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Engineering for Surgery

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Mechanical Engineering".

Deadline for manuscript submissions: closed (6 June 2020) | Viewed by 39993

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Prof. Dr. Nicola Pio Belfiore

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Department of Engineering, Roma Tre University, Via Vito Volterra 62, 00146 Rome, Italy
Interests: functional design; MEMS/NEMS; dynamic simulation of multi-body systems; robotics; topology; tribology
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Prof. Dr. Pietro Ursi

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Department of General Surgery and Surgical Specialities “Paride Stefanini”, Sapienza University of Rome, viale del Policlinico 155, 00161 Rome, Italy
Interests: multimodal and multidisciplinary rectal cancer treatment; with specific reference to mini invasive surgical treatment; adrenal gland bariatric mini invasive surgery; gastric surgery
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Dr. Andrea Scorza

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Department of Industrial, Electronic and Mechanical Engineering, University of Roma Tre, Via Della Vasca Navale 79, 00146 Rome, Italy
Interests: mechanical and thermal measurement systems and instrumentation; design and testing of biomedical instrumentation; experimental mechanics applied in biomedical fields
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Special Issue Information

Dear Colleagues,

the developments of new surgical methods have been often inspired by the availability of new technologies, design methods, and materials. This evolution has been successfully demonstrated by the recent growth of

smart surgical tools
micro/nano robots for surgery
minimally invasive procedures for general, lung, gynecologic, head and neck, heart, neuro-spine, vascular, urological surgery.

One way to explain how the cooperation between Technology and Surgery works consists in interpreting it as a customer-provider relationship where Engineering offers new technological developments to the Surgery’ demand. Among the recent evolutions in Engineering, the following fields have found a large application to Surgery:

design, mechanics, dynamics, kinematics, measurements, control, microelectronics, information technology, telecommunications, pneumatic, fluid dynamics, and nanotechnology.

However, regarding the complex and multifaceted cooperation between Engineering and Surgery as a mere offer-demand relationship would be such a limited way! We believe that any possible development in Surgery could be supported by a proper collaboration with the Engineering counterparts, while almost any new development in Engineering could be successfully applied to improve surgical operations. Both alliances need a strong and very integrated partnership and an enduring team work.

For these reasons, we are very glad to launch the present special issue and call for original or review papers which describe any recent experience of cooperation between surgery and engineering.

Contributions from all fields related to the subject are welcome to this Special Issue, such as the following general topics:

Laparoscopic Surgery
Endoscopic Surgery
Robotic Surgery
Natural Orifice Transluminal Endoscopic Surgery (NOTES)
New technologies for intraoperative imaging
MEMS/NEMS and microsystems for surgery

More specific topics will be also welcome, such as, and not limited to,

New technologies for training of residence and young surgeons in minimally invasive surgery;
Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS);
Ethics: ethical issues in the application of autonomous robots in surgery;
Education: new trends in teaching–learning methods and information technology.

Prof. Dr. Nicola Pio Belfiore
Prof. Dr. Pietro Ursi
Prof. Andrea Scorza
Guest Editors

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Keywords

Surgery
Engineering
Laparoscopy
Endoscopy
Robotics
MEMS/NEMS
NOTES
TAMIS
TEM

Published Papers (13 papers)

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Editorial

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5 pages, 186 KiB

Open AccessEditorial

Engineering-Aided Inventive Surgery

by Nicola Pio Belfiore, Andrea Scorza and Pietro Ursi

Appl. Sci. 2020, 10(11), 3957; https://0-doi-org.brum.beds.ac.uk/10.3390/app10113957 - 07 Jun 2020

Cited by 1 | Viewed by 1504

Abstract

This Editorial presents a new Special Issue dedicated to some old and new interdisciplinary areas of cooperation between engineering and surgery. The first two sections offer some food for thought, in terms of a brief introductory and general review of the past, present, future and visionary perspectives of the synergy between engineering and surgery. The last section presents a very short and reasoned review of the contributions that have been included in the present Special Issue. Given the vastness of the topic that this Special Issue deals with, we hope that our effort may have offered a stimulus, albeit small, to the development of cooperation between engineering and surgery. Full article

