Assessing Muscular Pain and Ergonomics Among Robotic Surgeons in China: A Validation

INTRODUCTION

Robotic surgery has transformed minimally invasive procedures, offering precision and efficiency. However, the ergonomic aspects of robotic consoles and their impact on surgeon health remain understudied. This review investigates the burden of ergonomics and muscle fatigue among robotic surgeons in China, comparing the findings to a multinational study.

METHODOLOGY

A literature review identified themes related to physical discomfort in robotic surgery. A questionnaire was administered to Chinese robotic surgeons, yielding 40 responses. The study assessed demographic characteristics, surgeon experience, ergonomic practices, reported discomfort, and pain-relief mechanisms.

RESULTS

The study revealed that most surgeons experienced shoulder and neck pain, with mixed opinions on whether robotic surgery was the primary cause. Stretching exercises were commonly used for pain relief. Surgeons believed that case volume and surgery duration contributed to discomfort. Comparisons with a multinational study suggested potential demographic and experience-related differences.

CONCLUSION

While the study has limitations, including a small sample size and potential translation issues, it underscores the importance of addressing ergonomic concerns and providing proper training to robotic surgeons to ensure their well-being and longevity in the field. Further research with larger cohorts and platform-specific analyses is warranted.

Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy: A propensity score matched analysis

Objective

Placement of human placenta derived grafts during robotic-assisted radical prostatectomy (RARP) hastens the return of continence and potency. The long-term impact on the oncologic outcomes remains to be investigated. Our objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane (dHACM) at RARP compared to a matched cohort.

Methods

In a referral centre, from August 2013 to October 2019, 599 patients used dHACM in bilateral nerve-sparing RARP. We excluded patients with less than 12 months follow-up, simple prostatectomy, and unilateral nerve-sparing. Patients with dHACM (amnio group) were 529, and were propensity score matched 1:1 to 2465 patients without dHACM (non-amnio group) and a minimum follow-up of 36 months. At the time of RARP, dHACM was placed around the neurovascular bundle in the amnio group. Continuous and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test respectively. Outcomes measured were biochemical recurrence (BCR), adjuvant and salvage therapy rates.

Results

Propensity score matching resulted in two groups of 444 patients. Cumulative incidence functions for BCR did not show a difference between the groups (p=0.3). Patients in the non-amnio group required salvage therapy more frequently than the amnio group, particularly after partial nerve-sparing RARP (6.3% vs. 2.3%, p=0.001). Limitations are the absence of prospective randomization.

Conclusion

The data suggest that using dHACM does not have a negative impact on BCR in patients. Outcomes of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts' impact on prostate cancer biology.

Muscle fatigue and physical discomfort reported by surgeons performing robotic-assisted surgery: a multinational survey

Robotic surgery has revolutionized surgical procedures and has provided many advantages over traditional laparoscopic and open surgeries. Despite the benefits, there are concerns about the physical discomfort and injuries that may be experienced by surgeons during robotic surgeries. This study aimed to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. A questionnaire was created and sent to 1000 robotic surgeons worldwide, with a response rate of 30.9%. The questionnaire consisted of thirty-seven multiple-choice questions, three short answer questions, and one multiple-option question pertaining to the surgeon's workload as well as their level of discomfort while and after performing surgery. The primary endpoint was to identify the most common muscle groups implicated in robotic surgeons' physical pain and discomfort. Secondary endpoints were to highlight any correlation between age group, BMI, hours of operation, workout regimen, and significant pain levels. The results showed that the most common muscle groups implicated in physical pain and discomfort were the neck, shoulders, and back, with many of the surgeons attributing their muscular fatigue and discomfort to the ergonomic design of the surgeon console. Despite the level of surgeon comfort the robotic console provides when compared to other conventional forms of surgery, the findings suggest the need for better ergonomic practices during robotic surgeries to minimize physical discomfort and injuries for surgeons.

Laser speckle contrast imaging compared with indocyanine green in renal perfusion of a porcine model

Background

When viewed under near-infrared light, indocyanine green (ICG) signal for kidney perfusion can be utilized in partial nephrectomy. Laser speckle contrast imaging (LSCI) uses coherent light to detect perfusion during real-time laparoscopic surgery.

