A novel hybrid 3D endoscope zooming and repositioning system : design and feasibility study

Background: Manipulation of the endoscope during minimally invasive surgery is a major source of inconvenience and discomfort. This report elucidates the architecture of a novel one-hand controlled endoscope positioning device and presents a practicability evaluation. Methods and materials: Setup time and total surgery time, number and duration of the manipulations, side effects of three-dimensional (3D) imaging, and ergonomic complaints were assessed by three surgeons during cadaveric and in vivo porcine trials. Results: Setup was accomplished in an average (SD) of 230 (120) seconds. The manipulation time was 3.87 (1.77) seconds for angular movements and 0.83 (0.24) seconds for zooming, with an average (SD) of 30.5 (16.3) manipulations per procedure. No side effects of 3D imaging or ergonomic complaints were reported. Conclusions: The integration of an active zoom into a passive endoscope holder delivers a convenient synergy between a human and a machine-controlled holding device. It is shown to be safe, simple, and intuitive to use and allows unrestrained autonomic control of the endoscope by the surgeon

ZILVERPASS Study: ZILVER PTX Stent versus Prosthetic Above-the-Knee Bypass Surgery in Femoropopliteal Lesions, 5-year Results.

PURPOSE To report the 60-month safety and effectiveness results of a multicenter, prospective, randomized controlled trial comparing the ZILVER PTX paclitaxel-eluting stent to prosthetic above-the-knee bypass for the treatment of symptomatic TransAtlantic Inter-Society Consensus (TASC) C and D femoropopliteal lesions. MATERIALS AND METHODS Patients were enrolled between October 2013 and July 2017. One of the secondary outcomes was primary patency at 60 months, defined as no evidence of binary restenosis or occlusion within the target lesion or bypass graft based on a duplex ultrasound peak systolic velocity ratio < 2.4 and no clinically-driven target lesion revascularization (TLR) in endovascular cases or reintervention to restore flow in the bypass at 60 months. Survival rates after 5 years were also analyzed. RESULTS 220 patients (mean age 68.6 ± 10.5 years; 159 men) were included and randomized to ZILVER PTX (n = 113, 51.40%) or BYPASS group (n = 107, 48.60%). The 60-month primary patency rate was 49.3% for the ZILVER PTX group versus 40.7% for the bypass group (p = 0.6915). Freedom from TLR was 63.8% for the ZILVER PTX group versus 52.8% for the bypass group (p = 0.2637). At 5 years, no significant difference in survival rate could be seen between the ZILVER PTX and the bypass group (69.1% vs. 71% respectively, p = 0.5503). CONCLUSION Even at 5 years, non-inferior safety and effectiveness results of the ZILVER PTX could be seen. These findings confirmed that the use of ZILVER PTX stents can be considered as a valid alternative for bypass surgery when treating long and complex femoropopliteal lesions

Motion Amplifier For a Steering Mechanism of a Steerable Tool

The present invention relates to mechanical transmission system (100, MTS) having a proximal (20) and distal end (40), for a longitudinal steerable tube (500), which MTS (100) comprises a set of longitudinal members, LM, (110) arranged in a longitudinal direction around a fictive tube (180) maintained at an essentially constant circumferential and radial position with respect to the fictive tube (180) and being slidable relative to the fictive tube (180), and has a transmission bendable proximal part (134, TBPP), transmission bendable distal part (130, TBDP), and transmission shaft region, TSR (132) between the TBDP (130) and TBPP (134) wherein movements of the TBPP (134) are transmitted to the TBDP (130) along the TSR (132) by the LMs (110), wherein the MTS (100) comprises a sub- region that is a transmission amplifier region, TAR, (135) in which the fictive tube (180) contains at least one plane-section (182) larger than that (184) of the TBDP (130)

Torque-transmitting steering mechanism for a steerable tool

A mechanical transmission system, MTS (100), for a steerable tool (500) which steerable tool (500) has a proximal end (20) and distal end (40) and comprises a shaft region (532), a bendable proximal part, BPP (534) that is omnidirectionally moveable, and a bendable distal part, BDP, (530) that is omnidirectionally moveable and moves responsive to movement of the BPP (534), which MTS (100) comprises a plurality of longitudinal members, LM (110) each having a proximal (20) and distal end (40), arranged in a longitudinal direction around a fictive tube (120), and has a corresponding transmission shaft region, TSR (132), transmission bendable proximal part, TBPP (134) and transmission bendable distal part, TBDP (130), wherein a plane section (114) of at least one LM (110) demonstrates an anisotropic area moment of inertia, and the majority of the LMs (110) are each axially rotationally constrained at 1 or more constraining points along the TBDP (130) or along the TSR (132) wherein the LMs are longitudinally slidable with respect to each discrete constraining point, and the MTS (100) is configured such that the BDP (530) tip is axially rotationable in a bent position by a complementary rotation of the BPP (534)