Preliminary in vivo evaluation of a needle insertion manipulator for central venous catheterization

Central venous catheterization is associated with potential complications secondary to accidental puncture, including venous bleeding and pneumothorax. We developed a system that avoids these complications and simplifies the procedure using a robot to provide puncture assistance. We herein report a puncture experiment conducted in vivo in a porcine to evaluate the manipulator. The right and left jugular veins of a pig were punctured five times each through both opened and unopened skin at a puncture angle and speed. A venous placement rate of 80% was obtained with opened skin. A much lower rate of 40% was obtained with unopened skin. One of five attempts in opened skin was unsuccessful, likely because of the stick-slip phenomenon. This system was effective for jugular venous puncture of opened skin. Future studies should focus on puncture conditions that facilitate needle placement, inhibit the stick-slip phenomenon, and minimize needle bending due to the presence of skin. © 2014 Kobayashi et al.; licensee Springer.1

Hepatic Foreign Body – a Sewing Needle – in a Child

We report a case of a 1-year-old boy with a needle-like foreign body embedded in the liver. The foreign body was incidentally found in the right hypochondrium on routine chest X-ray during a periodic medical examination. He was asymptomatic and there was neither a history of swallowing a needle nor a puncture wound on his body. The results of blood tests and physical examination were entirely within normal limits. Computed tomography scan showed that the needle was completely buried in the liver. At laparotomy, some fibrous tissue and a scar were recognized between the surface of the left lobe of the liver and the parietal peritoneum of the upper abdominal wall. The end of the sewing needle was manually squeezed out and extracted from the liver. From this operative finding, it was assumed that the needle had penetrated the liver through his skin. His postoperative course was uneventful and he was discharged on postoperative day 8

Procedural surgical skill assessment in laparoscopic training environments.

International audiencePurpose - This study aimed to identify detailed differences in laparoscopic surgical processes between expert and novice surgeons in a training environment and demonstrate that surgical process modeling can be used for such detailed analysis. Methods - Eleven expert surgeons each of whom had performed [Formula: see text] laparoscopic procedures were compared with 10 young surgeons each of whom had performed [Formula: see text] laparoscopic procedures, and five medical students. Each examinee performed a specific skill assessment task. During tasks, instrument motion was monitored using a video capture system. From the video, the corresponding workflow was recorded by labeling the surgeons' activities according to a predefined terminology. Activities represented manual work steps performed during the task, described by a combination of a verb (representing the action), a tool, and the involved structure. The results were described as the number of occurrences (times), average duration (seconds), total duration (seconds), minimal duration (seconds), maximal duration (seconds), and occupancy percentage (%). Results - The terminology for describing the processes of this task included 10 actions, six tools, four structures, and three events for each hand. There were 63 combinations of different possible activities; significant differences in 12 activities were observed between the expert and novice groups (young surgeons and medical students). The expert group performed the task with fewer occurrences and shorter duration than did the novice group in the left hand. Conclusions - We identified differences in surgical process between experts and novices in laparoscopic surgical simulation. Our proposed method would be useful for education and training in laparoscopic surgery

Feasibility of an AI-Based Measure of the Hand Motions of Expert and Novice Surgeons

This study investigated whether parameters derived from hand motions of expert and novice surgeons accurately and objectively reflect laparoscopic surgical skill levels using an artificial intelligence system consisting of a three-layer chaos neural network. Sixty-seven surgeons (23 experts and 44 novices) performed a laparoscopic skill assessment task while their hand motions were recorded using a magnetic tracking sensor. Eight parameters evaluated as measures of skill in a previous study were used as inputs to the neural network. Optimization of the neural network was achieved after seven trials with a training dataset of 38 surgeons, with a correct judgment ratio of 0.99. The neural network that prospectively worked with the remaining 29 surgeons had a correct judgment rate of 79% for distinguishing between expert and novice surgeons. In conclusion, our artificial intelligence system distinguished between expert and novice surgeons among surgeons with unknown skill levels

Kyushu University Interdisciplinary Programs in Education and Projects in Research Development \u22Core of Research and Education for Robotic Medical Technology\u22

九州大学病院統合1周年記念企画九州大学病院・先端医工学診療部は,平成14年度の文部科学省概算要求により,我が国で初めてのロボット手術の診療を中心とした高度先端医療開発センターとして九州大学医学部附属病院に設置を認定され,平成14年4月より発足,その活動を開始しました.わが国の高度先端医療の中核的存在である大学および大学附属病院は,先端生命科学技術等の急速な発展に対応して,より迅速に実験的臨床研究成果を臨床の場に還元し,国民の医療の高度化および発展に貢献することが強く求められています.このような役割を効果的に果たす場として,高度先端医療開発センターを拠点整備し,わが国から世界に発信できる最先端医療技術開発の重点的推進を図ることが,文部科学省調査研究班(班長:杉町圭蔵)より提案されました.本診療部はこの提案に基づいて発足するに至ったわけですが,百年を誇る九州大学病院のなかで最も新しい診療科でもあります

The incidence and outcome of allied disorders of Hirschsprung's disease in Japan: Results from a nationwide survey

Background: Allied disorders of Hirschsprung's disease (ADHD) have been proposed to be the concept of the functional obstruction of the intestine with the presence of ganglion cells in the terminal rectum. They are classified into two categories based on pathology: (1) abnormal ganglia, including immaturity of ganglia, hypoganglionosis (HG), and intestinal neuronal dysplasia; (2) normal ganglia, including megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS), segmental dilatation (SD), internal anal sphincter achalasia (IASA), and chronic idiopathic intestinal pseudo-obstruction (CIIP). Some of these show poor prognosis, therefore, the establishment of criteria and appropriate treatment strategies is required. Methods: The questionnaires were sent to the 161 major institutes of pediatric surgery or gastroenterology in Japan, in order to collect the cases of ADHD during 10 years from 2001 and 2010. Results: In total, 355 cases were collected. They included 28 immaturity of ganglia, 130 HG (121 congenital, 9 acquired), 18 intestinal neuronal dysplasia, 33 MMIHS, 43 SD, three IASA, and 100 CIIP. Of the 95 institutes, 69 (72.6%) had their own criteria for ADHD. Criteria were based on clinical symptoms and signs, and conventional pathological examinations. Prognosis was poor in congenital HG, MMIHS, and CIIP, while the others showed good survival rates. Conclusion: Almost all Japanese cases of ADHD in the past 10 years were collected. Congenital HG and CIIP showed relatively high incidence, whereas acquired HG and IASA were extremely rare in Japan. The criteria of each disorder were also collected and summarized. Prognosis was poor in congenital HG, MMIHS, and CIIP