A Novel Articulating Chip-on-Tip Endoscope for Dynamic Middle Ear Surgical Visualization.

Objective: To enhance visualization in pediatric Otolaryngology middle ear surgeries and reduce mastoidectomy instances, we introduce a novel Articulating Chip-on-Tip Endoscope (ACoT Endo).

Methods: The ACoT Endo incorporates a cable-driven distal end camera and off-the-shelf Chip-on-Tip camera to improve visualization. We compared its capabilities with standard endoscopes, evaluating its bending capacity (70 ± 2 ) and center axis rotation (360 ).

Deep Learning Segmentation of the Right Ventricle in Cardiac MRI: The M&Ms Challenge.

In recent years, several deep learning models have been proposed to accurately quantify and diagnose cardiac pathologies. These automated tools heavily rely on the accurate segmentation of cardiac structures in MRI images. However, segmentation of the right ventricle is challenging due to its highly complex shape and ill-defined borders.

Local lateral contact governs shear traction of micropatterned surfaces on hydrogel substrates.

Micropatterned surfaces exhibit enhanced shear traction on soft, aqueous tissue-like materials and, thus, have the potential to advance medical technology by improving the anchoring performance of medical devices on tissue. However, the fundamental mechanism underlying the enhanced shear traction is still elusive, as previous studies focused on interactions between micropatterned surfaces and rigid substrates rather than soft substrates. Here, we present a particle tracking method to experimentally measure microscale three-dimensional (3D) deformation of a soft hydrogel in normal and shear contact with arrays of microscale pillars.

Enabling Autonomous Colonoscopy Intervention Using a Robotic Endoscope Platform.

Objective: Robotic endoscopes have the potential to dramatically improve endoscopy procedures, however current attempts remain limited due to mobility and sensing challenges and have yet to offer the full capabilities of traditional tools. Endoscopic intervention (e.g.

Miniaturized Circuitry for Capacitive Self-Sensing and Closed-Loop Control of Soft Electrostatic Transducers.

Soft robotics is a field of robotic system design characterized by materials and structures that exhibit large-scale deformation, high compliance, and rich multifunctionality. The incorporation of soft and deformable structures endows soft robotic systems with the compliance and resiliency that makes them well adapted for unstructured and dynamic environments. Although actuation mechanisms for soft robots vary widely, soft electrostatic transducers such as dielectric elastomer actuators (DEAs) and hydraulically amplified self-healing electrostatic (HASEL) actuators have demonstrated promise due to their muscle-like performance and capacitive self-sensing capabilities.

Patterned enteroscopy balloon design factors influence tissue anchoring.

Balloon-assisted enteroscopy procedures allow visualization and intervention in the small intestine. These balloons anchor an endoscope and/or overtube to the small intestine, allowing endoscopists to plicate the small intestine over the overtube. This procedure can extend examination deeper into the small intestine than the length of the endoscope would allow with direct examination.

Three-Dimensional Microscale Imaging and Measurement of Soft Material Contact Interfaces under Quasi-Static Normal Indentation and Shear.

Understanding the contact and friction between soft materials is vital to a wide variety of engineering applications including soft sealants and medical devices such as catheters and stents. Although the mechanisms of friction between stiff materials have been extensively studied, the mechanisms of friction between soft materials are much less understood. Time-dependent material responses, large deformations, and fluid layers at the contact interface, common in soft materials, pose new challenges toward understanding the friction between soft materials.

Energy-Based Tissue Fusion for Sutureless Closure: Applications, Mechanisms, and Potential for Functional Recovery.

As minimally invasive surgical techniques progress, the demand for efficient, reliable methods for vascular ligation and tissue closure becomes pronounced. The surgical advantages of energy-based vessel sealing exceed those of traditional, compression-based ligatures in procedures sensitive to duration, foreign bodies, and recovery time alike. Although the use of energy-based devices to seal or transect vasculature and connective tissue bundles is widespread, the breadth of heating strategies and energy dosimetry used across devices underscores an uncertainty as to the molecular nature of the sealing mechanism and induced tissue effect.

