Traction Device Research Articles

Initial single centre experience of Aquablation of the prostate using the AquaBeam system with athermal haemostasis for the treatment of benign prostatic hyperplasia: 1-year outcomes.

Aquablation using the AquaBeam system combines real-time image guidance and robotics to enable precise and heat-free removal of prostatic tissue with a high velocity water jet. The aim of this study is to report the outcomes of Aquablation up to 1year in a single centre within the UK employing an athermal approach to haemostasis. Fifty-five consecutive men underwent Aquablation between September 2017 and December 2018 (as part of OPEN WATER trial). Standard Aquablation was performed with the AquaBeam system (PROCEPT® BioRobotics) with 2 passes of Aquablation followed by bladder washout with application of continuous bladder irrigation via a catheter on a continuous traction device. Patients were followed up at 3 and 12months. The data were prospectively collected on patient demographics, uroflowmetry, prostate volume, International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) and International Index of Erectile Function (IIEF-15). The mean age was 64.1 ± 7.9years. Operating time was 26.9 ± 9.2min. Mean prostate volume decreased from 58.2 ± 23.9cc to 33.2 ± 12.9cc (p < 0.0001). There were significant improvements at the 12month follow-up in maximum urinary flow rate (9.9 ± 5.1ml/s vs. 23.9 ± 11.6ml/s), IPSS (21.7 ± 7.4 vs. 6.1 ± 4.2) and quality of life score (4.8 ± 1.1 vs. 1.4 ± 1.4) (p < 0.0001). There was no significant change in IIEF-15 and MSHQ-EjD scores. There were 8 (14.5%) Clavien grade 2 or higher complications. Our single centre experience suggests Aquablation using an entirely athermal approach is a safe cavitating procedure resulting in significant LUTS improvement comparable to standard cavitating procedures with greater preservation of sexual function.

Study on Improvement of Driving Performance of Rope Traction Device used on Overhead Distribution Lines

Study on Improvement of Driving Performance of Rope Traction Device used on Overhead Distribution Lines

Endoscopic Submucosal Dissection Using EndoTrac, a Novel Traction Device

Background: Endoscopic submucosal dissection (ESD) is recognized as a minimally invasive and curative treatment for superficial gastrointestinal (GI) cancers. However, ESD is still challenging and time-consuming with a high risk of adverse events such as bleeding and perforation. Various traction methods have been explored for maintaining good visualization of the submucosal layer during ESD. We developed a novel traction device (the EndoTrac) which can easily tie the thread and has the ability to change the towing direction. The aim of this study is to evaluate safety and feasibility of ESD using the EndoTrac for GI neoplasms. Patients and Methods: We retrospectively analyzed 44 patients (45 lesions) with esophageal, gastric, duodenal, and colorectal neoplasms who had undergone ESD using the EndoTrac device between June 2018 and May 2019. Primary outcome measures were preparation time, procedural success using the EndoTrac device, and ease of ability to change towing direction. Results: Mean preparation time was 2 (2–5) min in esophagus, 3 (1–5) min in stomach, 6 (5–9) min in duodenum, and 4 (2–8) min in colorectum. The procedural success rate was 100% (8/8) in esophagus, 100% (21/21) in stomach, 100% (4/4) in duodenum, and 100% (12/12) in colorectum. The rate of successful towing to both proximal and distal sides was 100% (8/8) in esophagus, 100% (21/21) in stomach, 0% (0/4) in duodenum, and 100% (12/12) in colorectum. Conclusions: Use of the EndoTrac device appears to be a feasible approach to ESD for GI neoplasms.

Endoscopic submucosal dissection for superficial pharyngeal carcinoma using transnasal endoscope.

Endoscopic submucosal dissection for superficial pharyngeal carcinoma using transnasal endoscope.

