Robotic waterjet wound debridement - Workflow adaption for clinical application and systematic evaluation of a novel technology

Fabrication and application of continuous douche for Da Vinci surgical robot arm

BACKGROUND

The use of robotic surgery in hospitals is becoming increasingly widespread.

OBJECTIVE

This research was performed to design a continuous douche for surgical robotic arm operated instruments and evaluate its use.

METHODS

A continuous irrigator was designed for robotic arm operated surgical instruments. A total of 240 recovered robotic-arm instruments were selected from the Disinfection Supply Center of our hospital. These were divided into two groups according to their recycling order, with single number instruments in the control group and even number instruments in the experimental group. Each group included 120 pieces. In the experimental group, continuous douching was used for perfusion and soaking, while control group instruments were infused and soaked using a 50 mL syringe. Data on cleaning quality, accuracy of perfusion tool injection volume, incidence of liquid reverse osmosis during injection and washing, and product satisfaction were collected for both groups.

RESULTS

The qualified manipulator cleaning rate and satisfaction with perfusion tools were higher in the experimental group than in the control group, and incidence of liquid reverse osmosis was lower in the experimental group than in the control group.

CONCLUSIONS

The self-made continuous perfusion device improved the instrument cleaning efficacy of the robotic surgical arm, accuracy of injection volume, and product satisfaction.

Waterjet in Bacterial Clearance of Diabetic Lower Extremity Contaminated Wounds: A Retrospective Cohort Study

The waterjet debridement is now a standard practice in contaminated or infected diabetic lower extremity wounds. The bacterial clearance of the waterjet debridement remains an important parameter that should be predicted in this application. This study aimed to investigate the waterjet in reducing the diabetic lower extremity wound contaminants. A retrospective cohort study was conducted. Patients' etiology and pathogen diagnosis were established as diabetic lower extremity contaminated wound. The high-power waterjet (Versajet™, Smith-Nephew) was used in the treatment group and conventional surgical methods were used in the control group. The bacteriological swab samples were collected before and after the debridement. The results of bacterial culture were analyzed. A total of 74 patients were included in our study, 40 patients in the treatment group and 34 in the control group. Patient characteristics were well matched. The preoperative bacteriological swab samples of the 2 groups showed no significant difference between each other with a P value of .1022. The culture result of postoperative bacteriological swab samples in the treatment group was significantly lower than control with a P value of .0099. The odds of bacterial clearance were greater in the treatment group than in the control group (odds ratio, 5.139; 95% confidence interval, 1.386-18.41). As demonstrated by this retrospective research, waterjet debridement reduced the bacterial load in the diabetic lower extremity contaminated wounds.

Water jet as a novel technique for enamel drilling ex vivo

To investigate the usage of a water jet for enamel drilling ex vivo, 210 individual extracted molars without lesions or fillings were collected. Then, the specimens were drilled by a water jet or a high-speed dental drill. The cavities of 50 teeth were reconstructed digitally by micro-computed tomography (micro-CT) to measure the height and width. The cavities of 10 teeth were longitudinally incised and their surfaces were observed by scanning electronic microscopy (SEM). After the cavities were filled, 50 fillings were vertically incised. The bonding interface between tooth and filling was observed by SEM. 50 teeth with fillings were stained in 0.1% rhodamine B solution, and then the dye penetration between tooth and filling was observed under the stereomicroscope and confocal laser scanning microscopy (CLSM). The bonding strength between enamel and filling of 50 teeth was simulated and predicted with finite element analysis (FEA). At 140-150 MPa and for 2-3 s, cavities were made with a depth of approximately 764 μm in each tooth. SEM showed the cavity surface in the water jet group had a more irregular concave and convex structure than that in the high-speed dental drill group. There was a trend that the microleakage and bonding width was smaller in the water jet group than in the high-speed dental drill group. FEA indicated that the stress on the resin surface was greater than on the enamel surface in the water jet group. Compared with the tooth drilled by a high-speed dental drill, the tooth drilled by a water jet gained better retention of the filling material and suffered less bonding strength on the enamel surface. Water jet drilling is effective for enamel drilling.