Preclinical evaluation of the atraumatic nature of a spring loaded blunt tip coaxial needle in a swine model

International audiencePurpose: To test in vivo in an animal model the inherent atraumatic characteristics of the spring loaded blunt tip of a coaxial needle (Gangi-SoftGuard®, Apriomed, Sweden) against a conventional sharp stylet coaxial needle.Material and Methods: The study was conducted on a 40 kg male swine that was its own control for a vascular trauma model. The procedure consisted of voluntary attempts to transfix and traverse the artery/aorta under continuous real-time angiogram. Test and control needles were positioned in the region of the intercostal, superior mesenteric and femoral/deep femoral arteries, and in the aorta. Computed tomography (CT) angiogram was performed post trauma to check for bleeding in the form of extravasation of contrast material. One attempt was performed per site and needle, except for the intercostal artery where a second attempt was done with the test needle, resulting in a total of 4 and 5 tests for the control and test needles, respectively.Results: With the spring loaded blunt tip, no vascular trauma or bleeding was noted in the intercostal, superior mesenteric and femoral arteries, nor in the aorta. Vascular spasm that recovered with time was noted during the second attempt to transfix the same intercostal artery. There were consistent vascular traumas and bleedings with the control needle in all three tested arteries and the aorta, confirmed on angiogram as well as CT angiogram.Conclusion: The atraumatic feature offered by the spring loaded blunt tip prevented vascular trauma during the 5 attempts made to transfix the artery/aorta in a swin

Robotically Assisted CBCT-Guided Needle Insertions: Preliminary Results in a Phantom Model

Aim To compare robotic-assisted needle insertions performed under CBCT guidance to standard manual needle insertions. Materials and Methods A homemade robotic prototype was used by two operators to perform robotic and manual needle insertions on a custom-made phantom. Both the operators had no experience with the prototype before starting the trial. The primary endpoint was accuracy (i.e., the minimal distance between the needle tip and the center of the target) between robotic and manual insertions. Secondary endpoints included total procedure time and operators’ radiation exposure. The Wilcoxon test was used. A p value less than 0.05 was considered statistically significant. Results Thirty-three (17 manual, 16 robotic) needle insertions were performed. Mean accuracy for robotic insertion was 2.3 ± 0.9 mm (median 2.1; range 0.8–4.2) versus 2.3 ± 1 mm (median 2.1; range 0.7–4.4) for manual insertion (p = 0.84). Mean procedure time was 683 ± 57 s (median 670; range 611–849) for the robotic group versus 552 ± 40 s (median 548; range 486–621) for the manual group (p = 0.0002). Mean radiation exposure was 3.25 times less for the robotic insertion on comparison to manual insertion for the operator 1 (0.4 vs 1.3 µGy); and 4.15 times less for the operator 2 (1.9 vs 7.9 µGy). Conclusion The tested robotic prototype showed accuracy comparable to that achieved with manual punctures coupled to a significant reduction of operators’ radiation exposure. Further, in vivo studies are necessary to confirm the efficiency of the system

Assistance à l’injection d’un large volume de ciment osseux orthopédique

Extra-spinal cementoplasty is a percutaneous image-guided intervention whereby acrylic bone cement, polymethylmetacrylate (PMMA) most exclusively, is injected inside a pathological bone. The goal is to alleviate the pain and to provide bone consolidation, notably in the osseous pelvis. In this perspective, the volume of bone cement and the technique of injection may predict the outcomes of the procedure. The purpose of the thesis is to perform a state-of-the-art review of extra-spinal cementoplasty, PMMA and the biomechanics of the osseous pelvis in order to identify technical details that may be improved. A retrospective analysis of the clinical practice is also presented. The mechanical influence of the volume of bone cement and a comparison of the different techniques of injection of a volume greater than 10 ml are then evaluated using numerical simulations and experiments on phantoms. Finally, assistance to the injection of a volume greater than 10 ml is presented and evaluated through 3 different approaches.La cimentoplastie extra-rachidienne est une intervention percutanée guidée par l’image qui consiste à injecter du ciment acrylique, du polymethylmétacrylate (PMMA) le plus souvent, au sein d’un os pathologique. Le but est non seulement de traiter la douleur mais aussi de renforcer la tenue mécanique de l’os notamment au niveau du bassin. Dans cet optique, le volume de ciment et la technique d’injection pourraient être des facteur prédictifs de succès du geste. Le but de ce travail est de faire un état de l’art sur la cimentoplastie extra-rachidienne, le PMMA et sur la biomécanique du bassin afin d’identifier les axes potentiels de développement de la technique. Une étude des pratiques cliniques est également réalisée. S’en suit la présentation des résultats de travaux précliniques sur l’influence du volume de ciment et de la technique d’injection d’un volume de PMMA supérieur à 10 ml. Puis 3 axes d’assistance à l’injection d’un volume de plus de 10 ml sont présentés et évalués

Assistance à l’injection d’un large volume de ciment osseux orthopédique

La cimentoplastie extra-rachidienne est une intervention percutanée guidée par l’image qui consiste à injecter du ciment acrylique, du polymethylmétacrylate (PMMA) le plus souvent, au sein d’un os pathologique. Le but est non seulement de traiter la douleur mais aussi de renforcer la tenue mécanique de l’os notamment au niveau du bassin. Dans cet optique, le volume de ciment et la technique d’injection pourraient être des facteur prédictifs de succès du geste. Le but de ce travail est de faire un état de l’art sur la cimentoplastie extra-rachidienne, le PMMA et sur la biomécanique du bassin afin d’identifier les axes potentiels de développement de la technique. Une étude des pratiques cliniques est également réalisée. S’en suit la présentation des résultats de travaux précliniques sur l’influence du volume de ciment et de la technique d’injection d’un volume de PMMA supérieur à 10 ml. Puis 3 axes d’assistance à l’injection d’un volume de plus de 10 ml sont présentés et évalués.Extra-spinal cementoplasty is a percutaneous image-guided intervention whereby acrylic bone cement, polymethylmetacrylate (PMMA) most exclusively, is injected inside a pathological bone. The goal is to alleviate the pain and to provide bone consolidation, notably in the osseous pelvis. In this perspective, the volume of bone cement and the technique of injection may predict the outcomes of the procedure. The purpose of the thesis is to perform a state-of-the-art review of extra-spinal cementoplasty, PMMA and the biomechanics of the osseous pelvis in order to identify technical details that may be improved. A retrospective analysis of the clinical practice is also presented. The mechanical influence of the volume of bone cement and a comparison of the different techniques of injection of a volume greater than 10 ml are then evaluated using numerical simulations and experiments on phantoms. Finally, assistance to the injection of a volume greater than 10 ml is presented and evaluated through 3 different approaches

Aspect IRM de la prostate après cryothérapie percutanée sous guidage IRM

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Cryothérapie percutanée des métastases musculo-squelettiques (principes et résultats initiaux.)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Traitements loco-régionaux des tumeurs desmoides : quelles perspectives ? [Loco-regional therapy for desmoid tumeurs. Current status and perspectives]

Locoregional therapy for advanced or recurrent desmoid tumor is part of our therapeutic armamentarium. Radiation therapy at a dose of 56Gy is feasible and has led to favorable results despite limited prospective data available. Cryoablation is a novel, very promising technique that may be applied in the same clinical picture of advanced, progressing or recurrent disease, in the hands of trained teams. All these options have to be discussed in sarcoma tumor boards due to the rarity of the disease and the expertise needed