Traction Device Research Articles

New traction method (traction ring) for colorectal endoscopic submucosal dissection.

Colorectal endoscopic submucosal dissection (ESD) is challenging because of the difficulty in adequately visualizing the submucosal layer. Many traction methods have been developed to facilitate submucosal dissection; however, they are not widely applied. Therefore, we designed a new traction device, a traction ring, and conducted this pilot study to evaluate its feasibility and safety for colorectal ESD. Twenty patients with colorectal lesions who underwent traction ring-assisted ESD were retrospectively included. The main outcomes included en bloc resection rate, R0 resection rate, procedure time, resection time, and intraoperative and postoperative complications. The median procedure time was 74.5 min (range 35-269 min). The median resection time was 55 min (range 25-209 min). Application of the traction system accounted for only 2.7% of the entire procedure time. The en bloc resection rate was 95.0% (19/20), whereas the R0 resection rate was 90.0% (18/20). All traction rings were successfully set and retrieved. Significant intraoperative bleeding was not observed. One patient experienced perforation after treatment, but no further intervention was required. No delayed complications were observed within 1 month post-ESD. Traction ring is an effective and safe method for colorectal ESD and can be used at any location in the colorectum.

Human-robot-robot cooperative control using positioning robot and 1-DOF traction device for robot-assisted fracture reduction system.

While performing musculoskeletal long bone fracture reduction surgery, assistant surgeons can often suffer from physical fatigue as they provide resistance against the tension from surrounding muscles pulling on the patient's broken bones. These days, robotic systems are being actively developed to mitigate this physical workload by realigning and holding these fractured bones for surgeons. This has led to one consortium proposing the development of a robot-assisted fracture reduction system consisting of a 6-DOF positioning robot along with a 1-DOF traction device. With the introduction of the 1-DOF traction device, the positioning robot does not have to fight these contraction forces so can be compact improving its maneuverability and overall convenience; however, considering surgeon-robot interactions, this approach adds the requirement of controlling two different types of robots simultaneously. As such, an advanced cooperative control methodology is required to control the proposed bone fracture reduction robot system. In this paper, a human-robot-robot cooperative control (HRRCC) scheme is proposed for collaboration between the surgeon, the positioning robot, and the traction device. First, the mathematical background of this HRRCC scheme is provided. Next, we describe a series of experiments that show how the proposed scheme facilitates a reduction in the load placed on the positioning robot from strong muscular contraction forces making it possible to conduct fracture reduction procedures more safely despite the muscular forces.

The usefulness of combining the pocket-creation method with a traction device using a scissor-type knife for colorectal endoscopic submucosal dissection.

Technical issues and long procedure time still remain a concern in colorectal endoscopic submucosal dissection (ESD). We examined the usefulness of combining the pocket-creation method (PCM) with a traction device (S-O clip; SO) using a scissor-type knife (Clutch Cutter 3.5mm; CC) for decreasing ESD procedure time. We retrospectively analyzed 95 ESD cases of PCM + SO + CC managed from August 2017 to April 2020 and 103 cases of PCM + CC treated from July 2016 to July 2017. We compared these two groups through propensity score matching. The main outcome was the analysis of the ESD procedure times under various conditions in each group. After matching, 52 cases in the PCM + SO + CC and PCM + CC groups were analyzed. The PCM + SO + CC group showed a significantly shorter ESD procedure time than the PCM + CC group (57.8 ± 31.4 vs. 81.7 ± 33.5min, p < 0.01). Additionally, the ESD procedure time was significantly shorter in the PCM + SO + CC group than in the PCM + CC group: tumor size (tumor size < 40mm: 45.6 ± 15.8 vs. 72.7 ± 22.9min, p < 0.01; tumor size ≥ 40mm: 83.1 ± 40.1 vs. 111.8 ± 45.3min, p = 0.04), tumor location (right side: 64.7 ± 33.3 vs. 81.0 ± 29.7min, p = 0.03; left side: 50.5 ± 28.0 vs. 82.3 ± 36.9min, p < 0.01), tumor morphology (polypoid: 39.2 ± 18.6 vs. 74.7 ± 28.6min, p < 0.01; nonpolypoid: 62.3 ± 32.3 vs. 84.5 ± 35.2min, p < 0.01), endoscopist (expert: 67.3 ± 41.2 vs. 91.9 ± 40.2min, p = 0.02; nonexpert: 50.4 ± 18.3 vs. 73.6 ± 24.9min, p < 0.01), and fibrosis (severe fibrosis: 82.0 ± 20.5 vs. 99.8 ± 40.4min, p = 0.169; non-severe fibrosis: 52.1 ± 23.8 vs. 75.6 ± 29.0min, p < 0.01). The combination of the PCM and SO using CC achieved a reduction in the colorectal ESD procedure time.