(This article belongs to the Special Issue Engineering for Surgery)

Research

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14 pages, 3481 KiB

Open AccessArticle

User Friendliness of a Wearable Visual Behavior Monitor for Cataract and Refractive Surgery

by Bojan Pajic, Pavel Zakharov, Brigitte Pajic-Eggspuehler and Zeljka Cvejic

Appl. Sci. 2020, 10(6), 2190; https://0-doi-org.brum.beds.ac.uk/10.3390/app10062190 - 24 Mar 2020

Cited by 7 | Viewed by 2793

Abstract

A prospective feasibility study was conducted to determine whether a new wearable device, the Visual Behavior Monitor (VBM), was easy to use and did not present any difficulties with the daily activities of patients. Patients for cataract surgery and refractive lens exchange were randomly selected and screened for inclusion in the study. A total of 129 patients were included in the study as part of a multicenter study. All measurements were performed before surgery. Upon inclusion, patients were trained to wear the device, instructed to wear it for a minimum of 36 h, and were scheduled to return in one week. The VBM measures the distance at which patients’ visual activities are performed, the level of illumination, and head translational and rotational movements along the three axes. On the follow-up visit, patients completed a questionnaire about their experience in wearing the device. All patients underwent standard diagnostic testing, with their cataract grade determined by the Lens Opacities Classification System (LOCS) classification. Results indicate that 87% of patients felt comfortable using the wearable device while 8% of patients responded as not feeling comfortable (5% of patients did not respond to the question). In addition, 91% of patients found it easy to attach the wearable to the magnetic clip while 4% of patients did not find it easy, and 5% of patients did not respond. Overall, patients found the device easy to use, with most reporting that the device was not intrusive. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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14 pages, 3149 KiB

Open AccessArticle

Comparative Study of the Use of Different Sizes of an Ergonomic Instrument Handle for Laparoscopic Surgery

by Juan A. Sánchez-Margallo, Alfonso González González, Lorenzo García Moruno, J. Carlos Gómez-Blanco, J. Blas Pagador and Francisco M. Sánchez-Margallo

Appl. Sci. 2020, 10(4), 1526; https://0-doi-org.brum.beds.ac.uk/10.3390/app10041526 - 24 Feb 2020

Cited by 11 | Viewed by 5661

Abstract

Previous studies have shown that the handle design of laparoscopic instruments is crucial to surgical performance and surgeon’s ergonomics. In this study, four different sizes of an ergonomic laparoscopic handle design were tested in a blind and randomized fashion with twelve surgeons. They performed three laparoscopic tasks in order to analyze the influence of handle size. Execution time, wrist posture, and finger and palm pressure were evaluated during the performance of each task. The results show a significant reduction in the time required to complete the eye-manual coordination task using the appropriate handle. The incorrectly sized handle resulted in a rise in palm pressure and a reduction in the force exerted by the thumb during the transfer task. In the hand-eye coordination task, the use of the right handle size led to an increase in middle finger pressure. In general, surgeons had an ergonomically adequate wrist flexion in all tasks and an acceptable radio-ulnar deviation during the transfer task using the ergonomic instrument handle. Surgeons found it comfortable the use of the ergonomic handle. Therefore, the use of an appropriately sized instrument handle allows surgeons to improve ergonomics and surgical performance during the laparoscopic practice. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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7 pages, 1142 KiB

Open AccessArticle

Laser Vision Correction for Regular Myopia and Supracor Presbyopia: A Comparison Study

by Bojan Pajic, Zeljka Cvejic, Horace Massa, Brigitte Pajic-Eggspuehler, Mirko Resan and Harald P. Studer

Appl. Sci. 2020, 10(3), 873; https://0-doi-org.brum.beds.ac.uk/10.3390/app10030873 - 27 Jan 2020

