Rise of the Medical Machines

machine-surgery

source: this website

Pier Cristoforo Giulianotti (University of Illinois – Department of Surgery) cannot foresee a time when robots replace surgeons, but he has no doubts over the importance of robotics: robot surgery is the future of medicine.

After some historical hints, a brief presentation of “five of the coolest robots in medicine” is proposed: Da Vinci System, Cyberknife, Neuroarm, Rp-Vita and Paro.

Click on the image on the right, here, to be redirected to the official webpage and read the whole story ūüôā

                                              Perspective of a patient

…is there a future… for human doctors? maybe in science fiction…

just wipe that Cataract out of your eye

macchina fotoWe live in the Instagram era, when even a simple cup of coffee suddenly becomes one of the most artistic things to be photographed. After sharing your shot with all your friends on the web (so that you’ll have shown that you DO have a social life, yop!), you put back your Reflex (the best camera ever for shooting cups of coffee, we all know that) and notice that its lens is a bit misted up. Inside. So you’ll never be able to get rid of it and all your shots will look blurry. You’ll be able to post only photos of blurry coffee served in blurry cups on blurry tables. You’ll be a blurry person, forever.

Now, transpose this “blurriness” to one of your eyes. Imagine you have one eye which “works” perfectly, like HD vision, and the other one with some misted up lens inside, so that everything you see looks blurry. This is clearly a much worse problem than not being able to shoot cool photos. This problem is called Cataract and nowadays is¬†the most common cause of vision loss in people aged over 40.

human eyeHuman eye is composed of different layers. Without giving too many details, a very important component of the eye is a transparent tissue known as crystalline lens. This lens is able to change its thickness so that the eye is able to focus on objects at various distances. The changes of thickness are controlled by a suspensory ligament, called Zonule of Zinn, that connects the crystalline to the ciliary body of the eye. Their combined movements are really important for correctly focusing light onto the back of the eye (the retina) so that images appear clear and without distortion.

The crystalline lens is¬†made mainly of water and proteins and it is¬†nourished by the aqueous fluid that is present between the cornea and the crystalline lens.¬†Metabolic changes of the crystalline lens fibers over time lead to the development of¬†opacifications, mainly due to the proteins that clump together. As a consequence, the lens gets “clouded” and this clouding is actually known as Cataract. This process normally worsens the way light enters the eye and, as a result, our sight is blurry.

Cataract vs Normal

Nowadays, modern cataract surgery is one of the safest and most effective surgical procedures.¬†Over 90% of operations are successful in restoring useful vision, with a low complication rate. The operation itself is typically performed¬†using only local anesthesia and in one-day hospitals.¬†Very often, the postoperative recovery is really quick and¬†can greatly reduce the patient’s dependence on¬†eye glasses.

cataract surgeryThe most common surgical procedure for removing cataract is the so called phacoemulsification.

By using a microscope, the surgeon focuses on the lateral side of the eye and makes a small incision on the cornea.

Then, a tiny ultrasound probe is inserted into the eye in order to break the lens. The high vibration frequency (40 kHz) of the probe tip causes the emulsification of the lens material, which gets broken in very small fragments.

By accessing the eye always through the same incision, the crystalline pieces are removed through an aspiration probe.

Next, the same tool is employed again, this time to insert an artificial intraocular lens that actually replaces the crystalline. The artificial lens is usually made of plastic, silicone or acrylic compounds and is supposed to remain in place for the rest of the patient’s life. No stitch is generally necessary, just¬†a protective shield is usually placed over the eye to keep it safe in the early recovery stages.

Recently, lasers have been approved for use in cataract surgery: they improve the accuracy of the surgery, since they reduce the need for surgical blades and other hand-held tools. Moreover, they result to be more efficient than ultrasonic probes for crystalline fragmentation. Laser-assisted cataract surgery is fairly new and significantly increases cataract surgery cost. However, medical consultation is always the best way to evaluate all the possible surgical risks.

sources: one, two and three

Mallet Finger: don’t try this at home

There are a few everyday life experiences that everybody is destined to go through every now and then. Like correctly plugging a USB device only at the third attempt (despite there are only two possibilities), or directly setting the alarm clock half an hour earlier because we know we’re used to putting it off at least four times, or having Mallet Finger.

