Setup and initial testing of an endoscope manipulator system for assistance in transoral endoscopic surgery

2019 ◽  
Vol 64 (3) ◽  
pp. 347-356
Author(s):  
Axel Boese ◽  
Philipp Hündorf ◽  
Christoph Arens ◽  
Daniel T. Friedrich ◽  
Michael Friebe
Keyword(s):  
General Concept ◽  
Single Type ◽  
Transoral Surgery ◽  
Prototype System ◽  
Clinical Workflow ◽  
Posterior Commissure ◽  
Vocal Cords ◽  
Quick Release ◽  
Special Cases ◽  
Microlaryngeal Surgery

Abstract Purpose For the treatment of malignant diseases of the oral cavity and the larynx, a total or partial resection is the standard therapy, while in special cases chemo- and/or external radiation therapy is considered. Transoral access reduces trauma and hospitalization time. Transoral surgery is usually executed using external microscopic imaging. Therefore, the microscope is placed in the visual line of the opening of the mouth and throat. However, specific anatomical structures like the posterior commissure (dorsal end of the vocal cords) are not visible in these procedures. An endoscopic approach can improve this problem. We introduce a new prototype system for endoscopic assisted transoral surgery. Methods Based on clinical observation and discussions with professional users and surgeons, the clinical need was identified and specified. A general concept or an endoscopic manipulator to assist microlaryngeal surgery was designed. For that a steerable rigid endoscope was combined with an actuator that allows translational and rotational movement. A quick release fastener was designed allowing for fast change of the endoscope and independence from its shape and type. The actuator was fixed on a commercially available, semi-active medical holding arm for easy positioning. The holder can be fixed to the standard rails of the surgical table. The piezoelectric drives integrated in the actuator are activated with a foot pedal. This allows easy and fast fine positioning, while the hands are free to perform the surgery with standard instruments for microlaryngeal surgery. Results A prototype of the system for endoscopic assisted transoral surgery was developed. The entire technical setup was tested in terms of usability and performance in a simulated surgical scenario. A basic phantom, representing the throat and vocal cords was created and placed on a surgical table. The system was installed on the table and the clinical workflow of a simulated endoscopic assisted surgery on the vocal cords was performed. The performance of the setup and the procedure success was evaluated by clinical users. Conclusion Fixture of the system on the surgical table is fast and easy due to its low weight and compact design. The medical holder allows a fast initial positioning of the system in front of the phantom patient. An easy insertion and removal of the endoscope was realized using the quick release fastener. The developed endoscope fixation is universally adaptable and not limited to a single type of endoscope. The piezoelectric drives, combined with the foot pedal, allow a precise placement and readjustment of the endoscope during surgery. The use of a multi view endoscope enables a variable view on the surgical situs. The size and shape of the whole setup offer excellent access to the targeted structures. The development was classified beneficial by the clinical users.

A New Silicone Elastomer Tube for Use during Microsurgery on the Larynx

1974 ◽  
Vol 83 (3) ◽  
pp. 360-364 ◽  
Author(s):  
Edward Carden ◽  
George B. Ferguson ◽  
William M. Crutchfield
Keyword(s):  
Endotracheal Tube ◽  
Silicone Elastomer ◽  
Posterior Commissure ◽  
Operating Field ◽  
Surgical Field ◽  
Microlaryngeal Surgery ◽  
The Way

A new special endotracheal tube for ventilating patients during microlaryngeal surgery is described. It is 6.25 cm long, made of silicone elastomer and has a “soft” cuff built onto it. It is placed below the patient's cords and the cuff blown up while the patient is paralyzed, and under anesthesia. The patient's lungs can be ventilated by jetting oxygen from the jet tube which is built into it. While the oxygen is not flowing the patient can passively exhale through the tube and cords. Obstruction to the surgical field is minimal and consists of the cuff inflating tube .08 cm in diameter and the jet tube .25 cm in diameter which will be in the posterior commissure out of the way. The tube is designed in such a way that both during inflation and exhalation gas is blown out through the cords to help to blow blood and debris away from the operating field.

scholarly journals Mucociliary Transport Pathway on Laryngotracheal Tract and Stented Glottis in Guinea Pigs

