Effect of laparoscopic handle size on surgical performance: A randomized crossover trial

Laparoscopic instrument handles design and dimensions are crucial to determine the configuration of surgeons' hand grip and, therefore, can have a deleterious effect on overall surgical efficiency and surgeons' comfort. The aim of this study is to investigate the impact of laparoscopic handle size and hand surface area on surgical task performance. A single-blind, randomized crossover trial was carried out with 29 novice medical students. Participants performed three simulated tasks in "black box" simulators using two scissor-type handles of different sizes. Surgical performance was assessed by the number of errors and time required to complete each task. Hand anthropometric data were measured using a 3D scanner. Execution time was significantly higher when cutting and suturing tasks were performed with the smaller handle. In addition, hand surface area was positively correlated with peg transfer task time when performed with the standard handle and was correlated with cutting task time in small and standard handle groups. We also found positive correlations between execution time and the number of errors executed by larger-handed participants. Our findings indicate that laparoscopic handle size and hand area influence surgical performance, highlighting the importance of considering hand anthropometry variances in surgical instrument design.

Investigation of the Use of Hollow Elastic Biomodels Produced by Additive Manufacturing for Clip Choice and Surgical Simulation in Microsurgery for Intracranial Aneurysms

BACKGROUND

Intracranial aneurysms (IAs) are dilatations of the cerebral arteries, whose treatment is commonly based on the implant of a metallic clip on the aneurysm neck. Despite the dissection and understanding of the surgical anatomy of the IA when often only parts of it are visible, the choice of the ideal clip to be used is one of the surgical difficulties. Although current imaging tests guarantee IA visualization, currently there is no planning method that allows for a real three-dimensional (3D) visualization for optimal choice of clip prior to surgery. The aim of this study is to evaluate whether IA biomodels generated by additive manufacturing methods are useful for surgical clip selection in microsurgeries for IA.

METHODS

Three-dimensional (3D) IA biomodels of 10 patients with IA were evaluated using computerized tomography, surgical microscope, and 3D printer. The research was divided into 4 phases as follows: development of the 3D biomodels, evaluation of the biomodel dimensional characteristics, surgical planning evaluation with the biomodel and its clipping effectiveness, and evaluation of the actual surgical simulation process within the models.

RESULTS

Ten 3D biomodels were obtained, made of a malleable and hollow part, formed by the IA and related arteries, and another rigid part, mimicking the skull and other arteries of the skull base. Based on these 3D models, 10 clips were chosen during the surgical planning, and all exactly matched the clip characteristics used during the actual surgeries. The surgical simulation with the biomodels performed by 2 neurosurgeons still in training obtained 100% accuracy in the identification of the clips that were eventually used during the actual surgeries.

CONCLUSIONS

3D biomodels generated by additive manufacturing methods were effective for surgical clip selection in microsurgeries for IA, reducing surgical time, increasing cerebral angioarchitecture understanding, and providing more safety in this type of surgery.

Cicatrization of oncological wounds by autologous fibrin biopolymer dressing treatment: a case series

INTRODUCTION

Traditional therapies used to treat chronic wounds are often expensive and, in general, are not adequate to support healing. A promising alternative to conventional dressings is the autologous biopolymer FM, full of cytokines and growth factors that accelerate the healing process of wounds of various etiologies.

MATERIALS AND METHODS

The authors report 3 cases in which FM was used to treat chronic oncological wounds that had been conventionally treated for more than 6 months with no sign of healing.

RESULTS

Among the 3 reported cases, there was complete healing of 2 wounds. The other lesion did not heal, mainly due to the location (at the base of the skull). However, it significantly reduced its area, extension, and depth. No adverse effects or hypertrophic scar formation were recorded, and the patients reported an absence of pain from the second week of FM application.

CONCLUSIONS

The proposed FM dressing approach was effective in healing and speeding up tissue regeneration. It can also be considered one of the most versatile delivery systems to the wound bed, as it is an excellent carrier of growth factors and leukocytes.

