Transurethral Anastomosis after Transurethral Radical Prostatectomy: A Phantom Study on Intraluminal Suturing With Concentric Tube Robots.

Current surgical approaches to radical prostatectomy are associated with high rates of erectile dysfunction and incontinence. These complications occur secondary to the disruption of surrounding healthy tissue, which is required to expose the prostate. The urethra offers the least invasive access to the prostate, and feasibility has been demonstrated of enucleating the prostate with an endoscope using Holmium laser, which can itself be aimed by concentric tube robots.

Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery.

This article presents the development and experimental validation of a methodology to reduce the risk of thermal injury to the facial nerve during minimally invasive cochlear implantation surgery. The first step in this methodology is a pre-operative screening process, in which medical imaging is used to identify those patients that present a significant risk of developing high temperatures at the facial nerve during the drilling phase of the procedure. Such a risk is calculated based on the density of the bone along the drilling path and the thermal conductance between the drilling path and the nerve, and provides a criterion to exclude high-risk patients from receiving the minimally invasive procedure.

Increasing Safety of a Robotic System for Inner Ear Surgery Using Probabilistic Error Modeling Near Vital Anatomy.

Safe and effective planning for robotic surgery that involves cutting or ablation of tissue must consider all potential sources of error when determining how close the tool may come to vital anatomy. A pre-operative plan that does not adequately consider potential deviations from ideal system behavior may lead to patient injury. Conversely, a plan that is overly conservative may result in ineffective or incomplete performance of the task.

A walking controller for a powered ankle prosthesis.

This paper describes a walking controller implemented on a powered ankle prosthesis prototype and assessed by a below-knee amputee subject on a treadmill at three speeds. The walking controller is a finite state machine which emulates a series of passive impedance functions at the joint in order to reproduce the behavior of a healthy joint. The assessments performed demonstrate the ability of the powered prosthesis prototype and walking controller to reproduce essential biomechanical aspects (i.

Clinical testing of an alternate method of inserting bone-implanted fiducial markers.

Background: Deep brain stimulation (DBS) surgery utilizes image guidance via bone-implanted fiducial markers to achieve the desired submillimetric accuracy and to provide means for attaching microstereotactic frames. For maximal benefit, the markers must be inserted to the correct depth since over-insertion leads to stripping and under-insertion leads to instability.

Purpose: The purpose of the study was to test clinically a depth-release drive system, the PosiSeat™, versus manual insertion (pilot hole followed by manual screwing until tactile determined correct seating) for implanting fiducial markers into the bone.

Minimally invasive image-guided cochlear implantation surgery: first report of clinical implementation.

Objectives/hypothesis: Minimally invasive image-guided approach to cochlear implantation (CI) involves drilling a narrow, linear tunnel to the cochlea. Reported herein is the first clinical implementation of this approach.

Study Design: Prospective cohort study.

Validation of minimally invasive, image-guided cochlear implantation using Advanced Bionics, Cochlear, and Medel electrodes in a cadaver model.

Purpose: Validation of a novel minimally invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers-Medel, Cochlear, and Advanced Bionics-in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea.

Methods: Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel.

Percutaneous cochlear implant drilling via customized frames: an in vitro study.

Objective: Percutaneous cochlear implantation (PCI) surgery uses patient-specific customized microstereotactic frames to achieve a single drill-pass from the lateral skull to the cochlea, avoiding vital anatomy. We demonstrate the use of a specific microstereotactic frame, called a "microtable," to perform PCI surgery on cadaveric temporal bone specimens.

Study Design: Feasibility study using cadaveric temporal bones.

Clinical validation study of percutaneous cochlear access using patient-customized microstereotactic frames.

Objective: Percutaneous cochlear implant (PCI) surgery consists of drilling a single trough from the lateral cranium to the cochlea avoiding vital anatomy. To accomplish PCI, we use a patient-customized microstereotactic frame, which we call a "microtable" because it consists of a small tabletop sitting on legs. The orientation of the legs controls the alignment of the tabletop such that it is perpendicular to a specified trajectory.

Accuracy evaluation of microTargeting Platforms for deep-brain stimulation using virtual targets.

Deep-brain-stimulation (DBS) surgery requires implanting stimulators at target positions with submillimetric accuracy. Traditional stereotactic frames can provide such accuracy, but a recent innovation called the microTargeting Platform (FHC, Inc.) replaces this large, universal frame with a single-use, miniature, and custom-designed platform.