2000 ◽  
Vol 109 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Shiann-Yann Lee ◽  
Ching-Ting Tan ◽  
Te-Huei Yeh ◽  
Mao-Chang Su ◽  
Pei-Jen Lou ◽  
...  
Keyword(s):  
Guinea Pigs ◽  
Posterior Wall ◽  
Free Edge ◽  
Mucociliary Transport ◽  
Posterior Commissure ◽  
Transport Pathway ◽  
Vocal Cords ◽  
Short Delay ◽  
Mucociliary Function

We investigated the laryngotracheal mucociliary transport pathway of guinea pigs in vivo and immediately postmortem. Only intraperitoneal anesthesia was used during the procedure to avoid the disturbance of mucociliary function. Resin particles were used as the marking substance. A microcolpohysteroscope was placed at different levels in the laryngotracheal region for observing the marking particles and recording the transport pattern. The tracheal mucociliary transport flow primarily moved along the posterior wall and both lateral walls in a zigzag trace. Upon reaching the subglottis, the resin particles stayed underneath the vocal cords, and a whirlpool phenomenon developed. The majority of the particles were shifted and directed onto the posterior glottic area. With a short delay, some resin particles crossed over the free edge of the vocal cords and turned posteriorly along the medial upper cordal margin. No mucociliary transport could be observed on the entire upper surface of the true vocal cords, which is covered by squamous epithelium. Occasionally, a few resin particles in the vicinity of the epiglottic root traveled along the aryepiglottic folds toward the posterior commissure. All streams of mucociliary transport finally joined together in the interarytenoid area. After leaving the glottis, the resin particles traveled to the hypopharynx and entered the esophagus through the motion of deglutition. The pattern of mucociliary clearance in the laryngotracheal region was not delayed by stenting.

scholarly journals 99MTc-PSMA – radionuclide imaging of prostate cancer: an innovative diagnostic direction in nuclear medicine

2020 ◽  
pp. 26-38
Author(s):  
P. Korol ◽  
M. Tkachenko ◽  
A. Voloshin
Keyword(s):  
Prostate Cancer ◽  
Nuclear Medicine ◽  
Single Photon ◽  
Photon Emission ◽  
General Concept ◽  
Emission Computed Tomography ◽  
Clinical Use ◽  
Clinical Workflow ◽  
Therapeutic Concepts ◽  
Total Body

The literature review considers the prospects for the use of SPECT and PET imaging with 99mTc-PSMA as an innovative method for diagnosing prostate cancer. SPECT studies with 111In-PSMA-I have further expanded the scope of modern therapeutic concepts aimed at PSMA. However, the inherent limitations associated with 111In preclude the wider clinical use of 111In-PSMA-I and T, in addition to studies confirming the concept, in small cohorts of patients. The total body clearance of 99mTc-PSMA-I and S is relatively slow, which results in a relatively late clearance in the abdominal region. However, the accumulation of the radiopharmaceutical in previously identified areas of tumor lesions steadily grows over time due to the prolonged presence of an intact indicator in the blood and its internalization into tumor cells with high PSMA expression. In a delayed period, an excellent lesion-background ratio is obtained due to the synergistic effect of stable uptake of 99mTc-PSMA-I and S in tumor tissue and the continuation of the clearance of background activity. Several alternative therapeutic approaches have been implemented to provide a universal molecular platform for labeling with diagnostic (123I / 124I, 68Ga) and therapeutic radionuclide (131I, 177Lu). Baseline data on endoradiotherapeutic use of 131I-MIP-1095, 177Lu-DKFZ-617 and 177Lu-PSMA-I and T in patients with metastatic prostate cancer demonstrate the prospects of molecular and morphological treatment. Thus, the aim of this work was to adapt the general concept of the indicator with the requirements of 99mTc. The availability and ease of preparation of 99mTc-PSMA indicators is fully compatible with the daily clinical workflow. In this regard, a lyophilized kit for the routine manufacture of 99mTc-PSMA-I and S appears to be available and reliable, which facilitates the distribution and production of new effective radiopharmaceuticals for clinical use in urology and, in particular, nuclear medicine. Key words: nuclear medicine, prostate cancer, single-photon emission computed tomography, prostate-specific membrane antigen.