3D Multi-Modality Medical Imaging: Combining Anatomical and Infrared Thermal Images for 3D Reconstruction

Medical thermography provides an overview of the human body with two-dimensional (2D) information that assists the identification of temperature changes, based on the analysis of surface distribution. However, this approach lacks spatial depth information, which can be enhanced by adding multiple images or three-dimensional (3D) systems. Therefore, the methodology applied for this paper generates a 3D point cloud (from thermal infrared images), a 3D geometry model (from CT images), and the segmented inner anatomical structures. Thus, the following computational processing was employed: Structure from Motion (SfM), image registration, and alignment (affine transformation) between the 3D models obtained to combine and unify them. This paper presents the 3D reconstruction and visualization of the respective geometry of the neck/bust and inner anatomical structures (thyroid, trachea, veins, and arteries). Additionally, it shows the whole 3D thermal geometry in different anatomical sections (i.e., coronal, sagittal, and axial), allowing it to be further examined by a medical team, improving pathological assessments. The generation of 3D thermal anatomy models allows for a combined visualization, i.e., functional and anatomical images of the neck region, achieving encouraging results. These 3D models bring correlation of the inner and outer regions, which could improve biomedical applications and future diagnosis with such a methodology.

Finite element analysis to predict temperature distribution in the human neck with abnormal thyroid: A proof of concept

BACKGROUND AND OBJECTIVE

Hyperthyroidism, hypothyroidism, goiter and cancer are some of the dysfunctions that can occur concerning the thyroid, an important body homeostasis regulatory gland located in the cervical region. These disorders are mostly caused by changes in metabolism and can impair quality of life. This study presents a non-invasive approach that can detect changes in thyroid metabolism through the finite element analysis and medical images. The objective of this work was to develop a numerical model to represent the temperature distribution in the human neck with and without the presence of thyroid nodules. The patient-specific computational model for the case with thyroid nodules was calibrated with infrared thermography.

METHODS

A three-dimensional geometrical model of the neck was constructed based on the segmentation of magnetic resonance (MR) images. The Finite Element Method (FEM) was used to simulate heat diffusion and convection in the cervical region. The infrared thermography image was used to calibrate the heat transfer constants to obtain the surface temperature of the human neck model containing the enlarged thyroid with nodules. Subsequently, another case for the entire neck with an abnormally large thyroid without the nodules was simulated using the calibrated physical constants.

RESULTS

Results of the simulations with and without the presence of thyroid nodules were compared, showing the influence of the generation of heat from the nodules, allowing observation of the thermal differences on the cervical surface and at the thyroid itself. The model with nodules presented higher skin temperature distribution in the anterior triangle region when compared to the case without nodules. An average of 0.36^∘C of absolute error and 1% of relative error was obtained for the calibration between the simulated model and the infrared image.

CONCLUSIONS

This research consists of an innovative approach by comparing the results obtained via FEM simulation and the corresponding infrared image of the same neck region under study. Since there are great variability and uncertainties in the determination of the thermal constants, we applied a procedure for calibrating them based on a patient-specific case, which involves a multinodular goiter accompanied by hyperthyroidism. This proof-of-concept study allows the creation of comparative scenarios between the FEM simulations and the corresponding infrared image. Thus, it is expected that, in the future, this approach could be used to include the effect of drugs in the treatment strategies of thyroid diseases and disorders.

Multi-Sensing Techniques with Ultrasound for Musculoskeletal Assessment: A Review

The study of muscle contractions generated by the muscle-tendon unit (MTU) plays a critical role in medical diagnoses, monitoring, rehabilitation, and functional assessments, including the potential for movement prediction modeling used for prosthetic control. Over the last decade, the use of combined traditional techniques to quantify information about the muscle condition that is correlated to neuromuscular electrical activation and the generation of muscle force and vibration has grown. The purpose of this review is to guide the reader to relevant works in different applications of ultrasound imaging in combination with other techniques for the characterization of biological signals. Several research groups have been using multi-sensing systems to carry out specific studies in the health area. We can divide these studies into two categories: human-machine interface (HMI), in which sensors are used to capture critical information to control computerized prostheses and/or robotic actuators, and physiological study, where sensors are used to investigate a hypothesis and/or a clinical diagnosis. In addition, the relevance, challenges, and expectations for future work are discussed.

