저자는 어떤 승인이 없습니다.

윤리 문 : 우리 프로토콜은 우리의 기관 인간의 연구 윤리위원회가 설정 한 가이드 라인을 따른다. 의학 내화물 간질 환자의 1 식별 <ol><li> 해야 SEEG에 침입 모니터링을 추구하는 여부 멀티 - 징계 회의에서 논의 결정 후 1과 침입 감시하기 전에 비디오 - 뇌파 모니터링, MRI, PET, ictalSPECT 및 신경 심리 연구 등 allpatientswith 비 침습적 기술을 평가 했다. 1,6,7,11,14 </li><li> EZ의 위치에 대해 가설을 형성한다. 개입 이전하여 발작 발병 영역과 간질 (발작)의 초기 (즉, 빠른) 확산의 영역을 EZincorporating 추정 활동의 착상 전 가설을 개발한다. 참고 :이 단계는 결정이 침입 montitoring을 추구하게하는 멀티 - 징계 회의와 함께 수행 할 수 있습니다. 노트: 경막 EZ 가설에 그리드를 기반 SEEG 대, SEEG 및 경막 계통 감시 사이에서 결정. ) 가능한 깊은 앉아 EZ 1을 포함 할 수 있습니다 고려해야 할 기준; 2) 이전의 실패 경막 그리드 모니터링; 3) 양국 간 모니터링을위한 표시; 4) 비 병변 여분의 시간 간질이 의심됩니다. 또한 경막 그리드를 통해 SEEG의 추가 이익을 기록하고 웅변 영역이 EZ 근처에 가정 할 때 중요한 피질 영역을 자극하는 SEEG의 기능이 포함되어 있음을 주목해야한다. </li><li> 가설 EZ (그림 1)에 따라 개별적으로 맞춤형 주입 전략을 개발한다. -1,7,8,8-을 참고 : 적절한 주입 전략 1을 평가해야한다) 해부학 적 병변 (있는 경우); 2) 구조 (들) inictal 발병 참여 가능성이 가장 높은; 기능적 네트워크 내 발작 전파 및 / 또는 3) 가능한 경로 (들). 해부학 적 고려 사항 외에도 물류 사항도 고려되어야한다. 에 대한따라서, 직교 궤적은 이후에, 전극 위치 해석 주입을 용이하게하고 위하여 일반적으로 우선적이다. </li><li> 가정 된 EZ 기초 주입 전략을 개발 한 후, 로봇 지원을 사용 플랜을 생성한다. 첫째, &quot;새 환자&quot;를 선택하여, 새로운 만남을 만든 다음 다음 원하는 궤도에 해당 적절한 &quot;진입 점&quot;과 &quot;끝점&quot;을 선택, &quot;궤도 만들기 &#39;를 클릭합니다. 주 : 착상 가설에 따라 전극의 개수가 전형적 여덟 열두이다. 궤도와 가볼만한 곳은 일반적으로 대조 MRI 또는​​ 회전 혈관 조영술을 이용하여 계획되어 있습니다. 뇌의 문제가 아니라 뇌 혈관뿐만 아니라 보여 이러한 이미지는 혈관 손상과 출혈을 방지하기 무혈성 복도의 궤적 계획을 가능하게합니다. </li></ol> 2. 수술 절차 <ol><li> 스와 전날rgery, Kuzniecky 등에 의해 설명 된대로 대조, 체적 T1 강조 MRI 시퀀스를 얻을 수 있습니다. (14) 참고 :이 이미지는 로봇 도움을 등록에 사용되어야하며, 1mm 조각이 있어야합니다. 그런 다음 Kuzniecky 등에 의해 설명 된 바와 같이 궤도가 이전에 논의 주입 전략을 기반으로 계획되어 정위 신경 네비게이션 소프트웨어로 이미지를 전송합니다. (14) </li><li> 수술실에서되면, 앙와위에서 수술 테이블에 환자를 배치합니다. 그리고 마취 &#39;프로토콜에 따라 기관 내 삽관과 전신 마취를 얻을 수 있습니다. 참고 : 그들은 일반적으로 정맥 마취하고 완전한 약물 마비 받고하는 것이 필수적이다. 그런 다음, 환자의 머리를 면도 항생제 수술 응용 프로그램과 함께 피부 수험 후 머리 신경 외과 헤드 홀더에 환자의 머리를 배치합니다. 전신 마취는 환자에 환자 다르다. </li><li> 완료 한 후위치는 프레임 전체 등록에 로봇 시스템을 연결합니다. 로봇 보조 장치에서 선택 &quot;등록&quot;및 등록 절차를 완료하려면 지시를 따릅니다. 얼굴 특징 또는 이식 기준 마커를 기반으로 전체 등록하여 표면 랜드 마크 등록. </li><li> 삽입 (그림 2) <ol><li> 로봇 정위 시스템에서지도 지원을 두개골을 드릴 2.5 mm 드릴 비트를 사용합니다. 뇌경막을 엽니 다 극성 coagulator 프로브를 삽입합니다. 두개골에 주입 볼트 나사, 또한 로봇 정위 시스템에 의해 유도. </li><li> [- = D3 (대상-두라 거리) + (D2 D1)] : 다음 측정을 사용하여 전극 (D3)의 최종 깊이 거리를 계산합니다. 네비게이션 시스템을 이용하여 타겟 경질의 거리를 측정한다. 주 : D1이 경질로 안내 장치의 길이로서 측정하고, D2는 볼트의 단부까지 안내 장치의 길이로서 측정되는. D1 - D2 차이 볼트의 길이이다. 볼트 및 타깃 경질 거리의 길이의 합은 상기 전극의 깊이의 길이이다. </li><li> 주입 된 볼트에 의해 유도 stylette 프로브를 삽입하여 초기 궤적을 만듭니다. 다음에 전극을 삽입하고 볼트로 고정합니다. 이것은 더 변위 및 뇌척수액 (CSF) 누수를 방지 할 수 있습니다. </li><li> 배치하고 모든 전극을 연결 한 후, 볼트 캡 주위에 요오드 용액을 적신 거즈를 배치합니다. 그리고, 다음 머리를 정리. </li></ol></li></ol> 3. 모니터링 / 녹화 <ol><li> 사건을 마무리하기 전에 적절한 작동을 보장하기 위해 뇌파 기록 장치에 전극을 연결합니다. 수술실의 마지막 단계는 수술 중 영상 (그림 3)입니다. 측면과 전후방 두개골 X 선 또는 형광 투시 영상 수술 중을 수행합니다. 참고 : 전극의 적절한 궤적을 보장하기 위해 이러한를 얻습니다. 이러한 이미지는 obtaine 없습니다d를, 정위 배치를 보장하기 위해 오히려 그들은 전극의 일반 올바른 궤도와 위치를 확인합니다. </li><li> 수술 후 임상 적 및 electrographically SEEG 전극 기록을 통해 모두 발작 활동에 대한 환자 모니터 간질 감시 부에 환자를 전송합니다. 참고 : 투숙 기간이 달라집니다 수, 품질, 발작과 녹음의 간기 패턴에 따라 달라집니다. 모니터링 된 환자는 약간의 통증이있을 수 있지만, 아세트 아미노펜과이 취급합니다. 일반적으로, 체류 기간 7 일 (- 이십팔일 범위 3)입니다. </li><li> 전극을 제거하기 전에, 녹음 및 가설을 검토하기 위해 멀티 - 징계 회의에 환자에 대하여 논의한다. </li><li> 충분한 발작 데이터를 기록 후 (3.2 단계) 환자는 회의에서 논의 된, 대기 또는 전극을 제거하는 동안 환자의 이전에 항 간질 약물을 다시 시작합니다. </li></ol> 또는 제거 4. 반환 <ol><li> AF충분한 발작 데이터를 기록 운은 SEEG 전극의 제거를 위해 수술실에 환자를 반환합니다. 수면 마취하에이를 수행; 일반적으로 2 mg을 미다 졸람의 IV는 충분하다. </li><li> 마취가 충분히 진정을 구한 후 (일반적으로 미다 졸람과 [마취에 투여 연기), 환자 포장하여 머리 제거하고 전극 와이어를 잘라. 전극 제거 또는 봉합 삽입으로보고 고통 수준에 의해 임상 적으로 환자의 진정 작용을 모니터링합니다. 이어서 요오드화 겔을 사용하는 전극의 나머지 볼트와 꼬리 수험. </li><li> 개별적으로, 전극 다음에, 그것을 떨어져 왜곡하여 각 볼트 캡을 제거하고 마지막으로 볼트를 제거합니다. 부드럽게 자신의 삽입 축 방향을 잡아 당겨 전극을 제거합니다. 그런 다음 그것을 왜곡하여 볼트를 제거, 일반적으로 손가락을 사용하여이 작업을 수행. </li><li> 다음 전극으로 이동하기 전에, 나일론 봉합사의 한 스티치와 볼트에 의해 왼쪽 결함을 닫습니다. 각 전극에 대해 이러한 단계를 반복합니다. REM 수면 후모든 전극 oving, 항생제 연고와 느슨한 머리 랩과 스티치 영역을 커버한다. </li><li> 제거 후, ​​잔류 하드웨어 없도록 추가 영상 중 CT 또는 A / P 및 측면 엑스레이을 구하십시오. 참고 : 가능한 절제-경우 수술 적 절제가 환자의 간질에 도움이 될 것으로 생각 된 후 개두술과 절제 제거 후 약 육주 계획. 이 지연은 모니터링 기간과 동일한 입원시에 동작의 감염성 문제에 기인한다. </li></ol>

<ol>
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저자는 공개 아무것도 없어.

여기에 로봇 정위 지원을 활용 SEEG 삽입의 기술을 제공됩니다. SEEG 원래 프레임 기반 stereotaxis의 다른 방법을 사용하여 설명되었지만, 로봇 보조 SEEG 유사한 안전하지만 우수한 정확도와 효율성뿐만 아니라 제공합니다. 다른 이전의 연구는 다른 기술을 사용하여. 6,13-을 함께 동정 인 경우 76 % 이상,에 EZ 현지화의 문헌보고 성공. 어떤 침략 두개 절차와 마찬가?...

In medically refractory epilepsy there are many non-invasive pre-surgical tools (scalp EEG., magnetic resonance imaging (MRI), functional MRI, single photon emission computed tomography, positron emission topography, and magnetoencephalography). If these non-invasive evaluations fail to sufficiently localize or define the epileptic zone (EZ) then invasive recording may be indicated. Currently, subdural grids or Stereo-electro-encephalo-graphy (SEEG) are the two most prevalent methods of invasive monitoring. SEEG was originally developed in France in the 1950's by Jean Talairach and Jean Bancaud; recently it has mostly been used for invasive monitoring of refractory epilepsy patients in France.2-4 SEEG is the consists of stereotactically inserting intracerebral electrodes into the brain parenchyma to record brain electrical activity for an extended period of time. With the intracerebral electrical recordings many patients are able to have their EZ defined to allow for surgical resection. 
Despite this long history of success SEEG remains relatively rarely used for invasive recording in America. However, SEEG does offer several significant advantages; SEEG allows for 1) recording of deep structures, 2) bihemispheric recordings, 3) another recording option if subdural grids failed, and 4) mapping of epileptic networks in three dimensions, mainly in patients where non-lesional extra-temporal epilepsy is suspected.5-7 All of these benefits are achieved without requiring a large craniotomy. A recent technologic advance in SEEG surgery is the used of robotic guidance. This sophisticated development allows for improved operative times but safer and more accurate surgical implantation of electrodes.Recently published literature reviews the results of using two different techniques for SEEG insertion; a more traditional method utilizing stereotactic frames and a newer technique using robotic assistante for SEEG insertion.1, 8,15 the results were similarly successful with each method. 
With the advent of improved robotic assistance, the SEEG insertion technique has resulted in improved operative times. The robotic system is classified as a supervisory controlled system which means the surgeon plans the operation off line and implicitly specifies the motion the robot must follow to perform the operation.9 The robotic assist results in expedient transitions from one trajectory to the next for the placement of each intracranial electrode.

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		<tr height="21">
			<td height="21" style="height:21px;width:216px;">ROSA</td>
			<td style="width:71px;">ROSA</td>
			<td style="width:119px;"></td>
			<td style="width:167px;">robotic implantation system</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:216px;">electrodes</td>
			<td style="width:71px;">adtech</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

stereo-electro-encephalo-graphy (seeg) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: a technical note

SEEG는 입체 녹화 통해 발작 활동의 정확한 침입 기록하는데 사용되는 방법 및 기술이다. 침략 녹음에 적합한 후보를 판단되는 간질 환자에서 모니터링 할 수있는 결정은 SEEG 대 경막 그리드 사이에 이루어집니다. 간질에 대한 침략 neuromonitoring 복잡한 의학적 내화물 간질 환자에서 추진된다. 침입 모니터링의 목표는 발작 자유를 허용하는 희망 resective 수술을 제공하는 것입니다. SEEG의 장점은 깊은 대뇌 피질의 구조에 대한 액세스는 간질 영역 경막 그리드 그렇게하지 ​​못했다 (EZ), 비 병변 여분의 시간 간질 환자에서 지역화 할 수있는 능력을 포함한다. 이 논문에서 우리는 SEEG의 간결한 역사의 개요를 제시하고 로봇에서 틀 정위와 우리의 경험을보고하고자한다. SEEG 삽입의 필수 단계는 전극 궤도를 계획하고있다. 가장 효율적으로 기록하기 위해SEEG 궤적을 통해 발작 활동은 발작 활동이 추정 간질 존 (EZ)를 비롯 곳의 가설에 기초하여 계획하여야한다. EZ 가설은 비디오 EEG 모니터링, MRI (자기 공명 영상), PET (양전자 방출 단층 촬영), 발작 SPECT (단일 광자 방출 전산화 단층 촬영), 및 신경 정신 학적 평가를 포함하는 표준화 된 수술 후 처리에 기초한다. 의심 EZ를 사용 SEEG 전극 최소 침습적 아직 정확도와 정밀도를 유지 배치 될 수있다. 임상 결과는 간질 환자를 국산화하기 어려운의 78 %에 EZ을 지역화 할 수있는 능력을 보여 주었다. (1)

최근 결과는 로봇 지원을 통해 SEEG 삽입을 시행 한 78 명의 환자 중 하나 연속 시리즈에서 환자의 76.2 %에서 EZ의 성공적인 현지화를 가지고 있음을 나타냅니다. (1) 그 같은 연구는 한 학년 1 EZ의 수술 적 절제를 위하여 계속 환자의 보여 주었다 환자의 67.8 %에서 엥겔 발작 자유 (그림 4). 이환은 2.5 %이다. 발견 된 영구 사망률은 1 명 (1.2 %)이다. 전극마다, ...

Watch this Scientific Journal Video about Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note at JoVE.com

Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes.

의료 내화물 간질의 수술 전 평가에서 로봇 지원으로 스테레오 전기 Encephalo-그래피로 (SEEG) : A 기술 참고

SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients ...

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Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

17.0K 조회수.  Cleveland Clinic. Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes. 

비디오: Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.

The goal is to produce an arteriovenous fistula that is simple and reproducible. This method does not use sutures or glue adhesive. Therefore the samples can be used with the least amount of foreign materials for analysis.

마우스 Aortocaval 누관의 기술적 측면

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

연구

의학

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

간질 환자의 뇌 흥분을 연결 관련 평가하는 멀티 모달 Imaging- 및 자극 기반 방법

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency Oscillations (HFOs) have emerged as potential presurgical biomarkers for the identification of the EZ in addition to Interictal Epileptiform Discharges (IEDs) and ictal activity. Although they are promising to localize the EZ, they are not yet suited for the diagnosis or monitoring of epilepsy in clinical practice. Primary barriers remain: the lack of a formal and global definition for HFOs; the consequent heterogeneity of methodological approaches used for their study; and the practical difficulties to detect and localize them noninvasively from scalp recordings. Here, we present a methodology for the recording, detection, and localization of interictal HFOs from pediatric patients with refractory epilepsy. We report representative data of HFOs detected noninvasively from interictal scalp EEG and MEG from two children undergoing surgery.
The underlying generators of HFOs were localized by solving the inverse problem and their localization was compared to the Seizure Onset Zone (SOZ) as this was defined by the epileptologists. For both patients, Interictal Epileptogenic Discharges (IEDs) and HFOs were localized with source imaging at concordant locations. For one patient, intracranial EEG (iEEG) data were also available. For this patient, we found that the HFOs localization was concordant between noninvasive and invasive methods. The comparison of iEEG with the results from scalp recordings served to validate these findings. To our best knowledge, this is the first study that presents the source localization of scalp HFOs from simultaneous EEG and MEG recordings comparing the results with invasive recordings. These findings suggest that HFOs can be reliably detected and localized noninvasively with scalp EEG and MEG. We conclude that the noninvasive localization of interictal HFOs could significantly improve the presurgical evaluation for pediatric patients with epilepsy.

High Frequency Oscillations (HFOs) have emerged as presurgical biomarkers for the identification of the epileptogenic zone in pediatric patients with medically refractory epilepsy. A methodology for the noninvasive recording, detection, and localization of HFOs with simultaneous scalp electroencephalography (EEG) and magnetoencephalography (MEG) is presented.

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

로봇 수술에 긴급 도킹 해제: 시뮬레이션 커리큘럼

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow the examination of all semicircular canals in the clinical setting. Assessment methods of the otolithic system, which is responsible for the perception of linear acceleration and perception of gravity, are far less in clinical use. There are several experimental approaches for measuring the perception of gravity. The most frequently used method is the determination of the subjective visual vertical. This is usually measured with the head in an upright position. We present here an assessment method for testing otolith function in the roll plane. The subjective visual vertical is measured in the head upright position as well as with head inclination of &#177; 15&#176; and &#177; 30&#176; in the roll plane. This extended functional paradigm is an easy-to-perform clinical test of otolith function and ensures increased information content for the detection of impaired graviceptive perception.

The perception of gravity is commonly determined by the subjective visual vertical in the head upright position. The additional assessment at head tilts of &#177; 15&#176; and &#177; 30&#176; in the roll plane ensures increased information content for the detection of impaired graviceptive perception.