Vertical traction device prevents abdominal wall retraction and facilitates early primary fascial closure of septic and non-septic open abdomen

PurposeOne of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was to evaluate the impact of a novel vertical traction device (VTD) on primary fascial closure (PFC) and prevention of fascial retraction.MethodsTwenty patients treated with OA were included in this retrospective multicenter study. All patients were initially stabilized with laparostomy and the abdomen temporarily sealed either with a Bogotá bag or a negative pressure wound therapy system (NPWT).ResultsThe mean duration of OA and fascia-to-fascia distance (FTF) prior to the VTD application were 3 days and 15 cm, respectively. At relook laparotomy 48 h after VTD implementation, the mean FTF distance significantly decreased to 10 cm (p = 0.0081). In all cases, PFC was achieved after a mean period of 7 days. Twelve patients received the VTD in combination with a NPWT, whereas in eight patients, the device was combined with an alternative temporary abdominal closure system (TAC). Although not statistically significant, the FTF distance remarkably decreased in both groups at relook laparotomy 48 h following the device implementation. The mean periods of PFC for patients with septic and non-septic OA were comparable (7.5 vs. 7 days). During follow-up, two patients developed an incisional hernia.ConclusionVertical traction device prevents fascial retraction and facilitates early PFC in OA. In combination with NPWT, rapid fascial closure of large abdominal defects can be achieved.

A Novel Approach to Open Reduction and Internal Fixation of Distal Radius Fractures Utilizing a Multi-Degree-of-Freedom Traction and Stabilization Device.

Open reduction and internal fixation (ORIF) is a surgical procedure performed with the objectives of restoring normal alignment and providing stability to broken bone fragments after a fracture. This procedure is increasingly used to treat fractures of the distal end of the radius. Reduction is achieved by the surgeon pulling and manipulating the hand while looking at real-time X-rays, and frequently requires large forces to distract impacted fragments from the proximal bone. This study presents the design and preliminary testing of a multi-degree-of-freedom (DOF) device capable of performing both distraction and reduction of fractured bone fragments using a traction splint mechanism with locking ball joints. A prototype was manufactured, and tests were conducted by a practicing hand surgeon. Both qualitative and quantitative tests using a phantom arm were performed. Quantitative force testing found an 80% reduction in the maximum force required to create needed traction, while qualitative tests with a hand surgeon found the device's ability to reduce and stabilize bone fragments while the hardware is secured to be more intuitive and less obstructive than existing techniques.

Gastric endoscopic submucosal dissection using a detachable assistant robot.

318 Background: Effective traction and counter-traction for visualizing the dissection plane in endoscopic submucosal dissection (ESD) is difficult to be achieved with a conventional endoscope. We developed a robotic assistive traction device for flexible endoscopy that provides multi-directional traction during ESD. We compared its safety and efficiency in ESD between experienced and novice endoscopists. Methods: 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. Furthermore, incision and dissection speeds were compared between groups. Results: Twenty gastric lesions were resected from nine live pigs. The submucosal incision speed was significantly faster in the expert group than in the novice group (P = 0.002). There was no significant difference in the submucosal dissection speed between the groups (P = 0.365). No complications were reported in either group. Conclusions: When the robot was assisting in the ESD procedure, the dissection speed improved significantly, especially in the novice surgeons. Our robotic device can provide simple, effective, and safe multidirectional traction during ESD.

Colonic endoscopic submucosal dissection using a novel robotic system.

111 Background: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). We developed a robotic assistive traction device for colonoscopy.This is a preclinical animal study to evaluate the performance of colorectal ESD using novel robotic system. Methods: Experienced endoscopist performed ESD on ex vivo porcine colon ten times using a robot and ten times by the conventional method. The outcome measures were operating time (from starting incision to finishing dissection), completeness of resection, procedure-related adverse events, and limitations of arm manipulation in a narrow working space as assessed by counting the frequency of blind cutting.We also conducted an in vivo feasibility study on live pig. Results: Total of twenty colonic lesions were resected from ex vivo porcine colon. The submucosal dissection speed was significantly faster in robotic ESD than in conventional ESD (P = 0.002). Adverse events such as perforation were also significantly higher in the conventional group. In the in vivo feasibility study, robot was attached to the colonoscope and inserted into the proximal colon. ESD was performed successfully. Conclusions: When the robot was assisting in the ESD procedure, the dissection speed improved significantly. Our robotic device can thus provide simple, effective, and safe multidirectional traction during colonic ESD.

