Дисертації з теми "Robot for Endoscopic Dissection"

Thesis (Ph.D.)--University of Cincinnati, 2008.
Advisor: Joel Warm. Title from electronic thesis title page (viewed Sep.9, 2008). Keywords: endoscopy; laparoscopy;robotic surgery, stress; workload; coping; DSSQ; MRQ; CITS. Includes abstract. Includes bibliographical references.

Dans cette thèse, nous avons travaillé sur les différents versants de la technique de dissection sous-muqueuse et les problèmes que pose ce geste quasi chirurgical dans des unités d'endoscopie initialement médicales. Tout d'abord, nous avons travaillé sur la formation à la technique en développant un modèle d'apprentissage sur colon de bovin plus adapté à la situation européenne où les lésions colo-rectales sont les plus fréquentes. Ce modèle de rectum de bovin, simple à trouver et à préparer permet une formation dans des conditions plus proches de la paroi colique humaine que celles offertes par l'estomac de cochon. Un travail à plus grande échelle évaluant les bénéfices d'une aide à l'apprentissage par un logiciel interactif dédié mené sur ce modèle avec 37 étudiants français et japonais est en cours d'analyse et sera publié prochainement. Ensuite, nous avons réfléchi à la stratégie de la procédure pour la rendre plus simple en évaluant précocement la technique du tunnel pour la dissection des lésions œsophagiennes. Cette stratégie permet de maintenir une traction sur les bords lésionnels et nous offrent une sorte de triangulation en élargissant physiquement la zone de travail. Cette stratégie est devenue un standard pour les résections œsophagiennes dans de nombreuses équipes. Enfin, nous avons travaillé conjointement avec la société Nestis® au développement d'un outil permettant d'optimiser la procédure de dissection sous-muqueuse en associant les bénéfices des bistouris bi fonction (injectant et coupant avec le même outil}, de la haute pression pulsée et des solutions macromoléculaires visqueuses. Le système Nestis® permet pour la première fois cette association et a démontré son intérêt en termes de sécurité et de performance par rapport à la méthode classique utilisant l'aiguille et un bistouri électrique conventionnel. Avec cet outil bi fonction, il n'est plus nécessaire de changer d'instrument puisque toutes les étapes de la procédure sont désormais réalisées avec un seul et même outil. D'autres projets sont déjà prévus avec ce matériel pour étudier ses bénéfices et sa sécurité en dissection colique humaine qui est réputée comme la plus difficile compte tenu de la finesse de la paroi. Enfin, ce matériel offre la possibilité d'injecter sous pression des principes actifs qui pourrait dans le futur permettre de prévenir la survenue de sténoses œsophagiennes ou diriger la cicatrisation. Nous avons ainsi travailler avec la pharmacie de l'hôpital Edouard Herriot pour stabiliser la solution macromoléculaires de mélange de glycérol pour permettre son utilisation en pratique quotidienne
First of all, we worked on the training for unexperienced operators by developing a bovine colon model more adapted to the European situation where colo-rectal lesions are the most common. This model of rectum from bovine, easy to find and to prepare allows training in conditions most close to the human colonic wall than those offered by the pig stomach. Furthermore, such models allows to teach the initial skills but avoiding the risk of adverse events for the first procedures in humans. A future work evaluating the benefits of a learning support by a dedicated interactive software on this model with 37 french and Japanese students is now being analyzed and will be reported soon. Then we thought about the strategy of the procedure in order to make it more simple using the tunnel technique to perform ESD for the esophageal lesions. This strategy helps to maintain traction on the edges and offers a sort of triangulation physically expanding the working space. This strategy has become a standard for esophageal resections in many teams and we still work to improve its efficacy. Finally, we worked jointly with Nestis® Company to develop a tool to optimize the submucosal dissection procedure by combining the benefits of the catheters bi function (injecting and cutting with the same tool), but adding high pulsed pressure and capability to inject viscous macromolecular solutions. The Nestis® system allows for the first time this association and demonstrated his