34 research outputs found

    Automatic breach detection during spine pedicle drilling based on vibroacoustic sensing

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    Pedicle drilling is a complex and critical spinal surgery task. Detecting breach or penetration of the surgical tool to the cortical wall during pilot-hole drilling is essential to avoid damage to vital anatomical structures adjacent to the pedicle, such as the spinal cord, blood vessels, and nerves. Currently, the guidance of pedicle drilling is done using image-guided methods that are radiation intensive and limited to the preoperative information. This work proposes a new radiation-free breach detection algorithm leveraging a non-visual sensor setup in combination with deep learning approach. Multiple vibroacoustic sensors, such as a contact microphone, a free-field microphone, a tri-axial accelerometer, a uni-axial accelerometer, and an optical tracking system were integrated into the setup. Data were collected on four cadaveric human spines, ranging from L5 to T10. An experienced spine surgeon drilled the pedicles relying on optical navigation. A new automatic labeling method based on the tracking data was introduced. Labeled data was subsequently fed to the network in mel-spectrograms, classifying the data into breach and non-breach. Different sensor types, sensor positioning, and their combinations were evaluated. The best results in breach recall for individual sensors could be achieved using contact microphones attached to the dorsal skin (85.8\%) and uni-axial accelerometers clamped to the spinous process of the drilled vertebra (81.0\%). The best-performing data fusion model combined the latter two sensors with a breach recall of 98\%. The proposed method shows the great potential of non-visual sensor fusion for avoiding screw misplacement and accidental bone breaches during pedicle drilling and could be extended to further surgical applications

    Intraoperative tissue classification methods in orthopedic and neurological surgeries: A systematic review

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    Accurate tissue differentiation during orthopedic and neurological surgeries is critical, given that such surgeries involve operations on or in the vicinity of vital neurovascular structures and erroneous surgical maneuvers can lead to surgical complications. By now, the number of emerging technologies tackling the problem of intraoperative tissue classification methods is increasing. Therefore, this systematic review paper intends to give a general overview of existing technologies. The review was done based on the PRISMA principle and two databases: PubMed and IEEE Xplore. The screening process resulted in 60 full-text papers. The general characteristics of the methodology from extracted papers included data processing pipeline, machine learning methods if applicable, types of tissues that can be identified with them, phantom used to conduct the experiment, and evaluation results. This paper can be useful in identifying the problems in the current status of the state-of-the-art intraoperative tissue classification methods and designing new enhanced techniques

    Ultrasound and Photoacoustic Techniques for Surgical Guidance Inside and Around the Spine

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    Technological advances in image-guidance have made a significant impact in surgical standards, allowing for safer and less invasive procedures. Ultrasound and photoacoustic imaging are promising options for surgical guidance given their real-time capabilities without the use of ionizing radiation. However, challenges to improve the feasibility of ultrasound- and photoacoustic-based surgical guidance persists in the presence of bone. In this thesis, we address four challenges surrounding the implementation of ultrasound- and photoacoustic-based surgical guidance in clinical scenarios inside and around the spine. First, we introduce a novel regularized implementation of short-lag spatial coherence (SLSC) beamforming, named locally-weighted short-lag spatial coherence (LW-SLSC). LW-SLSC improves the segmentation of bony structures in ultrasound images, thus reducing the hardware and software cost of registering pre and intra-operative volumes. Second, we describe a contour analysis framework to characterize and differentiate photoacoustic signals originating from cancellous and cortical bone, which is critical for a safety navigation of surgical tools through small bony cavities such as the pedicle. This analysis is also useful for localizing tool tips within the pedicle. Third, we developed a GPU approach to SLSC beamforming to improve the signal-to-noise ratio of photoacoustic targets using low laser energies, thus improving the performance of robotic visual servoing of tooltips and enabling miniaturization of laser systems in the operating room. Finally, we developed a novel acoustic-based atlas method to identify photoacoustic contrast agents and discriminate them from tissue using only two laser wavelengths. This approach significantly reduces acquisition times in comparison to conventional spectral unmixing techniques. These four contributions are beneficial for the transition of a combined ultrasound and photoacoustic-based image-guidance system towards more challenging scenarios of surgical navigation. Focusing on bone structures inside and surrounding the spine, the newly combined systems and techniques demonstrated herein feature robust, accurate, and real-time capabilities to register to preoperative images, localize surgical tool tips, and characterize biomarkers. These contributions strengthen the range of possibilities for spinous and transthoracic ultrasound and photoacoustic navigation, broaden the scope of this field, and shorten the road to clinical implementation in the operating room

