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Preliminary Clinical Microneurosurgical Experience With the 4K3-Dimensional Microvideoscope (ORBEYE) System for Microneurological Surgery: Observation Study
摘要： BACKGROUND: The exoscope has been reported as a novel neurosurgical instrumentation in clinical practice. OBJECTIVE: To investigate the possibility that ORBEYE (OE), a novel instrument that excludes eyepiece lenses and allows for microsurgery by observation of the 4K3D monitor, could replace microscopes. METHODS: We report 22 clinical cases by 5 experienced neurosurgeons and the comparative results of training 10 residents. An observation study with questionnaire survey was conducted on usability. Twelve items including image quality, eyestrain, and function of the arm were evaluated. RESULTS: The following 22 clinical procedures were conducted: surgery for intracranial hemorrhage (n = 2) and brain tumor (n = 8), laminectomy (n = 3), aneurysm clipping (n = 3), vascular anastomosis (n = 2), carotid endarterectomy (n = 2), and nerve decompression (n = 1). No complications were observed. The fluorescent study, including indocyanine-green and 5-aminolevunic acid, allowed for clear depiction on the 4K monitor. The surgeon could operate in a comfortable posture. Similar to the microscope, it was possible to change the optical and viewing axes with the OE, but the OE was switched to the microscope or endoscope in hematoma removal and pituitary surgery. Residents judged that eyestrain was strong (P = .0096). Experienced neurosurgeons acting as assistants judged that the scope arm’s range of movement was narrow (P = .0204). Sixty percent of residents judged that the OE was superior to the microscope. CONCLUSION: Although based on limited experience, it was not possible to substitute the microscope with the OE in all operations; however, the OE surpasses the microscope in terms of ergonomic features.
关键词： Microsurgery,Fluorescence,Microscopy,Endoscope
更新于2025-09-23 15:23:52
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[IEEE 2018 27th IEEE International Symposium on Robot and Human Interactive Communication (RO-MAN) - Nanjing, China (2018.8.27-2018.8.31)] 2018 27th IEEE International Symposium on Robot and Human Interactive Communication (RO-MAN) - User Behavior Evaluation in Robot-Assisted Retinal Surgery
摘要： Retinal microsurgery is technically demanding and requires high surgical skill with very little room for manipulation error. The introduction of robotic assistance has the potential to enhance and expand a surgeon’s manipulation capabilities during retinal surgery, i.e., improve precision, cancel physiological hand tremor, and provide sensing information. However, surgeon performance may also be negatively impacted by robotic assistance due to robot structural stiffness and nonintuitive controls. In complying with robotic constraints, the surgeon loses the dexterity of the human hand. In this paper, we present a preliminary experimental study to evaluate user behavior when affected by robotic assistance during mock retinal surgery. In these experiments user behavior is characterized by measuring the forces applied by the user to the sclera, the tool insertion/retraction speed, the tool insertion depth relative to the scleral entry point, and the duration of surgery. The users’ behavior data is collected during three mock retinal surgery tasks with four users. Each task is conducted using both freehand and robot-assisted techniques. The univariate user behavior and the correlations of multiple parameters of user behavior are analyzed. The results show that robot assistance prolongs the duration of the surgery and increases the manipulation forces applied to sclera, but re?nes the insertion velocity and eliminates hand tremor.
关键词： duration,robotic assistance,insertion velocity,Retinal microsurgery,scleral force,user behavior,insertion depth
更新于2025-09-23 15:21:21
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Oncological and Surgical Outcomes of Patients Treated by Transoral CO <sub/>2</sub> Laser Cordectomy for Early-Stage Glottic Squamous Cell Carcinoma: A Retrospective Chart Review
摘要： Objective: To investigate the feasibility and the outcomes of transoral laser CO2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure. Methods: Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS). Results: A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs (P ? .01). Different procedure tips were described for improving the laryngeal exposition. The 5-year laryngeal preservation rate, DSS, and DFS were significantly better in patients without SCC involvement of the anterior commissure, and did not vary according to the margin status. The laryngeal exposure difficulties did not impact the margin status. Conclusion: The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.
关键词： vocal,exposure,glottic,margin,laryngeal,fold,transoral laser microsurgery,cancer
更新于2025-09-23 15:21:01
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Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels
摘要： A timely diagnosis of vascular compromise improves free flap survival. The aim of this study was to determine the feasibility of monitoring flap vascular patency through noninvasive microcirculation monitoring using SDF. An experimental study was performed in five volunteers. A radial forearm flap was simulated in both upper extremities and cutaneous microcirculation assessment devices were used (SDF and NIRS), and compared with clinical and doppler evaluation. Conditions of venous occlusion (VO) and total vascular occlusion (TVO) were mimicked by using a cuff. The results of the Microscan SDF monitoring during VO and TVO showed a reduced microcirculatory flow at 16.5 (6-30) and 6 (2-11) seconds respectively. Both NIRS and clinical evaluation were slower than SDF at identifying vascular compromise. During VO the Doppler signal does not disappear; while in TVO the signal disappeared at 1.8 (1-5) seconds. This study shows that evaluation of microcirculation with Microscan SDF is a viable alternative that may allow detection of flap venous and total vascular occlusion earlier than Doppler, NIRS and clinical evaluation.