interest in terms of security and performance compared with the conventional method using the needle and a conventional electrocautery device. With this bi function tool, it is not necessary to change instrument frequently since all stages of the procedure are now done with a single device. Other projects are already included with this material to explore its benefits and its safety in human colonic dissection that is deemed as the most difficult due to the thinner wall. Finally, this material offers the possibility to inject pressurized active drugs which could be used in the future to prevent the occurrence of esophageal strictures or to direct healing. We also worked with the hospital Edouard Herriot pharmacy to stabilize the solution glycerol mix to allow its use in daily practice in our unit

Il manque actuellement aux médecins une nouvelle méthode qui rationalise le traitement peu invasif pour en faire des procédures à opérateur unique, assistées par une caractérisation précise des tissus in situ et en temps réel, en situation de prise de décisions dans la gestion du cancer colorectal. Une solution prometteuse à ce problème a été développée par l'équipe AVR (Automatique, Vision et Robotique) du laboratoire ICube, au sein de laquelle l'endoscope interventionnel flexible (fabriqué par Karl Storz) a été entièrement robotisé, permettant ainsi à un seul opérateur de télémanipuler indépendamment l'endoscope et deux instruments thérapeutiques insérables, grâce à unité de contrôle commune. Cependant, l'endoscope flexible assisté par robot est soumis aux mêmes limites de précision diagnostique que les systèmes d'endoscopie standards. Il a été démontré que l'OCT endoscopique présente un potentiel pour l'imagerie des troubles de la voie gastro-intestinale et pour la différenciation de tissus sains des tissus malades. Actuellement, l'OCT se limite à l'imagerie de l'œsophage humain, qui présente une géométrie simple et un accès facile. Ni l'OCT, ni l'endoscope robotisé ne peuvent résoudre à eux seuls les limites de la norme actuelle de soins pour la prise en charge d’un cancer du côlon. La combinaison de ces deux technologies et le développement d'une nouvelle plate-forme pour la détection et le traitement précoce du cancer constituent l'objet principal de cette thèse, avec la vision de développer une console d'imagerie OCT et une sonde de haute technologie intégrée à l'endoscope robotisé. Ce système permet d'obtenir des images de l'intérieur du gros intestin pour la caractérisation des tissus et l'assistance au traitement, permettant ainsi à un seul opérateur d'effectuer une intervention peu invasive en mode télémanipulation
There exists an unmet clinical need to provide doctors with a new method that streamlines minimally invasive endoscopic treatment of colorectal cancer to single operator procedures assisted by in-situ and real-time accurate tissue characterization for informed treatment decisions. A promising solution to this problem has been developed at the ICube laboratory, in which the flexible interventional endoscope (Karl Storz) was completely robotized, so allowing a single operator to independently telemanipulate the endoscope and two insertable therapeutic instruments with a joint control unit. However, the robot-assisted flexible endoscope is subject to the same diagnostic accuracy limitations as standard endoscopy systems. It has been demonstrated that endoscopic optical coherence tomography (OCT) has a good potential for imaging disorders in the gastrointestinal tract and differentiating healthy tissue from diseased. Neither OCT, nor the robotized endoscope can solve the limitations of current standard of care for colon cancer management alone. Combining these two technologies and developing a new platform for early detection and treatment of cancer is the main interest of this work, with the aim of developing a state-of-the-art OCT imaging console and probe integrated with the robotized endoscope. The capabilities of this new technology for imaging of the interior of the large intestine were tested in pre-clinical experiments showing potential for improvement in margin verification during minimally invasive endoscopic treatment in the telemanipulation mode

Xu, Wenjun.
Thesis M.Phil. Chinese University of Hong Kong 2014.
Includes bibliographical references (leaves 94-103).
Abstracts also in Chinese.
Title from PDF title page (viewed on 27, October, 2016).