Materials and methods

Laser speckle contrast imaging or ActivSight, an imaging sensor adapter, was used during laparoscopy of an anesthetized porcine kidney model. ActivSight's "perfusion mode" and "quantification mode" displayed the blood flow as a heatmap and numerical signal intensity, respectively.

Results

After the upper segmental renal artery was clamped, ICG was seen in the lower pole, and LSCI showed low unit (dark color) quantification and perfusion in the upper pole. Indocyanine green was retained in the lower pole after the upper segmental artery was unclamped, and LSCI perfusion was demonstrated in the entire kidney.

Conclusions

Laser speckle contrast imaging is a dye-free, repeatable, real-time adjunct for renal parenchymal perfusion assessment applicable to minimally invasive renal surgery to complement the technology of ICG near-infrared fluorescence and advance digital surgery.

Magnetic-field-induced delocalized to localized transformation in GaAs:N

The use of a high magnetic field (57 T) to study the formation and evolution of nitrogen (N) cluster and supercluster states in GaAs:N is demonstrated. A magnetic field is used to lift the conduction band edge and expose resonant N cluster states so that they can be directly experimentally investigated. The reduction of the exciton Bohr radius also results in the fragmentation of N supercluster states, enabling a magnetic field induced delocalized to localized transition. The application of very high magnetic fields thus presents a powerful way to probe percolation phenomena in semiconductors with bound and resonant isoelectronic cluster states.

Elemental and magnetic sensitive imaging using x-ray excited luminescence microscopy

We demonstrate the potential of x-ray excited luminescence microscopy for full-field elemental and magnetic sensitive imaging using a commercially available optical microscope, mounted on preexisting synchrotron radiation (SR) beamline end stations. The principal components of the instrument will be described. Bench top measurements indicate that a resolution of 1 μm or better is possible; this value was degraded in practice due to vibrations and/or drift in the end station and associated manipulator. X-ray energy dependent measurements performed on model solar cell materials and lithographically patterned magnetic thin film structures reveal clear elemental and magnetic signatures. The merits of the apparatus will be discussed in terms of conventional SR imaging techniques.

The Nature and Origin of Lateral Composition Modulations in Short-Period Strained-Layer Superlattices

The nature and origin of lateral composition modulations in (AlAs)m(InAs)n short-period strained-layer superlattices grown by molecular beam epitaxy on InP substrates have been investigated by x-ray diffraction, atomic force microscopy, and transmission electron microscopy. Strong modulations were observed for growth temperatures between ≈ 540 and 560° C. The maximum strength of modulations was found for SPS samples with InAs mole fraction x (= n/(n+m)) close to ≈ 0.50 and when n ≈ m ≈ 2. The modulations were suppressed at both high and low values of x. For x > 0.52 (global compression), the modulations were along the <100> directions in the (001) growth plane. For x < 0.52 (global tension), the modulations were along the two <310> directions rotated ≈ ±27° from [110] in the growth plane. The remarkably constant wavelength of the modulations, between ≈ 20–30 nm, and the different modulation directions observed, suggest that the origin of the modulations is due to surface roughening associated with the high misfit between the individual SPS layers and the InP substrate. Highly uniform unidirectional modulations have been grown by control of the InAs mole fraction and growth on suitably offcut substrates, which show great promise for application in device structures.

Sub-micron Optoelectronic Properties of Polycrystalline Solar Cell Materials

Generation, transport and collection of carriers in polycrystalline (PX) solar cells and their constituent materials are poorly understood, and significantly different than in their single-crystal counterparts. Recent theoretical and experimental results have put forth the expectation that grain boundaries in PX-solar cell materials such as CdTe and CuInGaSe2, either as-grown or after appropriate post-growth treatment, may have electronic properties which are advantageous to charge separation and solar cell operation[1-3]. However, a microscopic picture of the spatial variations in the optoelectronic properties of these materials is, for the most part, still lacking. The goal of the work reported here is to explore the optoelectronic and spectroscopic properties of grain-boundaries in these materials at the nanometer length-scale, via novel, high-resolution optical techniques. Towards this end, a significant enhancement in photo-response near grain boundaries in CdTe solar cells, consistent with models put forth in reference 2, was observed via near-field Optical Beam Induced Current (n-OBIC) [4]. A systematic μ-PL study of the effect of CdC12-treatment on recombination in CdTe/CdS solar cell structures of varying thickness directly examined the variation in optoelectronic properties at grain-boundaries in this material, revealing the grain-boundary and surface passivation effects of this important post-growth processing step. For comparison, we also studied the effects of SiNx post-growth treatment and annealing on the photo-response of PX-silicon solar cells using n-OBIC. These results and our most-recent n-OBIC measurements in CdTe and CuInGaSe2 solar cells are discussed.