scholarly journals Adaptive Construction of the Virtual Debris Flow Disaster Environments Driven by Multilevel Visualization Task

2019 ◽  
Vol 8 (5) ◽  
pp. 209 ◽  
Author(s):  
Yunhao Zhang ◽  
Jun Zhu ◽  
Weilian Li ◽  
Qing Zhu ◽  
Ya Hu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Debris Flow ◽  
Emergency Response ◽  
Dynamic Scheduling ◽  
Single Type ◽  
Prototype System ◽  
Disaster Prevention ◽  
On Demand ◽  
Task Requirements ◽  
Debris Flow Disaster

The construction of a virtual debris flow disaster environment is of great significance in debris flow disaster prevention, risk assessment, accurate simulation, and disaster emergency response. However, existing research on virtual disaster environments mainly focus on the specific visualization task requirements of single-type users, and the multilevel visualization task requirements of multitype users are generally not met. In this paper, an adaptive construction method for virtual debris flow disaster environments driven by multilevel visualization task is proposed based on the characteristics of users with different professional knowledge backgrounds and requirements in disaster emergency response scenarios. The on-demand construction of virtual debris flow disaster environments and the corresponding diverse organization and dynamic scheduling technologies are discussed in detail. Finally, the Qipan Gully debris flow disaster is selected for experimental analysis, and a prototype system is developed. The experimental results show that the proposed method can adaptively construct virtual debris flow disaster environments according to the multilevel visualization task requirements of multitype users in debris flow disaster emergency response scenarios. This approach can provide efficient rendering of disaster scenes and appropriate disaster information to multitype users who are involved in debris flow disaster emergency response scenarios.

scholarly journals The Design Of A Quick Release Attachment Mechanism For A Hydrofoil Board

2021 ◽  
Author(s):  
Zarya O. Blackwood
Keyword(s):  
Compressive Strength ◽  
Market Research ◽  
General Concept ◽  
Primary Objective ◽  
Quick Release ◽  
Design Concepts ◽  
Final Design ◽  
Cyclical Loading ◽  
Attachment Mechanism ◽  
Project Objectives

<div>The primary objective of this project was to design a quick attach and detach system for use with a surfing foilboard. Foilboards are comprised of a board, mast, and fuselage, onto which wings are attached. These components are generally held together by long bolts, which makes the overall board tedious to assemble and disassemble. Research was conducted on the general concept of attaching components rigidly as well as on the market of current foilboard quick attach mechanisms, and a series of conceptual designs were created from it. All design concepts were rated using metrics generated from both the project objectives and market research, and the top-rated concept was then drawn up in Solidworks. Several design iterations were developed in order to meet both the minimum 300g weight, tensile and compressive strength, and attachment/detachment speed requirements. The design iterations were first validated using a series of Solidworks simulation analyses. Subsequently the final design candidate was analysed using a series of ANSYS Static Structural simulations. The final design can withstand the loads and torques during regular usage as well as cases of the rider standing on the side of the mast while the board is at rest. The design can be attached or detached within one second. It can survive up to 8.769x105 cycles of maximum cyclical loading and is easy to clean.</div>

A Hunsaker Mon-Jet tube trapped in the larynx

2011 ◽  
Vol 125 (11) ◽  
pp. 1204-1205 ◽  
Author(s):  
I Khan ◽  
M Shakeel ◽  
R Nagaraja ◽  
B Ram ◽  
A D Thomas
Keyword(s):  
Case Report ◽  
Vocal Cord ◽  
Airway Compromise ◽  
Ventilation Tube ◽  
Jet Ventilation ◽  
Successful Management ◽  
Vocal Cords ◽  
Vocal Cord Polyp ◽  
Microlaryngeal Surgery ◽  
Operating Surgeon

