2017 Robotic Instrument Segmentation Challenge

In mainstream computer vision and machine learning, public datasets such as ImageNet, COCO and KITTI have helped drive enormous improvements by enabling researchers to understand the strengths and limitations of different algorithms via performance comparison. However, this type of approach has had limited translation to problems in robotic assisted surgery as this field has never established the same level of common datasets and benchmarking methods. In 2015 a sub-challenge was introduced at the EndoVis workshop where a set of robotic images were provided with automatically generated annotations from robot forward kinematics. However, there were issues with this dataset due to the limited background variation, lack of complex motion and inaccuracies in the annotation. In this work we present the results of the 2017 challenge on robotic instrument segmentation which involved 10 teams participating in binary, parts and type based segmentation of articulated da Vinci robotic instruments

Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

Sengstaken-Blakemore tube as a rescue treatment for hemorrhagic shock secondary to laparoscopic adjustable gastric banding erosion

Gastrointestinal bleeding is an uncommon but potentially life-threatening complication of laparoscopic adjustable gastric banding (LAGB) erosion. We present the use of a Sengstaken-Blakemore tube as a treatment device for severe gastrointestinal bleeding secondary to persistent LAGB erosion. A 72-year-old woman post-LAGB placement presented with hemorrhagic shock from gastric band erosion that was not responsive to endoscopic and angiographic interventions. A salvage attempt to tamponade with a Sengstaken-Blakemore tube resulted in successful resuscitation of the patient. When used judiciously, balloon tamponade serves as a replicable technique to control severe gastric band erosion refractory to standard management

A study to determine the correlation between number of endoscopic gastric biopsy specimen and sensitivity of clo test in helicobacter pylori infection in Hospital Universiti Sains Malaysia

BACKGROUND: Northeastern peninsular state of Kelantan has an exceptionally low prevalence of Helicobacter Pylori infection; yet receive high volume of patients referred for Oesophago-gastroenteroscopy (OGDS) for upper gastrointestinal symptoms. CLO test is the most commonly used initial diagnostic test, but sensitivity is widely variable especially in the background of low prevalence. Amount of tissue biopsy and site of gastric biopsy may be crucial in maximizing the detection rate in this region. METHOD: 150 patients with upper gastrointestinal symptoms undergoing elective OGDS in Hospital Universiti Sains Malaysia (HUSM) were included. Four gastric mucosa biopsies were taken from each patient using a standard 2.8mm biopsy forcep, at the pre-pyloric region within 3cm from pylorus, each bite adjacent to each other. One biopsy specimen was compared with two biopsy specimens on a CLO test well, and positive results were recorded when there was colour change at 1 hour, 3 hour, 6 hour and 24 hour. The fourth specimen was sent for histopathological examination with Haematoxylin & Eosin staining, followed by Warthin-Starry staining as control to diagnose Helicobacter pylori. Data entry and analysis was done using SPSS software version 20. Mc Nemar’s test was used to compare the overall sensitivity of CLO test and sensitivity at each time between both groups to determine the earliest detection. RESULTS: Overall prevalence rate of Helicobacter pylori infection was 13.3%. Demographic pattern is consistent with previous local studies, but this study recorded a higher prevalence rate of 10.7% among Malay ethnic patients. Presentation with black tarry stool has the highest prevalence rate of infection at 22.2%, whereas endoscopic diagnosis of gastric ulcer has the highest prevalence rate of infection at 32%. Overall sensitivity of both group were equal at 75% with no statistical significance. However, speed of CLO test becoming positive was slightly higher in two biopsy group at 1 hour and 3 hour, recording sensitivities of 37.5% and 68.8% respectively, compared to single biopsy group with sensitivities of 25.0% and 37.5% respectively, without any statistical significance. CONCLUSION: This study confirmed the low prevalence of Helicobacter pylori infection in this region but suggested that the method applied may improve the detection rate, particularly among ethnic Malay population with low bacterial load in their gastric mucosa. Sensitivity of CLO test is similar with either single or double biopsy specimens, but speed of CLO test becoming positive appeared to be slightly higher with double biopsy specimens, even though statistically not significant. Both presenting symptoms and endoscopic diagnosis are poor indicator of Helicobacter pylori status in this region. However, prevalence according to racial distribution is consistent with national pattern

Endoscopy in Nonvariceal UGI Bleeding

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery

The Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients with Endoscopic Biopsy Negative Upper Gastrointestinal Lesions

Objective To determine the diagnostic accuracy of endoscopic ultrasound guided (EUS) fine needle aspiration in patients who had inconclusive endoscopic biopsies of the same lesion Methodology This retrospective study was conducted at Pak Emirates Military Hospital, Rawalpindi, Pakistan from Jan 2018 to July 2020. Patients who underwent EUS guided FNAC from June 2017 to July 2020 were screened. The FNAC results of patients satisfying the inclusion ciritera were compared with either a surgical biopsy in patients in whom surgeries were done, while in the remaining patients, EUS FNAC results were compared with a 3 months radiological and/or 6 months clinical follow-up. The final diagnosis was defined based on the following criteria: (1) Malignant lesions (n=36), histopathologic diagnosis obtained based on surgery resected samples (n=18) or clinical diagnosis as neoplasm based on clinical follow-up of symptoms (n=30) or radiologic diagnosis based on imaging follow-up at 3 months (n=13) (2) Benign lesions (n=18), benign cytopathologic histopathologic findings and clinical follow-up with no evidence of malignant progression or metastasis. Results EUS-guided FNA cytology turned out to be malignant in 60 percent (n=36) of the specimens. 30 percent of the samples showed benign epithelial cytology ( n=18) while in 10 percent  of the cases (n=6), the tissue samples were deemed insufficient for cytological diagnosis. The accuracy came out to be 66.6 percent (n=10 were true negative), sensitivity 93.4 percent, and specificity 100 percent.  Conclusion EUS guided-FNA cytology of the sub-mucosal upper GI lesions is highly sensitive and specific for upper GI lesions, which are negative on endoscopic biopsies

ADVANCED IMAGING AND ROBOTICS TECHNOLOGIES FOR MEDICAL APPLICATIONS

Due to the importance of surgery in the medical field, a large amount of research has been conducted in this area. Imaging and robotics technologies provide surgeons with the advanced eye and hand to perform their surgeries in a safer and more accurate manner. Recently medical images have been utilized in the operating room as well as in the diagnostic stage. If the image to patient registration is done with sufficient accuracy, medical images can be used as "a map" for guidance to the target lesion. However, the accuracy and reliability of the surgical navigation system should be sufficiently verified before applying it to the patient. Along with the development of medical imaging, various medical robots have also been developed. In particular, surgical robots have been researched in order to reach the goal of minimal invasiveness. The most important factors to consider are determining the demand, the strategy for their use in operating procedures, and how it aids patients. In addition to the above considerations, medical doctors and researchers should always think from the patient's point of view. In this article, the latest medical imaging and robotic technologies focusing on surgical applications are reviewed based upon the factors described in the above. © 2011 Copyright Taylor and Francis Group, LLC.1