Mallet Finger is probably one of the most painful and annoying injuries of all time. Technically, it¬†is an injury of the¬†extensor digitorum tendon of the fingers¬†at the¬†distal interphalangeal joint¬†(DIP). In more simple terms, it is the typical injury that occurs when we play basketball and the ball suddenly hits our extended finger. Besides the immediate sensation of pain, within a few minutes our finger will start swelling and we won’t be able to¬†straighten it for a while. We then leave the court with an awesome facial expression (it really hurts, you all know…), but do we know what happened inside our finger?

mallet finger The distal interphalangeal joint (DIP) hinge jointof the hand is nothing more than a hinge joint between the two last phalanges of the finger. This kind of joint only admits one degree of freedom, which is the rotation about the joint axis. As a result, our phalanges are allowed to make flexion and extension movements. Thus, the DIP is the last joint of the finger. A sudden high force acting at the tip of the finger (the ball we were trying to catch) strongly solicits the thin DIP extensor tendon. In case of rupture, or tearing, of this tendon from the bone, the finger usually gets painful, swollen, and bruised. Occasionally, blood can collect beneath the nail. In the worst case, the force of the blow may even pull away a piece of bone along with the tendon. mallet finger bruised The loss of extensor tendon continuity might lead to severe consequences and must be carefully treated. In a first moment, ice should be immediately applied and the hand should be elevated above the level of the heart. Medical attention should be sought within a week after injury. Most mallet finger injuries can be treated without surgery. fingertip splintsNormally, X-rays are necessary in order to look for potential bone fractures or joint misalignment. The presence of blood beneath the nail and nail detachment may be a sign of nail bed laceration or open (compound) fracture. A splint can be applied to hold the fingertip straight (in extension) until it heals (8 weeks full-time, 3-4 further weeks less frequently). With this treatment plan, the finger usually regains an acceptable function and appearance. Despite that, it is not guaranteed that the patient will be able to regain full fingertip extension.

If nonsurgical treatment fails, after mallet finger surgeryconsultation with an orthopaedic surgeon the patient may consider to resort to surgical repair. In case of very severe deformity or inability to properly use the injured finger, surgery is done to repair the fracture using pins, pins and wire, or even small screws. Surgical treatment of the damaged tendon can include tightening the stretched tendon tissue, using tendon grafts, or even fusing the joint straight.

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sources: mainly this website and this website, and then Google Images

the Patella: some hints

The patella (also known as knee cap) is a thick, circular-triangular bone which articulates with the femur and covers and protects the anterior articular surface of the knee joint.

It is the largest sesamoid bone in the human body. In the adult the articular surface is about 12 cm2 and covered by cartilage, which can reach a maximal thickness of 6 mm in the centre at about 30 years of age.

The patella is attached to the Quadriceps tendon (of the quadriceps femoris muscle), which contracts to extend/straighten the knee. The vastus lateralis and vastus medialis are attached to lateral and medial borders of patella respectively. The vastus intermedialis muscle, not showed in this picture, is attached to the base of patella.

The patella is stabilized by the insertion of vastus medialis and the prominence of the anterior femoral condyles, which prevent lateral dislocation during flexion. The retinacular fibres of the patella also stabilize it during exercise.

The primary functional role of the patella is knee extension. The patella increases the leverage that the Quadriceps tendon can exert on the femur by increasing the angle at which it acts.

Patellar problems are among the most common causes of knee pain. This disease may be associated with other symptoms, such as instability or giveaway, dislocation, catching, grinding (crepitation), and/or swelling. These symptoms may present spontaneously or following injury (such as subluxations, blows to the front of the knee etc.). In general terms, patellar problems can be organized as:

  1. Pain alone – “patellofemoral syndrome”,
  2. Pain from malalignment – tilt and/or displacement,
  3. Instability – subluxation and dislocation,
  4. “Wear and tear” – arthritis,
  5. Other problems – synovial plica, tendonitis, bursitis, Osgood Schlatter’s disease, etc.