AbstractObjective:We report a unique complication arising from the use of a Hunsaker Mon-Jet ventilation tube during microlaryngeal surgery, and we briefly review the literature on the use of this tube for jet ventilation.Method:A case report on the safe and successful management of a potential airway compromise, and a brief literature review on using the Hunsaker Mon-Jet ventilation tube during microlaryngeal surgery.Case report:A 46-year-old woman was scheduled to undergo removal of a vocal cord polyp under general anaesthesia. However, the polyp became stuck in the basket of the Hunsaker tube during intubation. The polyp and the Hunsaker tube were removed safely after a microlaryngeal tube was passed beyond the vocal cords. To our knowledge, this complication has not previously been reported.Conclusion:This case highlights the potential risk of laryngeal growths, especially vocal cord polyps, becoming trapped in the Hunsaker tube during intubation. Both the anaesthetist and the operating surgeon should be aware of this possible complication and, more importantly, how to deal with such a problem.

scholarly journals A Clinical Study of Laryngeal Cysts

2016 ◽  
Vol 6 (2) ◽  
pp. 53-56
Author(s):  
N Srikanth ◽  
Feroz B Shaik ◽  
KVS Kumar Chowdary
Keyword(s):  
Retrospective Study ◽  
Clinical Study ◽  
Surgical Intervention ◽  
Neoplastic Transformation ◽  
Precipitating Factors ◽  
Vocal Cords ◽  
The Mean ◽  
Microlaryngeal Surgery ◽  
False Vocal ◽  
Methods Of Treatment

ABSTRACT Aim To study cases of cysts of larynx and review the literature regarding precipitating factors and methods of treatment. Materials and methods A retrospective study of eight cases of cysts of larynx in our hospital was carried out from July 2012 to December 2015. In all cases, diagnosis was made by video laryngoscopy and was treated by microlaryngeal surgery under general anesthesia (GA). Results Eight patients with laryngeal cysts were identified, of which five were male and three were female. The mean age was ranging from 40 to 60. On examination, two were diagnosed with cysts from epiglottis, three from aryepiglottic folds, two from false vocal cords, and one from the ventricle. Conclusion As saccular cysts are identified to be associated with neoplastic transformation, it is important to recognize the laryngeal saccular cyst and manage appropriately in its early stages and to differentiate it from other laryngeal cysts. Thorough diagnostic evaluation and surgical intervention necessitates the appropriate management. How to cite this article Kumar Chowdary KVS, Srikanth N, Shaik FB. A Clinical Study of Laryngeal Cysts. Int J Phonosurg Laryngol 2016;6(2):53-56.

Theory, Reduction, and Hierarchy

1988 ◽  
Author(s):  
Keith Stewart Thomson
Keyword(s):  
Biological Sciences ◽  
Genetic Variation ◽  
General Concept ◽  
Simple Expression ◽  
Theory Reduction ◽  
Theory Of Evolution ◽  
Special Cases ◽  
Is Theory ◽  
Attack And Defense

Implicit in the reasons given in Chapter 1 for development being ignored until recently as a potential causal factor in evolutionary theory is the general concept of reductionism. It is a strictly reductionistic approach either to believe that phenotypic variation is equivalent to genetic variation, or to act as though this were the case until disproven. Thus, to take but a single example, we find Stebbins (1974), who is avowedly a “strict reductionist,” stating that “in the future all general theories about evolution will have to be based chiefly upon established facts of population and molecular genetics.” Reduction is, of course, a powerful tool, but it is one with which biologists have in general had difficulty, and which in recent years has come under strong attack and defense (see Williams, 1986). The basic reductionist statement with which we are all comfortable is ontological, namely that the processes underlying all living phenomena are reducible to the operation of mechanical causes: there is no irreducible vitalist essence. Reductionism in this sense is unexceptionable and universal in science. The more difficult sort of reductionism to deal with is theory reduction. A simple expression of this would be the statement that the laws of chemistry are all explicable in terms of the laws of physics, or the laws of biology in the laws of chemistry. Nagel (1961) shows that such theory reduction requires that, for example, the laws of chemistry must be deducible from the laws of physics and that the terms and concepts of both sets of laws be “connected” (see, for example, Newton-Smith, 1982; Beckner, 1974). Another way of putting it is that the laws of physics must be of wider scope than the laws of chemistry, which then constitute a series of special cases of the former, under particular boundary conditions. Talking about theory reduction within the biological sciences, where general theories of broad scope are lacking (except the general theory of evolution that all organisms are related by descent), is somewhat pretentious. In the biological sciences we are forced to work more modestly with rules and probabilities rather than grand laws.

