Relevant bibliographies by topics / Flexible Medical Instruments

Academic literature on the topic 'Flexible Medical Instruments'

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Published: 6 September 2023

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Journal articles on the topic "Flexible Medical Instruments"

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De Greef, Aline, Pierre Lambert, and Alain Delchambre. "Towards flexible medical instruments: Review of flexible fluidic actuators." Precision Engineering 33, no. 4 (October 2009): 311–21. http://dx.doi.org/10.1016/j.precisioneng.2008.10.004.

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He, Chaojiang, Yanlin He, Changxin Yu, Fei Luo, and Lianqing Zhu. "Optical fiber shape sensing of flexible medical instruments with temperature compensation." Optical Fiber Technology 74 (December 2022): 103123. http://dx.doi.org/10.1016/j.yofte.2022.103123.

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Sweigert, Patrick, Adam Van Huis, Eric Marcotte, and Bipan Chand. "Flexible Endoscopy: The Fundamentals." Digestive Disease Interventions 02, no. 04 (December 2018): 289–98. http://dx.doi.org/10.1055/s-0038-1675754.

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Endoscopy highlights the intersection of technological advancements and medical application. Innovation in optics, illumination, imaging, and manufacturing has allowed for the development of a complex array of instruments for use by endoscopists. Flexible gastrointestinal (GI) endoscopy has emerged to become a well-established minimally invasive aspect of prevention, diagnosis, and treatment of GI disease.Flexible endoscopes and their associated instruments and platforms are described, acknowledging that such lists are dynamic. The procedure environment is also described in terms of location, equipment, ergonomics, personnel involved, and recovery considerations.Recommendations from GI and anesthesiology associations are outlined to summarize current practices in the administration of sedative drugs to reduce patient discomfort, allow for a technically successful procedure, and reduce patient memory of the procedure.The training process for GI endoscopy is described for general surgery residents and GI fellows. Training involves didactic and technical curriculum along with mentor-supervised endoscopic procedures. After the completion of training, residents and fellows proceed through a credentialing process, which culminates in granting privileges to an individual to perform GI endoscopic procedures. Once in practice, providers must stay up to date on the ever-changing world of medical documentation, coding, and billing to ensure appropriate reimbursement.
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Cheng, Zhuo-Qi, Jiale He, Liang Zhou, Yu Li, Pengjie Lin, Jing Guo, Shuting Cai, and Xiaoming Xiong. "Smart handheld device with flexible wrist and electrical bioimpedance sensor for tissue inspection." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 236, no. 3 (December 1, 2021): 416–26. http://dx.doi.org/10.1177/09544119211060100.

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With the evolving demands of surgical intervention, there is a strong need for smaller and functionally augmented instruments to improve surgical outcomes, operational convenience, and diagnostic safety. Owing to the narrow and complicated anatomy, the probe head of the medical instrument is required to possess both good maneuverability and compact size. In addition, the development of medical instrument is moving toward patient-specialized, of which the articulation positions can be customized to reach the target position. To fulfill these requirements, this study presents the design of a smart handheld device which equips with a low cost, easy control, disposable flexible wrist, and an electrical bioimpedance sensor for medical diagnosis. Prototype of the device is made and tested. The experimental results demonstrate that the proposed device can provide accurate manipulation and effective tissue detection, showing a great potential in various medical applications.
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Okayasu, Haruna, Jun Okamoto, Hiroshi Iseki, and Masakatsu G. Fujie. "Development of a Hydraulically-Driven Flexible Manipulator for Neurosurgery." Journal of Robotics and Mechatronics 17, no. 2 (April 20, 2005): 149–57. http://dx.doi.org/10.20965/jrm.2005.p0149.

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Minimally invasive surgery has recently become a key word in medical engineering. In this operation, to facilitate the introduction of surgical instruments, spatulas which push tissues aside and retain the approach path to the affected area as well as workspace for the insertion of such instruments are necessary. Therefore, a new type of hydraulically-driven flexible manipulator for neurosurgery has been developed. Including an attached balloon and using only physiological saline for the drive system, the safety of the brain tissue, especially in terms of pressure, is assured as is the simplicity of the mechanism. In addition, this provides the advantage of MRI compatibility. Following several positive evaluations, the effectiveness of this manipulator has been proven as a new type of medical device.
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McIntosh, Roger L., and Alfred Yau. "A Flexible and Robust Peer-to-Peer Architecture with XML-Based Open Communication for Laboratory Automation." JALA: Journal of the Association for Laboratory Automation 8, no. 1 (February 2003): 38–45. http://dx.doi.org/10.1016/s1535-5535-04-00240-0.

