedure-related outcomes of CWL-assisted ESD (CWL-ESD) and SLC-assisted ESD (SLC-ESD).MethodsWe retrospectively examined 140 patients with superficial gastric neoplasms who underwent SLC-ESD or CWL-ESD by a single ESD expert during November 2017–September 2020. The traction direction was classified based on the endoscopic finding in the following five categories: proximal, diagonally proximal, vertical, diagonally distal, and distal. In SLC-ESD, we set vertical traction, using the multidirectional traction function. Propensity score matching was conducted to compensate for the differences in lesion size, injection function of electrosurgical knife, ulcerative lesion, lesion location, and lesion position. The primary outcome was gastric ESD procedure time.ResultsPropensity score matching created 42 pairs. The median gastric ESD procedure time in the SLC-ESD group was significantly shorter than that in the CWL-ESD group (28.3 min vs. 51.0 min, P = 0.022). All traction direction in the SLC-ESD group was vertical, while only 16.7% in the CWL-ESD group. En bloc resection was attained without perforation in all the patients in both groups.ConclusionOur findings suggest that SLC can provide vertical traction, which reduces the gastric ESD procedure time.Graphical Multidirectional traction devices can provide vertical traction in most cases of gastric ESD, unlike single-directional traction devices. Vertical traction may reduce the gastric ESD procedure time.

Endoscopic submucosal resection with adaptative traction device: a new strategy to facilitate resection in patient with inflammatory bowel disease.

Endoscopic submucosal dissection (ESD) is well described in non-IBD (inflammatory bowel disease) patients to remove non-invasive neoplastic lesions in the colon. Data are still limited in IBD patients. One of the limited factors for the resection by ESD of dysplasia in IBD is fibrosis, which leads to an increased risk of complication such as perforation.

A "clip-thread-elastic ring" internal traction device for endoscopic submucosal dissection of a duodenal tumor.

Duodenal endoscopic submucosal dissection (ESD) is one of the most challenging procedures. We developed a “clip–thread–elastic ring” internal traction device to facilitate ESD procedures in the duodenum ([Fig. 1]). The device consists of an endoscopic clip, a surgical thread, and an elastic ring cut with scissors from a commonly used sterile glove. Herein, we report the application of this device to facilitate an ESD procedure in a 52-year-old man with a flat tumor in the descending duodenum ([Fig. 2 a]; [Video 1]).

Engineering Design, Kinematic and Dynamic Analysis of High Lugs Rigid Driving Wheel, a Traction Device for Conventional Agricultural Wheeled Tractors

Traction failure on loose terrain is common in conventional agricultural wheeled tractors due to poor traction ability and lower power transfer efficiency of drive wheels, which leads to excessive energy consumption and soil compaction in agriculture. To overcome the problem, this paper presents a new design of a rigid lugged wheel for use in field tillage operations. This wheel was designed according to field operational requirements and also provided with rubber pads for smooth on-road drives. Kinematic and dynamic analysis of new wheel designs were carried out to study how they move, how they interact with the soil, and how they generate drive force in loose terrain soil. The relationship of wheel lug motion trajectories, displacement, and velocity of the wheel relative to field conditions, different travel reduction rates, and lug penetration/wheel sinkage were analyzed. Wheel-terrain interaction and shear stress-shear displacement relationships when the wheel is driven in soft, deformable terrain were studied using classic soil mechanics principles. It is found that the component of thrust in the direction of driving, i.e., driving force, is ranged between 81.52% and 86.17%, while the vertical component is reported to be less than 30% and further decreases to 9%, which is the compaction avoiding factor. The relationships, thus developed, of wheel parameters, soil stress and thrust characteristics, and wheel drive force were derived and revealed that the traction performance, power transfer efficiency, and trafficability of tractors in loose terrain can be improved by using the newly proposed wheel. A finite element method was used to analyze the designed wheel model for structural stability and optimization. The theoretical analysis results of the new drive wheel are convincing, so further tests and field operation research are recommended for sustainable adoption.

Motorized Robotic Closed Cervical Traction: Biomechanical Proof of Concept.