Microstructural deformation observed by Mueller polarimetry during traction assay on myocardium samples

Despite recent advances, the myocardial microstructure remains imperfectly understood. In particular, bundles of cardiomyocytes have been observed but their three-dimensional organisation remains debated and the associated mechanical consequences unknown. One of the major challenges remains to perform multiscale observations of the mechanical response of the heart wall. For this purpose, in this study, a full-field Mueller polarimetric imager (MPI) was combined, for the first time, with an in-situ traction device. The full-field MPI enables to obtain a macroscopic image of the explored tissue, while providing detailed information about its structure on a microscopic scale. Specifically it exploits the polarization of the light to determine various biophysical quantities related to the tissue scattering or anisotropy properties. Combined with a mechanical traction device, the full-field MPI allows to measure the evolution of such biophysical quantities during tissue stretch. We observe separation lines on the tissue, which are associated with a fast variation of the fiber orientation, and have the size of cardiomyocyte bundles. Thus, we hypothesize that these lines are the perimysium, the collagen layer surrounding these bundles. During the mechanical traction, we observe two mechanisms simultaneously. On one hand, the azimuth shows an affine behavior, meaning the orientation changes according to the tissue deformation, and showing coherence in the tissue. On the other hand, the separation lines appear to be resistant in shear and compression but weak against traction, with a forming of gaps in the tissue.

Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence.

Background. There is still no standardized treatment for vaginal agenesis; surgical repair using a minimally invasive technique is a good option, as it offers rapid results along with a fast postoperative recovery. Objective. To describe a new modified Vecchietti procedure by a mini-laparoscopic approach with intraoperative use of indocyanine green fluorescence technology for the creation of a neovagina in the setting of congenital vaginal agenesis. Methods. Retrospective review of all cases of congenital vaginal agenesis submitted to a mini-laparoscopic modified Vecchietti procedure with intraoperative use of indocyanine green (ICG) fluorescence (between June and September 2019). Patient relevant medical history, surgical technique, postoperative care, outcomes, and complications are described. Results. Four patients with Mayer-Rokitansky-Küster-Hauser syndrome (mean age: 19 years; mean preoperative vaginal length: 1.5cm) were included in the study. The procedure was completed successfully and uneventfully in all patients. External traction device was removed 5-7days after surgery and replaced by external vaginal silicone dilators. This technique was able to create 10-11cm neovaginas in 1week; six weeks after surgery all patients had an epithelized 10.5-12cm length and 2.5-3cm diameter neovagina. Complications consisted of one case of isolated fever at the ninth postoperative day, solved with empiric antibiotic treatment. Conclusion. The mini-laparoscopic modified Vecchietti approach, associated with ICG fluorescence imaging, is feasible and effective in the treatment of congenital vaginal agenesis, as it is a simple and safe procedure with promising outcomes.

Endoscopic submucosal tunnel dissection with ring-thread countertraction for a large gastric tumor with extensive severe fibrosis

