Development of a Virtual Laparoscopic Trainer using Accelerometer Augmented Tools to Assess Performance in Surgical training

Previous research suggests that virtual reality (VR) may supplement conventional training in laparoscopy. It may prove useful in the selection of surgical trainees in terms of their dexterity and spatial awareness skills in the near future. Current VR training solutions provide levels of realism and in some instances, haptic feedback, but they are cumbersome by being tethered and not ergonomically close to the actual surgical instruments for weight and freedom of use factors. In addition, they are expensive hence making them less accessible to departments than conventional box trainers. The box trainers in comparison, although more economical, lack tangible feedback and realism for handling delicate tissue structures. We have previously reported on the development of a modified digitally enhanced surgical instrument for laparoscopic training, named the Parkar Tool. This tool contains wireless accelerometer and gyroscopic sensors integrated into actual laparoscopic instruments. By design, it alleviates the need for both tethered and physically different shaped tools thereby enhancing the realism when performing surgical procedures. Additionally the software (Valhalla) has the ability to digitally record surgical motions, thereby enabling it to remotely capture surgical training data to analyse and objectively evaluate performance. We have adapted and further developed our initial single training tool method as used with a laparoscopic pyloromyotomy scenario, to an enhanced method using multiple Parkar wireless tools simultaneously, for use in several different case scenarios. This allows the use and measurement of right and left handed dexterity with the benefit of using several tasks of differing complexity. The development of a 3D tissue-surface deformations solution written in OpenGL gives us several different virtual surgical training scenario approximations to use with the instruments. The trainee can start with learning simple tasks e.g. incising tissue, grasping, squeezing and stretching tissue, to more complex procedures such as suturing, herniotomies, bowel anastomoses, as well as the original pyloromyotomy as used in the first model

Atypical tuberculosis presenting with primary infertility and endometrial calcification

Tuberculosis (TB) is caused by mycobacterium tuberculosis. It remains a public health concern especially in developing country. Pulmonary infection is the main presentation. However, genitourinary TB is common especially with the increase in Human Immunodeficiency virus (HIV) infection. Genitourinary TB is one of the most common causes of extrapulmonary tuberculosis which affects 12% patients with pulmonary tuberculosis. It is common in women less than 40 years of age and rarely occurs in post-menopausal. Therefore it is more likely to affect women in reproductive years leading to infertility. Fallopian tube involvement in genital TB is at least 95-100% of cases and is mainly from haematological spread and this leads to infertility. This is a case of a woman who presented a diagnosis of primary infertility and tuberculous endometritis with endometrial calcification

Right ectopic gestation following in vitro fertilisation: case report

The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure.A 35-year-old para 0 + 0, presented with lower abdominal pain and per vaginal bleeding six weeks after an in vitro fertilisation was done in South Africa. The patient was admitted with severe lower abdominal pain and per vaginal bleeding at six weeks gestation following an in vitro fertilisation procedure. She had undergone an evacuation one-week prior to this episode due to an initial diagnosis of an incomplete abortion. No chorionic villi were reported on histology. The repeat serum BhCG was 777mip/l and at laparoscopy a right unruptured ampullary ectopic gestation (4 ems in size) was evident. A right linear salpingostomy was subsequently performed laparoscopically.Histology confirmed the presence of tubal chorionic villi. The laparoscopic management of ectopic pregnancies is now regarded as the gold standard in many centres in the world. In this patient the ectopic pregnancy resulted following an intra-uterine zygote transfer, and was managed successfully

Endometriosis in unicornuate uterus with non-communicating rudimentary horn

Endometriosis, defined as the presence of endometrial tissue outside the uterine cavity, is itself an enigmatic  and multifaceted pathology, a puzzle whose manifold piece remain largely disconnected despite some decades  of investigation. Its medical history and clinical presentation is heterogeneous. Endometriosis affects  approximately 10% of women of reproductive age, given its high prevalence and that women with endometriosis may have severe pelvic pain and infertility, endometriosis poses a significant health problem.  Evaluating and understanding the pathogenesis, clinical presentation, diagnosis of the endometriosis is critical  in the management of this debilitating disease. A rare case of endometriosis in a patient with congenital  anomaly-Unicornuate uterus with one unconnected rudimentary horn is presented

Premature ovarian failure in twins: case report

Premature ovarian failure (POF)is a serious life-changing condition that affects young women, remains an enigma and the researchers’ challenge. POF, premature ovarian insufficiency (POI), premature menopause, premature dysfunction (POD), or hypergonadotropic hypogonadism is one of the most perplexing disorders with aheterogeneous origin. Infertility, social and psychological stress are common consequences of this entity. This paper presents a rare condition where both twins had presented with POF

