Abstract: Stiffness sensing is an important issue in medical diagnostic, robotics surgery, safe handling, and safe grasping of objects in production lines. Detecting and obtaining the characteristics in dwelling lumps embedded in a soft tissue and safe removing and handling of detected lumps is needed in surgery. Also in industry, grasping and handling an object without damaging in a place where it is not possible to access a human operator is very important. In this paper, a method for object handling is presented. It is based on the use of an intelligent gripper to detect the object stiffness and then setting a programmable force for grasping the object to move it. The main components of this system includes sensors (sensors for measuring force and displacement), electrical (electrical and electronic circuits, tactile data processing and force control system), mechanical (gripper mechanism and driving system for the gripper) and the display unit. The system uses a rotary potentiometer for measuring gripper displacement. A microcontroller using the feedback received by the load cell, mounted on the finger of the gripper, calculates the amount of stiffness, and then commands the gripper motor to apply a certain force on the object. Results of Experiments on some samples with different stiffness show that the gripper works successfully. The gripper can be used in haptic interfaces or robotic systems used for object handling.
Abstract: In this paper, the design and evaluation of a handle for laparoscopic surgery is presented. The design of the handle is based on ergonomic principles and tries to avoid awkward postures for surgeons. The handle combines the so-called power-grip and accurate-grip in order to provide strength and accuracy in the performance of surgery. The handle is tested using both objective and subjective approaches. The objective approach uses motion capture techniques to obtain the angles of forearm, arm, wrist and hand. The muscular effort is obtained with electromyography electrodes. On the other hand, a subjective survey has been carried out using questionnaires. Results confirm that the handle is preferred by the majority of the surgeons.
Abstract: A conventional optical coherence tomography (OCT) system has limited imaging depth, which is 1-2 mm, and suffers unwanted noise such as speckle noise. The motorized-stage-based OCT system, using a common-path Fourier-domain optical coherence tomography (CP-FD-OCT) configuration, provides enhanced imaging depth and less noise so that we can overcome these limitations. Using this OCT systems, OCT images were obtained from an onion, and their subsurface structure was observed. As a result, the images obtained using the developed motorized-stage-based system showed enhanced imaging depth than the conventional system, since it is real-time accurate depth tracking. Consequently, the developed CP-FD-OCT systems and algorithms have good potential for the further development of endoscopic OCT for microsurgery.
Abstract: Orthopaedic surgeries are characterized by a high degree of complexity. This is reflected by four main groups of resources: 1) surgical team which is consisted of people with different competencies, educational backgrounds and positions; 2) information and knowledge about medical and technical aspects of surgery; 3) medical equipment including surgical tools and materials; 4) space infrastructure which is important from an operating room layout point of view. These all components must be integrated and build a homogeneous organism for achieving an efficient and ergonomically correct surgical workflow. Taking this as a background, there was formulated a concept of international project, called “Online Vocational Training course on ergonomics for orthopaedic Minimally Invasive” (Train4OrthoMIS), which aim is to develop an e-learning tool available in 4 languages (English, Spanish, Polish and German). In the article, there is presented the first project research outcomes focused on three aspects: 1) ergonomic needs of surgeons who work in hospitals around different European countries, 2) the concept of structure of e-learning course, 3) the definition of tools and methods for knowledge assessment adjusted to users’ expectation. The methodology was based on the expert panels and two types of surveys: 1) on training needs, 2) on evaluation and self-assessment preferences. The major findings of the study allowed describing the subjects of four training modules and learning sessions. According to peoples’ opinion there were defined most expected test methods which are single choice test and right after quizzes: “True or False” and “Link elements” The first project outcomes confirmed the necessity of creating a universal training tool for orthopaedic surgeons regardless of the country in which they work. Because of limited time that surgeons have, the e-learning course should be strictly adjusted to their expectation in order to be useful.
Abstract: Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.