Various methods of traction have been reported for gastric endoscopic submucosal dissection (ESD). We report a successful case in which a new traction method combining a tunnel and a ring-thread counter traction was effective. The patient was a 78-year-old man with early gastric cancer; an 85-mm tumor was located at the lesser curvature of the upper gastric body (Fig. 1). The macroscopic type was 0-IIa, and there were no obvious findings of suspected submucosal invasive carcinoma, such as irregular protrusion, surface depression, and nonextension sign. Multiple ulcer scars were found on the anterior and posterior sides of the lesion. The histological type from the biopsy was well-differentiated tubular adenocarcinoma. The ESD was performed using a single-channel endoscope (GIF-Q260J; Olympus Co, Tokyo, Japan). The tumor resection devices used were the DualKnife (KD-650L, Olympus Co) and the ITknife2 (KD-611L, Olympus Co), and the solution for local injection was a mixture of 0.4% sodium hyaluronate and indigo carmine with diluted epinephrine. First, we made a circumferential incision; next we created the submucosal tunnel from the oral side to the anal side (Figs. 2 and 3). By creating the tunnel, the dissection line was clear in the fibrosis part of the anterior side, but we could not approach the posterior side because the fibrosis area was extensive. Therefore, we attached a ring-shaped thread (made of floss) with 2 endoclips to connect the oral side of the lesion to the greater curvature side (Fig. 4). In this case, the diameter of the ring was about 10 mm, and it was used to pull the lesion at the lesser curvature side of the stomach to the greater curvature side. The thread provided good traction for the fibrosis area and thus allowed us to perform submucosal dissection of the side of the tunnel (Fig. 5). Finally, the lesion was completely resected en bloc without any adverse events. The lesion was 85 x 60 mm in size, and histological examination revealed it to be well-differentiated intramucosal carcinoma, with no lymphovascular invasion. All of the margins were tumor-free (Fig. 6).Figure 3The submucosal tunnel was created from the oral side to the anal side.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4The ring-shaped thread was attached to connect the oral side of the lesion to the greater curvature side of the stomach.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 5Severe fibrosis area in the side of the tunnel, in which the dissection line became clearer after attaching the ring-shaped thread.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 6The opened specimen revealed intramucosal carcinoma and negative margins; the lesion was 85 × 60 mm in size.View Large Image Figure ViewerDownload Hi-res image Download (PPT) For difficult lesions, it has been a problem to provide the traction to secure a good view in ESD. The effectiveness of endoscopic submucosal tunnel dissection (ESTD) has been reported as a good method for providing traction.1Feng X. Linghu E. Chai N. et al.Endoscopic submucosal tunnel dissection for large gastric neoplastic lesions: a case-matched controlled study.Gastroenterol Res Pract. 2018; 2018: 1419369Crossref PubMed Scopus (12) Google Scholar,2Zhang X. Shi D. Yu Z. et al.A multicenter retrospective study of endoscopic submucosal tunnel dissection for large lesser gastric curvature superficial neoplasms.Surg Endosc. 2019; 33: 1910-1919Crossref PubMed Scopus (16) Google Scholar However, ESTD alone did not provide enough traction in this case because of the lesion size and extensive severe fibrosis. In such a situation, combined use of traction by using ring-thread counter traction was effective (Fig. 7). Several techniques, such as “clip and snare” and “internal traction method,” which have been reported previously, were effective traction methods using similar devices.3Matsumoto K. Nagahara A. Sakamoto N. et al.A new traction device for facilitating endoscopic submucosal dissection (ESD) for early gastric cancer: the “medical ring.Endoscopy. 2011; 43: E67-E68Crossref PubMed Scopus (38) Google Scholar,4Baldaque-Silva F. Vilas-Boas F. Velosa M. et al.Endoscopic submucosal dissection of gastric lesions using the “yo-yo technique.Endoscopy. 2013; 45: 218-221Crossref PubMed Google Scholar However, those methods may require the assistant’s habituation or reinsertion of the endoscope, may have limited traction direction, or may not be suitable for large lesions. This method is considered to be simple and inexpensive, it does not require another assistant, it is suitable for large lesions, and it allows the operator to decide the direction of traction depending on the clip position. Based on this case, ESTD with ring-thread counter traction may be effective for large gastric tumors with extensive severe fibrosis (Video 1, available online at www.VideoGIE.org). All authors disclosed no financial relationships relevant to this article. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJlMmNjMGQ2NzQxODZmZjRkNzI3YjU3ZDFjMjg1ZDVhZCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NDY0ODkzfQ.gjaAez8j4Wr7199z-8bz3AYl8ncfOCfLRgaEsH4OE7H9yCZAYPnM0006xSLBE4vncFqGsiVdbvauHJcXsP5a3vC-PIUtJNyKU7KEaWLsQh59uksWMYqxRjTJS6X37IfWhWF8CjiUUNa-Jsfewy7I6agXdcaWiHProO0Fvkni2RUlSPSl7riUHuQpxZTt-NvxUrO8hvbcSSucxmz4OiHij1oXIFMAsliqITH7sHPk2foVQ7FKA_avs_kgdTgn_3OYBOO8R39XmswaCFGWvgvpmIAd4dFL6LJnyQKKAaN25BzdysFcTD6l_moN-MScWPBTDI2wG1sO02VNkwJlFtwROw Download .mp4 (73.36 MB) Help with .mp4 files Video 1A large gastric tumor with severe fibrosis was successfully resected by endoscopic submucosal tunnel dissection with ring-thread counter traction.