Shock Wave Therapy for Peyronie's Disease—Learning From the Past and Looking Into the Future

Peyronie's disease (PD) is a wound-healing disorder often characterized by the triad of penile pain, curvature, and sexual dysfunction at initial presentation.1 Peyronie's plaque pathogenesis remains incompletely elucidated but is thought to arise from abnormal extracellular matrix production. Studies suggest that PD prevalence is as high as 9% in the general population and higher in patients with diabetes or after radical prostatectomy.2 A broad spectrum of treatments for PD are available including: surveillance, traction devices, intralesional injections and surgical interventions.

Multi-domain approach to modeling pantograph-catenary interaction

When a railway pantograph interacts with a catenary during the movement of a rail vehicle, several physical phenomena, both mechanical and electrical, occur in the system. These phenomena affect the quality of power supply of a train from traction devices. The unfavourable arcing occurring when there are disturbances of contact between the pantograph’s slider and the catenary contact wire. In turn, it results in energy loss and increased wear of the components of the system. When designing new solutions, computational models are helpful to predict the quality of interaction between the components of the pantograph-contact line system already at the virtual prototyping stage. In this paper, the authors comprehensively present a multi-domain (multiphysics) model, which takes into account necessary conditions for interaction between pantograph elements and a catenary. Finally, the impact of the individual physical domains are analysed and the ones which have a significant impact on the simulation of the operation results are identified.

Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience

BackgroundEndoscopic submucosal dissection (ESD) is technically difficult and requires considerable training. The authors have developed a multi-loop traction device (MLTD), a new traction device that offers easy attachment and detachment. We aimed to evaluate the utility of MLTD in ESD.MethodsThis ex vivo pilot study was a prospective, block-randomized, comparative study of a porcine stomach model. Twenty-four lesions were assigned to a group that undertook ESD using the MLTD (M-ESD group) and a group that undertook conventional ESD (C-ESD group) to compare the speed of submucosal dissection. In addition, the data of consecutive 10 patients with eleven gastric lesions was collected using electronic medical records to clarify the inaugural clinical outcomes of gastric ESD using MLTD.ResultsThe median (interquartile range) speed of submucosal dissection in the M-ESD and C-ESD groups were 141.5 (60.9–177.6) mm2/min and 35.5 (20.8–52.3) mm2/min, respectively; submucosal dissection was significantly faster in the M-ESD group (p < 0.05). The rate of en bloc resection and R0 resection was 100% in both groups, and there were no perforation in either group. The MLTD attachment time was 2.5 ± 0.9 min and the MLTD extraction time was 1.0 ± 1.1 min. Clinical outcomes of MLTD in gastric ESD were almost the same as those of ex vivo pilot study.ConclusionsMLTD increased the speed of submucosal dissection in ESD and was similarly effective when used by expert and trainee endoscopists without perforation. MLTD can potentially ensure a safer and faster ESD.

Rotational traction of soccer football shoes on a hybrid reinforced turf system and natural grass

Traction between a football shoe and the playing surface influences a players’ ability to perform football-specific movements. Too little traction means a player might slip. Too much traction is thought to increase the risk of injury due to foot fixation on the turf. Rotational traction is linked to increased injury risk in football. Elite football is increasingly played on hybrid reinforced natural grass playing surfaces. Our aim is to assess the magnitude of rotational traction of one new hybrid turf system and compare that to a natural grass (control) surface. Nine different Football shoes from three outsole groups (artificial grass, firm ground, soft ground) were loaded onto a portable shoe-surface traction machine to collect rotational traction data on two different playing surfaces (1. Natural Rye grass, 2. A hybrid reinforced turf system) at a single testing session. Peak rotational traction was significantly different across different shoe models (F = 379.8, df = 8, p < 0.0001) and shoe outsole groups (F = 387.4, df = 2, p < .0001). No significant difference was found between the natural grass surface and the hybrid reinforced turf system after considering the minimal detectable change (MDC) of the traction device. Wide-ranging differences in peak rotational traction were found across different individual soccer shoes and outsole groups. The Adidas Nemesis (AG) showed the lowest traction and the Nike Vision (SG) shoe had the highest traction (MD 28.7 N.m; 95% CIs 26.4–30.9; p < 0.0001). The artificial grass (AG) group showed the lowest traction values while the soft ground (SG) group the highest. This objective shoe-surface traction data can help with more informed footwear choices for football played on this type of hybrid playing surface to minimize the risk of lower extremity injury.