Development and Evaluation of a Customized Wrist-Hand Orthosis using 3D Technology for a Child with Cerebral Palsy - A Case Study

Cerebral Palsy (CP) is a disability that affects more than 100 million children. More than 60% of these children have significant difficulties within their hand abilities, affected by involuntary movements and spasticity. So, to overcome this issue, orthoses are being employed as therapeutic intervention and can allow children with CP to have an opportunity to better use their hands. Three-dimensional (3D) technologies provide the generation of high-quality orthopedic products. Although, there are limited studies related to the evaluation of such assistive devices, especially for children. Therefore, the purpose of this research was to design, develop and evaluate a customized wrist-hand orthosis using 3D technologies for a child with CP. So, it was used a high-level 3D scanning to acquire the wrist-hand anatomy, a free software for 3D modelling and a low-cost 3D printer for manufacturing the orthosis. The Jebsen-Taylor Test of Hand Function (JTTHF) was used to evaluate unilateral hand abilities. We noticed improvements while wearing the orthosis at the affected hand, in the following subtests: writing (13 s), lifting small objects (0.9 s) and simulated feeding (69.3 s). The customized orthosis was able not only to improve some functional hand skills, but also to provide comfort, better fitting and with an appealing aesthetic design.

Three-Dimensional Hollow Elastic Models for Intracranial Aneurysm Clipping Election - A Case Study

We describe a method for fabricating a three-dimensional hollow and elastic aneurysm model, which is useful for surgical clipping simulation. In this paper, we explain the generation of such hollow elastic model, based on 3D printing. Also, we report on the effects of applying it to presurgical clipping election and simulation. The advantages of this methodology are: (1) it generates a hollow and flexible 3D biomodel, represented as the vascular areas, apart from having together the skull, as a reference system; (2) it employs an inexpensive and easy to reproduce methodology; (3) it helps not only for training neurosurgeons, but also for planning and guiding the actual surgery clip's insertion.

A method for generating 3D thermal models with decoupled acquisition

BACKGROUND AND OBJECTIVE

Both thermal imaging and 3D scanning offer convenient advantages for medical applications, namely, being contactless, non-invasive and fast. Consequently, many approaches have been proposed to combine both sensing modalities in order to acquire 3D thermal models. The predominant approach is to affix a 3D scanner and a thermal camera in the same support and calibrate them together. While this approach allows straightforward projection of thermal images over the 3D mesh, it requires their simultaneous acquisition. In this work, a method for generation of 3D thermal models that allows combination of separately acquired 3D mesh and thermal images is presented. Among the advantages of this decoupled acquisition are increased modularity of acquisition procedures and reuse of legacy equipment and data.

METHODS

The proposed method is based on the projection of thermal images over a 3D mesh. Unlike previous methods, it is considered that the 3D mesh and the thermal images are acquired separately, so camera pose estimation is required to determine the correct spatial positioning from which to project the images. This is done using Structure from Motion, which requires a series of interest points correspondences between the images, for which the SIFT method was used. As thermal images of human skin are predominantly homogeneous, an intensity transformation is proposed to increase the efficacy of interest point detection and make the approach feasible. Before projection, the adequate alignment of the 3D mesh in space is determined using Particle Swarm Optimization. For validation of the method, the design and implementation of a test object is presented. It can be used to validate other methods and can be reproduced with common printed circuit board manufacturing processes.

RESULTS

The proposed approach is accurate, with an average displacement error of 1.41  mm (s = 0.74  mm) with the validation test object and 4.58 mm (s = 2.12  mm) with human subjects.

CONCLUSIONS

The proposed method is able to combine separately a acquired 3D mesh and thermal images into an accurate 3D thermal model. The results with human subjects suggest that the method can be successfully employed in medical applications.