Comparing a conventional and a spring-and-loop with clip traction method of endoscopic submucosal dissection for superficial gastric neoplasms: a randomized controlled trial (with videos)

Several traction methods have sought to overcome the technical difficulties of endoscopic submucosal dissection (ESD). However, traction direction has remained limited in most of these methods, with lack of clarity about the optimal method and traction direction for gastric ESD. A spring-and-loop with clip (SLC) has been developed as a multidirectional traction device. Here, we investigated whether SLC traction-assisted ESD (SLC-ESD) improved procedure-related outcomes compared with conventional ESD (C-ESD) among patients with superficial gastric neoplasms. This single-center randomized controlled trial included patients with superficial gastric neoplasms undergoing SLC-ESD or C-ESD between October 2018 and December 2019. Using the multidirectional traction function, we set traction vertical to the gastric wall for SLC-ESD. The primary outcome was the median procedure time for gastric ESD. The SLC-ESD and C-ESD groups comprised 40 patients each, and all the enrolled patients underwent the assigned treatment. The median ESD procedure time was significantly shorter in the SLC-ESD group (29.1 minutes) than in the C-ESD group (52.6 minutes; P= .005). SLC had a mean attachment time of 1.82 minutes. En bloc resection was achieved without perforation in all the patients in both groups. Our findings suggest that SLC-ESD reduces gastric ESD procedure time without increasing the risk of perforation and that the vertical direction to the gastric wall is the appropriate traction direction for gastric ESD. (Clinical trial registration number: UMIN 000034533.).

ДИНАМИКА ТЯГОВОГО УСТРОЙСТВА ШАХТНОЙ ПОДВЕСНОЙ МОНОРЕЛЬСОВОЙ ДОРОГИ

During the operation of the mine suspension monorail track and traction device form a mechanical system experiencing high dynamic loads associated with implementation of traction and braking forces. Emerging dynamic loads lead to formation of elastic deformations and oscillations that cause vibrations, which leads to displacement of drive wheels and reduces the implementation of traction. The study of the dynamics of traction device is an important step in improving safety and reliability of monorail transport. The aim of the work is to study dynamics of a friction-type traction device moving along a suspended monorail to assess influence of parameters of the elements of device on the vibrations and nature of interaction of drive wheels with monorail. Research methods. Mathematical modeling of the oscillatory processes resulting from interaction of the running gear of the traction device with the monorail is used. Stages of research include drawing up a design diagram oscillations of drive wheels of the traction device interacting with the monorail, developing a mathematical model for the analysis of vibrations caused by moving loads, also assessing the influence of structural parameters of mechanical system under consideration on nature of oscillations. Research results. The developed mathematical model of friction-type traction device movement allows us to establish relationship between parameters of structural elements of its running gear and pressure mechanism, as well as nature of vibrations that arise. As a result, frequencies of the mechanical system under consideration and maximum deviations were found, which allows you to set optimal device parameters to increase traction and increase lifespan of monorail suspended roads. Findings. It was determined that the frequency range of vibration of drive wheels mainly corresponds to the mid-frequency local vibrations of 16–36 Hz. Increasing length of lever for fixing axles of wheels and reducing their radius leads to formation of low-frequency vibrations with a frequency of less than 15 Hz. When length of lever of drive wheels is more than 0.5 m, shoulder of the spring is more than 0.6 m and radius of drive wheels is less than 0.25 m, vibrations with frequencies below 5 Hz can occur. It was found that increasing the length of lever for securing spring increases the oscillation frequency of one drive wheel and reduces frequency of the other. The difference between these frequencies significantly affects changes in the pressure of the wheels against monorail. When difference between frequencies is more than 10–12 Hz, direction of load changes pulsed, with a maximum swing of 0.02 rad, which reduces formation of fatigue fractures of tire wheels, and moments of decrease and increase in pressing force have a negative effect on traction, leading to slippage of drive wheels. When difference between frequencies is less than 10–12 Hz, direction of the load changes sharply, with a maximum swing of 0.03 rad, which increases deformation and formation of fatigue fractures of tire wheels, and short moments of weakening and increase of pressing force, constituting 0.1–0.3 s does not have a significant negative effect on traction.

Cable Angle and Minimum Resultant Force Response Analysis of Lower Limb Traction Device for Rehabilitation Robot With Interval Parameters

Abstract This paper proposes a hybrid uncertainty analysis method (HUAM) based on the first-order interval perturbation method (FIPM) and Monte Carlo method (MCM) for minimum resultant force response analysis of the lower limb traction device (LLTD) of a hybrid-driven parallel waist rehabilitation robot (HDPWRR) with interval parameters. Based on the analysis of cable angles by using the interval algorithm, the problem of non-uniqueness of the force solution in redundant constraint mechanisms is solved. The force response domain prediction with interval parameters on rehabilitation patients is estimated by using the HUAM which combining the first-order interval perturbation technique with direct Monte Carlo method in different stages, and it reduces the calculation amount. First, the kinematic and static models of the LLTD with deterministic information are established according to its work principle. Then, the interval matrices with interval parameters are calculated by using the FIPM and the response of cable angles is combined with the static model. Third, by numerical examples, the accuracy and efficiency of the HUAM for solving the force response domain problem with interval parameters are verified. The bounds of cable angle response domain of the interval LLTD model are determined. Finally, the minimum resultant force response domain prediction with interval parameters on rehabilitation patients is estimated by combining the FIPM and MCM.