scholarly journals Tuberculosis of the Larynx: A Review of Two Cases

2017 ◽  
Vol 7 (1) ◽  
pp. 27-30
Author(s):  
Kamalika P Roy ◽  
Dhruba J Datta ◽  
Srikanth Madam ◽  
Praneeth K Koduru
Keyword(s):  
Weight Loss ◽  
Histopathological Examination ◽  
Early Recognition ◽  
Case Reports ◽  
Vocal Cords ◽  
Desirable Outcome ◽  
History Of ◽  
Microlaryngeal Surgery ◽  
Subepithelial Layer ◽  
Laryngeal Tuberculosis

ABSTRACT Aim To investigate the changes in the vibratory function of the vocal cords in two diagnosed cases of tuberculosis during and after completion of treatment. Background Laryngeal tuberculosis is one of the most common granulomatous diseases of the larynx. Patients present with hoarseness, irritation in throat, dysphagia, and breathlessness. The hoarseness occurs due to the granulomatous reaction involving the subepithelial layer of the vocal cords, which heal with fibrosis. Case reports A 56-year-old male presented with a 2-month history of cough, hoarseness allegedly precipitated by vocal abuse, dysphagia, weight loss, and evening rise of temperature. There was associated history of tobacco and betel nut intake. A 50-year-old female patient presented with complaints of hoarseness of 3 months duration not associated with any cough, dysphagia, fever, weight loss, or breathlessness. Clinical examination showed whitish lesions in the vocal cords. Microlaryngeal surgery done in both cases for collecting biopsy specimen showed a chronic inflammatory process with granuloma. Antitubercular treatment consisting of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol was given for a period of 6 months. The patients were assessed at the end of 2 and 6 months of treatment symptomatically and clinically with fiber-optic laryngoscopy and stroboscopy. Significant improvement in the vibratory pattern of vocal cords and voice quality was noted in both the patients. Conclusion Early recognition of the disease and initiation of treatment are necessary for a desirable outcome of vibratory function of the vocal cords. Clinical significance As patients present with nonspecific symptoms, an accurate diagnosis of laryngeal tuberculosis can be made by a proper histopathological examination and acid-fast staining of specimen obtained by microlaryngeal surgery. Early initiation of treatment is the key to better outcome. How to cite this article Roy KP, Datta DJ, Madam S, Koduru PK. Tuberculosis of the Larynx: A Review of Two Cases. Int J Phonosurg Laryngol 2017;7(1):27-30.

scholarly journals Population-size-dependent branching processes

1996 ◽  
Vol 9 (4) ◽  
pp. 449-457 ◽  
Author(s):  
Peter Jagers
Keyword(s):  
Population Size ◽  
Branching Processes ◽  
Tumor Model ◽  
Population History ◽  
Single Type ◽  
Offspring Number ◽  
Number Of Children ◽  
Special Cases ◽  
Size Population ◽  
Binary Splitting

In a recent paper [7] a coupling method was used to show that if population size, or more generally population history, influence upon individual reproduction in growing, branching-style populations disappears after some random time, then the classical Malthusian properties of exponential growth and stabilization of composition persist. While this seems self-evident, as stated, it is interesting that it leads to neat criteria via a direct Borel-Cantelli argument: If m(n) is the expected number of children of an individual in an n-size population and m(n)≥m>1, then essentially ∑n=1∞{m(n)−m}<∞ suffices to guarantee Malthusian behavior with the same parameter as a limiting independent-individual process with expected offspring number m. (For simplicity the criterion is stated for the single-type case here.)However, this is not as strong as the results known for the special cases of Galton-Watson processes [10], Markov branching [13], and a binary splitting tumor model [2], which all require only something like ∑n=1∞{m(n)−m}/n<∞.This note studies such latter criteria more generally. It is dedicated to the memory of Roland L. Dobrushin.

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