    Medical Robotics

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    The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

    Advanced cranial navigation

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    Neurosurgery is performed with extremely low margins of error. Surgical inaccuracy may have disastrous consequences. The overall aim of this thesis was to improve accuracy in cranial neurosurgical procedures by the application of new technical aids. Two technical methods were evaluated: augmented reality (AR) for surgical navigation (Papers I-II) and the optical technique of diffuse reflectance spectroscopy (DRS) for real-time tissue identification (Papers III-V). Minimally invasive skull-base endoscopy has several potential benefits compared to traditional craniotomy, but approaching the skull base through this route implies that at-risk organs and surgical targets are covered by bone and out of the surgeon’s direct line of sight. In Paper I, a new application for AR-navigated endoscopic skull-base surgery, based on an augmented-reality surgical navigation (ARSN) system, was developed. The accuracy of the system, defined by mean target registration error (TRE), was evaluated and found to be 0.55±0.24 mm, the lowest value reported error in the literature. As a first step toward the development of a cranial application for AR navigation, in Paper II this ARSN system was used to enable insertions of biopsy needles and external ventricular drainages (EVDs). The technical accuracy (i.e., deviation from the target or intended path) and efficacy (i.e., insertion time) were assessed on a 3D-printed realistic, anthropomorphic skull and brain phantom; Thirty cranial biopsies and 10 EVD insertions were performed. Accuracy for biopsy was 0.8±0.43 mm with a median insertion time of 149 (87-233) seconds, and for EVD accuracy was 2.9±0.8 mm at the tip with a median angular deviation of 0.7±0.5° and a median insertion time of 188 (135-400) seconds. Glial tumors grow diffusely in the brain, and patient survival is correlated with the extent of tumor removal. Tumor borders are often invisible. Resection beyond borders as defined by conventional methods may further improve a patient’s prognosis. In Paper III, DRS was evaluated for discrimination between glioma and normal brain tissue ex vivo. DRS spectra and histology were acquired from 22 tumor samples and 9 brain tissue samples retrieved from 30 patients. Sensitivity and specificity for the detection of low-grade gliomas were 82.0% and 82.7%, respectively, with an AUC of 0.91. Acute ischemic stroke caused by large vessel occlusion is treated with endovascular thrombectomy, but treatment failure can occur when clot composition and thrombectomy technique are mismatched. Intra-procedural knowledge of clot composition could guide the choice of treatment modality. In Paper IV, DRS, in vivo, was evaluated for intravascular clot characterization. Three types of clot analogs, red blood cell (RBC)-rich, fibrin-rich and mixed clots, were injected into the external carotids of a domestic pig. An intravascular DRS probe was used for in-situ measurements of clots, blood, and vessel walls, and the spectral data were analyzed. DRS could differentiate clot types, vessel walls, and blood in vivo (p<0,001). The sensitivity and specificity for detection were 73.8% and 98.8% for RBC clots, 100% and 100% for mixed clots, and 80.6% and 97.8% for fibrin clots, respectively. Paper V evaluated DRS for characterization of human clot composition ex vivo: 45 clot units were retrieved from 29 stroke patients and examined with DRS and histopathological evaluation. DRS parameters correlated with clot RBC fraction (R=81, p<0.001) and could be used for the classification of clot type with sensitivity and specificity rates for the detection of RBC-rich clots of 0.722 and 0.846, respectively. Applied in an intravascular probe, DRS may provide intra-procedural information on clot composition to improve endovascular thrombectomy efficiency

    Spine Surgery

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    We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

    CT Scanning

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    Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

    Impact of image-guided surgery on surgeons' performance: a literature review

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    he goal of current work is to provide a literature review of the performance consequences of image-guided surgery (IGS) use. Regarding IGS system functionalities, the pattern of results suggests to distinguish between IGS systems which only provide information support (e.g. pointer-based systems) and those which directly intervene in surgeons' decision-making and actions (e.g. instrument disablement). The former offer benefits for patient safety and surgical outcome, as well as improved intraoperative orientation for surgeons, helping them to identify anatomical structures. Furthermore, IGS systems providing information support seem to shorten the time needed for surgery and reduce the subjective workload. IGS systems which intervene in a surgeon's decision-making and actions also have positive impact on patient safety and surgical outcome. In addition, these systems seem to reduce the physiological effort of surgeons. However, they can also prolong surgery and increase the subjective workload