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Traditional lab automation systems are highly centralized: dispatch and coordination of activities are mediated by a system controller, usually via a single, monolithic control procedure. This approach, while conceptually simple, makes changes to the system difficult; adding or removing instruments and functionality can be a daunting task. In addition, most automated systems are tied to particular development languages and protocols, making operation in heterogeneous environments (i.e., the real world) problematic, since instrument software comes in many different implementations. We present a peer-to-peer architecture for lab automation, using an XML-based communication protocol. The architecture consists of peer instrument servers, an XML communication layer, and an open control center. Each instrument peer can control, be controlled by, and communicate information to other instrument peers to fulfill the automation task. Our protocol is based on XML-RPC, a lightweight communication standard built atop HTTP. This provides an open and flexible means of peer-to-peer interfacing. The control center serves as a convenient, Web-based interface to manage the instruments. The automated procedure can be distributed across all available instrument peers (each instrument assigned a set of responsibilities); the controller implements a limited set of high-level instructions. The software components included in our prototype system are implemented in various programming languages, including Java, C/C++, Visual Basic, and LabVIEW. Our approach facilitates rapid development of laboratory automation systems.
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Caceres, Adrian. "Neuroendoscopy - Surgical instruments." Archives of Pediatric Neurosurgery 3, no. 1(January-April) (January 31, 2021): e732021. http://dx.doi.org/10.46900/apn.v3i1(january-april).73.

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Objective: A thorough knowledge of the endoscope and associated hardware is essential to adequately apply neuroendoscopic techniques in the treatment of cerebral and spinal diseases. The purpose of this presentation is to discuss general principles regarding neuroendoscopy instruments and provide some useful tips for those initiating and/or delving deeper in the field. Methods: The development, evolution and correct use of endoscopic instruments are reviewed, as per the author’s own wide experience and medical literature data. Results/Discussion: Both basic endoscopic surgical tools – lens systems, light sources, coagulation and recording devices, adapted scissors and forceps, etc. – along with advanced tools – holders, laser diodes, aspiration devices, arthropumps, etc. – were shown. Differences between rigid and flexible endoscopes were discussed, as well as specific features of the various current commercially available endoscopes (StorzÔ and BBraunÔ). Lastly, surgical aspects regarding positioning and neuroendoscopic approaches were also summarized. Conclusion: The field of neuroendoscopy is continually evolving. This basic knowledge of the neuroendoscopic tools is fundamental and must be combined with further technical refinements to achieve the best results in our clinical Pediatric Neurosurgery practice https://youtu.be/pvxAPjQGC08
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Khan, Fouzia, Abdulhamit Donder, Stefano Galvan, Ferdinando Rodriguez y. Baena, and Sarthak Misra. "Pose Measurement of Flexible Medical Instruments Using Fiber Bragg Gratings in Multi-Core Fiber." IEEE Sensors Journal 20, no. 18 (September 15, 2020): 10955–62. http://dx.doi.org/10.1109/jsen.2020.2993452.

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Khan, Fouzia, Alper Denasi, David Barrera, Javier Madrigal, Salvador Sales, and Sarthak Misra. "Multi-Core Optical Fibers With Bragg Gratings as Shape Sensor for Flexible Medical Instruments." IEEE Sensors Journal 19, no. 14 (July 15, 2019): 5878–84. http://dx.doi.org/10.1109/jsen.2019.2905010.

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Sudarevic, Boban, Joel Troya, Karl-Hermann Fuchs, Alexander Hann, Andras Vereczkei, and Alexander Meining. "Design and Development of a Flexible 3D-Printed Endoscopic Grasping Instrument." Applied Sciences 13, no. 9 (May 4, 2023): 5656. http://dx.doi.org/10.3390/app13095656.

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(1) Background: Interventional endoscopic procedures are growing more popular, requiring innovative instruments and novel techniques. Three-dimensional printing has demonstrated great potential for the rapid development of prototypes that can be used for the early assessment of various concepts. In this work, we present the development of a flexible endoscopic instrument and explore its potential benefits. (2) Methods: The properties of the instrument, such as its maneuverability, flexibility, and bending force, were evaluated in a series of bench tests. Additionally, the effectiveness of the instrument was evaluated in an ex vivo porcine model by medical experts, who graded its properties and performance. Furthermore, the time necessary to complete various interventional endoscopic tasks was recorded. (3) Results: The instrument achieved bending angles of ±216° while achieving a bending force of 7.85 (±0.53) Newtons. The time needed to reach the operating region was 120 s median, while it took 70 s median to insert an object in a cavity. Furthermore, it took 220 s median to insert the instrument and remove an object from the cavity. (4) Conclusions: This study presents the development of a flexible endoscopic instrument using three-dimensional printing technology and its evaluation. The instrument demonstrated high bending angles and forces, and superior properties compared to the current state of the art. Furthermore, it was able to complete various interventional endoscopic tasks in minimal time, thus potentially leading to the improved safety and effectiveness of interventional endoscopic procedures in the future.
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Dissertations / Theses on the topic "Flexible Medical Instruments"

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De, Greef Aline. "Towards medical flexible instruments: a contribution to the study of flexible fluidic actuators." Doctoral thesis, Universite Libre de Bruxelles, 2010. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210073.