Positioning Performance of Power and Manual Drivers in Posterior Spinal Fusion Procedures.

This work presents an analysis and comparison of the efficacy of two methods for pedicle screw placement during posterior spinal fusion surgery. A total of 100 screws (64 manual and 36 power driven), all placed utilizing a surgical navigation system, were analyzed and compared. Final screw placement was compared to initial surgical plans using the navigation system, and the final screw locations were analyzed on the basis of angular deviation from these planned trajectories as well as screw translation within a critical reference plane.

Characterizing Adhesion between a Micropatterned Surface and a Soft Synthetic Tissue.

The work of adhesion and work of separation are characteristic properties of a contact interface that describe the amount of energy per unit area required to adhere or separate two contacting substrates, respectively. In this work, the authors present experimental and data analysis procedures that allow the contact interface between a soft synthetic tissue and a smooth or micropatterned poly(dimethylsiloxane) (PDMS) substrate to be characterized in terms of these characteristic parameters. Because of physical geometry limitations, the experimental contact geometry chosen for this study differs from conventional test geometries.

Strength and Persistence of Energy-Based Vessel Seals Rely on Tissue Water and Glycosaminoglycan Content.

Vessel ligation using energy-based surgical devices is steadily replacing conventional closure methods during minimally invasive and open procedures. In exploring the molecular nature of thermally-induced tissue bonds, novel applications for surgical resection and repair may be revealed. This work presents an analysis of the influence of unbound water and hydrophilic glycosaminoglycans on the formation and resilience of vascular seals via: (a) changes in pre-fusion tissue hydration, (b) the enzymatic digestion of glycosaminoglycans (GAGs) prior to fusion and (c) the rehydration of vascular seals following fusion.

A Novel Parameter for Predicting Arterial Fusion and Cutting in Finite Element Models.

Current efforts to evaluate the performance of laparoscopic arterial fusion devices are limited to costly, time consuming, empirical studies. Thus, a finite element (FE) model, with the ability to predict device performance would improve device design and reduce development time and costs. This study introduces a model of the heat transfer through an artery during electrosurgical procedures that accounts for changes in thermal material properties due to water loss and temperature.

Towards autonomous motion control in minimally invasive robotic surgery.

Introduction: While autonomous surgical robotic systems exist primarily at the research level, recently these systems have made a strong push into clinical settings. The autonomous or semi-autonomous control of surgical robotic platforms may offer significant improvements to a diverse field of surgical procedures, allowing for high precision, intelligent manipulation of these systems and opening the door to advanced minimally invasive surgical procedures not currently possible.

Areas Covered: This review highlights those experimental systems currently under development with a focus on in vivo modeling and control strategies designed specifically for the complex and dynamic surgical environment.

Bond Strength of Thermally Fused Vascular Tissue Varies With Apposition Force.

Surgical tissue fusion devices ligate blood vessels using thermal energy and coaptation pressure, while the molecular mechanisms underlying tissue fusion remain unclear. This study characterizes the influence of apposition force during fusion on bond strength, tissue temperature, and seal morphology. Porcine splenic arteries were thermally fused at varying apposition forces (10-500 N).

A new 3-dimensional method for measuring precision in surgical navigation and methods to optimize navigation accuracy.

Purpose: Description of a novel method for evaluation of pedicle screws in 3 dimensions utilizing O-arm(®) and StealthStation(®) navigation; identifying sources of error, and pearls for more precise screw placement.

Methods: O-arm and StealthStation navigation were utilized to place pedicle screws. Initial and final O-arm scans were performed, and the projected pedicle probe track, projected pedicle screw track, and final screw position were saved for evaluation.

Intestinal Manometry Force Sensor for Robotic Capsule Endoscopy: An Acute, Multipatient In vivo Animal and Human Study.

Goal: Development of a new medical device class generally termed robotic capsule endoscopes (RCE) is currently being pursued by multiple research groups. These maneuverable devices will allow minimally invasive diagnosis and treatment of intestinal pathologies. While the intraluminal pressures related to the migrating motor complex (MMC) are well understood, no previous study has measured the active contact forces exerted by the human small bowel wall on a solid, or near solid bolus such as an RCE.