    Endoscopic tissue liquidisation of the prostate, bladder and kidney

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    Endoscopic techniques have revolutionised the practice of all specialities of surgery. Endoscopic access has been either via a natural route, such as the urethra, or percutaneously, as in percutaneous intrarenal stone surgery. Potential endoscopic procedures for bulk tissue removal have been limited by the need to reduce that tissue to a size smaller than the endoscopic channel used. An attempt has been made to create a device that will liquidise and aspirate tissue through an endoscope, This Instrument has been called the Endoscopic Liquidiser and Surgical Aspirator (ELSA). This report details the design and development of the ELSA which has led to its clinical application. The device is 5 mm in diameter and is used through a specially made endoscope of 8.5 mm outer diameter (approximately 27 French). It consists of a high speed rotating blade mounted in a housing that provides irrigation for efficient 1iquidisation and a channel for aspiration of the tissue. Laboratory evaluation was measured by the removal rates of different tissues. The optimum parameters of blade speed, irrigation flow and aspiration were established after a series of controlled experiments. Blade shape was also found to be important and a study of the material strengths of different tissues was required to establish that blade design should vary for each tissue used. Under optimum laboratory conditions fresh human prostate could be removed at 2.4 g/min and renal cortex at 14.6 g/min. The resultant aspirate contained particles ranging from 10 microns to 3 mm, but the majority were less than 200 microns. Flow cytometry was required as the only reasonable method of rapid pathological diagnosis. The action of the ELSA did not confer any Inherent haemostatic benefit and a diathermy plate was added to the tip of the instrument. The ELSA was successfully used to remove benign prostatic tissue from 7 patients with bladder outflow obstruction. However the procedures were slow and visualisation was poor once the liquidisation began. The mean operating time was 85 minutes (range 50 - 120). 1 patient suffered a fatal capsular perforation, but otherwise morbidity v/as not dissimilar from a control group undergoing a standard transurethral diathermy resection. 6'7 patients regained an improved stream with good control. The ELSA was used in the same transurethral method for the removal of superficial bladder tumours in 10 patients. The same problem of impaired vision was found, but the removal was very rapid as one would expect with a soft non-fibro\is material. The postoperative morbidity was greater than in a control group using a diathermy resectoscope due to bladder perforation with the ELSA in 1 case. A percutaneous endoscopic nephrectomy has been achieved in 2 dogs. Each kidney was embolised with "Ethibloc" (a material that completely occupies all arterial capillary beds), An Intrarenal approach was compared with an extrarenal, retroperitoneal one; the latter using carbon dioxide insufflation. Both procedures were successful. Haeraostasis was not a problem. These may be suitable clinical techniques for the minimally invasive removal of infected kidneys prior to transplantation. The presence of stones would not be a problem because of the ability of the ELSA to fragment and aspirate stone particles as efficently as any ultrasound device. This was confirmed in a series of laboratory tests on various stone types and in 5 patients with urinary stones. An extension of the concept of minimally invasive bulk tissue aspiration is the integration of robotics into this form of surgery. The ELSA has been attached to an industrial robot. The mechanism of a transurethral prostatectomy has been studied in order to program the robot. A robotic prostatectomy in a simulation model has been performed. Each procedure can be preprogrammed according to the dimensions of the gland. The in vitro study confirmed that the robot was consistent and therefore safe; and rapid (mean removal time 5 rains) because visualisation was not required for orientation. In conclusion, the ELSA has proved to be ati efficient instrument for endoscopic tissue removal but its clinical superiority is only for less fibrous tissues and improved visualisation will be required. It still requires ancillary methods for haemostasis and the use of a capillary embolisation technique in the kidney may have applications elsewhere. The robotic study was not just an academic exercise. Robotics will be a feature of future surgery

    Advances on Mechanics, Design Engineering and Manufacturing III

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    This open access book gathers contributions presented at the International Joint Conference on Mechanics, Design Engineering and Advanced Manufacturing (JCM 2020), held as a web conference on June 2–4, 2020. It reports on cutting-edge topics in product design and manufacturing, such as industrial methods for integrated product and process design; innovative design; and computer-aided design. Further topics covered include virtual simulation and reverse engineering; additive manufacturing; product manufacturing; engineering methods in medicine and education; representation techniques; and nautical, aeronautics and aerospace design and modeling. The book is organized into four main parts, reflecting the focus and primary themes of the conference. The contributions presented here not only provide researchers, engineers and experts in a range of industrial engineering subfields with extensive information to support their daily work; they are also intended to stimulate new research directions, advanced applications of the methods discussed and future interdisciplinary collaborations
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