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The medical community has expressed a need for flexible medical instruments. Hence, this work investigates the possibility to use "flexible fluidic actuators" to develop such flexible instruments. These actuators are driven by fluid, i.e. gas or liquid, and present a flexible structure, i.e. an elastically deformable and/or inflatable structure. Different aspects of the study of these actuators have been tackled in the present work:

• A literature review of these actuators has been established. It has allowed to identify the different types of motion that these actuators can develop as well as the design principles underlying. This review can help to develop flexible instruments based on flexible fluidic actuators.

• A test bench has been developed to characterize the flexible fluidic actuators.

• A interesting measuring concept has been implemented and experimentally validated on a specific flexible fluidic actuator (the "Pneumatic Balloon Actuator", PBA). Ac- cording to this principle, the measurements of the pressure and of the volume of fluid supplied to the actuator allow to determine the displacement of the actuator and the force it develops. This means being able to determine the displacement of a flexible fluidic actuator and the force it develops without using a displacement sensor or a force sensor. This principle is interesting for medical applications inside the human body, for which measuring the force applied by the organs to the surgical tools remains a problem.

The study of this principle paves the way for a lot of future works such as the implemen- tation and the testing of this principle on more complex structures or in a control loop in order to control the displacement of the actuator (or the force it develops) without using a displacement or a force sensor.

• A 2D-model of the PBA has been established and has helped to better understand the physics underlying the behaviour of this actuator.

• A miniaturization work has been performed on a particular kind of flexible fluidic actu- ator: the Pleated Pneumatic Artificial Muscle (PPAM). This miniaturization study has been made on this type of actuator because, according to theoretical models, minia- turized PPAMs, whose dimensions are small enough to be inserted into MIS medical instruments, could be able to develop the forces required to allow the instruments to perform most surgical actions. The achieved miniaturized muscles have a design similar to that of the third generation PPAMs developed at the VUB and present a total length of about 90 mm and an outer diameter at rest of about 15 mm. One of the developed miniaturized PPAMs has been pressurized at p = 1 bar and it was able to develop a pulling force F = 100 N while producing a contraction of 4 %.

Propositions have been made regarding a further miniaturization of the muscles.
Doctorat en Sciences de l'ingénieur
info:eu-repo/semantics/nonPublished

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Cabras, Paolo. "3D Pose estimation of continuously deformable instruments in robotic endoscopic surgery." Thesis, Strasbourg, 2016. http://www.theses.fr/2016STRAD007/document.

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Connaître la position 3D d’instruments robotisés peut être très utile dans le contexte chirurgical. Nous proposons deux méthodes automatiques pour déduire la pose 3D d’un instrument avec une unique section pliable et équipé avec des marqueurs colorés, en utilisant uniquement les images fournies par la caméra monoculaire incorporée dans l'endoscope. Une méthode basée sur les graphes permet segmenter les marqueurs et leurs coins apparents sont extraits en détectant la transition de couleur le long des courbes de Bézier qui modélisent les points du bord. Ces primitives sont utilisées pour estimer la pose 3D de l'instrument en utilisant un modèle adaptatif qui prend en compte les jeux mécaniques du système. Pour éviter les limites de cette approche dérivants des incertitudes sur le modèle géométrique, la fonction image-position-3D peut être appris selon un ensemble d’entrainement. Deux techniques ont été étudiées et améliorées : réseau des fonctions à base radiale avec noyaux gaussiens et une régression localement pondérée. Les méthodes proposées sont validées sur une cellule expérimentale robotique et sur des séquences in-vivo
Knowing the 3D position of robotized instruments can be useful in surgical context for e.g. their automatic control or gesture guidance. We propose two methods to infer the 3D pose of a single bending section instrument equipped with colored markers using only the images provided by the monocular camera embedded in the endoscope. A graph-based method is used to segment the markers. Their corners are extracted by detecting color transitions along Bézier curves fitted on edge points. These features are used to estimate the 3D pose of the instrument using an adaptive model that takes into account the mechanical plays of the system. Since this method can be affected by model uncertainties, the image-to-3d function can be learned according to a training set. We opted for two techniques that have been improved : Radial Basis Function Network with Gaussian kernel and Locally Weighted Projection. The proposed methods are validated on a robotic experimental cell and in in-vivo sequences
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Elloian, Jeffrey. "Design of a Flexible Ultrasound Phased Array with Adaptive Phasing for Curvature." Thesis, 2021. https://doi.org/10.7916/d8-d1kz-kq89.