Abstract: Growth and remodeling of biological structures have
gained lots of attention over the past decades. Determining the
response of living tissues to mechanical loads is necessary for a wide
range of developing fields such as prosthetics design or computerassisted
surgical interventions. It is a well-known fact that biological
structures are never stress-free, even when externally unloaded. The
exact origin of these residual stresses is not clear, but theoretically,
growth is one of the main sources. Extracting body organ’s shapes
from medical imaging does not produce any information regarding
the existing residual stresses in that organ. The simplest cause of such
stresses is gravity since an organ grows under its influence from
birth. Ignoring such residual stresses might cause erroneous results in
numerical simulations. Accounting for residual stresses due to tissue
growth can improve the accuracy of mechanical analysis results. This
paper presents an original computational framework based on gradual
growth to determine the residual stresses due to growth. To illustrate
the method, we apply it to a finite element model of a healthy human
face reconstructed from medical images. The distribution of residual
stress in facial tissues is computed, which can overcome the effect of
gravity and maintain tissues firmness. Our assumption is that tissue
wrinkles caused by aging could be a consequence of decreasing
residual stress and thus not counteracting gravity. Taking into
account these stresses seems therefore extremely important in
maxillofacial surgery. It would indeed help surgeons to estimate
tissues changes after surgery.
Abstract: Thoracotomy is a great surgery that has serious pulmonary complications, so purpose of this study was to determine the response of diaphragmatic excursion to inspiratory muscle trainer post thoracotomy. Thirty patients of both sexes (16 men and 14 women) with age ranged from 20 to 40 years old had done thoracotomy participated in this study. The practical work was done in cardiothoracic department, Kasr-El-Aini hospital at faculty of medicine for individuals 3 days Post operatively. Patients were assigned into two groups: group A (study group) included 15 patients (8 men and 7 women) who received inspiratory muscle training by using inspiratory muscle trainer for 20 minutes and routine chest physiotherapy (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Group B (control group) included 15 patients (8 men and 7 women) who received the routine chest physiotherapy only (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Ultrasonography was used to evaluate the changes in diaphragmatic excursion before and after training program. Statistical analysis revealed a significant increase in diaphragmatic excursion in the study group (59.52%) more than control group (18.66%) after using inspiratory muscle trainer post operatively in patients post thoracotomy. It was concluded that the inspiratory muscle training device increases diaphragmatic excursion in patients post thoracotomy through improving inspiratory muscle strength and improving mechanics of breathing and using of inspiratory muscle trainer as a method of physical therapy rehabilitation to reduce post-operative pulmonary complications post thoracotomy.
Abstract: Objective: Safety and efficacy of Ahmed glaucoma
valve implantation for the management of uveitis induced glaucoma
evaluated on the five dogs with uncontrollable glaucoma. Materials
and Methods: Ahmed Glaucoma Valve (AGV®; New World
Medical, Rancho Cucamonga, CA, USA) is a flow restrictive, nonobstructive
self-regulating valve system. Preoperative ocular
evaluation included direct ophthalmoscopy and measurement of the
intraocular pressure (IOP). The implant was examined and primed
prior to implantation. The selected site of the valve implantation was
the superior quadrant between the superior and lateral rectus muscles.
A fornix-based incision was made through the conjunectiva and
Tenon’s capsule. A pocket is formed by blunt dissection of Tenon’s
capsule from the episclera. The body of the implant was inserted into
the pocket with the leading edge of the device around 8-10 mm from
the limbus. Results: No post-operative complications were detected
in the operated eyes except a persistent corneal edema occupied the
upper half of the cornea in one case. Hyphaema was very mild and
seen only in two cases which resolved quickly two days after surgery.
Endoscopical evaluation for the operated eyes revealed a normal
ocular fundus with clearly visible optic papilla, tapetum and retinal
blood vessels. No evidence of hemorrhage, infection, adhesions or
retinal abnormalities was detected. Conclusion: Ahmed glaucoma
valve is safe and effective implant for treatment of uveitic glaucoma
in dogs.
Abstract: Cochlear Implantation (CI) which became a routine
procedure for the last decades is an electronic device that provides a
sense of sound for patients who are severely and profoundly deaf.
The optimal success of this implantation depends on the electrode
technology and deep insertion techniques. However, this manual
insertion procedure may cause mechanical trauma which can lead to
severe destruction of the delicate intracochlear structure.