Surgery is rarely necessary, and must be carefully considered. For example, for the “pain alone” case, surgery is rarely indicated since it may even make pain worse. In these terms, surgery is best used as a last resort, after all other techniques fail (normally: conservative care trials).

Arthroscopy is the very best way to evaluate the patella and surrounding portions of the knee joint. Surgery will vary depending upon the type of patellar problem.  Of course it has risks, such as infection, stiffness, continued instability, weakness, pain, blood clots, fracture, impaired bone healing, etc. Recovery ranges from 6 weeks to 6 months, or even longer, depending upon the type of surgery, healing rates and limitations, and patient rehabilitation and efforts.

sources: two websites, this one and this one

what’s LaTIM ?

The Laboratory of Medical Information Processing (LaTIM – INSERM UMR 1101) is a research team made up of the University Hospital of Brest, the Faculty of Medicine and Telecom Bretagne (graduate engineering school). It carries out many projects in three main research areas:

  1. Computer-Assisted Orthopaedic Surgery (IPAL research team);
  2. Quantitative Multimodal Imaging for Diagnosis and Therapy (Quantitative Multi-modality Imaging Team);
  3. Multimedia Medical Information Indexing, Tracking and Integrity (IT2IM Team).

These three themes are integrated within a methodological approach of the diagnostic and therapeutic imaging based on information and knowledge. For my PhD project I am member of the IPAL Team, carrying out my research in the field of Computer-Assisted Orthopaedic Surgery (CAOS).

A day at the hospital

Last week I was invited to attend in a knee surgery at the Hospital Cavale Blanche, in Brest. For my PhD project, the research work that I am currently carrying on is actually closer to the mechanical side of Robotics (microactuators, tiny mechanical structures, wireless energy transfer techniques ‚Ķ). Although, since one of my supervisors is an orthopedic surgeon, I was invited to participate to TKA surgery. Basically, this meant two things: I had to put on specific sterilized clothes and, once in the operating room, I was allowed to watch and put questions ūüôā

When I got here I was told that, for PhD students in the field of Robotic Surgery, half a day at the hospital was more useful, in terms of acquirable knowledge, than a month of theoretical study. Actually, one of the aspects I mostly appreciated was the ‚Äúpedagogical approach‚ÄĚ of the surgeon towards the observers. We were two, a sweet girl who’s completing her studies in Pharmacology and me. And the surgeon kept explaining each single step, motivating each procedure and answering all our questions. The confidence he showed while (literally) manipulating the patient’s knee and conducting the operation in front of younger and less experienced surgeons was simply amazing.

Before the surgery, the patient can decide to undergo either general or local anesthesia. Let’s say that the noises and, especially, the smells produced by hammers and saws are not the best way to stimulate one’s appetite ūüėČ But one thing is sure: after living the atmosphere of such a delicate surgical operation, and understanding that one can really trust expert surgeons, personally I wouldn’t be so worried/scared to undergo TKA as I was before ūüôā

A bleeding and breathing Simulation Mannequin for Surgical Interventions

On the official website of CAE Healthcare an amazing new generation simulation mannequin, iStan, is described as follows:

CAE Healthcare’s new wireless and tetherless simulator represents the first real breakthrough in healthcare mannequin technology in the last 30 years. iStan looks, feels and acts so real your students won’t even know it’s a mannequin. iStan’s array of advanced features and breakthrough technology will take your simulation training to a new and exciting level of realism.

ImageWhat are we talking about? iStan is an extremely realistic patient simulator, completely wireless (operated by a rechargeable battery) and able to reproduce an impressive range of articulated movements and reactions to the surgical acts that are simulated on (and inside) its body. It can sweat, bleed, breathe and even cry in a perfectly life-like way. Its spine, neck, arms and hips are programmed to mimic “the anatomical workings of the human body to a level of realism not possible with other simulators“.

Blood losses, arterial pressure measurements, Imageheart attacks, anethesia effects, pupillary contraction and dilation. But also bone fractures, damages to vital organs and even a pregnancy. They all can be reproduced with incredible accuracy by iStan, which is currently used by future surgeons as a practise tool.

The price of a single mannequin is about 65 k‚ā¨. Everybody is sure it worths investing in this product, presented as the most powerful and most advanced patient simulator in the world.