Endoscopic laser-ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008-2017).

BACKGROUND: Ureteroceles are a rare condition in dogs in which conventional treatments can result in substantial morbidity. Cystoscopic and fluoroscopic-guided laser ablation (CLA) of ureteroceles can successfully relieve obstruction. OBJECTIVES: To describe the technique and outcomes of attempting CLA for treatment of ureteroceles in dogs. ANIMALS: Thirteen client-owned dogs that underwent CLA for treatment of ureteroceles. METHODS: Retrospective multicentered study. Medical records were reviewed in all dogs that underwent CLA for ureterocele(s). A laser was used to extend the opening of the ureteral orifice (UO) unless surgical conversion was necessary. Data collected included signalment, clinicopathologic data, imaging, procedural findings, complications, and short- and long-term outcome. RESULTS: Thirteen dogs with 13 ureteroceles associated with 14 UOs resulting in ureteral obstruction were included. One ureterocele extended bilaterally. Treatment was initiated via retrograde cystoscopy (7 females), percutaneous perineal urethrocystoscopy (4 males), or percutaneous antegrade cystoscopy (2 males). Surgical conversion was necessary in 2 males. Ten of 14 (71%) UOs associated with the ureteroceles were ectopic. Thirteen of 14 had stenotic or imperforate UOs. No postoperative complications were noted. Preoperative incontinence or pollakiuria was present in 9 of 13 and 3 of 13 dogs and resolved in 8 of 9 and 3 of 3 dogs, respectively. Follow-up imaging showed resolution of all ureteroceles and improved ureteral/renal pelvic dilatation. Median follow-up time was 27 months (range, 3-96 months). CONCLUSIONS AND CLINICAL IMPORTANCE: Cystoscopic-guided laser ablation was effective for the treatment of ureteroceles(s) in 11 of 13 dogs

Medical image computing and computer-aided medical interventions applied to soft tissues. Work in progress in urology

Until recently, Computer-Aided Medical Interventions (CAMI) and Medical Robotics have focused on rigid and non deformable anatomical structures. Nowadays, special attention is paid to soft tissues, raising complex issues due to their mobility and deformation. Mini-invasive digestive surgery was probably one of the first fields where soft tissues were handled through the development of simulators, tracking of anatomical structures and specific assistance robots. However, other clinical domains, for instance urology, are concerned. Indeed, laparoscopic surgery, new tumour destruction techniques (e.g. HIFU, radiofrequency, or cryoablation), increasingly early detection of cancer, and use of interventional and diagnostic imaging modalities, recently opened new challenges to the urologist and scientists involved in CAMI. This resulted in the last five years in a very significant increase of research and developments of computer-aided urology systems. In this paper, we propose a description of the main problems related to computer-aided diagnostic and therapy of soft tissues and give a survey of the different types of assistance offered to the urologist: robotization, image fusion, surgical navigation. Both research projects and operational industrial systems are discussed

Recent Advances in Laparoscopic Surgery

The implementation of laparoscopy has revolutionized surgery over the past few years, incorporating significant benefits for the patient. However, this evolution has also entailed many technical obstacles for surgeons. This book is for readers wanting to learn more about recent surgical techniques and technologies. Topics cover novel sophisticated approaches for single-site surgery, natural orifice transluminal endoscopic surgery, and transanal surgery, among others. Also included are reviews of new innovative surgical devices, robotic platforms, and methodological guidelines for improving surgical performance and surgeon ergonomics

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Recent finding and new technologies in nephrolithiasis: a review of the recent literature

This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy

Comparative investigation of reusable and single-use flexible endoscopes for urological interventions

In order to evaluate the technical adaptability of a type of disposable endoscope compared to reusable flexible endoscopes, in vitro and in vivo studies were conducted. A disposable digital ureteroscope ("chip on tip") and two reusable endoscopes were investigated with respect to spatial resolution, geometric distortion in air and water the maximum. Additionally, the clinical performance of the disposable device was tested during clinical procedures (n = 20). The disposable endoscope showed an optical resolution of 6.72 lines/mm at 10 mm distance, similar to the other devices. In comparison, the disposable endoscope showed a barrel-shaped image distortion in air of -24.2%, which is in the middle range, but was best under water (-8.6%). The bendability of 297 degrees (275 mu m fiber) and 316 degrees (empty channel, 1.5 F basket) and the maximum irrigation (1 m: 58.1 ml/min, 2 m: 91.9 ml/min) were convincing. Clinically the maneuverability was very good in (13/20), good or satisfactory in (7/20). Visibility was evaluated as very good in (11/20), just in (1/20) either satisfactory or sufficient. The consistency of visibility was not affected in (19/20). In all cases there were no adverse events. The technical examination and clinical application of the disposable endoscope are of equal quality compared to reusable devices. Disposable endoscopes can be an alternative to reusable devices, but economic aspects such as reduction of repair costs, sterilization effort and additional waste must be taken into account