First prenatally detected small supernumerary neocentromeric derivative chromosome 13 resulting in a non-mosaic partial tetrasomy 13q

Neocentromeres are functional centromeres located in non-centromeric euchromatic regions of chromosomes. The formation of neocentromeres results in conferring mitotic stability to chromosome fragments that do not contain centromeric alpha satellite DNA. We present a report of a prenatal diagnosis referred to cytogenetic studies due to ultrasound malformations such as large cisterna magna, no renal differentiation, hypotelorism and ventriculomegaly. Cytogenetic analysis of GTG-banded chromosomes from amniotic fluid cells and fetal blood cells revealed a de novo small supernumerary marker chromosome. Molecular cytogenetic studies using fluorescence in situ hybridization and comparative genomic hybridization showed this marker to be an inverted duplication of the distal portion of chromosome 13q which did not contain detectable alpha satellite DNA. The neocentromeric constriction was located at band 13q31. The presence of a functional neocentromere on this marker chromosome was confirmed by immunofluorescence with antibodies to centromere protein-C. The anatomopathologic study revealed a female fetus with facial dysmorphisms, low set ears and renal dysplasia. Ten small supernumerary neocentromeric chromosomes originating from the distal region of chromosome 13q have been reported to date. There are only three additional cases described with the location of the neocentromere in band 13q31. This is the first reported case detected prenatally.

Non-Bloch nature of alloy states in a conventional semiconductor alloy: GaxIn1-xP as an example

Using GaxIn1-xP as a prototype system, we present the first systematic examination of the alloy scattering effects on the global electronic structure of a semiconductor alloy for the whole composition range. Contrary to conventional wisdom, many electronic states in such a "well behaved" alloy are found to differ drastically from a Bloch state, including band edge states that are derived from degenerate critical points. This study offers a more comprehensive picture of the electronic structure of the alloy, and reveals new nontrivial but vital implications of the alloy scattering on transport and optical properties.

Zero thermal expansion in a nanostructured inorganic-organic hybrid crystal

There are very few materials that exhibit zero thermal expansion (ZTE), and of these even fewer are appropriate for electronic and optoelectronic applications. We find that a multifunctional crystalline hybrid inorganic-organic semiconductor, beta-ZnTe(en)(0.5) (en denotes ethylenediamine), shows uniaxial ZTE in a very broad temperature range of 4-400 K, and concurrently possesses superior electronic and optical properties. The ZTE behavior is a result of compensation of contraction and expansion of different segments along the inorganic-organic stacking axis. This work suggests an alternative route to designing materials in a nanoscopic scale with ZTE or any desired positive or negative thermal expansion (PTE or NTE), which is supported by preliminary data for ZnTe(pda)(0.5) (pda denotes 1,3-propanediamine) with a larger molecule.

Understanding the structure of the turbulent mixing layer in hydrodynamic instabilities

When a heavy fluid is placed above a light fluid, tiny vertical perturbations in the interface create a characteristic structure of rising bubbles and falling spikes known as Rayleigh-Taylor instability. Rayleigh-Taylor instabilities have received much attention over the past half-century because of their importance in understanding many natural and man-made phenomena, ranging from the rate of formation of heavy elements in supernovae to the design of capsules for Inertial Confinement Fusion. We present a new approach to analyze Rayleigh-Taylor instabilities in which we extract a hierarchical segmentation of the mixing envelope surface to identify bubbles and analyze analogous segmentations of fields on the original interface plane. We compute meaningful statistical information that reveals the evolution of topological features and corroborates the observations made by scientists. We also use geometric tracking to follow the evolution of single bubbles and highlight merge/split events leading to the formation of the large and complex structures characteristic of the later stages. In particular we (i) Provide a formal definition of a bubble; (ii) Segment the envelope surface to identify bubbles; (iii) Provide a multi-scale analysis technique to produce statistical measures of bubble growth; (iv) Correlate bubble measurements with analysis of fields on the interface plane; (v) Track the evolution of individual bubbles over time. Our approach is based on the rigorous mathematical foundations of Morse theory and can be applied to a more general class of applications.