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Diagnostic ultrasound has become invaluable to healthcare professions for the purpose of imaging soft tissue without the risk of exposure to damaging, ionizing radiation. However, the majority of commercially available transducers have rigid, fixed interfaces that cannot conform to the surface of the human body. Such limitations both introduce a potential air gap (requiring the application of ultrasound gel) and make long-term monitoring impractical. In this work, I propose a novel flexible 2D ultrasound phased array with adaptive phasing that is capable of compensating for the radius of curvature. I describe the phasing algorithm and illustrate the detrimental effect of a lack of phase correction through simulation. I conduct phase detection by using time of arrival (TOA) without additional external hardware. In addition to simulations, I provide details of the fabrication process of a flexible 16 by 16 element array. The manufactured array, with an operating frequency of 1.4MHz and bandwidth of 41.3%, was capable of generating pressures up to 600 kPa. Finally, I conduct an in-vivo human study to demonstrate the functionality of the array on a human humerus. Although visible without phase correction, the location of the bone can easily be tracked in real-time after applying the correction algorithm.
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Saurabh, Kumar. "Force and Shape Estimation using Fiber Bragg Grating Sensors for Assistance in Minimally Invasive Diagnostic and Surgical Procedures." Thesis, 2017. https://etd.iisc.ac.in/handle/2005/4652.

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Fiber Bragg Grating (FBG) sensors have become increasingly popular for applications in biomedical engineering. Amongst these, use of FBGs in ‘smart instruments’ for minimally invasive diagnostic and surgical procedures look promising as FBG sensors provide significant advantages compared to other sensing modalities in terms of size, electromagnetic immunity, and ability to withstand sterilization procedures. Minimally invasive procedures provide lower discomfort to the patients and faster healing time. Procedures based on use of needles as well as flexible medical instruments like endoscopes form an important part of these procedures. As a natural progression, there is a growing trend towards robotic and robot-assisted procedures. Effective sensing of interactions between the instruments and tissues and the state of the devices plays an important role in this. This thesis showcases the effectiveness of FBG sensors in the estimation of forces during device-tissue interactions and the shape of flexible devices through two applications. The first application demonstrates the feasibility of estimating needle transitions through tissues using force estimation at the needle tip. Needles with integrated fiber Bragg grating sensors have been developed for this purpose and experiments have been conducted using multi-layered Polydimethylsiloxane (PDMS) phantoms. The design has been extended to handle temperature induced effects and the experiments have also been performed using heated chicken tissue. The second application demonstrates the feasibility of estimating the shape of a flexible medical instrument like endoscope using strain information from fiber Bragg grating sensors embedded in a polymer filled tube. This overcomes some of the constraints of solutions based on sensors bonded on nitinol wires which have been used earlier. The computation of shape from strain data has been explained. Widespread use of FBG sensors in such applications is dependent not only on sensor characteristics but also on the interrogation system. Since the number of sensors per fiber and the distance between the source and the sensors are small in these applications, interrogation systems based on linear detector arrays provide a good option. However, their accuracy depends on the curve fitting method used. For this purpose, a comparison of accuracies of interrogation systems based on swept tunable laser and In GaAs linear detector arrays has been performed. The choice and effectiveness of curve fitting techniques to achieve accuracies similar to tunable laser-based systems have been investigated. The computational feasibility of the algorithm on embedded hardware has been demonstrated.
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Books on the topic "Flexible Medical Instruments"

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Great Britain: Department of Health. Decontamination of Flexible Endoscopes : Part e: Testing Methods. Stationery Office, The, 2016.

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Great Britain: Department of Health. Decontamination of Flexible Endoscopes : Part C: Operational Management. Stationery Office, The, 2016.

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Great Britain: Department of Health. Decontamination of Flexible Endoscopes : Part a: Policy and Management. Stationery Office, The, 2016.

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Great Britain: Department of Health. Decontamination of Flexible Endoscopes : Part d: Validation and Verification. Stationery Office, The, 2016.

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Great Britain: Department of Health. Decontamination of Flexible Endoscopes : Part B: Design and Installation. Stationery Office, The, 2016.

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Book chapters on the topic "Flexible Medical Instruments"

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Kukuk, Markus, and Bernhard Geiger. "A Real-Time Deformable Model for Flexible Instruments Inserted into Tubular Structures." In Medical Image Computing and Computer-Assisted Intervention — MICCAI 2002, 331–38. Berlin, Heidelberg: Springer Berlin Heidelberg, 2002. http://dx.doi.org/10.1007/3-540-45787-9_42.

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Marshall, Jane. "Alcohol-related dementia (alcohol-induced dementia; alcohol-related brain damage)." In New Oxford Textbook of Psychiatry, 399–402. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0051.