Proposal of custom made wrist orthoses based on 3D modelling and 3D printing

Accessibility to three-dimensional (3D) technologies, such as 3D scanning systems and additive manufacturing (like 3D printers), allows a variety of 3D applications. For medical applications in particular, these modalities are gaining a lot of attention enabling several opportunities for healthcare applications. The literature brings several cases applying both technologies, but none of them focus on the spreading of how this technology could benefit the health segment. This paper proposes a new methodology, which employs both 3D modelling and 3D printing for building orthoses, which could better fit the demands of different patients. Additionally, there is an opportunity for sharing expertise, as it represents a trendy in terms of the maker-movement. Therefore, as a result of the proposed approach, we present a case study based on a volunteer who needs an immobilization orthosis, which was built for exemplification of the whole process. This proposal also employs freely available 3D models and software, having a strong social impact. As a result, it enables the implementation and effective usability for a variety of built to fit solutions, hitching useful and smarter technologies for the healthcare sector.

Generation of 3D thermal models for dentistry applications

There are a variety of medical imaging modalities available, although each modality focus into different aspects, for example: anatomical, physiological or geometrical information. This paper presents a new imaging modality (3D THERMO-SCAN) that combines anatomical computer tomography (CT) imaging slices, together with 2D infrared thermography images and 3D scanned shaped models of the area under study. Therefore, it is presented the 3D reconstructions involving a case study of a volunteer with bruxism. Some characteristics of bruxism are the hyperactivity of the chewing muscles, which changes the dynamics of microcirculation, also changing the correspondent skin's temperature. The emphasis is to show the corresponding structures, such as jaw/mandibular region that will produce either decrease or increase in temperature, which are related to bruxism and the associated use of an occlusal splint, respectively.

Combining 3D models with 2D infrared images for medical applications

Infrared images are very useful for providing physiological information, although the representation is two-dimensional. On the other hand, a 3D scanning system is able to generate precise 3D spatial models of the area under study. This paper presents a methodology for combining both imaging modalities into a single representation. The Structure from Motion (SfM) technique is used in order to find the correct infrared camera's positioning and rotations in the space. Then, those 2D infrared images generate a 3D SfM model. Following this stage, the SfM model is replaced by an accurate 3D model from a scanning system, which is wrapped around by the infrared images. The experiments performed with a volunteer's face have shown that the proposed methodology successfully reconstruct a unique 3D surface model, which is able to deliver potential clinical applications.

3D thermal medical image visualization tool: Integration between MRI and thermographic images

Three-dimensional medical image reconstruction using different images modalities require registration techniques that are, in general, based on the stacking of 2D MRI/CT images slices. In this way, the integration of two different imaging modalities: anatomical (MRI/CT) and physiological information (infrared image), to generate a 3D thermal model, is a new methodology still under development. This paper presents a 3D THERMO interface that provides flexibility for the 3D visualization: it incorporates the DICOM parameters; different color scale palettes at the final 3D model; 3D visualization at different planes of sections; and a filtering option that provides better image visualization. To summarize, the 3D thermographc medical image visualization provides a realistic and precise medical tool. The merging of two different imaging modalities allows better quality and more fidelity, especially for medical applications in which the temperature changes are clinically significant.

Assessment of techniques of massage and pumping in the treatment of breast engorgement by thermography

OBJECTIVE

to evaluate techniques of massage and pumping in the treatment of postpartum breast engorgement through thermography.

METHOD

the study was conducted in the Human Milk Bank of a hospital in Curitiba, Brazil. We randomly selected 16 lactating women with engorgement with the classification lobar, ampullary and glandular, moderate and intense. We compared the differential patterns of temperature, before and after the treatment by means of massage and pumping.

RESULTS

we found a negative gradient of 0.3°C of temperature between the pre- and post-treatment in the experimental group. Breasts with intense engorgement were 0.7°C warmer when compared with moderate engorgement.

CONCLUSION

massage and electromechanical pumping were superior to manual methods when evaluated by thermography.

REBEC

U1111-1136-9027.