Modeling method for frequency characteristics of bogie suspension based on vibration test and dynamics simulation

To predict the dynamic behavior of bogie frame vibration and stress under the operational condition in the design phase for railway vehicles, vehicle dynamics simulation is commonly used. This paper describes the modeling method for frequency characteristics of bogie suspension for vehicle dynamics simulation. The proposed method is based on the force-displacement hysteresis loop measured with vibration test and simulation model of bogie suspension to identify dynamic stiffness and damping coefficient of suspension model. As an example of bogie suspension, a single link assembly, which is used in traction device in railway vehicles, was modeled as suspension which had stiffness and damping coefficient that depend on frequency with this method. By comparing simulation and vibration test, it was confirmed that the simulation results of vibration and dynamic stress of a single link assembly with the proposed suspension model were good agreement with vibration test results.

Experimental test to determine the strength of the seat belt anchorages

Experimental tests on the type-approval of motor vehicles with regard to safety belt anchorages, ISOFIX anchorages and ISOFIX top anchorages have been carried out in accordance with Regulation No. 14 UNECE [1]. From the design stage, the safety belt anchorages must comply with the requirements for the installation of a safety belt and reduce slipping and damage to the belt while wearing it. These can be components of the seat structure or of the body’s resistance structure, which have the role of fastening the seat belts. The position of the anchor points is determined by the R point. The R point is defined as the seat reference point on the seat. This point is set by the vehicle manufacturer for each seat in the vehicle. In this paper, two models of chairs were tested. Both seat models are equipped with seat belts anchored at three anchor points. Seat belt anchorages were tested simultaneously using parallel force devices. These traction devices are placed on the seat cushion and are pressed into the seat back. The pulling device has a vertical pulling arm, which has the role of anchoring the steel wire cables. Two test forces are applied simultaneously to the anchor points during the test.

Особливості зносу пар тертя канат-блок і канат-барабан за умов роботи підйомно-тягових пристроїв

The features of wear of rope-block and rope-drum friction pairs of lifting and traction devices operating in the conditions of a hot manufactory of the metallurgical plant and also the mining and beneficiation plant were studied. It is shown that the causes of wear of the elements of the rope-block and rope-drum friction pairs are the interaction in their contact zones, which occurs in the surface layers under the influence of high contact stresses, friction, cyclic loads, abrasive particles, active atmospheric and industrial environments. It was found that these actions lead to irreversible processes of accumulation of stresses and plastic shifts, which have a periodic and heterogeneous character. It is shown that the strength of the lifting or traction rope is determined by the degree of wear of the wires, primarily those in contact with the block and the drum. The structural changes in the surface layers of the wires and the mechanisms of the formation of wear particles were analyzed, which confirm the heterogeneous nature of the wear of the wires in the strands of the rope. Areas of abrasive wear were also observed on the worn surface of the wires, where under the action of solid foreign particles of contamination with sharp corners falling between the wires, the surface of the wires was undercut. It is shown that the presence of non-metallic inclusions leads to the formation of wear particles and fatigue cracks. It was established that the wear of friction pairs of rope-block and rope-drum of hoisting and traction devices has a fatigue-corrosive nature, and the main mechanism of the formation of wear particles is the development of plastic shifts in the surface layers of friction pairs and their separation by plastic exfoliation and abrasive and corrosive destruction. The shape of the wear particles depends on the type of material and the conditions of their formation. It is proposed to take measures regarding structural approaches to friction pairs, taking into account their working conditions, in order to reduce contact stresses and increase their wear resistance, reliability and durability.

Loads and Damage Characteristics of the Traction and Brake Devices of Bogie of High Speed EMU

Loads and Damage Characteristics of the Traction and Brake Devices of Bogie of High Speed EMU

Safety and Efficacy of an Atraumatic Uterine Cervical Traction Device: A Pilot Study.

