Surgical technique for arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor.

The long head of the biceps is a frequent pain generator in the shoulder. Tendinopathy of the long head of the biceps may be treated with biceps tenodesis. There has been great debate about the optimal technique for biceps tenodesis, without a clear distinction between different techniques. Biceps tenodesis fixation may include interference fixation, suspensory fixation, all-suture anchors, and soft tissue fixation. In this technical note, we describe an all-arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor

Finite element model set-up of colorectal tissue for analyzing surgical scenarios

Finite Element Analysis (FEA) has gained an extensive application in the medical field, such as soft tissues simulations. In particular, colorectal simulations can be used to understand the interaction with the surrounding tissues, or with instruments used in surgical procedures. Although several works have been introduced considering small displacements, as a result of the forces exerted on adjacent tissues, FEA applied to colorectal surgical scenarios is still a challenge. Therefore, this work aims to provide a sensitivity analysis on three geometric models, taking in mind different bioengineering tasks. In this way, a set of simulations has been performed using three mechanical models named Linear Elastic, Hyper-Elastic with a Mooney-Rivlin material model, and Hyper-Elastic with a YEOH material model

NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator

Purpose: Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. Methods: We developed NOViSE - the first force-feedback enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom built and the behaviour of the virtual flexible endoscope is based on an established theoretical framework – the Cosserat Theory of Elastic Rods. Results: We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES Conclusions: VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype and the initial results indicate that it provides promising foundations for further development

A soft multi-axial force sensor to assess tissue properties in RealTime

Objective: This work presents a method for the use of a soft multi-axis force sensor to determine tissue trauma in Minimally Invasive Surgery. Despite recent developments, there is a lack of effective haptic sensing technology employed in instruments for Minimally Invasive Surgery (MIS). There is thus a clear clinical need to increase the provision of haptic feedback and to perform real-time analysis of haptic data to inform the surgical operator. This paper establishes a methodology for the capture of real-time data through use of an inexpensive prototype grasper. Fabricated using soft silicone and 3D printing, the sensor is able to precisely detect compressive and shear forces applied to the grasper face. The sensor is based upon a magnetic soft tactile sensor, using variations in the local magnetic field to determine force. The performance of the sensing element is assessed and a linear response was observed, with a max hysteresis error of 4.1% of the maximum range of the sensor. To assess the potential of the sensor for surgical sensing, a simulated grasping study was conducted using ex vivo porcine tissue. Two previously established metrics for prediction of tissue trauma were obtained and compared from recorded data. The normalized stress rate (kPa.mm⁻¹) of compression and the normalized stress relaxation (ΔσR) were analyzed across repeated grasps. The sensor was able to obtain measures in agreement with previous research, demonstrating future potential for this approach. In summary this work demonstrates that inexpensive soft sensing systems can be used to instrument surgical tools and thus assess properties such as tissue health. This could help reduce surgical error and thus benefit patients