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Long-term heavy alcohol consumption causes significant brain abnormalities and impairs cognitive functioning. A number of terms have been used to describe these effects, including: ‘alcohol-related dementia’, ‘alcohol-induced dementia’, and ‘alcoholic dementia’. The more pragmatic umbrella term ‘alcohol-related brain damage’ (ARBD) is also used. The literature is beset with limitations, in particular the lack of a diagnostic gold standard, and the difficulty in making a clinical diagnosis. Many individuals labelled as having an alcohol-related dementia are, in fact, suffering from the Wernicke–Korsakoff syndrome (WKS). (This is a specific neuropathological disease caused by thiamine deficiency, which can occur secondary to alcohol misuse. It is considered in Chapter 4.1.12.) When considering the topic of ‘alcohol-related dementia’ it is probably sensible to take a broad clinically-based diagnostic view that includes both WKS and other cases of ‘dementia’ that appear to be alcohol-related. Alcohol-related dementia should be recognized as a preventable condition. However, identification is hampered by a lack of clarity in terminology, and a lack of standardized and specialized screening instruments and assessment procedures. These individuals make repeated use of Accident and Emergency Departments, general medical, and long stay wards. Early identification would reduce their need for these services. Abstinence is the key to recovery. Treatment services should be integrated and flexible.
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Garg, Rama. "Ureteric Injury in Gynecology Surgery." In Urinary Tract Infection and Nephropathy - Insights into Potential Relationship [Working Title]. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.99649.

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It is the most serious and trouble-some complication of pelvic surgery and common reason for medico-legal action by the patient. It can be unilateral or bilateral. Lowest 3 cm of ureter is usually injured. 75% of injuries result from gynecological operations - 3/4th during abdominal and 1/4th during vaginal operations. As most injuries can be diagnosed intraoperatively, systematic assessment of urinary tract integrity should be part of the surgical plan. Intraoperative cystoscopy using either flexible or rigid instruments can aid in the diagnosis or exclusion of urinary tract injury. Identification of the mechanism of injury and its location guides immediate or delayed repair. Mobilization should be sufficient to allow a tension-free closure. Tissue interposition is typically recommended. Common sites for ureteral injury are found beneath the uterine vessels near the cardinal ligament and beneath the infundibulopelvic ligament and the tunnel of Wertheim. Successful ureteral repair relies on careful mobilization, wide spatulation, use of fine absorbable suture (4-0, 5-0), and temporary stenting. Postoperative signs and symptoms of ureteral injury may include unilateral flank pain, fever, prolonged ileus, and abdominal or pelvic fluid collection (urinoma).
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Tsika, Noah. "Solemn Venues." In Traumatic Imprints, 48–81. University of California Press, 2018. http://dx.doi.org/10.1525/california/9780520297630.003.0003.

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In 1943, the army psychiatrist George S. Goldman began to develop a series of documentaries that could “contribute to mental health” by “removing some of the mystery connected with psychiatry and by properly explaining many of the misconceptions commonly connected with this specialty.” The hope was that such films would help rehabilitate affected veterans and also prevent future psychiatric casualties, and, in the process, that they would solidify the military’s reputation as a “healthful” set of institutions—or, at the very least, as institutions capable of providing effective psychiatric treatment for those in need. Because the so-called neuropsychiatric problem had become so large, threatening to “amount to the largest medical-social problem this country [had] ever faced,” documentary film was deemed necessary as a flexible instrument of education, rehabilitation, and public relations. Because the resulting films dealt with “death and the fear of death,” they were deemed widely relevant, particularly during the nuclear age. Their “focus is on the wartime patient,” noted a 1953 manual, “but the psychodynamics portrayed are generally applicable,” making these films helpful for the population at large. The postwar passage of the National Mental Health Act (1946) and the emergence of a bona fide mental health movement seemed to confirm this power, as government and civilian agencies continued to find new uses for the documentaries.
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Pazmiño, Pablo. "Foraminoplasty." In Advances in Spine Surgery [Working Title]. IntechOpen, 2023. http://dx.doi.org/10.5772/intechopen.1001457.

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The lumbar foraminoplasty is a novel surgical option for appropriately indicated patients, and high success rates have been reported in the literature. Complications and failures are often associated with patient indications or technical variables, and the goal of this chapter is to assist surgeons in understanding these factors. There are several conventional approaches to addressing foraminal stenosis, each facing specific challenges in the operative setting. Often in order to perform a sufficient foraminal decompression surgeons must balance the resection of a considerable amount of the overlying facet joints, with the need to preserve and maximize their bony architecture in order to ensure postoperative spinal stability. In fact residual foraminal stenosis has been shown to be a leading cause of failed back surgery syndrome. Moreover, there are other potential long term drawbacks with the standard decompression ranging from the development of instability, postlaminectomy syndrome, neuropathic pain, residual disc, persistent pain, and the degeneration of adjacent segments. During a standard foraminotomy instruments can only reach a specified distance within the neuroforamina, and this often leads to an incomplete decompression. In efforts to reach far lateral pathology standard instruments could potentially excise more of the facet joint than required, which could inadvertently lead to long term segmental instability. Ahuja et al have demonstrated that a resection of 30% of the facet joint led to an increase in mediolateral spinal mobility. The same study found that an excision of 45% of the facet joints resulted in an increase of segmental instability in both anteroposterior and mediolateral planes. In patients with symptomatic lumbar neuroforaminal stenosis, there has been a growing enthusiasm towards foraminoplasty with a microblade shaver. In essence the lumbar foraminoplasty is a reshaping and restructuring of the neuroforaminal arch using a flexible microblade shaver. This is performed in conjunction with neuromonitoring and fluoroscopy, which maximizes neural safety while providing live onscreen visualization as the neural arch is expanded and remodeled. Foraminoplasty with a microblade shaver provides the unique opportunity to perform a full foraminal decompression along the entire length and width of the superior articular process. Lauryssen et al compared traditional decompression techniques with the microblade shaver in order to discover any iatrogenic insults which could later lead towards the development of segmental instability. Using quantitative image CT scan analysis they determined the microblade shaver excised less laminar bone, less bone from the central canal, and less bone from the structural pars compared with traditional decompression methods. Moreover they found the foraminoplasty decompressed and reshaped the foramina in an anteroposterior plane, as opposed to the traditional medial to lateral plane, while simultaneously increasing the neuro foraminal volume. Compared to traditional instrumentation the microblade shaver was also found to have resected less facet width, facet cross sectional and facet surface area from both nondiseased and stenotic spines. This procedure has been demonstrated to be a safe and effective means of treating single or multiple level lumbar neuroforaminal stenosis by several studies as well as from the United States Food and Drug Administration.
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Conference papers on the topic "Flexible Medical Instruments"

