195 research outputs found
Chondroid tenosynovial giant cell tumour : a rarity in the temporomandibular joint
Tenosynovial giant cell tumours of the temporomandibular joint (TMJ) are extremely rare, particularly the subset of chondroid tumours. They can be broadly divided into localised and diffuse types, of which we know of only 116 reported cases in the TMJ. Rarer still are the subset of chondroid tenosynovial giant cell tumours, of which we know of only 30 cases that have affected the TMJ. We present a case that involved the TMJ, and include a discussion of its management
Autonomous Tissue Retraction in Robotic Assisted Minimally Invasive Surgery â A Feasibility Study
In this letter, we describe a novel framework for planning and executing semi-autonomous tissue retraction in minimally invasive robotic surgery. The approach is aimed at removing tissue flaps or connective tissue from the surgical area autonomously, thus exposing the underlying anatomical structures. First, a deep neural network is used to analyse the endoscopic image and detect candidate tissue flaps obstructing the surgical field. A procedural algorithm for planning and executing the retraction gesture is then developed from extended discussions with clinicians. Experimental validation, carried out on a DaVinci Research Kit, shows an average 25% increase of the visible background after retraction. Another significant contribution of this letter is a dataset containing 1,080 labelled surgical stereo images and the associated depth maps, representing tissue flaps in different scenarios. The work described in this letter is a fundamental step towards the autonomous execution of tissue retraction, and the first example of simultaneous use of deep learning and procedural algorithms. The same framework could be applied to a wide range of autonomous tasks, such as debridement and placement of laparoscopic clips
An Ultrasound-guided System for Autonomous Marking of Tumor Boundaries during Robot-assisted Surgery
Towards Autonomous Robotic Minimally Invasive Ultrasound Scanning and Vessel Reconstruction on Non-Planar Surfaces
Autonomous robotic Ultrasound (US) scanning has been the subject of research for more than 2 decades. However, little work has been done to apply this concept into a minimally invasive setting, in which accurate force sensing is generally not available and robot kinematics are unreliable due to the tendon-driven, compliant robot structure. As a result, the adequate orientation of the probe towards the tissue surface remains unknown and the anatomy reconstructed from scan may become highly inaccurate. In this work we present solutions to both of these challenges: an attitude sensor fusion scheme for improved kinematic sensing and a visual, deep learning based algorithm to establish and maintain contact between the organ surface and the US probe. We further introduce a novel scheme to estimate and orient the probe perpendicular to the center line of a vascular structure. Our approach enables, for the first time, to autonomously scan across a non-planar surface and navigate along an anatomical structure with a robotically guided minimally invasive US probe. Our experiments on a vessel phantom with a convex surface confirm a significant improvement of the reconstructed curved vessel geometry, with our approach strongly reducing the mean positional error and variance. In the future, our approach could help identify vascular structures more effectively and help pave the way towards semi-autonomous assistance during partial hepatectomy and the potential to reduce procedure length and complication rates
First urology simulation boot camp in the United Kingdom
Objective: Simulation is now firmly established in modern surgical training and is applicable not only to acquiring surgical skills but also to non-surgical skills and professionalism. A 5-day intensive Urology Simulation Boot Camp was run to teach emergency procedural skills, clinical reasoning, and communication skills using clinical scenario simulations, endoscopic and laparoscopic trainers. This paper reports the educational value of this first urology boot camp. Subjects and methods: Sixteen urology UK trainees completed pre-course questionnaires on their operative experience and confidence level in common urological procedures. The course included seven modules covering basic scrotal procedures, laparoscopic skills, ureteroscopy, transurethral resection of the prostate and bladder tumour, green light laser prostatectomy, familiarisation with common endoscopic equipment, bladder washout to remove clots, bladder botox injection, setting up urodynamics. Emergency urological conditions were managed using scenarios on SimManÂź. The main focus of the course was hands-on training using animal models, bench-top models and virtual reality simulators. Post-course assessment and feedback on the course structure and utility of knowledge gained together with a global outcome score was collected. Results: Overall all the sections of feedback received score of over 4.5/5, with the hands-on training on simulators getting the best score 4.8/5. When trainees were asked âThe training has equipped me with enhanced knowledge, understanding and skills,â the average score was 4.9/5.0. The vast majority of participants felt they would recommend the boot camp to future junior trainees. Conclusion: This first UK Urology Simulation Boot Camp has demonstrated feasibility and effectiveness in enhancing traineeâs experience. Given these positive feedbacks there is a good reason to expect that future courses will improve the overall skills of a new urology trainee