Biomechanical study. To demonstrate that robotic cervical traction can apply closed cervical traction as effectively as manual weight-and-pulley traction in extension spring and cadaveric models. Closed cervical traction is used to reduce subaxial cervical spine dislocation injuries and to distract the intervertebral space during cervical spine surgery. Weight-and-pulley cervical traction relies on cumbersome and imprecise technology without any safeguard to prevent over-traction or weights being pulled/released inadvertently. A prototype robotic traction device was designed and manufactured by the authors with real-time tensile force measurement, ±1-lbs (5 N) force application accuracy, locking/non-backdriveable linear actuators with actuator position sensing, 200-lbs (900 N) maximum force capability, up to 20° of flexion/extension manipulation, <25-lbs (111 N) device weight, and compatibility with Gardner-Wells tongs or Mayfield head clamp. The device was tested using an extension spring model and an intact fresh cadaver specimen to assess applied and desired force over time and radiographic changes in the cervical spine as traction force increased. The cadaver was tested in manual traction initially and then robotic traction in 10-lbs (50 N) increments up to 80-lbs (355 N) to compare methods. The prototype device met or exceeded all requirements. In extension spring testing, the device reached the prescribed forces of both 25-lbs (111 N) and 80-lbs (355 N) accurately and maintained the desired weight. In cadaveric testing, radiographic outcomes were equivalent between the prototype and manual weight-and-pulley traction at 80-lbs (355 N; disk space measurements within ±10% for all levels), and the device reached the desired weight within±1-lbs (5 N) of accuracy at each weight interval. This preliminary work demonstrates that motorized robotic cervical traction can safely and effectively apply controlled traction forces.

Endoscopic submucosal tunnel dissection with an elastic traction device for a circumferential superficial esophageal neoplasm.

Endoscopic submucosal dissection (ESD) is an established treatment for superficial esophageal squamous cell neoplasms (SESCNs) [1] [2]. However, it is time-consuming and challenging for large SESCNs, especially circumferential lesions. Endoscopic submucosal tunnel dissection (ESTD) has been reported as an effective technique for circumferential SESCNs [3] [4]. Herein, we report a case of traction-assisted ESTD using a novel elastic traction device (Micro-Tech, Nanjing, China), consisting of a rotatable soft-tissue clip and an elastic double ring attached to the clip arm ([Fig. 1]).

Colorectal endoscopic submucosal dissection using a concealable robotic add-on device: A comparative in vivo feasibility study.

128 Background: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe colonic endoscopic submucosal dissection (ESD). In this preclinical ex vivo and in vivo animal study, we developed a concealable robotic-assisted traction device and evaluated its performance in colorectal ESD. Methods: An experienced endoscopist performed ESD on an ex vivo porcine colon 18 times using our robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. We also conducted an in vivo feasibility study in live pigs. Robotic ESD was performed by experienced and novice endoscopist groups (n = 2, each). The outcomes included time to complete each ESD step, total procedure time, size of the dissected mucosa, rate of en bloc resection, and major adverse events. Results: Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robotic ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 vs. 34.3±8.3; P &lt; 0.05). The submucosal dissection speed was significantly higher in the RESD group than in the CESD group (36.8±9.2 vs. 18.1±4.7; P &lt; 0.05). The blind dissection rate was also significantly lower in the robotic group (12.8±3.4% vs. 35.1±3.9%; P &lt; 0.05). In an in vivo feasibility study, the robot was attached to the colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. There was no significant difference in the submucosal dissection speed between the groups (P = 0.465). Conclusions: When the concealable robot assisted the colonic ESD procedure, the dissection speed and safety profile improved significantly. Thus, our robotic device can provide a simple, effective, and safe multidirectional traction during colonic ESD. When the robot was assisting in the ESD procedure, the dissection speed improved significantly, especially in the novice endoscopists.

Endoscopic submucosal dissection of appendiceal lesions by using a novel adjustable traction device: A-TRACT-2.

Video 1Dissections of appendiceal lesions using A-TRACT-2.

A Modified Suture Technique to Improve Scar Appearance in Wounds Under High Tension.

The purpose of this study was to introduce a modified suture technique and to compare its effects on skin scar formation with 2 traditional suture methods: simple interrupted suture (SIS) and vertical mattress suture (VMS). Three groups of healthy adult female Sprague-Dawley rats were selected (6 replicates in each group), and the full-thickness skin of 5 cm × 0.2 cm was cut off on the back of the rats after anesthesia. The wounds were then sutured using 1 of the 3 methods for each group: SIS, VMS, and a newly introduced modified vertical mattress suture (M-VMS) technique with the needle reinsertion at the exit point. A traction device was installed on the back of the rats to achieve high tension wounds. The tensile distance was increased by 1 mm every day for 20 days. After 20 days of healing, the hematoxylin-eosin staining method was used for observation of scar morphology. The collagen production rate was measured by Masson staining, and the type I collagen and type III collagen were detected by the immunofluorescence method. Immunohistochemical staining was used to detect the expression of myofibroblast marker α-smooth muscle actin, and real-time quantitative polymerase chain reaction and Western blot techniques were used to detect the expressions of transforming growth factors TGFβ1, TGFβ2, and TGFβ3 to understand the mechanisms of scar formation. Results showed that the quantity and density of collagen fibers were both lower in the M-VMS group than in the other 2 groups. Immunofluorescence results showed that type I collagen was significantly lower, whereas type III collagen was significantly higher in the M-VMS group than in the other 2 groups. The expressions of α-smooth muscle actin and TGFβ1 both were lower in the M-VMS group than in the other 2 groups. The expression of TGFβ2 and TGFβ3 had no obvious difference among the 3 groups. For wounds under high tension, compared with SIS and VMS methods, the M-VMS technique we proposed can reduce scar formation due to the reduction of collagen formation, myofibroblast expression, and TGFβ1 expression.

