Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals

Objectives To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student’s t test. In the animal experiment, 6 robotic out-of-plane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7° in the XY plane and 0.6°, 6.3°, and 0.6° in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p Conclusion Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion

The Current Status of Small Bowel Transplantation : A First Case Report of Cadaveric Small Bowel Transplantation in Kyushu Area

小腸移植は拒絶反応のコントロールが困難で, 移植後の感染症をはじめとする合併症が多いことから, その成績は他の臓器移植の成績と比較して満足できるものではなかった. しかし, 免疫抑制療法, 移植周術期管理, 拒絶反応モニタリング技術の進歩などにより近年その成績は向上し, 短腸症候群や腸管運動機能障害などの小腸不全患者の根本的な治療方法として確立されてきている. 世界的には年間約200例の小腸移植が行われており, その成績も移植後1年生存率は80%程度にまで改善してきている. 日本国内では2011年6月までに18例の患者に対し, 20回の小腸移植が行われており本邦でもその成績向上を背景に症例数が今後増加してくるものと考えられる. 本稿では小腸移植の国内外の現状について概説するとともに2010年9月, 当科において九州では初めてとなる脳死小腸移植を実施した1例について経過を報告する

Hemorrhagic shock due to rupture of a nephroblastoma in an infant: A case report

Introduction: Nephroblastoma is the most common type of malignant renal tumor in children, but hemorrhage in ruptured nephroblastoma is rare. Case presentation: A three-month-old boy was admitted to our hospital with a large right renal tumor and hemorrhagic shock. Laparotomy showed that the tumor had invaded the right lobe of the liver; therefore, surgeons decided to perform only hemostasis and a tumor biopsy. The following day, intratumoral bleeding persisted, necessitating continuous blood infusion, resulting in abdominal compartment syndrome. Therefore, tumor resection was performed. Intra-tumoral hemorrhage continued during the operation, resulting in bradycardia and chest compressions. Histopathological examination confirmed a diagnosis of nephroblastoma. The postoperative course was uneventful. Conclusion: This report underlines the need to choose treatment based on both extratumoral and intratumoral bleeding, keeping in mind the risks of each treatment option

A new abdominal wall reconstruction strategy for giant omphalocele

The mortality rate of giant omphalocele has improved; however long-term follow-up has revealed umbilical defects and deformities after primary closure. We herein report the efficacy of a new abdominal wall reconstruction strategy combining a component separation technique with delayed natural and deep umbilicoplasty. Keywords: Giant omphalocele, Component separation technique, Delayed natural and deep umbilicoplasty, Abdominal wall defec