Giant spin-orbit bowing in GaAs1-xBix

We report a giant bowing of the spin-orbit splitting energy Delta0 in the dilute GaAs1-xBix alloy for Bi concentrations ranging from 0% to 1.8%. This is the first observation of a large relativistic correction to the host electronic band structure induced by just a few percent of isoelectronic doping in a semiconductor material. It opens up the possibility of tailoring the spin-orbit splitting in semiconductors for spintronic applications.

Intrinsic and extrinsic effects in the temperature-dependent photoluminescence of semiconducting carbon nanotubes

The temperature dependence of the band gap of semiconducting carbon nanotubes was measured for ten different nanotube species. The unprecedented effectiveness in avoiding the effect of external strain, or any other effects originating from the surrounding environment, lead to an accurate measurement of the band gap temperature dependence, giving fundamental insight into the nanotube electron-phonon interaction. Small but reproducible energy shifts of the emission lines with temperature were observed, showing a moderate chirality dependence, well in agreement with recent theoretical calculations. In addition to the energy shift, a substantial narrowing of the emission lines was also observed. The removal of the temperature shift of the band gap allows the precise measurement of the effect of external strain on carbon nanotubes in different environments.

Novel approach to tuning the physical properties of organic-inorganic hybrid semiconductors

We discuss theoretically a novel approach to tailoring the properties of a new family of organic-inorganic hybrid superlattices, using two isostructural materials, ZnSe(en)0.5 and ZnTe(en)0.5, as examples. Replacing Se with Te leads to a number of nontrivial changes: the conduction band parity, singularity type, conductivity in the superlattice direction, and the p-type dopability. Experimentally, we report the first unambiguous observation of exciton-polariton emission in a hybrid semiconductor, i.e., ZnTe(en)0.5 . The band-edge excitonic transitions in both emission and absorption are explained by the calculated electronic structures.

Optical spectroscopy of single impurity centers in semiconductors

Using optical spectroscopy with diffraction limited spatial resolution, the possibility of measuring the luminescence from single impurity centers in a semiconductor is demonstrated. Selectively studying individual centers that are formed by two neighboring nitrogen atoms in GaAs makes it possible to unveil their otherwise concealed polarization anisotropy, analyze their selection rules, identify their particular configuration, map their spatial distribution, and demonstrate the presence of a diversity of local environments. Circumventing the limitation imposed by ensemble averaging and the ability to discriminate the individual electronic responses from discrete emitters provides an unprecedented perspective on the nanoscience of impurities.

Total negative refraction in real crystals for ballistic electrons and light

It is found that there exists a category of material interfaces, readily available, that not only can provide total refraction (i.e., zero reflection) but can also give rise to amphoteric refraction (i.e., both positive and negative refraction) for electromagnetic waves in any frequency domain as well as for ballistic electron waves. These two unusual phenomena are demonstrated experimentally for the propagation of light through such an interface.

Layer ordering and faulting in (GaAs)n/(AlAs)n ultrashort-period superlattices

We report studies of (GaAs)(n)/(AlAs)(n) ultrashort-period superlattices using synchrotron x-ray scattering. In particular, we demonstrate that interfaces of these superlattices contain features on two different length scales: namely, random atomic mixture and ordered mesoscopic domains. Both features are asymmetric on the two interfaces (AlAs-on-GaAs and GaAs-on-AlAs) for n>2. Periodic compositional stacking faults, arising from the intrinsic nature of molecular-beam epitaxy, are found in the superlattices. In addition, the effect of growth interruption on the interfacial structure is discussed. The relevant scattering theory is developed to give excellent fits to the data.