Accordingly, future improvement of the cochlear electrode implant
insertion needs reduction of the excessive force application during
the cochlear implantation which causes tissue damage and trauma.
This study is examined tool-tissue interaction of large prototype scale
digit embedded with distributive tactile sensor based upon cochlear
electrode and large prototype scale cochlea phantom for simulating
the human cochlear which could lead to small scale digit
requirements. The digit, distributive tactile sensors embedded with
silicon-substrate was inserted into the cochlea phantom to measure
any digit/phantom interaction and position of the digit in order to
minimize tissue and trauma damage during the electrode cochlear
insertion. The digit have provided tactile information from the digitphantom
insertion interaction such as contact status, tip penetration,
obstacles, relative shape and location, contact orientation and
multiple contacts. The tests demonstrated that even devices of such a
relative simple design with low cost have potential to improve
cochlear implant surgery and other lumen mapping applications by
providing tactile sensory feedback information and thus controlling
the insertion through sensing and control of the tip of the implant
during the insertion. In that approach, the surgeon could minimize the
tissue damage and potential damage to the delicate structures within
the cochlear caused by current manual electrode insertion of the
cochlear implantation. This approach also can be applied to other
minimally invasive surgery applications as well as diagnosis and path
navigation procedures.
Abstract: Excessive fretting wear at the taper-trunnion junction
(trunnionosis) apparently contributes to the high failure rates of hip
implants. Implant wear and corrosion lead to the release of metal
particulate debris and subsequent release of metal ions at the tapertrunnion
surface. This results in a type of metal poisoning referred to
as metallosis. The consequences of metal poisoning include;
osteolysis (bone loss), osteoarthritis (pain), aseptic loosening of the
prosthesis and revision surgery. Follow up after revision surgery,
metal debris particles are commonly found in numerous locations. Background: A stable connection between the femoral ball head
(taper) and stem (trunnion) is necessary to prevent relative motions
and corrosion at the taper junction. Hence, the importance of
component assembly cannot be over-emphasized. Therefore, the aim
of this study is to determine the influence of head-stem junction
assembly by press fitting and the subsequent
disengagement/disassembly on the connection strength between the
taper ball head and stem. Methods: CoCr femoral heads were assembled with High stainless
hydrogen steel stem (trunnion) by Push-in i.e. press fit; and
disengaged by pull-out test. The strength and stability of the two
connections were evaluated by measuring the head pull-out forces
according to ISO 7206-10 standards. Findings: The head-stem junction strength linearly increases with
assembly forces.
Abstract: Introduction: The process to build a better safety
culture, methods of error analysis, and preventive measures, starts
with an understanding of the effects when human factors engineering
refer to remote microscopic diagnosis in surgery and specially in
organ transplantation for the remote evaluation of the grafts. It has
been estimated that even in well-organized transplant systems an
average of 8% to 14% of the grafts (G) that arrive at the recipient
hospitals may be considered as diseased, injured, damaged or
improper for transplantation. Digital microscopy adds information on
a microscopic level about the grafts in Organ Transplant (OT), and
may lead to a change in their management. Such a method will
reduce the possibility that a diseased G, will arrive at the recipient
hospital for implantation. Aim: Ergonomics of Digital Microscopy
(DM) based on virtual slides, on Telemedicine Systems (TS) for
Tele-Pathological (TPE) evaluation of the grafts (G) in organ
transplantation (OT). Material and Methods: By experimental
simulation, the ergonomics of DM for microscopic TPE of Renal
Graft (RG), Liver Graft (LG) and Pancreatic Graft (PG) tissues is
analyzed. In fact, this corresponded to the ergonomics of digital
microscopy for TPE in OT by applying Virtual Slide (VS) system for
graft tissue image capture, for remote diagnoses of possible
microscopic inflammatory and/or neoplastic lesions. Experimentation
included: a. Development of an OTE-TS similar Experimental
Telemedicine System (Exp.-TS), b. Simulation of the integration of
TS with the VS based microscopic TPE of RG, LG and PG applying