Research on electro-hydraulic control technology of train with long distance self-moving equipment

Aiming at the problems of manual laying of tracks, sliding car and dropping lanes in the process of traditional train transportation of winch traction equipment, this paper presents a long-distance self-moving equipment train, which is powered by hydraulic pressure, self-contained track, highly integrated train self-moving, walking deviation, anti-dropping and other functions, so as to realize the striding forward movement of the whole equipment train driven by the traction device. Innovative adopt of loop liquid supply, multiple group remote control and other technologies, and using multi-master control, and high reliability, strong anti-interference CAN (Controller Area Network) fieldbus real-time control network, it ensures the synchronous and smooth lifting of the train, and it moves forward with the self-moving traction device. Thereby, the automatic system development and demonstration application of the fully mechanized mining equipment can be realized.

Simulation of layout schemes of soil-throwing machine-tractor units based on articulated load-bearing machines

The work is devoted to the study of possible layout options for various soil-throwing machine-tractor units using the 3D-CAD SolidWorks system. In the process of research, three basic mass-produced models of wheeled traction devices were selected. This is the T-150K tractor, the DZ-122 grader and Amkodor 2661-01 forwarder. Its simplified 3D models were created, while all the basic geometric parameters were saved. At the next stage, the mass-inertial characteristics of the main moving elements were set by applying the properties of materials from standard libraries to it. These are wheels, suspension elements, linkage mechanisms of working equipment, front and rear frames. To compensate for the mass-inertial characteristics of the stationary elements located on the front and rear half-frames, spherical elements were added, with the possibility of changing the spatial position and mass. To study the possibilities of aggregation, simulation 3D models of three types of soil throwers were created: heavy mounted, mounted medium, light manipulator. Also, various types of additional tillage equipment were modeled: stripper harrows, strip cultivators. Next, ten versions of the most promising soil-throwing machine-tractor units were arranged. The coordinates of the center of gravity of the aggregates and the mass-inertial characteristics were obtained and analyzed. In the future, the developed models can be studied on static and dynamic virtual stands using the methods of multibody dynamics (MBD), for example, in the integrated environment for engineering calculations SolidWorks Motion, or exported to specialized programs, for example, MSC.ADAMS.

Cold snare polypectomy in combination with a traction device for resection of a colonic adenoma partially extending into a diverticulum.

Cold snare polypectomy in combination with a traction device for resection of a colonic adenoma partially extending into a diverticulum.

A Novel Penile Splint as Early Traction Therapy After Grafting Techniques for Peyronie's Disease

