Navigation Improves Tumor Ablation Performance: Results From a Novel Liver Tumor Simulator Study

Background The efficacy of microwave ablation in treating hepatic tumors requires advanced ultrasound skills. Failure of proper technique has the potential for either under- or over-treatment and possible harm to the patient. Emprint SX? navigation provides surgeons with intra-operative, real-time navigation through augmented reality localization of the ablation antenna and the expected ablation zone. We hypothesize that incorporating this technology leads to improved targeting and optimizes ablation coverage. This study utilizes a simulated model to evaluate ablation outcomes using Emprint SX? navigation vs standard ultrasound. Methods Surgical residents and faculty were recruited from a single institution. Using a novel tumor ablation simulator, participants performed ablations via 2 modes: standard ultrasound guidance (STD) and Emprint SX? navigation (NAV). Primary outcome was the percentage of under-ablation. Secondary outcomes included percentage of over-ablation, time to complete trial, and number of attempts to position antenna. Results 281 trials were performed by fifteen participants, with 47% female and 60% novice ablationists. Under-ablation volume decreased by a mean of 16.3% (SEM ±12.9, P < .001) with NAV compared to STD. Over-ablation volume decreased by a mean of 14.0% (±8.2, P < .001). NAV time was faster by a mean of 32 seconds (±24.9, P < .001) and involved fewer antenna placement attempts by a mean of 1.3 (±1.0, P < .001). For novice ablationists, all outcomes were improved with NAV and novices saw larger improvements compared to experienced ablationists (P = .018). Discussion In a simulated model, NAV improves ablation efficacy and efficiency, with novices gaining the greatest benefit over standard ultrasound

Application of endoscopic tattooing in intraoperative localization of colon tumours and sentinel lymph nodes

Introduction. Minimally invasive techniques in colorectal surgery have become increasingly popular and are considered a standard of care in most surgical cenres. Locating the tumour during laparoscopic procedure can be technically challenging. Incorrect localization of the primary lesion may lead to a non-radical resection margin. The technique of endoscopic tattooing (ET) prior to surgery or endoscopic treatment is considered a useful tool. Various dyes can be used for this purpose, such as: Indian ink, methylene blue, indigocarmine, toluidine blue, isosulfan blue, haematoxylin and eosin, indoxin green. This procedure is recommended by international scientific societies (ASGE and ESGE). Objective. The purpose of the study is to review the current literature on the use of ET in large intestine tumour lesions. Materials and method. A MEDLINE literature search of English language articles addressing the use of ET to enable intraoperative tumour localization in colorectal surgery was performed to evaluate and summarize the feasibility of this technique. Results. The use of ET enables the easy and safe localization of colorectal tumurs during minimally invasive colorectal procedures. The percentage of complications is insignificant. Conclusions. The available literature proves the safety and benefits of using the ET prior to surgical or endoscopic treatment. ASGE and ESGE recommend the use of ET in marking tumours before surgical treatment, and the area after endoscopic resection for further evaluation

The Upgraded D0 detector.

The DØ experiment enjoyed a very successful data-collection run at the Fermilab Tevatron collider between 1992 and 1996. Since then, the detector has been upgraded to take advantage of improvements to the Tevatron and to enhance its physics capabilities. We describe the new elements of the detector, including the silicon microstrip tracker, central fiber tracker, solenoidal magnet, preshower detectors, forward muon detector, and forward proton detector. The uranium/liquid-argon calorimeters and central muon detector, remaining from Run I, are discussed briefly. We also present the associated electronics, triggering, and data acquisition systems, along with the design and implementation of software specific to DØ