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O’Brien, Kevin, Zachary R. Boyer, Benjamin G. Mart, Cory T. Brolliar, Thomas L. Carroll, and Loris Fichera. "Towards Flexible Steerable Instruments for Office-Based Laryngeal Surgery." In 2019 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2019. http://dx.doi.org/10.1115/dmd2019-3309.

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Office-based endoscopic procedures are becoming an increasingly attractive option for the treatment of laryngeal abnormalities, but their effectiveness is limited by the lack of articulation in currently available surgical instruments. In this paper, we propose the development of novel miniaturized steerable instruments aimed to overcome this limitation and extend a surgeon’s reach inside the larynx. To guide the designs of these new instruments, we report on a simulation study which uses image-based anatomical models to derive the kinematic requirements to operate inside the laryngeal cavity.
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Mimoun, B., A. van der Horst, R. Dekker, D. van der Voort, A. van der Horst, M. Rutten, F. van de Vosse, and R. Dekker. "Thermal flow sensors on flexible substrates for minimally invasive medical instruments." In 2012 IEEE Sensors. IEEE, 2012. http://dx.doi.org/10.1109/icsens.2012.6411429.

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Floris, Ignazio, Javier Madrigal, Salvador Sales, Pedro A. Calderón, and Jose M. Adam. "Twisting compensation of optical multicore fiber shape sensors for flexible medical instruments." In Optical Fibers and Sensors for Medical Diagnostics and Treatment Applications XX, edited by Israel Gannot. SPIE, 2020. http://dx.doi.org/10.1117/12.2543783.

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Shi, Jialei, and Helge Wurdemann. "Design and Control of a Tele-operated Soft Instrument in Minimally Invasive Surgery." In THE HAMLYN SYMPOSIUM ON MEDICAL ROBOTICS. The Hamlyn Centre, Imperial College London London, UK, 2023. http://dx.doi.org/10.31256/hsmr2023.16.

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The medical sector has emphasised increasing levels of autonomy to achieve safe and efficient robot-assisted surgeries [1]. In this case, robust and intuitive manip- ulation of medical robots is crucial, and many tele- operated surgical robots have been developed, e.g., the da Vinci robotic platform. The tele-operation can of- fer high operation precision and intuitive manipulation. In addition, soft robots have led to the development of inherently safe and flexible interventional tools for medical applications, e.g, the minimally invasive surgery (MIS). Soft instruments are particular advantageous to navigate in tortuous anatomical environments with constrained space [2]. Combining the tele-operation technology with soft robots might further result in a significant reduction in operation time and increase of surgeons’ dexterity [3]. The contribution of this work lies in the design and control of a tele-operated soft instrument for laparoscopic examination are proposed based on the miniaturised STIFF-FLOP manipulators (with a diameter of 11.5 mm) [4]. Specifically, the robot has two serially connected modules, which can seamlessly fit to commercially available 12 mm trocar ports used in MIS (see Fig. 1). The bending angle of the soft instrument can achieve 180◦ . We also preliminarily validate the feasibility of the soft instrument.
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Porto, Rafael Aleluia, Florent Nageotte, Philippe Zanne, and Michel de Mathelin. "Position control of medical cable-driven flexible instruments by combining machine learning and kinematic analysis." In 2019 International Conference on Robotics and Automation (ICRA). IEEE, 2019. http://dx.doi.org/10.1109/icra.2019.8793692.

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Katoch, Rohan, Boao Xia, Yoshinori Yamakawa, Jun Ueda, and Hiroshi Honda. "Design and Analysis of a Symmetric Articulated Single-Port Laparoscopic Surgical Device." In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3441.