BackgroundSome studies showed encouraging results on the efficacy and safety of penile traction therapy after Peyronie's disease (PD) surgery. The early traction therapy (ETT) could be an effective and safe approach to minimize penile shortening in patients undergoing PD surgery. AimTo evaluate the feasibility, efficacy, and safety of a novel penile splint as ETT in patients with PD undergoing grafting techniques. MethodsPatients with PD underwent plaque incision and grafting technique; at the end of the procedure, a novel penile splint (ETT) was applied to all patient. The device consisted of 2 10CH intubating stylets, self-adapted to each patient, that kept the penis stretched with the aid of non-absorbable sutures. The total expense for the materials needed to build each penile splint was less than 15 euros. This active traction was maintained for 1–3 weeks; then, we removed the stitches leaving the device on-site for a passive traction. Within 3–4 weeks from surgery, the penile splint was replaced by a standard penile traction device. OutcomesThe main outcomes evaluated at 6 months included stretched penile length (SPL), penile curvature, International Index of Erectile Function-erectile function (IIEF-EF) domain, patient satisfaction, and time to first satisfactory sexual intercourse. ResultsA total of 46 patients were enrolled. The median preoperative IIEF-EF, penile curvature, and SPL were 27 points, 70°, and 13 cm, respectively. The median follow-up was 15 months. The median postoperative IIEF-EF was 25 points (P < .001). The median residual penile curvature was 10° (P < .001). The median postoperative SPL was 13 cm (P = .269). 8 patients (17.4%) lost 1 cm of SPL; no shortening greater than 1 cm was recorded. The median time to first satisfactory sexual intercourse and patient satisfaction score was 6 weeks and 9 points, respectively. Clinical ImplicationsOur results could pave the way for a new line of research, which in turn could lead to an improvement in the postoperative management of the patient undergoing surgery for PD. Strength & LimitationsThis is the first study evaluating the ETT after PD surgery. The main limitation of this study is the lack of a randomized control group. Other weaknesses are the small sample size and the short follow-up time. ConclusionOur novel penile splint is inexpensive, easy to assemble, and adaptable to the patient. ETT using this novel device, followed by standard traction therapy, seems to be feasible, effective, and safe.Fernández-Pascual E, Manfredi C, Cocci A, et al. A Novel Penile Splint as Early Traction Therapy After Grafting Techniques for Peyronie's Disease. J Sex Med 2020;17:1819–1824.

Kinematic discrepancy between driving wheels evaluated for a modular traction device

One of the options for increasing the versatility of tractors is to use them as a part of a modular traction device (MTD). The model MTD-100 consists of a power-generator module and a technical module. The power-generator module is a tractor with a nominal traction force of 14–16 kN. The technical module is an additional axle with wheels driven by the power-generator module ground speed power take-off. For agricultural implements whose traction resistance does not exceed 16 kN, only the tractor is used. When the technical module is attached to it, the traction force of the entire MTD-100 increases. The MTD-100 makes it possible to tow implements with a traction resistance of up to 30 kN. Since the rear wheels of the power-generator module are connected by a locked drive to the wheels of the technical module, there is a kinematic discrepancy K v between them. Our studies have established that the greater the K v value, the greater is the inflation pressure of the tyres on the wheels of the MTD-100 power-generator and technical modules. If it is necessary to ballast the MTD-100 technical module, the inflation pressure of its tyres should be increased. This makes it possible to maintain the value of the kinematic discrepancy coefficient K v unchanged. Replacement of the standard 16.9R38 tyres with15.5R38 tyres on the rear wheels of the power-generator module and the wheels of the technical module of the MTD-100 requires practically no adjustment to their inflation pressure. • Kinematic discrepancy among the MTD-100 traction modular device driving wheels. • Tyres inflation pressure influences the lead among traction device drive wheels. • Tyres inflation pressure increase produces a lowering lead among the driving wheels. • Ballast requires tyres inflation pressure increase to keep the same lead coefficient. • Kinematic mismatch coefficient is less affected by the tyres width.

Endoscopic closure assisted by a novel traction device after duodenal endoscopic submucosal dissection.

Endoscopic closure assisted by a novel traction device after duodenal endoscopic submucosal dissection.

P-02-49 Waterablation of the Prostate for the Treatment of Lower Urinary Tract Symptoms in Men With Benign Prostatic Hyperplasia: First Italian Multicenter Experience after 1-Month of Follow-Up

Waterablation is gaining new interest in treating lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The Aquabeam system uses high-velocity water jets to robotically ablate prostatic tissue under real-time ultrasound guidance, with hemostasis achieved via a catheter balloon tamponade and a novel traction device or electrocautery. The aim of this study was to describe our preliminary outcomes following Waterablation procedure. Waterablation was performed in 36 patients with symptomatic BPH in a multicenter prospective study. Baseline, peri-operative and 1-month urinary function data were collected, including uroflowmetry, international prostate symptom score (IPSS), IPSS-Quality of life (IPS-QoL) and post void residual (PVR). Mean age was 67.5 (SD 1.83), baseline mean IPSS was 20.4 (SD 1.15), baseline mean peak flow was 9.05 (SD 0.65) and mean prostate volume was 85.9 cc (SD 6.08). After 1 month of surgery, mean change of peak flow was +7.94 ml/s (SD 1.51)(p< 0.01), of IPSS was -10.2 (SD 2.06)(p< 0.01), of PVR -80.2 cc (SD 26.26) (p< 0.01) and IPSS-QOL was -2 (SD 4.11)(p< 0.01). Median of catheterization (days) was 3.0 (SD 3.1) and median of hematuria 1.0 (SD 1.33) while the rate of post-operative antegrade ejaculation was 80.0% (30/6).