Novel Assistive Devices for Umbilical Artery Catheterisation

Background: 300+ neonates/year in a New Zealand neonatal intensive care unit (NICU) need umbilical arterial catheterisation (UAC), of whom 7.5% die or have permanent impairment because an umbilical arterial catheter could not be inserted. Complexities associated with the procedure can lead to lengthy procedure times and increased risk of catheterisation failure, increasing the risk of poor outcomes. While several manual techniques are used, very few use assistive devices. Objective: Design and test assistive devices to significantly simplify UAC. Methods: Main requirements include: 1) insertion time <15 minutes; 2) only one practitioner required. The procedure requires two primary tasks: 1) traction (tensioning) of the umbilical cord; 2) dilation of the umbilical artery to admit the (wider, 5F) catheter. A full design analysis addresses these tasks and requirements. Prototypes are evaluated by a NICU clinician using a silicone phantom umbilical cord. Results: A two-device solution was developed, comprising a hands-free traction device and a dilation device. The traction device utilises a small hair-cliplike device with torsional spring and stabilising skirt. The dilator comprises an insertor and a sheath. The insertor tip diameter of 0.1 mm allows easy insertion, while the following sheath dilates the artery to allow catheter insertion. All devices are removed after insertion. UAC time decreased an average of 51.8% over 6 tests versus without assistive devices, and only one practitioner was required. Conclusions: The coordination, complexity, and time for UAC were significantly reduced, using simple, novel assistive devices, which could improve outcomes for infants suffering negative outcomes due to UAC insertion failure.

Peyronie hastalığı: Cerrahi dışı tedavi yaklaşımları

Peyronie’s disease is a condition characterized by progressive fibrosis in the tunica albuginea, resulting in deformities such as penile shortening and curvature. This situation not only causes sexual problems, but also can cause an increase in sexual performance anxiety, difficulty in relationship and depression. The course of the disease consists of two periods, acute and chronic. In the acute phase and in the stable disease period, while non-surgical treatments are used to relieve symptoms and regress fibrosis, surgical treatments are on the agenda, especially after serious deformities develop. Non-surgical treatment methods are oral treatments, intralesional injection treatments, topical treatments, vacuum and traction devices and shock wave treatments. Intralesional clostridium histolyticum collagenase treatment has been approved by the US-FDA and it’s indicated in patients with noncalcified plaques. For multimodal treatments, there is no clear consensus yet. Keywords: Peyronie’s disease, penil curvature, medical therapy, vacuum device

Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up.

Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.

Theoretical estimate of the operating effectiveness of the battery-powered suspended monorail mining locomotives

Research objective is to develop a mathematical model for a theoretical estimate of the operating effectiveness of the battery-powered suspended monorail mining locomotives. Research relevance. Comparison of the functional capabilities of cargo and personnel mine carriers shows that only suspended monorail tracks can provide cost-effective transportation along alternating curved track profiles of mine workings with inclination angles up to 30º. Battery-powered suspended monorail locomotives are currently more common. Theoretical estimate of battery-powered monorail locomotives operating effectiveness is therefore of great relevance. Methods of research. The technical details of suspended monorail mining locomotives were analyzed when solving the assigned problem. The paper uses the methods of mathematical analysis based on differential calculus to construct a universal equation for determining the operational efficiency of battery-powered suspended monorail mining locomotives. Results. In order to theoretically evaluate the operating effectiveness of battery-powered monorail locomotives, a mathematical model has been developed that makes it possible to determine a comprehensive indicator for estimating the battery traction effectiveness and the operational efficiency. It has been established that the operational efficiency of a battery-powered locomotive is generally determined both by economic features of all links of its traction electric circuit and their operation modes. It has to be considered that the operating modes of traction devices and accessories are entirely determined by the traction mode of the battery-powered locomotive entirely and partly determined by the electrochemical characteristics of the battery. After finding the operating efficiency, it is possible to provide recommendations for battery-powered suspended locomotives operating effectiveness improvement. Scope of the results. The obtained results are recommended to be used when estimating the operating effectiveness of battery-operated suspended monorail locomotives, as well as when comparing the effectiveness of various types of traction of support service mining vehicles.