Introdução e objetivos: As lesões superficiais gastrointestinais podem ser tratadas por musectomia (EMR) e/ou disseção endoscópica da submucosa (ESD). Estas técnicas são usadas frequentemente nos países asiáticos, mas a experiência é mais limitada nos países ocidentais. O objetivo deste estudo foi avaliar a implementação atual da ESD nos países ocidentais. Métodos: Gastroenterologistas ocidentais (n = 279) com artigos publicados entre 2005 e 2017 relacionados com EMR/ESD foram solicitados a preencher um questionário online, no período de Dezembro 2017 até Fevereiro 2018. Resultados: Um total de 58 gastroenterologistas (21%) completou o inquérito. Trinta realizaram ESD esofágica (52%); 45 gástrica (78%); 36 co- loretal (62%); e 6 duodenal (10%). A mediana do número total de lesões ressecadas por endoscopista foi 190, sendo que, em 2016, a mediana de lesões tratadas por cada gastroenterologista foi 41 (7 [IQR 1-21] no esófago, 6 [IQR 4-16] no estômago e 28 [5-63] no cólon e reto). A taxa de ressecção em bloco foi de 97% nas lesões esofágicas; 95% nas lesões gástricas e 84% nas lesões coloretais, com uma proporção de casos R0 de 88, 91 e 81%, respetivamente. A taxa de casos curados foi de 69, 70 e 67%, respetivamente. A taxa de complicações graves (perfuração e he- morragia tardia) foi maior na ESD coloretal (12% dos casos vs. 6% no esófago e 7% no estômago). A maioria das lesões esofagogástricas eram adenocarcinomas intramucosos (59% no esófago; 47% no estômago), enquanto as lesões coloretais eram maioritariamente adenomas (59%). Conclusões: Este estudo mostra uma disseminação da ESD na europa por um maior número de centros e gastrenterologistas. Os nossos resultados sugerem uma utilização e eficácia global de acordo com as recomendações europeias.
Background and Study Aim: Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; however, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries. Methods: Western endoscopists (n = 279) who published papers related to EMR/ESD between 2005 and 2017 were asked to complete an online survey from December 2017 to February 2018. Results: A total of 58 endoscopists (21%) completed the survey. Thirty performed ESD in the esophagus (52%), 45 in the stomach (78%), 36 in the colorectum (62%), and 6 in the duodenum (10%). The median total number of lesions ever treated per endoscopist was 190, with a median number per endoscopist in 2016 of 41 (7 [IQR 1-21], 6 [IQR 4-16], and 28 [5-63] in the esophagus, in the stomach, and in the colon and rectum, respectively). En bloc resection rates were 97% in the esophagus, 95% in the stomach, and 84% in the colorectum. Complete resection (R0) was achieved in 88, 91, and 81%, respectively. Curative rates were 69, 70, and 67%, respectively. Major complications (perforation or delayed bleeding) occurred more often in colorectal ESD (12 vs. 6% in the esophagus and 7% in the stomach). In the upper GI tract, the majority of resected lesions were intramucosal adenocarcinoma (59% in the esophagus; 47% in the stomach), while in the colorectum the majority were adenomas (59%). Conclusion: ESD seems to be performed by a large number of centers and endoscopists. Our results suggest that ESD is being successfully implemented in Western countries, achieving a good rate of efficacy and safety according to European guidelines.

Introdução e objetivos: As lesões superficiais gastrointestinais podem ser tratadas por musectomia (EMR) e/ou disseção endoscópica da submucosa (ESD). Estas técnicas são usadas frequentemente nos países asiáticos, mas a experiência é mais limitada nos países ocidentais. O objetivo deste estudo foi avaliar a implementação atual da ESD nos países ocidentais. Métodos: Gastroenterologistas ocidentais (n = 279) com artigos publicados entre 2005 e 2017 relacionados com EMR/ESD foram solicitados a preencher um questionário online, no período de Dezembro 2017 até Fevereiro 2018. Resultados: Um total de 58 gastroenterologistas (21%) completou o inquérito. Trinta realizaram ESD esofágica (52%); 45 gástrica (78%); 36 co- loretal (62%); e 6 duodenal (10%). A mediana do número total de lesões ressecadas por endoscopista foi 190, sendo que, em 2016, a mediana de lesões tratadas por cada gastroenterologista foi 41 (7 [IQR 1-21] no esófago, 6 [IQR 4-16] no estômago e 28 [5-63] no cólon e reto). A taxa de ressecção em bloco foi de 97% nas lesões esofágicas; 95% nas lesões gástricas e 84% nas lesões coloretais, com uma proporção de casos R0 de 88, 91 e 81%, respetivamente. A taxa de casos curados foi de 69, 70 e 67%, respetivamente. A taxa de complicações graves (perfuração e he- morragia tardia) foi maior na ESD coloretal (12% dos casos vs. 6% no esófago e 7% no estômago). A maioria das lesões esofagogástricas eram adenocarcinomas intramucosos (59% no esófago; 47% no estômago), enquanto as lesões coloretais eram maioritariamente adenomas (59%). Conclusões: Este estudo mostra uma disseminação da ESD na europa por um maior número de centros e gastrenterologistas. Os nossos resultados sugerem uma utilização e eficácia global de acordo com as recomendações europeias.