DM. Simulation of the DM based TPE was performed by 2
specialists on a total of 238 human Renal Graft (RG), 172 Liver Graft
(LG) and 108 Pancreatic Graft (PG) tissues digital microscopic
images for inflammatory and neoplastic lesions on four electronic
spaces of the four used TS. Results: Statistical analysis of specialist‘s
answers about the ability to diagnose accurately the diseased RG, LG
and PG tissues on the electronic space among four TS (A,B,C,D)
showed that DM on TS for TPE in OT is elaborated perfectly on the
ES of a Desktop, followed by the ES of the applied Exp.-TS. Tablet
and Mobile-Phone ES seem significantly risky for the application of
DM in OT (p
Abstract: This study, for its research subjects, uses patients who
had undergone total knee replacement surgery from the database of the
National Health Insurance Administration. Through the review of
literatures and the interviews with physicians, important factors are
selected after careful screening. Then using Cross Entropy Method,
Genetic Algorithm Logistic Regression, and Particle Swarm
Optimization, the weight of each factor is calculated and obtained. In
the meantime, Excel VBA and Case Based Reasoning are combined
and adopted to evaluate the system. Results show no significant
difference found through Genetic Algorithm Logistic Regression and
Particle Swarm Optimization with over 97% accuracy in both
methods. Both ROC areas are above 0.87. This study can provide
critical reference to medical personnel as clinical assessment to
effectively enhance medical care quality and efficiency, prevent
unnecessary waste, and provide practical advantages to resource
allocation to medical institutes.
Abstract: Robotic surgery is used to enhance minimally invasive
surgical procedure. It provides greater degree of freedom for surgical
tools but lacks of haptic feedback system to provide sense of touch to
the surgeon. Surgical robots work on master-slave operation, where
user is a master and robotic arms are the slaves. Current, surgical
robots provide precise control of the surgical tools, but heavily rely
on visual feedback, which sometimes cause damage to the inner
organs. The goal of this research was to design and develop a realtime
Simulink based robotic system to study force feedback
mechanism during instrument-object interaction. Setup includes three
VelmexXSlide assembly (XYZ Stage) for three dimensional
movement, an end effector assembly for forceps, electronic circuit for
four strain gages, two Novint Falcon 3D gaming controllers,
microcontroller board with linear actuators, MATLAB and Simulink
toolboxes. Strain gages were calibrated using Imada Digital Force
Gauge device and tested with a hard-core wire to measure
instrument-object interaction in the range of 0-35N. Designed
Simulink model successfully acquires 3D coordinates from two
Novint Falcon controllers and transfer coordinates to the XYZ stage
and forceps. Simulink model also reads strain gages signal through
10-bit analog to digital converter resolution of a microcontroller
assembly in real time, converts voltage into force and feedback the
output signals to the Novint Falcon controller for force feedback
mechanism. Experimental setup allows user to change forward
kinematics algorithms to achieve the best-desired movement of the
XYZ stage and forceps. This project combines haptic technology
with surgical robot to provide sense of touch to the user controlling
forceps through machine-computer interface.
Abstract: Total hip replacement had been one of the most
successful operations in hip arthritis surgery. The purpose of this
research had been to develop a dynamic hip contact of Thai femoral
bone to analyze the stress distribution on the implant and the strain
distribution on the bone model under daily activities and compared
with the static load simulation. The results showed the different of
maximum von Mises stress 0.14 percent under walking and 0.03
percent under climbing stair condition and the different of equivalent
total strain 0.52 percent under walking and 0.05 percent under
climbing stair condition. The muscular forces should be evaluated
with dynamic condition to reduce the maximum von Mises stress and
equivalent total strain.
Abstract: In orthopedic surgery there are various situations in
which the surgeon needs to implement methods of cutting and
drilling the bone. With this type of procedure the generated friction
leads to a localized increase in temperature, which may lead to the
bone necrosis. Recognizing the importance of studying this
phenomenon, an experimental evaluation of the temperatures
developed during the procedure of drilling bone has been done.
