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Abdelaziz MEMK, Zhao J, Gil Rosa B, Lee HT, Simon D, Vyas K, Li B, Koguna H, Li Y, Demircali AA, Uvet H, Gencoglan G, Akcay A, Elriedy M, Kinross J, Dasgupta R, Takats Z, Yeatman E, Yang GZ, Temelkuran B. Fiberbots: Robotic fibers for high-precision minimally invasive surgery. Sci Adv 2024; 10:eadj1984. [PMID: 38241380 PMCID: PMC10798568 DOI: 10.1126/sciadv.adj1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
Precise manipulation of flexible surgical tools is crucial in minimally invasive surgical procedures, necessitating a miniature and flexible robotic probe that can precisely direct the surgical instruments. In this work, we developed a polymer-based robotic fiber with a thermal actuation mechanism by local heating along the sides of a single fiber. The fiber robot was fabricated by highly scalable fiber drawing technology using common low-cost materials. This low-profile (below 2 millimeters in diameter) robotic fiber exhibits remarkable motion precision (below 50 micrometers) and repeatability. We developed control algorithms coupling the robot with endoscopic instruments, demonstrating high-resolution in situ molecular and morphological tissue mapping. We assess its practicality and safety during in vivo laparoscopic surgery on a porcine model. High-precision motion of the fiber robot delivered endoscopically facilitates the effective use of cellular-level intraoperative tissue identification and ablation technologies, potentially enabling precise removal of cancer in challenging surgical sites.
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Affiliation(s)
- Mohamed E. M. K. Abdelaziz
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Jinshi Zhao
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Bruno Gil Rosa
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Hyun-Taek Lee
- Department of Mechanical Engineering, Inha University, Incheon 22212, South Korea
| | - Daniel Simon
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- The Rosalind Franklin Institute, Didcot OX11 0QS, UK
| | - Khushi Vyas
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Bing Li
- The UK DRI Care Research and Technology Centre, Department of Brain Science, Imperial College London, London W12 0MN, UK
- Institute for Materials Discovery, University College London, London WC1H 0AJ, UK
| | - Hanifa Koguna
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Yue Li
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Ali Anil Demircali
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Huseyin Uvet
- Department of Mechatronics Engineering, Faculty of Engineering, Yildiz Technical University, Istanbul 34349, Turkey
| | - Gulsum Gencoglan
- Department of Dermatology and Venereology, Liv Hospital Vadistanbul, Istanbul 34396, Turkey
- Department of Skin and Venereal Diseases, Faculty of Medicine, Istinye University, Istanbul 34010, Turkey
| | - Arzu Akcay
- Department of Pathology, Faculty of Medicine, Yeni Yüzyıl University, Istanbul 34010, TR
- Pathology Laboratory, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul 34303, TR
| | - Mohamed Elriedy
- Anesthesiology, University Hospitals of Derby and Burton, Derby, DE22 3NE, UK
| | - James Kinross
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Ranan Dasgupta
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- The Rosalind Franklin Institute, Didcot OX11 0QS, UK
| | - Eric Yeatman
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Guang-Zhong Yang
- Institute of Medical Robots, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Burak Temelkuran
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- The Rosalind Franklin Institute, Didcot OX11 0QS, UK
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Abstract
'Apnoeic oxygenation' describes the diffusion of oxygen across the alveolar-capillary interface in the absence of tidal respiration. Apnoeic oxygenation requires a patent airway, the diffusion of oxygen to the alveoli, and cardiopulmonary circulation. Apnoeic oxygenation has varied applications in adult medicine including facilitating tubeless anaesthesia or improving oxygenation when a difficult airway is known or anticipated. In the paediatric population, apnoeic oxygenation prolongs the time to oxygen desaturation, facilitating intubation. This application has gained attention in neonatal intensive care where intubation remains a challenging procedure. Difficulties are related to the infant's size and decreased respiratory reserve. In addition, policy changes have led to limited opportunities for operators to gain proficiency. Until recently, evidence of benefit of apnoeic oxygenation in the neonatal population came from a small number of infants recruited to paediatric studies. Evidence specific to neonates is emerging and suggests apnoeic oxygenation may increase intubation success and limit physiological instability during the procedure. The best way to deliver oxygen to facilitate apnoeic oxygenation remains an important question.
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Affiliation(s)
- Elizabeth K Baker
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia.
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Kate A Hodgson
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia.
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Weinberg L, Russell A, Mackley L, Dunnachie C, Meyerov J, Tan C, Li M, Hu R, Karalapillai D. Relationship between acute hypercarbia and hyperkalaemia during surgery. World J Clin Cases 2019; 7:3711-3717. [PMID: 31799295 PMCID: PMC6887608 DOI: 10.12998/wjcc.v7.i22.3711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The relationship between hyperkalaemia and metabolic acidosis is well described in the critical care setting; however, the relationship between acute respiratory acidosis and plasma potassium concentration is less well understood. In a controlled model of increasing levels of hypercarbia, we tested the hypothesis of whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations.
AIM To determine whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations.
METHODS We performed a post-hoc study examining changes in serum potassium in 24 patients who received increased levels of hypercarbia during cardiac surgery. Arterial blood gases and plasma concentrations of potassium were measured at baseline, 3 min prior to, and then every 3 min for 15 min during the intervention of hypercarbia. The primary endpoint was the absolute change in serum K+ at 15 min compared to the baseline K+ value. The following secondary endpoints were evaluated: (1) The association between CO2 and serum K+ concentration; and (2) The correlation between plasma pH and serum K+ concentrations.
RESULTS During the intervention, PaCO2 increased from 43.6 mmHg (95%CI: 40.1 to 47.1) at pre-intervention to 83.9 mmHg (95%CI: 78.0 to 89.8) at 15 min after intervention; P < 0.0001. The mean (SD) serum potassium increased from 4.16 (0.35) mmol/L at baseline to 4.28 (0.33) mmol/L at 15 min (effect size 0.09 mol/L; P = 0.22). There was no significant correlation between PaCO2 and potassium (Pearson’s coefficient 0.06; 95%CI: -0.09 to 0.21) or between pH and potassium (Pearson’s coefficient -0.07; 95%CI: -0.22 to 0.09).
CONCLUSION Acute hypercarbia and subsequent respiratory acidaemia were not associated with hyperkalaemia in patients undergoing major surgery.
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Affiliation(s)
- Laurence Weinberg
- Department of Anaesthesia, Austin Health, Melbourne, Victoria 3084, Australia
| | - Amelia Russell
- Department of Intensive Care, Austin Health, Melbourne, Victoria 3084, Australia
| | - Lois Mackley
- Department of Intensive Care, Austin Health, Melbourne, Victoria 3084, Australia
| | - Charles Dunnachie
- Department of Anaesthesia, Austin Health, Melbourne, Victoria 3084, Australia
| | - Joshua Meyerov
- Melbourne Medical School, University of Melbourne, Victoria 3010, Australia
| | - Chong Tan
- Department of Anaesthesia, Austin Health, Melbourne, Victoria 3084, Australia
| | - Michael Li
- Department of Anaesthesia, Austin Health, Melbourne, Victoria 3084, Australia
| | - Raymond Hu
- Department of Anaesthesia, Austin Health, Melbourne, Victoria 3084, Australia
| | - Dharshi Karalapillai
- Department of Intensive Care, Austin Health, Melbourne, Victoria 3084, Australia
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