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1997 evaluation of tritium removal and mitigation technologies for Hanford Site wastewaters
This report contains results of a biennial assessment of tritium separation technology and tritium nitration techniques for control of tritium bearing wastewaters at the Hanford Site. Tritium in wastewaters at Hanford have resulted from plutonium production, fuel reprocessing, and waste handling operations since 1944. this assessment was conducted in response to the Hanford Federal Facility Agreement and Consent Order
A Comparative Study of Spatio-Temporal U-Nets for Tissue Segmentation in Surgical Robotics
In surgical robotics, the ability to achieve high levels of autonomy is often limited by the complexity of the surgical scene. Autonomous interaction with soft tissues requires machines able to examine and understand the endoscopic video streams in real-time and identify the features of interest. In this work, we show the first example of spatio-temporal neural networks, based on the U-Net, aimed at segmenting soft tissues in endoscopic images. The networks, equipped with Long Short-Term Memory and Attention Gate cells, can extract the correlation between consecutive frames in an endoscopic video stream, thus enhancing the segmentationâs accuracy with respect to the standard U-Net. Initially, three configurations of the spatiotemporal layers are compared to select the best architecture. Afterwards, the parameters of the network are optimised and finally the results are compared with the standard U-Net. An accuracy of 83:77%±2:18% and a precision of 78:42%±7:38% are achieved by implementing both Long Short Term Memory (LSTM) convolutional layers and Attention Gate blocks. The results, although originated in the context of surgical tissue retraction, could benefit many autonomous tasks such as ablation, suturing and debridement
What Goes Around Comes Around: Learning Sentiments in Online Medical Forums
Currently 19%-28% of Internet users participate in online health discussions. A 2011 survey of the US population estimated that 59% of all adults have looked online for information about health topics such as a specific disease or treatment. Although empirical evidence strongly supports the importance of emotions in health-related messages, there are few studies of the relationship between a subjective lan-guage and online discussions of personal health. In this work, we study sentiments expressed on online medical forums. As well as considering the predominant sentiments expressed in individual posts, we analyze sequences of sentiments in online discussions. Individual posts are classified into one of five categories. We identified three categories as sentimental (encouragement, gratitude, confusion) and two categories as neutral (facts, endorsement). 1438 messages from 130 threads were annotated manually by two annotators with a strong inter-annotator agreement (Fleiss kappa = 0.737 and 0.763 for posts in se-quence and separate posts respectively). The annotated posts were used to analyse sentiments in consec-utive posts. In four multi-class classification problems, we assessed HealthAffect, a domain-specific af-fective lexicon, as well general sentiment lexicons in their ability to represent messages in sentiment recognition
PRESS survey: PREvention of surgical site infectionâa global pan-specialty survey of practice protocol
BackgroundSurgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices.MethodsThis collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using Qualtrics XM Platformâą through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses.DiscussionCurrent SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries
Infrared vibrational spectroscopy: a rapid and novel diagnostic and monitoring tool for cystinuria
Cystinuria is the commonest inherited cause of nephrolithiasis (~1% in adults; ~6% in children) and is the result of impaired cystine reabsorption in the renal proximal tubule. Cystine is poorly soluble in urine with a solubility of ~1âmM and can readily form microcrystals that lead to cystine stone formation, especially at low urine pH. Diagnosis of cystinuria is made typically by ion-exchange chromatography (IEC) detection and quantitation, which is slow, laboursome and costly. More rapid and frequent monitoring of urinary cystine concentration would significantly improve the diagnosis and clinical management of cystinuria. We used attenuated total reflection - Fourier transform infrared spectroscopy (ATR-FTIR) to detect and quantitate insoluble cystine in 22 cystinuric and 5 healthy control urine samples. Creatinine concentration was also determined by ATR-FTIR to adjust for urinary concentration/dilution. Urine was centrifuged, the insoluble fraction re-suspended in 5âÎŒL water and dried on the ATR prism. Cystine was quantitated using its 1296 cmâ1 absorption band and levels matched with parallel measurements made using IEC. ATR-FTIR afforded a rapid and inexpensive method of detecting and quantitating insoluble urinary cystine. This proof-of-concept study provides a basis for developing a high-throughput, cost-effective diagnostic method for cystinuria, and for point-of-care clinical monitoring
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