Second Thoughts on First Thoughts

This article represents the inaugural edition of our new “Second Thoughts on First Thoughts” section with Dr Aly as our featured master surgeon. In this article we will explore the evolution of his now renowned surgical strategies from their birth, through their active tinkering, to their ongoing tweaking, even today. The reader will then come away with a deeper understanding of Dr Aly’s “learning curve” and in so doing be spurred forward on their own learning curves.

A Novel Universal Endovascular Robot for Peripheral Arterial Stent–Assisted Angioplasty: Initial Experimental Results

Background: The bottleneck of the development of endovascular interventional robot is that it cannot fully adapt to commercialized endovascular devices, such as guidewires, catheters, and stents, and cannot complete the entire procedure of endovascular treatment, for instance, stent implantation. The purpose of this study is to evaluate whether the novel universal endovascular interventional robot can adapt to different commercialized endovascular devices and accomplish the entire procedure of endovascular treatment of peripheral vascular disease. Methods and Material: The novel universal endovascular interventional robot consists of 2 components: a master surgeon console and a robotic platform with 4 manipulators. An adult pig was served as the experimental animal. Bilateral iliac artery stent implantation was performed on the pig by the endovascular interventional robot using commercialized guidewires, catheters, and stent delivery systems. Results: The novel universal endovascular interventional robot can adapt to commercialized endovascular devices, and most interventional procedures, such as insertion, withdrawal, and rotating, can be done through remote control. By coordinating multiple manipulators, complex actions such as superselection, crossing action, or implantation of self-expanding bare stent can be realized. The entire procedure took about 50 minutes, and the total exposure time of the surgeon was less than 1 minute. Postoperative angiography showed that the position of the stent grafts was accurate. The procedure was stable without any stent or surgical-related complications. Conclusion: The novel universal endovascular interventional robot can realize peripheral arterial stent-assisted angioplasty with commercialized devices. Through the design improvement, the problem related to stent implantation is solved, and the remote operation is realized throughout the endovascular procedure.

Professor William Wayne Babcock (1872-1963) and His Innovations in Surgery

Professor William Wayne Babcock (1872-1963) is considered as a leading figure of American surgery during early 20th century. He introduced many innovative surgical techniques such as Babcock operation for the treatment of varicose veins, the Babcock-Bacon operation for the treatment of cancer of the rectum and sigmoid colon preserving anal sphincters, the “soup bone” cranioplasty technique, and the nerve disassociation technique for the relief of certain forms of paralysis or parasthesia due to injury or inflammation. He invented many surgical instruments such as Babcock forceps, which is widely used in everyday surgical practice, the Babcock probe, and also sump drain and lamp chimney sump drain, which also bear his name. In 1947, he received the Master Surgeon Award from the International College of Physicians and Surgeons and in 1954 the American Medical Association presented him with the Distinguished Service Medal.