Experimental Evaluation and Analysis of LED Illumination Source for Endoscopy Imaging

The minimally invasive surgery uses a small instrument with camera and light to fit the tiny cut in the skin. The selection of the light depends on the power and driving current of the circuit. It can also help in the standardization of the camera and capture the tissues' true-colour image. This paper presents the LED source analysis used in the clinical endoscopes for surgery and the human body's medical examination. Initially, a LED source selection mechanism generating intense illuminance in a visible band is proposed. A low-cost prototype model is developed to analyze the wavelength and illuminance of three different LEDs types. An effect on variation in LED illumination is investigated by changing the distance between the Borescope and LED source. True-colour image generation and tissue contrast are more important in medical diagnostics. Therefore, a sigmoid function improving the whole contrast ratio of the captured image in real-time is presented. The results of spectrum and wavelength for a current variation are presented. Type 3 LED produces higher illumination (i.e., 395 Klux) and peak wavelength (i.e., 622.05 nm) than other LEDs, while type-2 LED has better FWHM for the blue colour spectrum. The modification in the sigmoid function enhances the image with 34.25 peak PSNR producing a true-colour image

Resection of sentinel lymph nodes by an extraperitoneal minilaparoscopic approach using indocyanine green for uterine malignancies: a preclinical comparative study

Background. The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in cervical and endometrial malignancies. The aim of the study was to test the feasibility and reliability of minilaparoscopic extraperitoneal SLN excision after indocyanine green (ICG) cervical injection using a high-definition near infrared (NIR) imaging system in an in vivo porcine model. The same procedure was performed using conventional laparoscopic instruments and both outcomes were compared. Methods. Twenty-four animals were equally and randomly divided into a minilaparoscopic group (group A) and a 5-mm conventional laparoscopic group (group B). A high-definition NIR imaging system and a 30 degrees ICG endoscope were used. First, ICG (0.5 mL) was injected in the paracervical region. The SLN coloring time was recorded. An extraperitoneal approach to the SLN was executed with the same CO2 retropneumoperitoneum pressures (10 mm Hg). In both groups, the times for SLN localization and excision, as well as complications, were registered. Finally, a laparotomy was then done to evaluate whether any stained SLN still remained. The same surgical team performed all experiments. Results. SLNs were identified and extraperitoneally excised in all animals without major complications. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times were shorter with minilaparoscopy (39.3 +/- 13 minutes) than with conventional 5-mm instruments (51.3 +/- 14.17 minutes; P = .042). In group B, one stained SLN remained and was only detected by laparotomy. Conclusions. We confirmed the feasibility and reliability of extraperitoneal minilaparoscopic approach for identification, dissection, and excision of SLN using an NIR imaging system and ICG.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Science & Technology Foundation (FCT), Portugal—PTDC/SAU-OSM/105578/2008.info:eu-repo/semantics/publishedVersio

Design of a wireless ureteropyeloscope

Ureteroscopy is a form of endoscopy that concerns itself with the urinary system. Flexible ureteropyeloscopes are instruments used to access the urinary system for diagnostic and therapeutic procedures. An average ureteropyeloscope requires a repair for every 3 to 13 hours of use, or alternatively 6 to 15 procedures. Therefore, there is a need to increase the durability of the ureteropyeloscope to lower the frequency of repairs required. In addition, the number of cables in the workspace needs to be reduced for improved handling by the clinician. The present study details the design of an ureteropyeloscope, which is modelled after currently existing instruments. Current endoscopes use fibre-optics for lighting area of interest as well as image acquisition. However, the ureteropyeloscope discussed was developed with a camera at the distal end of the insertion tube as its image acquisition system. The images captured were transmitted to a monitor for viewing via a wireless transmission module. The ureteropyeloscope discussed in the study was aimed at increasing the durability of the deflection unit of the ureteropyeloscope, with primary component made of nitinol, and reducing the number of cables around the workstation by using wireless means to transmit images from image acquisition system to monitor