Cited by 4 | Viewed by 2707

Abstract

A study to compare femto-presbyLASIK to standard myopia femto-LASIK refractive surgical correction with a total of 45 candidates was performed. The goal was to identify a more specific set of indications for presbyopia LASIK treatments. The results showed thoroughly good uncorrected visual acuity for myopia (decimal: 1.01 ± 0.15) as well as for presbyLASIK (decimal: 0.78 ± 0.17) corrections. Astigmatism was comparable in both groups and did not change significantly from preoperative (0.98D ± 0.53 SD) to postoperative (1.01D ± 0.50 SD). Our study results suggest, that presbyLASIK treatment is as safe and effective as regular LASIK myopia correction and can hence be recommended to treat presbyopia. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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9 pages, 3489 KiB

Open AccessArticle

High-Frequency Deep Sclerotomy, A Minimal Invasive Ab Interno Glaucoma Procedure Combined with Cataract Surgery: Physical Properties and Clinical Outcome

by Bojan Pajic, Zeljka Cvejic, Kaweh Mansouri, Mirko Resan and Reto Allemann

Appl. Sci. 2020, 10(1), 218; https://0-doi-org.brum.beds.ac.uk/10.3390/app10010218 - 27 Dec 2019

Cited by 3 | Viewed by 2897

Abstract

Background: The efficiency and safety of primary open-angle glaucoma with high-frequency deep sclerotomy (HFDS) combined with cataract surgery has to be investigated. Methods: Right after cataract surgery, HFDS was performed ab interno in 205 consecutive patients with open angle glaucoma. HFDS was performed with a custom-made high-frequency disSection 19 G probe (abee tip 0.3 × 1 mm, Oertli Switzerland). The bipolar current with a frequency of 500 kHz is applied. The nasal sclera was penetrated repetitively six times through the trabecular meshwork and consecutively through Schlemm’s canal. Every time, a pocket of 0.3 mm high and 0.6 mm width was created. Results: Mean preoperative intraocular pressure (IOP) was 24.5 ± 2.1 mmHg (range 21 to 48 mmHg). After 48 months, the follow up average IOP was 15.0 ± 1.7 mmHg (range 10 to 20 mmHg). Postoperative IOP has been significantly reduced compared to preoperative IOP for all studied cases (p < 0.001). After 48 months, the target IOP less than 21 mmHg reached in 84.9%. No serious complications were observed during the surgical procedure itself and in the postoperative period. Conclusions: HFDS is a minimally invasive procedure. It is a safe and efficacious surgical technique for lowering IOP combined with cataract surgery. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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17 pages, 1279 KiB

Open AccessArticle

Tip Estimation Method in Phantoms for Curved Needle Using 2D Transverse Ultrasound Images

by Zihao Li, Shuang Song, Li Liu and Max Q.-H. Meng

Appl. Sci. 2019, 9(24), 5305; https://0-doi-org.brum.beds.ac.uk/10.3390/app9245305 - 05 Dec 2019

Cited by 3 | Viewed by 2450

Abstract

Flexible needles have been widely used in minimally invasive surgeries, especially in percutaneous interventions. Among the interventions, tip position of the curved needle is very important, since it directly affects the success of the surgeries. In this paper, we present a method to estimate the tip position of a long-curved needle by using 2D transverse ultrasound images from a robotic ultrasound system. Ultrasound is first used to detect the cross section of long-flexible needle. A new imaging approach is proposed based on the selection of numbers of pixels with a higher gray level, which can directly remove the lower gray level to highlight the needle. After that, the needle shape tracking method is proposed by combining the image processing with the Kalman filter by using 3D needle positions, which develop a robust needle tracking procedure from 1 mm to 8 mm scan intervals. Shape reconstruction is then achieved using the curve fitting method. Finally, the needle tip position is estimated based on the curve fitting result. Experimental results showed that the estimation error of tip position is less than 1 mm within 4 mm scan intervals. The advantage of the proposed method is that the shape and tip position can be estimated through scanning the needle’s cross sections at intervals along the direction of needle insertion without detecting the tip. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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11 pages, 2612 KiB