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Laparoscopic surgery is a practice of minimally invasive surgery (MIS) performed in the abdominal area. Prior to surgery, instead of exposing the target region to air as in a typical conventional open surgery, “key holes” are opened for positioning ports, through which surgical tools (e.g. laparoscope, needle drivers, etc.) are inserted. MIS therefore minimizes trauma and reduces the risk of hemorrhaging and infection. MIS also generates economic benefits such as shorter hospitalization time for patients and better utilization of operating rooms and wards for hospitals. MIS procedures, however, require extra dexterity from surgeons: they must use instruments with little to none haptic feedback to remotely manipulate tissue within a limited range of motion, assisted by an indirect view from laparoscope. Such unintuitive operations not only require additional training, but also increase the risk of medical errors. Thus, the development of novel surgical devices that can provide a better operating experience will allow surgeons to deliver safer and more effective surgeries. At the advent of MIS only rigid straight laparoscopic instruments were available. Therefore, surgeons used multiple incisions to position the tools and achieve triangulation. In single port laparoscopic surgeries (SPLS), only one incision is made for positioning a port. Two rigid straight instruments inserted through one incision cannot provide sufficient triangulation for operations. Rigid bent, or articulated, instruments can achieve triangulation, but the tools must intersect at a point. The mapping to control the end-effector, therefore, must be inverted such that the right hand controls the left end-effector, and vice versa [1]. Given this inverted mapping, surgeons need to undergo extra training to intuitively control the end-effector, and greater attention is required toward operating the device, which can potentially detract from the ability of surgeons to focus on procedures. The disadvantage of an inverted mapping can be overcome by providing additional mobility with flexible tools and actuating structures [2]. For example, Transenterix has developed a flexible laparoscopic device which utilizes a cable-driven system for articulation of the end-effectors. However, using flexible elements as the driving mechanism can result in new problems such as diminished force feedback [3]. In 2015, a novel design of an articulated single port laparoscopic device was presented with 6 degrees of freedom (DOF). The system provides intuitive control, accurate force feedback, and sufficient manipulation for laparoscopic procedures. The design proposed in this paper keeps much of the functional features in the previous model, including 1:1 mapping and force feedback, while incorporating flexible hydraulic graspers. The articulated mechanism was redesigned to have a symmetrical structure, which is more intuitive to control and provides better operating angles for surgeons. Joint structures are redesigned for enhanced robustness and misalignment prevention. Kinematic analysis is presented for the proposed mechanisms, which is used to determine the manipulator workspace.
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Cheung, L. W., K. C. Lau, Flora F. Leung, Donald N. F. Ip, Henry G. H. Chow, Philip W. Y. Chiu, and Y. Yam. "Distal Joint Rotation Mechanism for Endoscopic Robot Manipulation." In The Hamlyn Symposium on Medical Robotics: "MedTech Reimagined". The Hamlyn Centre, Imperial College London London, UK, 2022. http://dx.doi.org/10.31256/hsmr2022.74.

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Robot-assisted Minimally Invasive Surgery (MIS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) are commonly adopted in Gastro-Intestinal (GI) cancer treatment with Endoscopic Submucosal Dissection (ESD). While using fully flexible cable- driven robots brings benefits to patients such as lower rate of complications and shorter healing time, the engineering challenges, for example, size and stiffness, manufacturability and sensorless environment, limit functionalities of robotic instruments and surgery performance. The rolling feature, rotation along the wrist of the instrument, is a good-to-have feature for surgical procedures with orientational and positional requirements such as tractioning and suturing with graspers. In traditional laparoscopy, rolling can be achieved by rotating the long straight rod of the instruments, which is straightforward and effective. However, this is not commonly found in cable-driven endoscopic robotic systems due to mechanical limit for linear-to-rolling motion conversion at distal-end and unmodelled friction resisting torque transmission from proximal-end. Generally, researchers have three approaches to this problem. First, rotate the endoscope or overtube and the instrument together [1] [2]. However, this is not favorable to both surgeon and patient since rotating a twisted endoscope inside a patient’s body requires a large amount of torque and rubbing would create discomfort to the patient. Second, rotate the torque coil or backbone of the instrument [3] [4]. Because friction inside the endoscope is unpredicted and rotation is coupled with roll, pitch, and yaw motion, sophisticated modeling, shape/orientation sensing feedback may be required for robotic automation. Third, develop a distal mechanism to convert cable linear motion into axial rotation [5] [6]. With this method, the coupling problem is solved and power transmission efficiency is improved but a larger and more complicated design is required, and an extra-rigid segment is usually unavoidable. The performance depends greatly on design and implementation. This paper aims to demonstrate a scalable distal joint rotation mechanism for continuum endoscopic robots that can increase instrument dexterity and manipulability to ease the work of surgeons.
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Roppenecker, Daniel B., Mattias F. Traeger, Jan D. J. Gumprecht, and Tim C. Lueth. "How to Design and Create a Cardan Shaft for a Single Port Robot by Selective Laser Sintering." In ASME 2012 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2012. http://dx.doi.org/10.1115/imece2012-87654.