关键词： Evaluation,Microsurgery,Monitoring,Microcirculation
更新于2025-09-23 15:21:01
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Ytterbium-doped fibre femtosecond laser offers robust operation with deep and precise microsurgery of C. elegans neurons
摘要： Laser microsurgery is a powerful tool for neurobiology, used to ablate cells and sever neurites in-vivo. We compare a relatively new laser source to two well-established designs. Rare-earth-doped mode-locked fibre lasers that produce high power pulses recently gained popularity for industrial uses. Such systems are manufactured to high standards of robustness and low maintenance requirements typical of solid-state lasers. We demonstrate that an Ytterbium-doped fibre femtosecond laser is comparable in precision to a Ti:Sapphire femtosecond laser (1–2 micrometres), but with added operational reliability. Due to the lower pulse energy required to ablate, it is more precise than a solid-state nanosecond laser. Due to reduced scattering of near infrared light, it can lesion deeper (more than 100 micrometres) in tissue. These advantages are not specific to the model system ablated for our demonstration, namely neurites in the nematode C. elegans, but are applicable to other systems and transparent tissue where a precise micron-resolution dissection is required.
关键词： Ytterbium-doped fibre femtosecond laser,Laser microsurgery,neuronal regeneration,Ti:Sapphire femtosecond laser,solid-state nanosecond laser,C. elegans
更新于2025-09-23 15:19:57
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Ergonomic aspects in the design of instrumentation for ophthalmic microsurgery; Aspekte der Ergonomie bei der Gestaltung von Instrumenten der ophthalmologischen Mikrochirurgie;
摘要： The following report introduces two projects, dealing about ergonomics in ophthalmic microsurgery. The first project is devoted to the development of a method, by means of which the design of microsurgical instrumentation is evaluated quantitatively. Developed method particularly considers conditions of instrument use as found in microsurgical practice. In a first attempt, the method was validated using laypersons. In the second project, various measures are introduced aiming to improve the posture of the surgeon during the microsurgery. One of the measures consists in using a large 3D-monitor to present the microscopic image to the surgeon instead of viewing the image through the oculars of a traditional microscope. The measure therefore enables a more relaxed posture of the surgeon. In addition, a chair was developed, considering to support the surgeon's posture when operating using the 3D-monitor or the traditional microscope while performing the microsurgery. Practical relevance. The method suggested in the first project closes a gap in product design as it provides developers with a quantitative, objective and ecologic valid methods for evaluating designs of microsurgical instrumentation. The measures presented in the second project will contribute to reduce postural complaints of the surgeon caused by microsurgical interventions.
关键词： ophthalmology,posture,product ergonomics,3D-visualization,microsurgery,fine motor control
更新于2025-09-19 17:15:36
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Femtosecond lasers for high-precision orthopedic surgery
摘要： Laser micromachining with ultrashort pulses has shown great promise for clean, safe surgical treatment of bone tissue. However, comparisons of performance and development of “best practice” have been hampered by the difficulty of comparing results across a wide variety of experimental approaches and under surgically irrelevant conditions (e.g., dried, dead bone). Using a femtosecond (fs) pulsed laser system (τ = 140 fs, repetition rate = 1 kHz, λ = 800 nm), a comprehensive study of femtosecond laser microsurgery using the standard metrics of laser micromachining (ablation threshold, incubation effects, ablation rates, effect of focal point depth within the material and heat affected zone (HAZ)) was conducted on live, freshly harvested bovine and ovine cortical bone. Three important points of optimism for future implementation in the surgical theatre were identified: (1) the removal of material is relatively insensitive to the focal point depth within the material, removing the need for extreme depth precision for excellent performance; (2) femtosecond laser ablation of fresh bone demonstrates very little incubation effect, such that multiple passes of the laser over the same region of bone removes the same amount of material; and (3) the complete absence of collateral damage, heat- or shock-induced, on both the macro- and microscopic scales can be achieved readily, within a broad parameter range. Taken together, these results indicate a handheld or robotic deployed fiber laser platform for femtosecond laser microsurgery is a very viable prospect.
