Sara Condino

How to build patient-specific synthetic abdominal anatomies. An innovative approach from physical toward hybrid surgical simulators

According to literature evidence, simulation is of the utmost importance for training and innovative surgical strategies assessment. At present commercial physical simulators are limited to single or only a few anatomical structures and these are often just standard anatomies.

Electromagnetic navigation platform for endovascular surgery: how to develop sensorized catheters and guidewires.

Endovascular procedures are nowadays limited by difficulties arising from the use of 2D images and are associated with dangerous X‐ray exposure and the injection of nephrotoxic contrast medium.

Electromagnetic navigation system for endovascular surgery

Endovascular procedures are nowadays limited by difficulties arising from the use of 2D images and are associated with dangerous X‐ray exposure and the injection of nephrotoxic contrast medium.

Simultaneous tracking of catheters and guidewires: comparison to standard fluoroscopic guidance for arterial cannulation.

OBJECTIVES The purpose of this in vitro study was to clinically assess the feasibility of a three-dimensional (3D) electromagnetic (EM) navigator, including sensorized catheters and guidewires, to determine any reduction in radiation dose and contrast medium injection. METHODS The study was performed using a navigator prototype developed at the EndoCAS center. The system includes catheters and guidewires simultaneously tracked with an EM localizer (Aurora, Northern Digital, Waterloo, Canada). Tests were performed on a commercial abdominal aortic aneurysm model. Fifteen operators were asked to cannulate renal arteries using the conventional fluoroscopic guidance and the EM navigator without fluoroscopic support. Each trial was video-recorded and analyzed for timing and success of completing the cannulation task by two blinded and independent observers. Performances were also qualitatively evaluated using the Imperial College Endovascular Cannulation Scoring Tool (IC3ST). Moreover, a questionnaire was administered to participants to evaluate the navigator potentialities. RESULTS Quantitative analysis results show no significant difference between the fluoroscopic and EM guidance regarding the total procedure time (median 2.36 minutes [interquartile range {IQR} = 1.26-4.7) vs. 2.95 min [IQR = 1.35-5.38], respectively; p = .93); number of total hits with catheter/guidewire tip to vessels wall (median 5.50 [IQR = 2.00-10.00] vs. 3.50 [IQR = 2.50-7.00], respectively; p = .65); and number of attempts at cannulation (median 4.0 [IQR = 2.00-5.00] vs. 4.0 [IQR = 2.00-5.00], respectively; p = .72]. Moreover, there was no significant difference between the IC3ST score obtained using the EM navigator and the traditional method (average 22.37 [STD = 7.95] vs. 21.58 [STD = 6.86]; p = .92). Finally, questionnaire results indicate a general agreement concerning the navigator usefulness, which clearly shows the positions of instruments inside the 3D model of the patients anatomy. Participants also agreed that the navigator can reduce the amount of contrast media delivered to the patient, as well as fluoroscopy time. CONCLUSIONS This work provides proof of concept that simultaneous EM navigation of guidewires and catheters is feasible without the use of live fluoroscopic images.

An optimal design for patient‐specific templates for pedicle spine screws placement

Currently, pedicle screws are positioned using a free‐hand technique or under fluoroscopic guidance, with error in the range 10–40%, depending on the skill of the surgeon.

A pilot study on a new anchoring mechanism for surgical applications based on mucoadhesives

Abstract In order to minimize the invasiveness of laparoscopic surgery, different techniques are emerging from research to clinical practice. Whether the incision is performed on the outside – as in Single Port Laparoscopy (SPL) – or on the inside – as in Natural Orifice Transluminal Endoscopic Surgery (NOTES) – of the patients body, inserting and operating all the instruments from a single access site seems to be the next challenge in surgery. Magnetic guidance has been recently proposed for controlling surgical tools deployed from a single access. However, the exponential drop of magnetic field with distance makes this solution suitable only for the upper side of the abdominal cavity in nonobese patients. In the present paper we introduce a polymeric anchoring mechanism to lock surgical assistive tools inside the gastric cavity, based on the use of mucoadhesive films. Mucoadhesive properties of four formulations, with different chemical components and concentration, are evaluated by using both in vitro and ex vivo test benches on porcine stomach samples. Hydration of mucoadhesive films by contact with the aqueous mucous layer is analyzed by means of in vitro swelling tests, whereas optimal preloading conditions and adhesion performances, in terms of detachment force, supported weight and size are investigated ex vivo. Mucoadhesion is observed with all the four formulations. For a contact area of 113 mm2, the maximum normal and shear detachment forces withstood by the adhesive film are 2,6 N and 1 N respectively. These values grow up to 12,14 N and 4,5 N when the contact area increases to 706 mm2. Lifetime of the bonding on the inner side of the stomach wall was around two hours. Mucoadhesive anchoring represents a fully biocompatible and safe approach to deploy multiple assistive surgical tools on mucosal tissues by minimizing the number of access ports. This technique has been quantitatively assessed ex vivo for anchoring on the inner wall of the gastric cavity or in gastroscopic surgery. By properly varying the chemical formulation, this approach can be extended to other cavities of the human body.

Augmented reality visualization of deformable tubular structures for surgical simulation

Surgical simulation based on augmented reality (AR), mixing the benefits of physical and virtual simulation, represents a step forward in surgical training. However, available systems are unable to update the virtual anatomy following deformations impressed on actual anatomy.

Natale et. al.'s response to Stecco's fascial nomenclature editorial

Despite their importance in anatomy, physiology, pathology and surgery, the fasciae and the fascial spaces have been poorly described in classic textbooks. This little attention depends on the fact that these fasciae vary in thickness and composition, especially at the cervical level. Indeed, in the main literature they have been described in different forms. Furthermore, the definition itself of the fascia is not consistent in a variety of authors. As a consequence, different criteria have been used to define and classify the fascial systems. In this paper, a brief terminological history and the most common nomenclatures and classifications of the fascia have been summarized.

Tactile Augmented Reality for Arteries Palpation in Open Surgery Training

Palpation is an essential step of several open surgical procedures for locating arteries by arterial pulse detection. In this context, surgical simulation would ideally provide realistic haptic sensations to the operator. This paper presents a proof of concept implementation of tactile augmented reality for open-surgery training. The system is based on the integration of a wearable tactile device into an augmented physical simulator which allows the real time tracking of artery reproductions and the user finger and provides pulse feedback during palpation. Preliminary qualitative test showed a general consensus among surgeons regarding the realism of the arterial pulse feedback and the usefulness of tactile augmented reality in open-surgery simulators.

Is the cervical fascia an anatomical proteus

The cervical fasciae have always represented a matter of debate. Indeed, in the literature, it is quite impossible to find two authors reporting the same description of the neck fascia. In the present review, a historical background was outlined, confirming that the Malgaigne’s definition of the cervical fascia as an anatomical Proteus is widely justified. In an attempt to provide an essential and a more comprehensive classification, a fixed pattern of description of cervical fasciae is proposed. Based on the morphogenetic criteria, two fascial groups have been recognized: (1) fasciae which derive from primitive fibro-muscular laminae (muscular fasciae or myofasciae); (2) fasciae which derive from connective thickening (visceral fasciae). Topographic and comparative approaches allowed to distinguish three different types of fasciae in the neck: the superficial, the deep and the visceral fasciae. The first is most connected to the skin, the second to the muscles and the third to the viscera. The muscular fascia could be further divided into three layers according to the relationship with the different muscles.