Background and Study Aim: Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; however, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries. Methods: Western endoscopists (n = 279) who published papers related to EMR/ESD between 2005 and 2017 were asked to complete an online survey from December 2017 to February 2018. Results: A total of 58 endoscopists (21%) completed the survey. Thirty performed ESD in the esophagus (52%), 45 in the stomach (78%), 36 in the colorectum (62%), and 6 in the duodenum (10%). The median total number of lesions ever treated per endoscopist was 190, with a median number per endoscopist in 2016 of 41 (7 [IQR 1-21], 6 [IQR 4-16], and 28 [5-63] in the esophagus, in the stomach, and in the colon and rectum, respectively). En bloc resection rates were 97% in the esophagus, 95% in the stomach, and 84% in the colorectum. Complete resection (R0) was achieved in 88, 91, and 81%, respectively. Curative rates were 69, 70, and 67%, respectively. Major complications (perforation or delayed bleeding) occurred more often in colorectal ESD (12 vs. 6% in the esophagus and 7% in the stomach). In the upper GI tract, the majority of resected lesions were intramucosal adenocarcinoma (59% in the esophagus; 47% in the stomach), while in the colorectum the majority were adenomas (59%). Conclusion: ESD seems to be performed by a large number of centers and endoscopists. Our results suggest that ESD is being successfully implemented in Western countries, achieving a good rate of efficacy and safety according to European guidelines.

"A thesis submitted to the University of Adelaide and Nagoya University in fulfilment of the requirements for the joint degree of Doctor of Philosophy"
Colorectal cancer (CRC) is among the commonest and deadliest types of cancer. It is the second highest in economic burden among all cancers and the thirteenth of all diseases in Australia. In Japan, it has been gaining importance and in 2018 CRC was identified as second in incidence among all cancers for both women and men, and the leading cause of death amongst all cancers in women and the third leading cause of death in men. Research that can improve the prevention and treatment of this cancer is of the utmost importance. In primary prevention, I studied the factors that contribute to the development of colorectal lesions (e.g. colorectal adenomas and sessile serrated adenomas/polyps). This was a prospective study carried out at the Lyell McEwin Hospital (South Australia) examining whether and by how much factors such as alcohol consumption and smoking are associated with colorectal lesions. A cohort of 291 procedures and 260 patients was recruited. In this cohort, we found that different factors are associated with different histologic subtypes of lesions. Furthermore, in terms of primary prevention of CRC, I sought to discover how to optimally conduct colonoscopy (e.g. in the morning or afternoon). This, added to research on the simplification of methods for assessing quality measures (e.g. adenoma detection rate – ADR – through adenoma detection quotient - ADQ), was aimed at optimising CRC screening programs. In the retrospective cohort of 2,657 procedures performed at the Lyell McEwin Hospital (South Australia), morning endoscopy lists were associated with better detection and ADQ was a reliable predictor of ADR. With respect to secondary prevention, I undertook several studies. The main aim of these studies was to assess advanced endoscopic imaging (e.g. narrow band imaging - NBI) nationally and internationally, comparing different endoscopic classification methods for colorectal lesions to evaluate how well each performed. Two of our studies showed that the modified Sano's (MS) classification was the most accurate tool for predicting the histology of colorectal lesions during colonoscopy. The first of these two studies involved a single centre randomised trial on 348 patients comparing the MS with the NBI international colorectal endoscopic (NICE) classification, but did not include the differentiation of sessile serrated adenomas/polyps (SSA/Ps) in the comparison. The second, a prospective study between Australia (exploratory phase with 483 colorectal lesions included) and Japan (validation phase with 30 colorectal lesions evaluated by four