Open AccessArticle

The Effect of Patellar Tendon Release on the Characteristics of Patellofemoral Joint Squat Movement: A Simulation Analysis

by Jianping Wang, Yongqiang Yang, Dong Guo, Shihua Wang, Long Fu and Yu Li

Appl. Sci. 2019, 9(20), 4301; https://0-doi-org.brum.beds.ac.uk/10.3390/app9204301 - 14 Oct 2019

Cited by 3 | Viewed by 2481

Abstract

Objectives: This paper studies the patellar tendon release’s effect on the movement characteristics of the artificial patellofemoral joint squat to provide reference data for knee joint surgery. Methods: Firstly, the dynamic finite element model of the human knee joint under squatting was established. Secondly, in the above no-release models, the release of 30% of the attachment area at the upper end, the lower end, or both ends of the patellar tendon were conducted, respectively. Then the simulations of all above four models were conducted. Finally, the results of the simulation were compared and analyzed. Results: The simulation results show that, after releasing the patellar tendon (compared with the no-release simulation’s results), the relative flexion, medial-lateral rotation, medial-lateral tilt, and superior-inferior shift of the patella relative to the femur increased; the medial-lateral shift and anterior-posterior shift of the patella relative to the femur decreased. Conclusion: In this paper, the maximum flexion angle of the patella increased after the patellar tendon being released (compared with the no-release model), which indicated that the mobility of knee joint was improved after the patellar tendon release. The simulation data in this paper can provide technical reference for total knee arthroplasty. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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17 pages, 3141 KiB

Open AccessArticle

Pressure Observer Based Adaptive Dynamic Surface Control of Pneumatic Actuator with Long Transmission Lines

by Deyuan Meng, Bo Lu, Aimin Li, Jiang Yin and Qingyang Li

Appl. Sci. 2019, 9(17), 3621; https://0-doi-org.brum.beds.ac.uk/10.3390/app9173621 - 03 Sep 2019

Cited by 1 | Viewed by 2437

Abstract

In this paper, the needle insertion motion control of a magnetic resonance imaging (MRI) compatible robot, which is actuated by a pneumatic cylinder with long transmission lines, is considered and a pressure observer based adaptive dynamic surface controller is proposed. The long transmission line is assumed to be an intermediate chamber connected between the control valve and the actuator in series, and a nonlinear first order system model is constructed to characterize the pressure losses and time delay brought by it. Due to the fact that MRI-compatible pressure sensors are not commercially available, a globally stable pressure observer is employed to estimate the chamber pressure. Based on the model of the long transmission line and the pressure observer, an adaptive dynamic surface controller is further designed by using the dynamic surface control technique. Compared to the traditional backstepping design method, the proposed controller can avoid the problem of “explosion of complexity” since the repeated differentiation of virtual controls is no longer required. The stability of the closed-loop system is analytically proven by employing the Lyapunov theory. Extensive experimental results are presented to demonstrate the effectiveness and the performance robustness of the proposed controller. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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15 pages, 7425 KiB

Open AccessArticle

Scanning Electron Microscopy Analysis and Energy Dispersion X-ray Microanalysis to Evaluate the Effects of Decontamination Chemicals and Heat Sterilization on Implant Surgical Drills: Zirconia vs. Steel

by Antonio Scarano, Sammy Noumbissi, Saurabh Gupta, Francesco Inchingolo, Pierbiagio Stilla and Felice Lorusso

Appl. Sci. 2019, 9(14), 2837; https://0-doi-org.brum.beds.ac.uk/10.3390/app9142837 - 16 Jul 2019