关键词： Laser ablation,Ultrafast laser micromachining,Femtosecond microsurgery,Laser micromachining,Orthopedic surgery
更新于2025-09-16 10:30:52
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Laryngeal Cancer (Clinical Case-Based Approaches) || 4 T1b Glottic Cancer Treated with Transoral Laser Surgery
摘要： T1b squamous cell carcinoma (SCC) of the glot- tis can be treated with radiotherapy or transoral laser surgery. Radiotherapy is usually advocated since voice results are considered better compared to transoral laser surgery; nevertheless, the tran- soral approach is also frequently performed for T1b at the request of the patients. In such cases, special care is needed to avoid unexpected scar. This chapter reports the typical case of a T1b SCC of the glottis with involvement of the anterior commissure observed in a 69-year-old male with a clinical history of daily cigarette smoking for 20 years, and progressive hoarseness lasting for 1 year, who underwent en bloc bilateral subligamen- tal type II cordectomy. The patient, after 3 years of follow-up, is free of cancer. The endoscopic treat- ment in the form of type II cordectomy was chosen for the following reasons: (1) the surgical strat- egy has the advantages of a histologically proven resection without residual cancer and, in case of recurrence a further surgical treatment (includ- ing transoral surgery) and also radiotherapy are still available; (2) early cancer of the glottis is associated with a low incidence of occult metas- tasis and there is no indication for the neck dis- section in cN0 patients; (3) the transoral approach allows for treatment of the cancer with minimal complications, low trauma to healthy tissue, and without the need for tracheostomy and/or nasoga- stic feeding tube; (4) the patient requested to be treated quickly in one stage. In our opinion, tran- soral CO2 laser microsurgery is an important treat- ment option in T1b cancer of glottis.
关键词： laryngeal microsurgery,T1b glottic carcinoma,CO2 laser
更新于2025-09-16 10:30:52
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Periapical Microsurgery: Assessment of Different Types of Light-emitting Diode Transilluminators in Detection of Dentinal Defects
摘要： Introduction: This study evaluated 4 different light-emitting diode (LED) transilluminators and the impact of operator experience in the detection of dentinal defects through an ex vivo TRUEJAW surgical model (Dental Engineering Laboratories, Santa Barbara, CA). Methods: Forty-four extracted and endodontically treated mandibular premolar teeth were evaluated. Teeth were mounted in the models followed by surgical ?aps and osteotomies to expose the apical third of the roots. After apical resection, the root-end surfaces were randomly inspected for the presence or absence of dentinal defects using a dental operating microscope (DOM) at !19.4 magni?cation by experienced and novice LED evaluators. The assessment was made with the DOM light and 4 masked LED transilluminators of different diameters and luminous ?ux. The teeth were examined outside the models to establish the ground truth. The sensitivity, speci?city, and kappa and McNemar test values of each light source by examiner were calculated. Results: The use of LED transilluminators improved the diagnostic sensitivity of dentinal defects when compared with the DOM light alone for both examiners. For the LED-experienced evaluator, the medium-low transilluminator had statistically signi?cant higher sensitivity than the DOM light and the small-low and small-high transilluminators (P , .05). For the novice LED evaluator, the medium-high transilluminator had the highest sensitivity. There was a statistically signi?cant difference between the sensitivities of the medium-low transilluminator between the examiners (P , .05). Conclusions: Within the limitations of this ex vivo surgical study, dentinal defects were more often detected with the LED transilluminators with a larger diameter and increased lumens. The operator’s LED transilluminator experience was found to have a positive effect on the detection of dentinal defects using transillumination.
关键词： Dentinal defects,periapical microsurgery,light-emitting diode,transillumination
更新于2025-09-12 10:27:22
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The Utility of Thulium Laser in Neuroendoscopy
摘要： In the last years, neuroendoscopy has gained consensus as a minimally invasive surgical approach to ventricular lesions. The magnification of the endoscope has become wonderful, but the bleeding control and tumor ablation continue to be harmful by standard tools only through the working channel. Specially, in vascularized tumors and near vital structures the traditional electrosurgery can be ineffective and dangerous. Since 2009, we are using the Tu diode pumped solid state (DPSS) laser (Revolix, LISA laser products) to improve neuroendoscopic procedures. In the Tu DPSS laser the active material is thulium (Tu), emitting light at wavelength of 2,0 μ, through one microfiber large 0,2 mm in diameter introduced in the endoscope working channel. The Tu DPSS laser works very well in water solution, as in the CSF of the ventricles. This laser can hit the tumor by touching or targeting from short distance with low penetration. Tumor cutting and ablation is possible, too. We report our experience in 26 ventricular tumors, 16 in 3rd ventricle and 10 in the lateral ventricle. The histology was: 13 high grade glioma, 5 craniopharyngiomas, 2 PNET, 2 metastasis, 4 colloid cysts. A flexible or rigid scope was used. In 18 neuroendoscopic biopsies the Tu DPSS laser microfiber was used for hemostasis and partial ablation. In 5 craniopharyngiomas wall ablation was performed. In 4 colloid cysts complete removal was possible in one case 3rd ventricular nodule was totally removed by Tu laser ablation. The ETV or tumors cyst fenestration or septostomy through infiltrated septum was successfully performed. The Tu laser showed precise coagulation at low temperature without tissue sticking. In all surgical procedures bleeding control was easy and successful. During Tu laser activation endoscopic vision was always clear. No side effects due to this device were observed. We consider Tu DPSS laser extremely handle and safe. The Tu laser is very efficient for coagulation and ablation of vascularized tumors.
关键词： Thulium,Coagulation,Laser,Neuroendoscopy,Microsurgery,Ablation
更新于2025-09-12 10:27:22