Additionally the influence of the use of the procedure with / without
additional lubrication during drilling of bone has also been done. The
obtained results are presented and discussed and suggests an
advantage in using additional lubrication as a way to minimize the
appearance of bone tissue necrosis during bone drilling procedures.
Abstract: Robotics provides answers to amputees. The most
expensive solutions surgically connect the prosthesis to nerve endings.
There are also several types of non-invasive technologies that recover
nerve messages passing through the muscles. After analyzing these
messages, myoelectric prostheses perform the desired movement.
The main goal is to avoid all surgeries, which can be heavy and offer
cheaper alternatives. For an amputee, we use valid muscles to recover
the electrical signal involved in a muscle movement. EMG sensors
placed on the muscle allows us to measure a potential difference,
which our program transforms into control for a robotic arm with two
degrees of freedom. We have shown the feasibility of non-invasive
prostheses with two degrees of freedom. Signal analysis and an
increase in degrees of freedom is still being improved.
Abstract: Bone properties and response behavior after static or
dynamic activation (loading) are still interesting topics in many fields
of the science especially in the biomechanical problems such as bone
loss of astronauts in space, osteoporosis, bone remodeling after
fracture or remodeling after surgery (endoprosthesis and implants)
and in osteointegration. This contribution deals with the relation
between physiological, demineralized and deproteinized state of the
turkey long bone – tibia. Three methods for comparison were used: 1)
densitometry, 2) three point bending and 3) frequency analysis. The
main goal of this work was to describe the decrease of the protein
(collagen) or mineral of the bone with relation to the fracture in three
point bending. The comparison is linked to the problem of different
bone mechanical behavior in physiological and osteoporotic state.
Abstract: Human face has a fundamental role in the appearance
of individuals. So the importance of facial surgeries is undeniable.
Thus, there is a need for the appropriate and accurate facial skin
segmentation in order to extract different features. Since Fuzzy CMeans
(FCM) clustering algorithm doesn’t work appropriately for
noisy images and outliers, in this paper we exploit Possibilistic CMeans
(PCM) algorithm in order to segment the facial skin. For this
purpose, first, we convert facial images from RGB to YCbCr color
space. To evaluate performance of the proposed algorithm, the
database of Sahand University of Technology, Tabriz, Iran was used.
In order to have a better understanding from the proposed algorithm;
FCM and Expectation-Maximization (EM) algorithms are also used
for facial skin segmentation. The proposed method shows better
results than the other segmentation methods. Results include
misclassification error (0.032) and the region’s area error (0.045) for
the proposed algorithm.
Abstract: Nonstationary and nonlinear signals generated by living complex systems defy traditional mechanistic approaches, which are based on homeostasis. Previous our studies have shown that the evaluation of the interactions of physiological signals by using special analysis methods is suitable for observation of physiological processes. It is demonstrated the possibility of using deep physiological model, based on the interpretation of the changes of the human body’s functional states combined with an application of the analytical method based on matrix theory for the physiological signals analysis, which was applied on high risk cardiac patients. It is shown that evaluation of cardiac signals interactions show peculiar for each individual functional changes at the onset of hemodynamic restoration procedure. Therefore, we suggest that the alterations of functional state of the body, after patients overcome surgery can be complemented by the data received from the suggested approach of the evaluation of functional variables’ interactions.
Abstract: In this paper, the feasibility of using machine vision to assess task completion in a surgical intervention is investigated, with the aim of incorporating vision based inspection in robotic surgery systems. The visually rich operative field presents a good environment for the development of automated visual inspection techniques in these systems, for a more comprehensive approach when performing a surgical task. As a proof of concept, machine vision techniques were used to distinguish the two possible outcomes i.e. satisfactory or unsatisfactory, of three primary surgical tasks involved in creating a burr hole in the skull, namely incision, retraction, and drilling. Encouraging results were obtained for the three tasks under consideration, which has been demonstrated by experiments on cadaveric pig heads. These findings are suggestive for the potential use of machine vision to validate successful task completion in robotic surgery systems. Finally, the potential of using machine vision in the operating theatre, and the challenges that must be addressed, are identified and discussed.