Introduction: Alignment of the uterine cervix with the vaginal canal is often required during insertion of an intrauterine contraceptive device (IUD). Currently available instruments are traumatic tenacula, which can cause pain and bleeding and represent an obstacle for certain patients to pursue their medical follow-up. A novel investigational cervical vacuum tenaculum, enables atraumatic traction of the cervix using a semi-circular suction pad, designed to conform to the anatomical shape of the external cervical os. Suction is generated by manually pulling out a sliding tube in a vacuum chamber.Methods: We performed a single arm non-comparative pilot study to assess the safety and efficacy of the cervical vacuum tenaculum in 13 women receiving an IUD. Data on procedural efficacy, safety, patient-reported pain scores at specific time points during IUD insertion procedure and patient satisfaction were collected prospectively.Results: Insertion of IUD was successful with use of the study device in 7 of the 13 enrolled patients (54%). No bleeding or only limited ecchymosis were caused by the device. No adverse events were reported. Participants reported very little pain (mean Visual Analog Scale <10) when applying the device. Participants who achieved IUD insertion with the device reported strong overall satisfaction with the procedure.Conclusions: The suction-based atraumatic tenaculum can be used to manipulate the cervix during IUD insertion with satisfactory efficacy and safety. The results of this pilot study support further studies of this device in larger populations comparing with standard single-tooth tenaculum.Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT 04441333.

Indications and characteristics of penile traction and vacuum erection devices.

A variety of devices are available for the management of patients with erectile dysfunction, Peyronie's disease, penile dysmorphophobia, for support before and after penile prosthesis insertion, and after radical prostatectomy. Traction devices include, but are not limited to, Penimaster PRO (MSP Concept, Berlin, Germany), Andropenis and Andropeyronie (Andromedical, Madrid, Spain), and the Restorex (PathRight Medical, Plymouth, USA). The other type of devices are vacuum devices such the Osbon ErecAid (Timm Medical, MN, USA). Different devices are optimal for different clinical applications, and robust and contemporary clinical data show a variety of strengths and weaknesses for each device. Research currently favours the use of traction devices for improvement of penile curvature and erectile function in patients with Peyronie's disease compared with vacuum devices; Penimaster Pro and Restorex have been shown to be associated with the best outcomes in this indication. Vacuum devices are favoured for treatment of erectile dysfunction and penile length loss after radical prostatectomy; the Osbon ErecAid is the most well-studied device for this indication. Research into other uses of vacuum and traction devices, such as for penile dysmorphophobia or before and after penile prosthesis, is very limited. Compliance, cost and availability remain substantial challenges, and further high-quality evidence is required to clarify the role of traction devices in urology and sexual medicine.

Endoscopic submucosal dissection by using a new traction device.

Video 1Patient with a history of gastric ectopic pancreas and epigastric pain. We illustrate the endoscopic submucosal dissection of the ectopic pancreas using a new traction device, the ProdiGi traction wire. Using this device, we were able to resect the lesion en bloc with no adverse events.

Training program using a traction device improves trainees' learning curve of colorectal endoscopic submucosal dissection.

Colorectal endoscopic submucosal dissection (ESD) requires advanced endoscopic skill. For safer and more reliable ESD implementation, various traction devices have been developed in recent years. The purpose of this research was to evaluate whether an ESD training program using a traction device (TD) would contribute to the improvement of trainees' skill acquisition. The differences in treatment outcomes and learning curves by the training program were compared before and after the introduction of TD (control group: January 2014 to March 2016; TD group: April 2016 to June 2018). A total of 316 patients were included in the analysis (TD group: 202 cases; control group: 114 cases). The number of cases required to achieve proficiency in ESD techniques was 10 in the TD group and 21 in the control group. Compared to the control group, the TD group had a significant advantage in ESD self-completion rate (73.8% vs. 58.8%), dissection speed (19.5 mm2/min vs. 15.9 mm2/min), en bloc resection rate (100% vs. 90%), and R0 resection rate (96% vs. 83%). The rate of colorectal ESD self-completion by trainees improved immediately after the start of the training program using a traction device compared to the conventional method, and the dissection speed tended to increase linearly with ESD experience. We believe that ESD training using a traction device will help ESD techniques to be performed safely and reliably among trainees.

Successful endoscopic submucosal dissection of a laterally spreading tumor involving a diverticulum assisted by a traction device.

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