Heterotopic pregnancy in an assisted reproduction conception; case report and literature review

Infertility management by assisted reproduction techniques has had rapid increase. While there is robust evidence supporting the efficacy and safety of assisted reproduction technique (ART), complications are encountered. Heterotopic pregnancy, defined as the presence of both an intrauterine and an ectopic gestation, is a rare eventuality of early pregnancy. A 42 years old patient (Para 0+1) with a diagnosis of secondary infertility is presented; she had In Vitro fertilization (IVF) with egg donation. Two weeks after the IVF, a positive serum Beta Human Chorionic Gonadotropin confirmed the pregnancy and she continued with intake of progestins for luteal phase support. At 7 weeks gestation she presented at a local hospital with acute pelvic pain. A diagnosis of heterotopic pregnancy was made after transvaginal showed right slow leaking ectopic pregnancy andintrauterine missed abortion. Laparoscopic surgery, right salpingectomy and manual vacuum aspiration were performed with good subsequent recovery. The case presented, discusses the aetiology, clinical presentation, diagnosis and management of heterotopic pregnancy

Successful pregnancy outcome following laparoscopic myomectomy: case report

Laparoscopic myomectomy is now widely used as an alternative to laparotomy in the management of symptomatic uterine fibroids. The advantages of this minimal access approach outweigh those of the open techniques. The pregnancy outcomes between the two methods have been studied and are comparable, but there still exists a lot of scepticism locally concerning this. It is against this background that we present a 31 year old nulliparous lady who had a two year history of primary infertility secondary to multiple uterine fibroids, the largest being fundal and measuring 6.6cm. She underwent a successful laparoscopic myomectomy in November, 2006 and conceived spontaneously in February 2007. Her antenatal follow up was uneventful. She delivered a live male, 2,650 grams by Caesarean section in October, 2007 and had an unremarkable peuperium. With the availability of proper equipment, instruments, and adequately developing skills, laparoscopic myomectomy is feasible locally and with proper patient selection could result in favourable outcome as it is elsewhere

Distributed Online Rollout for Multivehicle Routing in Unmapped Environments

In this work we consider a generalization of the well-known multivehicle routing problem: given a network, a set of agents occupying a subset of its nodes, and a set of tasks, we seek a minimum cost sequence of movements subject to the constraint that each task is visited by some agent at least once. The classical version of this problem assumes a central computational server that observes the entire state of the system perfectly and directs individual agents according to a centralized control scheme. In contrast, we assume that there is no centralized server and that each agent is an individual processor with no a priori knowledge of the underlying network (including task and agent locations). Moreover, our agents possess strictly local communication and sensing capabilities (restricted to a fixed radius around their respective locations), aligning more closely with several real-world multiagent applications. These restrictions introduce many challenges that are overcome through local information sharing and direct coordination between agents. We present a fully distributed, online, and scalable reinforcement learning algorithm for this problem whereby agents self-organize into local clusters and independently apply a multiagent rollout scheme locally to each cluster. We demonstrate empirically via extensive simulations that there exists a critical sensing radius beyond which the distributed rollout algorithm begins to improve over a greedy base policy. This critical sensing radius grows proportionally to the $\log^*$ function of the size of the network, and is, therefore, a small constant for any relevant network. Our decentralized reinforcement learning algorithm achieves approximately a factor of two cost improvement over the base policy for a range of radii bounded from below and above by two and three times the critical sensing radius, respectively

Fusion of 6^{6}Li with 159^{159}Tb} at near barrier energies

Complete and incomplete fusion cross sections for $^{6}$Li+$^{159}$Tb have been measured at energies around the Coulomb barrier by the $\gamma$-ray method. The measurements show that the complete fusion cross sections at above-barrier energies are suppressed by $\sim$34% compared to the coupled channels calculations. A comparison of the complete fusion cross sections at above-barrier energies with the existing data of $^{11,10}$B+$^{159}$Tb and $^{7}$Li+$^{159}$Tb shows that the extent of suppression is correlated with the $\alpha$-separation energies of the projectiles. It has been argued that the Dy isotopes produced in the reaction $^{6}$Li+$^{159}$Tb, at below-barrier energies are primarily due to the $d$-transfer to unbound states of $^{159}$Tb, while both transfer and incomplete fusion processes contribute at above-barrier energies.Comment: Phys. Rev. C (accepted