endoscopists), involved the comparison of the MS, NICE and Japan NBI expert team (JNET) classifications. The last two classifications were combined with the workgroup serrated polyps and polyposis (WASP) add-on to allow the comparison including SSA/Ps' differentiation. The results from both studies were then used as a template for the development of a computer-aided diagnosis (CAD) system that could enable expert-level accuracy for any endoscopist. A CAD system was created, learning from 1,235 colorectal images, and tested with data from two different centres (Australia and Japan) and imaging technologies (i.e. NBI and blue laser imaging - BLI), showing results comparable to expert endoscopists. The mean AUC from the exploratory phase reached 94.3% (internal NBI dataset) while the mean AUCs for the validation phase scored 84.5% with the external NBI dataset and 90.3% with the external BLI dataset. In addition to imaging, two other studies also focused on secondary prevention by specifically looking at (i) the different microbiota profile of early and invasive CRCs; and (ii) the learning curve of colorectal endoscopic submucosal dissection (ESD). The former study, conducted at Nagoya University (Aichi prefecture) was based on DNA extraction of colonic mucosa brush and faecal samples from 25 patients and found to be statistically different relative to the abundance of several bacteria related with each type; this included the Fusobacterium nucleatum (a known bacterium species related to invasive CRC) as well as nine other genera of bacteria. The latter study evaluated how the learning curve of the complex ESD procedure progressed in an expert Japanese endoscopy centre. This retrospective study comprised a large colorectal ESD database of 590 procedures (514 patients) performed by 26 endoscopists at Nagoya University Hospital (Aichi prefecture). Although the speed of dissection continuously improved throughout the years, ESD could be performed safely by non-experts. Lastly, considering tertiary prevention, I evaluated the necessity of routine biopsies for the follow up of previous endoscopic resection of colorectal lesions, and proposed an innovative classification which provides a highly sensitive diagnosis of recurrence on a scar. This classification was conceived and prospectively explored at the Lyell McEwin Hospital (South Australia) with 100 scars (82 patients) and validated in five other countries in addition to Australia (i.e. Malaysia, Brazil, Japan, Singapore and United States of America) by 49 endoscopists where it achieved similar results. The evidence produced during the research for this thesis has the potential to immediately influence not only research but also clinical practice related to primary, secondary and tertiary prevention of CRC. I strongly believe that this influence will contribute to improved clinical outcomes related to this burdensome disease
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2020

Ο στόχος αυτής της εργασίας είναι να αποκτήσουμε μία βασική γνώση όλων των διαφορετικών σχεδιαστικών παραμέτρων που πρέπει να εξεταστούν για να είναι εφικτή η κατασκευή και ο έλεγχος ενός πολυαρθρωτού εργαλείου. Επιπλέον, όλες οι αναλυτικές μέθοδοι ελέγχου που βασίζονται στις ιδιαιτερότητες των SMA παρουσιάζονται λεπτομερώς, ώστε να παραχθεί μία ικανοποιητική λύση βασιζόμενη στις μεταβολές κατάστασης των κραμάτων και του συγκεκριμένου βραχίονα. Με άλλα λόγια, μία πλήρης γνώση του πώς σχεδιάζουμε, κατασκευάζουμε, προσομοιώνουμε, ελέγχουμε και απεικονίζουμε ένα λειτουργικό μικροσκοπικό πολυαρθρωτό βραχίονα, με τένοντες βασισμένους σε SMA για ελάχιστα επεμβατική χειρουργική είναι ο στόχος της παρούσας εργασίας.
The purpose of this work is to acquire a fundamental knowledge of all the different design parameters, which must be evaluated in order to be able to fabricate and control a multi-DOF manipulator. Moreover, all the analytical control techniques based on the particularities of the shape memory alloys will be shown in details, in order to provide an efficient solution based on the variations of the alloys and the specific manipulator. In other words, the knowhow of building, evaluating, controlling and displaying a functional tiny multi- DOF SMA-based manipulator for minimally invasive surgery is the purpose of this work.