Multiple Synchronous Squamous Cell Cancers of the Skin and Esophagus: Differential Management of Primary Versus Secondary Tumor

Multiple primary tumors are uncommon in patients with squamous cell esophageal cancer. Conventional imaging methods have limitations in detecting those tumors. Although 18-F-fluoro-deoxyglucose-positron emission tomography scanner increases the detection of multiple synchronous tumors in patients with other malignancies, its contribution in patients with squamous cell esophageal cancer has not been assessed as it is not systematically performed. The detection of synchronous skin squamous cell tumors in patients with squamous cell esophageal cancer presents a challenge for making diagnostic and therapeutic decisions. A metastatic tumor leads to palliative management, whereas the diagnosis of a primary skin tumor requires curative treatment of both squamous cell tumors. Pathological evaluation appears crucial in the decision

Injectable Hybrid Hydrogels, with Cell-Responsive Degradation, for Tumor Resection

Biocompatible soft materials have recently found applications in interventional endoscopy to facilitate resection of mucosal tumors. When neoplastic lesions are in organs that can be easily damaged by perforation, such as stomach, intestine, and esophagus, the formation of a submucosal fluid cushion (SFC) is needed to lift the tumor from the underlying muscle during the resection of neoplasias. Such procedure is called endoscopic submucosal dissection (ESD). We describe an injectable, biodegradable, hybrid hydrogel able to form a SFC and to facilitate ESD. The hydrogel, based on polyamidoamines, contains breakable silica nanocapsules covalently bound to its network and able to release biomolecules. To promote degradation, the hydrogel is composed of cleavable disulfide moieties that are reduced by the cells through secretion of glutathione. The same stimulus triggers the breaking of the silica nanocapsules; therefore, the entire hybrid material can be completely degraded and its decomposition depends entirely on the presence of cells. Interestingly, the hydrogel precursor solution showed rapid gelation when injected in vivo and afforded a long-lasting high mucosal elevation, keeping the cushion volume constant during the dissection. This novel material can provide a solution to ESD limitations and promote healing of tissues after surgery

Sunram 7: An MR Safe Robotic System for Breast Biopsy

In breast cancer patients, some nodules are only visible on MRI, thus, requiring MRI-guidance to perform the biopsy. MRI interventions are cumbersome due to the magnetic field and the constrained working space. An MR safe robotic system actuated by pneumatic stepper motors may enable these procedures, improving both accuracy and image-guided navigation. A compact multipurpose pneumatic stepper motor has been designed with outer dimensions $(45 \times 40\times 15)\mathbf{mm}^{\mathbf{3}}$. This is configurable as a linear, rotational or curved stepper motor with a customizable step size and radius of curvature. Five copies of these motors actuate the Sunram 7 biopsy robot, of which the moving part (without protruding racks and tubes) measures $(130 \times 65\times 55)\mathbf{mm}^{\mathbf{3}}$. After manually choosing the target location and angle of approach, the needle is robotically inserted into the breast and the integrated pneumatic biopsy gun is fired to sample tissue from the lesion. The maximum torque of the presented motor is 0.61 N m at 6 bar which can be achieved using 13-teeth polycarbonate gears. Using 17-teeth gears for higher accuracy and a more convenient working pressure of 2 bar the maximum torque is 0.28 N m. The accuracy in free air of the Sunram 7 robot is 1.69mm and 1.72mm in X and Z-direction respectively, with a resulting 2-D error of 2.54 mm. The workspace volume is 4.1 L. When targeting 10 mm-sized lesions in phantoms under MRI guidance, Sunram 7 achieved a success rate of 68%. The minimum interval between two successive biopsies was 5:47 minutes. The presented multipurpose stepper motor has distinct advantages over previous designs in terms of robustness, customizability, printability and ease of integration in MR safe robotics. The Sunram 7 is able to perform accurate MRI-guided biopsies in a large workspace volume while reducing the intervention time when compared to the gold standard (i.e., MRI-guided free-hand biopsy)

Image-Guided Surgical e-Learning in the Post-COVID-19 Pandemic Era: What Is Next?

The current unprecedented coronavirus 2019 (COVID-19) crisis has accelerated and enhanced e-learning solutions. During the so-called transition phase, efforts were made to reorganize surgical services, reschedule elective surgical procedures, surgical research, academic education, and careers to optimize results. The intention to switch to e-learning medical education is not a new concern. However, the current crisis triggered an alarm to accelerate the transition. Efforts to consider e-learning as a teaching and training method for medical education have proven to be efficient. For image-guided therapies, the challenge requires more effort since surgical skills training is combined with image interpretation training, thus the challenge is to cover quality educational content with a balanced combination of blended courses (online/onsite). Several e-resources are currently available in the surgical scenario; however, further efforts to enhance the current system are required by accelerating the creation of new learning solutions to optimize complex surgical education needs in the current disrupted environment

NOTES new frontier: Natural orifice approach to retroperitoneal disease

AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market