Magnetically driven medical devices: a review.

A widely accepted definition of a medical device is an instrument or apparatus that is used to diagnose, prevent or treat disease. Medical devices take a broad range of forms and utilize various methods to operate, such as physical, mechanical or thermal. Of particular interest in this paper are the medical devices that utilize magnetic field sources to operate.

Tissue storage ex vivo significantly increases vascular fusion bursting pressure.

Introduction: Harvested biological tissue is a common medium for surgical device assessment in a laboratory setting; this study aims to differentiate between surgical device performance in the clinical and laboratory environments prior to and following tissue storage. Vascular tissue fusion devices are sensitive to tissue-device temperature gradients, tissue pre-stretch in vivo and tissue water content, each of which can vary during tissue storage. In this study, we compare the results of tissue fusion prior to and following storage using a standardized bursting pressure protocol.

Soft material adhesion characterization for in vivo locomotion of robotic capsule endoscopes: Experimental and modeling results.

The objective of this work is to validate an experimental method and nondimensional model for characterizing the normal adhesive response between a polyvinyl chloride based synthetic biological tissue substrate and a flat, cylindrical probe with a smooth polydimethylsiloxane (PDMS) surface. The adhesion response is a critical mobility design parameter of a Robotic Capsule Endoscope (RCE) using PDMS treads to provide mobility to travel through the gastrointestinal tract for diagnostic purposes. Three RCE design characteristics were chosen as input parameters for the normal adhesion testing: pre-load, dwell time and separation rate.

Biocompatibility and tissue integration of a novel shape memory surgical mesh for ventral hernia: in vivo animal studies.

Approximately 400,000 ventral hernia repair surgeries are performed each year in the United States. Many of these procedures are performed using laparoscopic minimally invasive techniques and employ the use of surgical mesh. The use of surgical mesh has been shown to reduce recurrence rates compared to standard suture repairs.

Evaluating temperature and duration in arterial tissue fusion to maximize bond strength.

Tissue fusion is a growing area of medical research that enables mechanical closure of tissues without the need of foreign bodies such as sutures or staples. Utilizing heat and pressure applied for a specified time, a bond can be formed between adjacent tissues. The success or failure of tissue fusion is contingent upon the strength of the bond it creates between opposing tissues, yet little characterization has been done to measure the strength of this interface as a function of the input parameters, such as heat and pressure.

Wireless tissue palpation for intraoperative detection of lumps in the soft tissue.

In an open surgery, identification of precise margins for curative tissue resection is performed by manual palpation. This is not the case for minimally invasive and robotic procedures, where tactile feedback is either distorted or not available. In this paper, we introduce the concept of intraoperative wireless tissue palpation.

Temperature measurement methods during direct heat arterial tissue fusion.

Fusion of biological tissues through direct and indirect heating is a growing area of medical research, yet there are still major gaps in understanding this procedure. Several companies have developed devices which fuse blood vessels, but little is known about the tissue's response to the stimuli. The need for accurate measurements of tissue behavior during tissue fusion is essential for the continued development and improvement of energy delivery devices.

A quasi-static model of wheel-tissue interaction for surgical robotics.

Wheel-driven mobile in vivo robotic devices can provide an unconstrained platform for visualization and task performance. Careful understanding of the wheel-tissue interaction is necessary to predict in vivo performance of medical mobility systems. Here, an analytical study of the friction involving rolling contact of a surgical wheel, moving at constant velocities over soft tissue, is presented and verified.

A quantitative comparison of soft tissue compressive viscoelastic model accuracy.

Viscoelastic models are generally considered a good option for modeling biological tissue due to tissue time-dependency. However, although various forms of viscoelastic models have been developed, only a few have shown a good balance between model mathematical simplicity and experimental fit accuracy. Starting from a basic Standard Linear Solid (SLS) model, a systematic modification of the viscoelastic model leading to a more accurate tissue model is presented.