Snake-Like Robots for Minimally Invasive, Single Port, and Intraluminal Surgeries

The surgical paradigm of Minimally Invasive Surgery (MIS) has been a key driver to the adoption of robotic surgical assistance. Progress in the last three decades has led to a gradual transition from manual laparoscopic surgery with rigid instruments to robot-assisted surgery. In the last decade, the increasing demand for new surgical paradigms to enable access into the anatomy without skin incision (intraluminal surgery) or with a single skin incision (Single Port Access surgery - SPA) has led researchers to investigate snake-like flexible surgical devices. In this chapter, we first present an overview of the background, motivation, and taxonomy of MIS and its newer derivatives. Challenges of MIS and its newer derivatives (SPA and intraluminal surgery) are outlined along with the architectures of new snake-like robots meeting these challenges. We also examine the commercial and research surgical platforms developed over the years, to address the specific functional requirements and constraints imposed by operations in confined spaces. The chapter concludes with an evaluation of open problems in surgical robotics for intraluminal and SPA, and a look at future trends in surgical robot design that could potentially address these unmet needs.Comment: 41 pages, 18 figures. Preprint of article published in the Encyclopedia of Medical Robotics 2018, World Scientific Publishing Company www.worldscientific.com/doi/abs/10.1142/9789813232266_000

A tissue tensioner to limit water injection during high pressure water jet debridement

Thesis: S.B., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2015.Cataloged from PDF version of thesis.Includes bibliographical references (pages 53-55).Removing necrotic tissue and foreign materials from wounds is a critical step in the management and treatment of chronic wounds. MIT's BioInstrumentation Laboratory developed a novel debridement technology that uses two high-speed impinging water jets to excise necrotic tissue. However, this device potentially causes accidental injection of water into healthy tissue beneath the wound bed, which can cause injury and necrosis in the healthy tissue. The purpose of this thesis is to explore tissue tension as a solution to reduce the required cutting power and consequently reduce water injection to acceptable levels. After validating the positive effect of tissue tension on the cutting efficiency of the water jet debridement device, we developed a technology that uses angled rolling wheels to tension tissue prior to debridement. This novel tensioner was qualitatively tested and successfully applied local tension at the site of cutting. Suggestions for further testing to improve this device are given. This tissue tensioner shows promise as a complementary appendage to the water jet debridement device.by Colette P. Abah.S.B

Elizabeth Cavicchi (interviewed by Colette Abah)

​​Interview conducted with an MIT alumna as part of the Margaret MacVicar Memorial AMITA (Association of MIT Alumnae) Oral History Project. The purpose of the project is to document the life histories of women graduates of the Massachusetts Institute of Technology

Josette Goldish (interviewed by Colette Abah)

Interview conducted with an MIT alumna as part of the Margaret MacVicar Memorial AMITA (Association of MIT Alumnae) Oral History Project. The purpose of the project is to document the life histories of women graduates of the Massachusetts Institute of Technology

Holliday (Holly) Heine (interviewed by Colette Abah)

Interview conducted with an MIT alumna as part of the Margaret MacVicar Memorial AMITA (Association of MIT Alumnae) Oral History Project. The purpose of the project is to document the life histories of women graduates of the Massachusetts Institute of Technology

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally