Name: implantation of human-sized coronary stents into rat abdominal aorta using a trans-femoral access
Uploaded: 2020-11-19T13:00:00
Description: Watch this Scientific Journal Video about Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access at JoVE.com

Vi vil gerne takke fru Angela Freund for hendes uvurderlige tekniske bistand med indlejring og diasproduktion. Vi vil også gerne takke Mr. Tadeusz Stopinski på Institute for Laboratory Animal Science &experimental surgery for hans indsigtsfulde hjælp med veterinærarbejdet.

Forsøgene blev udført i overensstemmelse med den tyske dyrevelfærdslovgivning (TSchG) og direktiv 2010/63/EU om beskyttelse af dyr, der anvendes til videnskabelige formål. Den officielle godkendelse af denne undersøgelse blev givet af den statslige komité for dyrepleje og -anvendelse (protokol nr.: AZ 87-51.04.2010.A065; Landesamt für Natur, Umwelt und Verbraucherschutz Nordrhein-Westfalen, Recklinghausen, Tyskland). Forsøgsprotokollen var i overensstemmelse med vejledningen om pasning og anvendelse af forsøgsdy...

<ol>
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R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS+2017+Appropriate+Use+Criteria+for+Coronary+Revascularization+in+Patients+With+Stable+Ischemic+Heart+Disease:+A+Report+of+the+American+College+of+Cardiology+Appropriate+Use+Criteria+Task+Force,+American+Association+for+Thoracic+Surgery,+American+Heart+Association,+American+Society+of+Echocardiography,+American+Society+of+Nuclear+Cardiology,+Society+for+Cardiovasular+Angiography+and+Interventions,+Society+of+Cardiovascular+Computed+Tomography,+and+Society+of+Thoracic+Surgeons.">ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovasular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.</a> Journal of the American College of Cardiology. 69 (17), 2212-2241 (2017).</li><li>Virmani, R., Farb, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathology+of+in-stent+restenosis.">Pathology of in-stent restenosis.</a> Current Opinion in Lipidology. 10 (6), 499-506 (1999).</li><li>Buccheri, D., Piraino, D., Andolina, G., Cortese, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Understanding+and+managing+in-stent+restenosis:+a+review+of+clinical+data,+from+pathogenesis+to+treatment.">Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment.</a> Journal of Thoracic Disease. 8 (10), 1150-1162 (2016).</li><li>Perkins, L. 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G., Schwartz, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preclinical+restenosis+models:+challenges+and+successes.">Preclinical restenosis models: challenges and successes.</a> Toxicologic Pathology. 34 (1), 11-18 (2006).</li><li>Wei, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Apolipoprotein+E-deficient+rats+develop+atherosclerotic+plaques+in+partially+ligated+carotid+arteries.">Apolipoprotein E-deficient rats develop atherosclerotic plaques in partially ligated carotid arteries.</a> Atherosclerosis. 243 (2), 589-592 (2015).</li><li>Zhao, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hyperlipidemia+induces+typical+atherosclerosis+development+in+Ldlr+and+Apoe+deficient+rats.">Hyperlipidemia induces typical atherosclerosis development in Ldlr and Apoe deficient rats.</a> Atherosclerosis. 271, 26-35 (2018).</li><li>Ekuni, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Occlusal+disharmony+accelerates+the+initiation+of+atherosclerosis+in+apoE+knockout+rats.">Occlusal disharmony accelerates the initiation of atherosclerosis in apoE knockout rats.</a> Lipids in Health and Disease. 13 (144), 13 (2014).</li><li>Bhattacharya, D., Van Meir, E. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+simple+genotyping+method+to+detect+small+CRISPR-Cas9+induced+indels+by+agarose+gel+electrophoresis.">A simple genotyping method to detect small CRISPR-Cas9 induced indels by agarose gel electrophoresis.</a> Scientific Reports. 9 (1), 39950 (2019).</li><li>Malik, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intravascular+stents:+a+new+technique+for+tissue+processing+for+histology,+immunohistochemistry,+and+transmission+electron+microscopy.">Intravascular stents: a new technique for tissue processing for histology, immunohistochemistry, and transmission electron microscopy.</a> Heart. 80 (5), 509-516 (1998).</li><li>Kumar, A. H., McCauley, S. D., Hynes, B. G., O'Dea, J., Caplice, N. 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Deviation of man from the usual pattern.</a> Circulation Research. 25 (6), 677-686 (1969).</li><li>Lowe, H. C., James, B., Khachigian, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+model+of+in-stent+restenosis:+rat+aortic+stenting.">A novel model of in-stent restenosis: rat aortic stenting.</a> Heart. 91 (3), 393-395 (2005).</li><li>Unthank, J. L., Nixon, J. C., Lash, J. 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Denne protokol beskriver implantationen af koronarstenter i menneskestørrelse i aorta af apoE-/- rotter. Flere tekniske punkter er værd at understrege. For det første bør en uoverensstemmelse mellem stentstørrelsen og størrelsen af aorta undgås. Placering for lille en stank kan føre til stank malapposition, mens implantation af en stank, der er for stor til aorta kan forårsage overstretch, rive, og skade på fartøjet. Derfor anbefaler vi at bruge stenter mellem 2,0 og 2,5 mm i diameter og at holde im...

Perkutan koronar intervention (PCI), kombineret med indsættelsen af en koronar stent, repræsenterer guldstandarden i interventionel behandling af koronararteriesygdom1. Stenternes langsigtede succes kan dog begrænses af forekomsten af in-stent restenosis (ISR), der bestemmes af en overdreven spredning af neointimalt væv inden forstenten 2,3. ISR kan kræve en re-intervention enten med kranspulsåren bypass eller re-PCI. En række dyremodeller er blevet foreslået til undersøgelse af ISR, hver af dem med fordele og mangler. De største ulemper ved de mest almindeligt anvendte koronar- og kaninpulsåremodeller, omend udvikling af læsioner, der ligner mennesker markant efter stentimplantation4,5, er store dyre- og boligomkostninger, hvilket bringer logistiske vanskeligheder op, især i langsigtede undersøgelser samt begrænsninger i håndtering og udstyr. Desuden er tilgængeligheden af antistoffer mod cellulære proteiner af svin og kaniner begrænset. På den anden side giver murinemodeller de store fordele ved høj gennemløb og reproducerbarhed samt nem håndtering, boliger og derfor omkostningseffektivitet. Desuden er der et større antal antistoffer til rådighed. Men mens apolipoprotein E-mangelfulde (apoE-/-) mus er blevet bredt anvendt til undersøgelse af åreforkalkning6,7,8, de er uegnede til undersøgelse af ISR som stents skal miniaturiseres at blive implanteret i mus, potentielt ændre stents mekaniske egenskaber. Desuden måler musens aortavæg mellem 50 μm hos unge mus og 85 μm i gamle mus9, og stenter skal indsættes ved hjælp af trykniveauer så lavt som 2 atm, hvilket kan føre til malapposition afstenten 10. Rotter giver imidlertid mulighed for implantation af kommercielt tilgængelige menneskelige koronarstenter og demonstrerer et vaskulært helbredende kursus svarende til større dyr efter aorta stentimplantation, først rapporteret af Langeveld et al.11. Denne teknik krævede oprindeligt en trans-abdominal adgang, hvilket nødvendiggjorde en fysisk indsnævring af aorta for at opnå en midlertidig afbrydelse af blodgennemstrømningen. For at undgå den potentielt tilknyttede fartøjsskade og inflammatoriske reaktioner blev teknikken senere raffineret ved indførelsen af en trans-iliacaadgang, hvilket desuden resulterede i en højere overlevelsesrate for dyrene12.
Da wildtyperoro ikke udvikler aterosklerotiske læsioner13, er der genereret apoE-/- rotter ved hjælp af nukleaseteknikker som Transskription Activator-Like Effector Nuclease (TALEN)14, Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR/Cas9)15og Zinc Finger (ZF)16. ApoE-/- rotter har været kommercielt tilgængelige siden 2011. Med en aterogen baggrund giver apoE-/- rotter mulighed for en mere realistisk vurdering af koronarstents i menneskelig størrelse, især med hensyn til ISR.
Heri beskriver vi metoden via transfemoral adgangsvejen og ved hjælp af en kommercielt tilgængelig tyndstrut kobolt-chrom stof-eluting stent (DES), men det kan også anvendes til undersøgelse af andre stenttyper, såsom bare metalstents (BMS) eller bionedbrydelige stenter.

<table>
	<tbody>
		<tr>
			<td>Diet</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>SNIFF High Fat diet + Clopidogrel (15 mg/kg)</td>
			<td>SNIFF Spezialdi&#228;ten GmbH, Soest</td>
			<td>custom prepared</td>
			<td>Western Diet</td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Drugs and Anesthetics</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Buprenorphine</td>
			<td>Essex Pharma</td>
			<td>997.00.00</td>
			<td></td>
		</tr>
		<tr>
			<td>ISOFLO (Isoflurane Vapor) vaporiser</td>
			<td>Eickemeyer</td>
			<td>4802885</td>
			<td></td>
		</tr>
		<tr>
			<td>Isoflurane</td>
			<td>Forene Abbott</td>
			<td>B 506</td>
			<td></td>
		</tr>
		<tr>
			<td>Isotonic (0.9%) NaCl solution</td>
			<td>DeltaSelect GmbH</td>
			<td>PZN 00765145</td>
			<td></td>
		</tr>
		<tr>
			<td>Ringer&#39;s lactate solution</td>
			<td>Baxter Deutschland GmbH</td>
			<td>3775380</td>
			<td></td>
		</tr>
		<tr>
			<td>(S)-ketamine</td>
			<td>CEVA Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Xylazine</td>
			<td>Medistar Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Consumable supplies</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>10 mL syringes</td>
			<td>BD Plastipak</td>
			<td>4606108V</td>
			<td></td>
		</tr>
		<tr>
			<td>2 mL syringes</td>
			<td>BD Plastipak</td>
			<td>4606027V</td>
			<td></td>
		</tr>
		<tr>
			<td>6-0 prolene suture</td>
			<td>ETHICON</td>
			<td>N-2719K</td>
			<td></td>
		</tr>
		<tr>
			<td>4-0 silk suture</td>
			<td>Seraflex</td>
			<td>IC 158000</td>
			<td></td>
		</tr>
		<tr>
			<td>Bepanthen Eye and Nose Ointment</td>
			<td>Bayer Vital GmbH</td>
			<td>6029009.00.00</td>
			<td></td>
		</tr>
		<tr>
			<td>Cotton Gauze swabs</td>
			<td>Fuhrmann GmbH</td>
			<td>32014</td>
			<td></td>
		</tr>
		<tr>
			<td>Durapore silk tape</td>
			<td>3M</td>
			<td>1538-1</td>
			<td></td>
		</tr>
		<tr>
			<td>Poly-Alcohol Skin Desinfection Solution</td>
			<td>Antiseptica GmbH</td>
			<td>72PAH200</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterican needle 18 G</td>
			<td>B. Braun</td>
			<td>304622</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterican needle 27 3/4 G</td>
			<td>B.Braun</td>
			<td>4657705</td>
			<td></td>
		</tr>
		<tr>
			<td>Tissue Paper</td>
			<td>commercially available</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical instruments</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Graefe forceps curved x1</td>
			<td>Fine Science Tools Inc.</td>
			<td>11151-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Graefe forceps straight</td>
			<td>Fine Science Tools Inc.</td>
			<td>11050-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Needle holder Mathieu</td>
			<td>Fine Science Tools Inc.</td>
			<td>12010-14</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td>Fine Science Tools Inc.</td>
			<td>14074-11</td>
			<td></td>
		</tr>
		<tr>
			<td>Semken forceps</td>
			<td>Fine Science Tools Inc.</td>
			<td>11008-13</td>
			<td></td>
		</tr>
		<tr>
			<td>Small surgical scissors curved</td>
			<td>Fine Science Tools Inc.</td>
			<td>14029-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Small surgical scissors straight</td>
			<td>Fine Science Tools Inc.</td>
			<td>14028-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Standard pattern forceps</td>
			<td>Fine Science Tools Inc.</td>
			<td>11000-12</td>
			<td></td>
		</tr>
		<tr>
			<td>Vannas spring scissors</td>
			<td>Fine Science Tools Inc.</td>
			<td>15000-08</td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Equipment</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Dissecting microscope</td>
			<td>Leica MZ9</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Temperature controlled heating pad</td>
			<td>Sygonix</td>
			<td>26857617</td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Equipment for stent implantation</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Drug-eluting stent Xience 2,25mm x 8mm</td>
			<td>Abbott Vascular USA</td>
			<td>1009544-18</td>
			<td></td>
		</tr>
		<tr>
			<td>Guide wire Fielder XT PTCA guide wire: 0.014&#34; x 300cm</td>
			<td>ASAHI INTECC CO., LTD Japan</td>
			<td>AGP140302</td>
			<td></td>
		</tr>
		<tr>
			<td>Inflation syringe system</td>
			<td>Abbott 20/30 Priority Pack</td>
			<td>1000186</td>
			<td></td>
		</tr>
		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tissue processing and analysis</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>30% H2O2</td>
			<td>Roth</td>
			<td>9681</td>
			<td>Histology</td>
		</tr>
		<tr>
			<td>Ethanol</td>
			<td>Roth</td>
			<td>K928.1</td>
			<td>Histology</td>
		</tr>
		<tr>
			<td>Giemsas Azur-Eosin-Methylenblau</td>
			<td>Merck</td>
			<td>109204</td>
			<td>Histology</td>
		</tr>
		<tr>
			<td>Graphic Drawing Tablet</td>
			<td>WACOM Europe GmbH</td>
			<td>CTL-6100WLK-S</td>
			<td></td>
		</tr>
		<tr>
			<td>Roti Histofix, Formaldehyd 4% buffered</td>
			<td>Roth</td>
			<td>P087</td>
			<td>Histology</td>
		</tr>
		<tr>
			<td>Technovit 9100</td>
			<td>Morphisto</td>
			<td>12225.K1000</td>
			<td>Histology</td>
		</tr>
	</tbody>
</table>

implantation of human-sized coronary stents into rat abdominal aorta using a trans-femoral access

Perkutan koronar intervention (PCI), kombineret med indsættelsen af en koronar stent, repræsenterer guldstandarden i interventionel behandling af koronararteriesygdom. In-stent restenosis (ISR) bestemmes af en overdreven spredning af neointimalt væv i stenten og begrænser stenternes langsigtede succes. En række dyremodeller er blevet brugt til at belyse patofysiologiske processer, der ligger til grund for in-stent restenosis (ISR), hvor svin koronar og kanin iliac arterie modeller er de hyppigst anvendte. Murine modeller giver fordelene ved høj gennemløb, nem håndtering og boliger, reproducerbarhed, og en bred tilgængelighed af molekylære markører. Den apolipoprotein E mangelfuld (apoE-/- ) mus model er blevet udbredt til at studere hjerte-kar-sygdomme. Stents skal dog miniaturiseres for at blive implanteret i mus, hvilket indebærer vigtige ændringer af deres mekaniske og (potentielt) biologiske egenskaber. Brugen af apoE-/- rotter kan overvinde disse mangler, da apoE-/- rotter giver mulighed for evaluering af koronarstenter i menneskelig størrelse, samtidig med at de giver en aterogen fænotype. Dette gør dem til en fremragende og pålidelig model til at undersøge ISR efter stentimplantation. Her beskriver vi i detaljer implantationen af kommercielt tilgængelige menneskelige koronarstenter i abdominal aorta af rotter med en apoE-/- baggrund ved hjælp af en trans-femoral adgang.

Denne protokol beskriver stentimplantation i rotters abdominale aorta ved hjælp af en trans-femoral adgangsvej (Figur 1). Det første centrale punkt i denne dyremodel er, at den giver mulighed for indsættelse af koronarstents i menneskelig størrelse. En kommercielt tilgængelig krympet og ballonmonteret koronar stent kan placeres i abdominal aorta af rotter. Således kan det samme princip om stentudrulning som hos mennesker anvendes. En anden fordel ved brugen af rotter er tilgængelighed...

Watch this Scientific Journal Video about Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access at JoVE.com

Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access

Denne protokol beskriver implantationen af menneskelige koronar stenter i abdominal aorta af rotter med en apoE-/- baggrund ved hjælp af en trans-femoral adgang. Sammenlignet med andre dyremodeller bærer murinmodeller fordelene ved høj gennemløb, reproducerbarhed, nem håndtering og boliger og en bred tilgængelighed af molekylære markører.

Implantation af human størrelse koronar stenter i Rat Abdominal Aorta Ved hjælp af en Trans-Femoral Access

Percutaneous coronary intervention (PCI), combined with the deployment of a coronary stent, represents the gold standard in interventional treatment of ...

Research

JoVE Journal

Medicine

Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration

Rotte Heterotop Abdominal Heart / Single-lunge transplantation i en Volume-loaded konfiguration

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft ...

Creation of Abdominal Adhesions in Mice

Oprettelse af Abdominal adhæsioner i mus

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or ...

Fabrication of Small Caliber Stent-grafts Using Electrospinning and Balloon Expandable Bare Metal Stents

Fremstilling af små Caliber stentimplantater Brug Electrospinning og Balloon kan udvides Bare Metal Stents

Stent-grafts are widely used for the treatment of various conditions such as aortic lesions, aneurysms, emboli due to coronary intervention procedures and ...

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

En model af Cardiac Remodeling Gennem Sammensnøring af den abdominale aorta i rotter

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and ...

Patch Angioplasty in the Rat Aorta or Inferior Vena Cava

Patch Angioplastik i Rat aorta eller vena cava inferior

Pericardial patches are commonly used in vascular surgery to close vessels. To facilitate studies of the neointimal hyperplasia that forms on the patch, ...

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Direkte Re-implantation af venstre koronararterie i aorta i Voksne med Anomalous Oprindelse af venstre koronararterie fra lungepulsåren (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

Ballon-baserede skade til at fremkalde Myointimal hyperplasi i mus Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions

Ultralyd scanning af thorax og abdominale Aorta i mus til at bestemme aneurisme dimensioner

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been ...

A Murine Model of Hemodialysis Access-Related Hand Dysfunction

En murin model af hæmodialyse adgangsrelateret hånd dysfunktion

Chronic kidney disease is a major public health problem, and the prevalence of end-stage renal disease (ESRD) requiring chronic renal replacement ...

Robotic Cochlear Implantation for Direct Cochlear Access

Cochlear-robotimplantation for direkte cochlear-adgang

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of ...