Image fusion improvements applied at the generation of 3D thermal models

The application of multimodal image registration to various medical applications has been investigated. Image fusion involving 3D thermal and MRI/CT images allows the extraction of both functional and anatomical information, which may become a powerful tool to aid in clinical diagnoses. This paper presents innovations at the image fusion methodology, which currently requires that both imaging modalities are represented and visualized at the same 3D viewing projection. The proposed solution is based and compared with two different viewing projections: orthogonal and perspective. The methodology requires that the thermographic images (or photographs) are visualized in the orthogonal view, in order to match with the 2D projected images (using range images) from MRI/CT. The results obtained have shown significant improvements in the 3D thermal models, when compared and evaluated with the perspective approach. This allowed the generation of more accurate 3D models, which match both the geometry and texture (functional temperature information). Since it is desirable to combine or unify more than one imaging modality, these 3D multimodal models may have a strong impact in many clinical applications.

Growth hormone, gender and face shape in Prader-Willi syndrome

Prader-Willi syndrome is a neurodevelopmental disorder resulting from the absence of expression of paternally expressed gene(s) in a highly imprinted region of chromosome 15q11-13. The physical phenotype includes evidence of growth retardation due to relative growth hormone deficiency, small hands and feet, a failure of normal secondary sexual development, and a facial appearance including narrow bifrontal diameter, almond-shaped palpebral fissures, narrow nasal root, and thin upper vermilion with downturned corners of the mouth. Anecdotally, the face of individuals with PWS receiving hGH treatment is said to "normalize." We used dense surface modelling and shape signature techniques to analyze 3D photogrammetric images of the faces of 72 affected and 388 unaffected individuals. We confirmed that adults with Prader-Willi syndrome who had never received human growth supplementation displayed known characteristic facial features. Facial growth was significantly reduced in these adults, especially in males. We demonstrated that following human growth hormone (hGH) supplementation, vertical facial growth of affected individuals falls within the normal range. However, lateral and periorbital face shape and nose shape differences in affected children who have received hGH therapy remain sufficiently strong to be significantly discriminating in comparisons with age-sex matched, unaffected individuals. Finally, we produced evidence that age at initiation and length of treatment with hGH do not appear to play a role in normalization or in consistent alteration of the face shape of affected individuals. This is the first study to provide objective shape analysis of craniofacial effects of hGH therapy in Prader-Willi syndrome.

Pode a termografia auxiliar no diagnóstico de lesões musculares em atletas de futebol?

INTRODUÇÃO: Considerando que as lesões musculares desencadeiam processos inflamatórios e que a inflamação gera calor em decorrência do aumento do metabolismo local, então, o nível inflamatório pode ser avaliado por meio do gradiente de temperatura. OBJETIVO: Verificar a viabilidade da aplicação da termografia no diagnóstico de lesões causadas pelo treinamento físico. MÉTODOS: O estudo foi realizado com atletas adolescentes do Paraná Clube, Curitiba, PR, Brasil, que foram divididos em dois grupos, denominados controle e experimental. O grupo controle participou de uma sessão de treinamento de baixa intensidade e o grupo experimental de alta intensidade. Primeiramente, foi capturada uma imagem termográfica do quadríceps femoral de cada atleta antes do início da sessão de treinamento. Após a sessão de treinamento, coletou-se uma amostra de sangue para verificar o nível sérico de lactato de cada atleta. Posteriormente, 24h após o treinamento, efetuou-se outra coleta de sangue para verificar o nível sérico de CK de cada atleta. Outra imagem termográfica individual do quadríceps femoral também foi adquirida nessa etapa. RESULTADOS: A correlação entre os índices de lactato e CK foi positiva e estatisticamente significativa, com valor rho = 0,661 (p = 0,038). Não houve correlação estatisticamente significativa entre os valores de CK 24h pós-treino e na variação de temperatura (24h pós-treino - pré-treino) nos músculos avaliados para o grupo controle. Houve diferença de temperatura (24h pós-treino - pré-treino) estatisticamente significativa (p < 0,05) para os três músculos estudados apenas no grupo experimental. CONCLUSÃO: Os resultados do presente estudo sugerem a possibilidade da utilização de imagens termográficas para, em conjunto com a creatina-quinase, determinar a intensidade e a localização de lesões musculares pós-treino, uma vez que o citado marcador bioquímico não consegue determinar a localização anatômica da lesão muscular.