HP-9-2 Adding a Penile Traction Device to a Classic Scheme of Treatment With Collagenase of the Clostridium Histolyticum Helps Reduce the Number of Cylces Needed and Lenghten the Penis

HP-9-2 Adding a Penile Traction Device to a Classic Scheme of Treatment With Collagenase of the Clostridium Histolyticum Helps Reduce the Number of Cylces Needed and Lenghten the Penis

Volume-outcome relationship in halo vest utilization for C2 fractures

The prevalence of C2 fractures has increased in recent years. The treatment of these fractures include halo-vest immobilization (HVI), rigid cervical collar, or spinal fusion. There is controversy regarding the management of these fractures with different institutions having their own protocols based on individualized experience. The volume-outcome relationship of HVI use for C2 fractures has not been studied. Evaluation of such relationships are important as they suggest that patients may benefit from referral to and treatment at high-volume institutions. To evaluate the volume-outcome relationship in HVI use for C2 fractures in New York State. Retrospective analysis of a statewide database. We queried the New York Statewide Planning and Research Cooperative System database for the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 805.02 (closed fracture of second cervical vertebra) and procedure code 029.4 (insertion or replacement of skull tongs or halo traction device) to identify all patients who received HVI for a fracture of the second cervical vertebra between the years 2001 and 2014. Those who had isolated C2 fractures were selected. Outcomes of interest included resource utilization characteristics (hospitalization charges and length of stay), perioperative complications, comorbidities, 30-day mortality, any readmission, and any future cervical fusion surgery. The 2001 to 2014 Statewide Planning and Research Cooperative System database was used to identify patients with C2 fractures who received HVI. Our key independent variable was institution volume modeled as high- (>25 halos/year), medium-, (10-25 halos/year), or low-volume (<10 halos/year) based on the total number of HVI procedures reported by hospitals during the study period. We compared outcomes with respect to hospital volume. We also compared patients by age groups: <40, 40 to 60, 60 to 80, and >80. Multivariate logistic regressions were performed for the binary variables any complication and any readmission while controlling for covariates hospital volume, age, sex, race, insurance status, and Elixhauser comorbidity mean. Statistical significance was set at a value of p<.05 for all analyses. In all, 625 patients with C2 fractures managed with HVI were included. Most patients were male (53%) and Caucasian (76%) with a mean age of 57. Patients at high-volume hospitals were younger (52 vs. 59 and 60 for medium- and low-volume, respectively; p<.01) and had fewer future readmissions (40% vs. 54% and 84% for medium- and low-volume, respectively; p<.01). On multivariable analysis, those with private insurance and worker's compensation had lower likelihood of future readmission compared to Medicaid patients. Patients >80 had higher rates of major in-hospital complications (52% vs. 40%, 18%, and 19% for groups 60-79, 40-59, and <40, respectively; p<.01), mortality (14% vs. 5%, 1%, and 1% for groups 60-79, 40-59, and <40, respectively; p<.01), and readmissions after the initial HVI (62% vs. 50%, 54%, and 37% for groups 60-79, 40-59, and <40, respectively; p<.01). The annual rate of HVI use for C2 fractures decreased significantly from 2001 to 2014 (0.32 to 0.06 HVI procedures per 100,000 people; p<.01) with the rate of decline being less pronounced in high-volume institutions (70% decrease vs. 85% and 90% for medium- and low-volume, respectively). Halo vest utilization for C2 fractures in New York State has been declining over the past decade, with the decline being less pronounced in high-volume hospitals. Our hospital volume analysis suggests that HVI use in high-volume institutions is associated with a lower rate of future readmissions. This finding suggests that patients with C2 fractures may benefit from treatment at high-volume institutions. Further research to help improve referral of appropriate patients and increase access to such institutions is warranted.

Usefulness of a thin-endoscope endoscopic submucosal dissection using the traction device for early gastric cancer in a patient with esophageal stricture.

Usefulness of a thin-endoscope endoscopic submucosal dissection using the traction device for early gastric cancer in a patient with esophageal stricture.