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With the spread of endoscopic interventions the postoperative stress for patients has been reduced clearly. These interventions through natural orifices of the body (Natural orifice transluminal endoscopic surgery: NOTES) need miniaturized instruments with high precision, high range of motion and a high force load transmission. Our aim is to develop a mechatronic, single-port robotic system to guide and move flexible endoscopic instruments and optics inside the body. The system should be adapted to a flexible endoscope and consists of two flexible and actuated end-effectors that carry and manipulate flexible instruments. Due to the flexible end of the structure, laparoscopic single-port surgery through one incision and endoscopic surgery through a natural orifice would be possible. The concepts and prototypes were realized by selective laser sintering (SLS). One way to create flexible structures for a single use robot is to use universal joints assembled together in series. Next, selective laser sintering can now print these parts with the joints already assembled, in one part. There is no need for assembling or adhesive bonding. The final step is to replace the real joints of the cardan shafts with elastic joints. The proposed joints are made by the powder PA 2200 based on nylon. This basic powder is certificated as biocompatible according to ISO 10993-1. The challenge in this new field of printed medical robotics is to define a manufacturing process that enables you to design a part, create it by SLS and get it approved as a medical product.
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Leavitt, Alexandra, Ryan Lam, Nichols Crawford Taylor, Daniel S. Drew, and Alan Kuntz. "Toward a Millimeter-Scale Tendon-Driven Continuum Wrist with Integrated Gripper for Microsurgical Applications." In THE HAMLYN SYMPOSIUM ON MEDICAL ROBOTICS. The Hamlyn Centre, Imperial College London London, UK, 2023. http://dx.doi.org/10.31256/hsmr2023.31.

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Microsurgery, wherein surgeons operate on extremely small structures frequently visualized under a micro- scope, is a particularly impactful yet challenging form of surgery. Robot assisted microsurgery has the poten- tial to improve surgical dexterity and enable precise operation on such small scales in ways not previously possible [1], [2]. Clinical applications of microsurgery include intraocular surgery, fetal surgery, otology, laryn- geal surgery, neurosurgery, and urology. Intraocular microsurgery is a particularly challenging domain [3], [4]. Challenges arise, in part, due to the lack of dexterity that is achievable with rigid instruments inserted through the eye. The insertion point introduces a remote center of motion (RCM) constraint that pre- vents control over a tool-tip’s full pose (position and orientation) for conventional, straight instruments. Con- tinuum robots based on concentric tubes [5], magnetic actuation [6], and tendon-actuated stacked disks [7], [8] have been proposed for intraocular microsurgery in order to overcome this constraint, but are frequently limited in their local curvatures—an important consideration in constrained spaces. Inspired by these works, we present a new design for a millimeter-scale, dexterous wrist intended for micro- surgery applications. The wrist is based on recent ad- vances in tendon-driven continuum robot designs [9] and created via a state-of-the-art two-photon-polymerization (2PP) microfabrication technique. The 2PP 3D printing method enables our wrist to be constructed of flexible material, with complex internal geometries and critical features at the micron-scale (Fig. 1).
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Lam, Chun Ping, Ming Ho Ho, Shi Pan Siu, Ka Chun Lau, Yeung Yam, and Philip Wai Yan Chiu. "Implementation of a Novel Handheld Endoscopic Operation Platform (EndoGRASP)." In THE HAMLYN SYMPOSIUM ON MEDICAL ROBOTICS. The Hamlyn Centre, Imperial College London London, UK, 2023. http://dx.doi.org/10.31256/hsmr2023.20.

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Flexible endoscopes are widely used due to their effective treatment of various conditions with minimal surgery. Existing ESD platform, such as Incisionless operation platform (IOP) [1] and ANUBIScope [2], while they may offer reliable support for endoscopic bending, they lack the ability to provide precise motorized motion or may potentially restrict the maneuverability of the platform in confined endoluminal environments. Another more advanced operation platform, namely EndoMaster [3], while providing excellent visualization of the surgical area due to its compact design, which allowed for easy docking and prevented interference from the working arms, however, its complex operational requirements, where the surgeon must control the console remotely and manipulate the robotic arms using hand controls, can be time-consuming and challenging for the surgeon to master. Over-the-Scope Clip (OTSC) [4] use a device that places clips over the endoscope to hold tissue before removal, but the effectiveness of these clips in securing the tissue is sometimes inadequate, resulting in incomplete tissue acquisition and suboptimal surgical outcomes. Existing operating systems face challenges such as limited mobility, insufficient tissue collection, complex setup, and high costs. EndoGRASP, a novel handheld endoscopic platform, addresses these issues with its flexible robotic overtube and actuation unit. Optimized for efficient endoscopic submucosal dissection, it enhances patient safety and ensures precise, motorized control of the endoscope and instruments.
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