주관적인 시각적 수직 패러다임을 사용하여 롤 플레인에서 정적 중력 지각의 평가

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

레이저 도플러 흐름 측정을 사용하여 쥐에 대뇌 혈액 흐름 자동 조절의 평가

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training physicians&#39; wire-skills as well as improving planning of interventional procedures. The aim of this study was to develop a manufacturing process of patient-specific 3D-printed models for cardiovascular interventions.
To create a 3D-printed elastic phantom, different 3D-printing materials were compared to porcine biological tissues (i.e., aortic tissue) in terms of mechanical characteristics. A fitting material was selected based on comparative tensile tests and specific material thicknesses were defined. Anonymized contrast-enhanced CT-datasets were collected retrospectively. Patient-specific volumetric models were extracted from these datasets and subsequently 3D-printed. A pulsatile flow loop was constructed to simulate the intraluminal blood flow during interventions. Models&#39; suitability for clinical imaging was assessed by x-ray imaging, CT, 4D-MRI and (Doppler) ultrasonography. Contrast medium was used to enhance visibility in x-ray-based imaging. Different catheterization techniques were applied to evaluate the 3D-printed phantoms in physicians&#39; training as well as for pre-interventional therapy planning.
Printed models showed a high printing resolution (~30 &#181;m) and mechanical properties of the chosen material were comparable to physiological biomechanics. Physical and digital models showed high anatomical accuracy when compared to the underlying radiological dataset. Printed models were suitable for ultrasonic imaging as well as standard x-rays. Doppler ultrasonography and 4D-MRI displayed flow patterns and landmark characteristics (i.e., turbulence, wall shear stress) matching native data. In a catheter-based laboratory setting, patient-specific phantoms were easy to catheterize. Therapy planning and training of interventional procedures on challenging anatomies (e.g., congenital heart disease (CHD)) was possible.
Flexible patient-specific cardiovascular phantoms were 3D-printed, and the application of common clinical imaging techniques was possible. This new process is ideal as a training tool for catheter-based (electrophysiological) interventions and can be used in patient-specific therapy planning.

Here we present development of a mock circulation setup for multimodal therapy evaluation, pre-interventional planning, and physician-training on cardiovascular anatomies. With the application of patient-specific tomographic scans, this setup is ideal for therapeutic approaches, training, and education in individualized medicine.

중재 계획 및 교육을 위한 3D 인쇄 심장 혈관 팬텀의 개발 및 평가

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training ...

Repetitive Blood Sampling from the Subclavian Vein of Conscious Rat

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to detect drug exposure. The rat blood sampling method determines the quality of the plasma and further affects the precision of the test results. The subclavian vein blood collection method described in this protocol collects blood samples repeatedly in the conscious state of animals to meet the needs of PK and TK tests. The skills of restraint handling and appropriate procedure of needle incision ensure the success rate of blood collection. It is easy to operate while ensuring the quality of plasma and at the same time catering to animal welfare. However, this method requires skilled operation, and an improper one may cause animal weakness, pain, lameness, and even mortality. The current method has been used in the testing facility for a 4-week oral toxicity study in Sprague Dawley (SD) rats with TK. The maximum amount of blood collected within 24 h did not exceed 20% of the animal's total blood. The animals' body weight was more than 200 g for males and females. The data showed that the animals' bodyweight increased steadily every week, and the clinical observation was normal after repetitive sample collection.

The present protocol describes a simple and efficient method for collecting blood from the subclavian vein in rats. It enables rapid, timely, and easily identifiable sampling without anesthesia and obtains high-quality blood through repetitive sample collection.

의식 쥐의 쇄골 하 정맥에서 반복적 인 혈액 샘플링

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to ...

Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In this study, a 32-year-old male patient with Bismuth Type IVa hilar cholangiocarcinoma underwent radical robotic resection of hepatic S4b, S5, and S1 (Taj Mahal hepatectomy) combined with regional lymphadenectomy, hilar bile duct reconstruction, and hepaticojejunostomy by the robotic surgical system. Postoperative pathological examination showed moderately-differentiated adenocarcinoma of the hilar bile duct. The surgical margins of the liver and bile ducts were negative. Recovery was smooth and the patient was discharged on the 17th postoperative day. The robotic surgical system and associated multiple instruments along with flexible and precise movements is suitable for the local hepatectomy around the porta hepatis, and delicate reconstruction of the hilar bile duct with a smaller diameter. This first clinical application study found that robotic Taj Mahal hepatectomy for hilar cholangiocarcinoma is safe and feasible and needs more experience for the evaluation of its long-term outcomes.

Robotic resection of hepatic S4b, S5, and S1 using the Taj Mahal procedure is feasible and safe for selected patients with hilar cholangiocarcinoma. The step-by-step details for this surgery are presented here.

Hilar Cholangiocarcinoma에 대한 로봇 타지마할 간 절제술

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In ...