Cited by 29 | Viewed by 3167

Abstract

Background: Drills are an indispensable tool for dental implant surgery. Today, there are ceramic zirconium dioxide and metal alloy drills available. Osteotomy drills are critical instruments since they come in contact with blood and saliva. Furthermore, they are reusable and should be cleaned and sterilized between uses. Depending on the material, sterilizing agents and protocols can alter the surface and sharpness of implant drills. The hypothesis is that cleaning and sterilization procedures can affect the surface structure of the drills and consequently reduce their cutting efficiency. Methods: Eighteen zirconia ceramic drills and eighteen metal alloy drills were evaluated. Within the scope of this study, the drills were not used to prepare implant sites. They were immersed for 10 min in human blood taken from volunteer subjects and then separately exposed to 50 cycles of cleansing with 6% hydrogen peroxide, cold sterilization with glutaraldehyde 2%, and autoclave heat sterilization. Scanning Electron Microscopy (SEM) and energy dispersion X-ray (EDX) microanalysis were conducted before and after each cycle and was used to evaluate the drill surfaces for alterations. Results: After exposure to the cleansing agents used in this study, alterations were seen in the steel drills compared to zirconia. Conclusions: The chemical sterilization products used in this study cause corrosion of the metal drills and reduce their sharpness. It was observed that the cycles of steam sterilization did not affect any of the drills. Zirconia drill surfaces remained stable. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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15 pages, 7493 KiB

Open AccessArticle

A Feasibility Study of a Novel Piezo MEMS Tweezer for Soft Materials Characterization

by Fabio Botta, Andrea Rossi and Nicola Pio Belfiore

Appl. Sci. 2019, 9(11), 2277; https://0-doi-org.brum.beds.ac.uk/10.3390/app9112277 - 02 Jun 2019

Cited by 8 | Viewed by 2339

Abstract

The opportunity to know the status of a soft tissue (ST) in situ can be very useful for microsurgery or early diagnosis. Since normal and diseased tissues have different mechanical characteristics, many systems have been developed to carry out such measurements locally. Among them, MEMS tweezers are very relevant for their efficiency and relative simplicity compared to the other systems. In this paper a novel piezoelectric MEMS tweezer for soft materials analysis and characterization is presented. A theoretical approach has developed in order to carry out the values of the stiffness, the equivalent Young’s modulus, and the viscous damping coefficients of the analyzed samples. The method has been validated by using both Finite Element Analysis and data from the literature. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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19 pages, 17031 KiB

Open AccessArticle

Toward Operations in a Surgical Scenario: Characterization of a Microgripper via Light Microscopy Approach

by Federica Vurchio, Pietro Ursi, Francesco Orsini, Andrea Scorza, Rocco Crescenzi, Salvatore A. Sciuto and Nicola P. Belfiore

Appl. Sci. 2019, 9(9), 1901; https://0-doi-org.brum.beds.ac.uk/10.3390/app9091901 - 09 May 2019

Cited by 12 | Viewed by 2140

Abstract

Micro Electro Mechanical Systems (MEMS)-Technology based micro mechanisms usually operate within a protected or encapsulated space and, before that, they are fabricated and analyzed within one Scanning Electron Microscope (SEM) vacuum specimen chamber. However, a surgical scenario is much more aggressive and requires several higher abilities in the microsystem, such as the capability of operating within a liquid or wet environment, accuracy, reliability and sophisticated packaging. Unfortunately, testing and characterizing MEMS experimentally without fundamental support of a SEM is rather challenging. This paper shows that in spite of large difficulties due to well-known physical limits, the optical microscope is still able to play an important role in MEMS characterization at room conditions. This outcome is supported by the statistical analysis of two series of measurements, obtained by a light trinocular microscope and a profilometer, respectively. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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Review

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23 pages, 1145 KiB

Open AccessReview

3D Soft-Tissue Prediction Methodologies for Orthognathic Surgery—A Literature Review

by Elena Carlotta Olivetti, Sara Nicotera, Federica Marcolin, Enrico Vezzetti, Jacqueline P. A. Sotong, Emanuele Zavattero and Guglielmo Ramieri

Appl. Sci. 2019, 9(21), 4550; https://0-doi-org.brum.beds.ac.uk/10.3390/app9214550 - 26 Oct 2019

Cited by 29 | Viewed by 5021

Abstract

Three-dimensional technologies have had a wide diffusion in several fields of application throughout the last decades; medicine is no exception and the interest in their introduction in clinical applications has grown with the refinement of such technologies. We focus on the application of 3D methodologies in maxillofacial surgery, where they can give concrete support in surgical planning and in the prediction of involuntary facial soft-tissue changes after planned bony repositioning. The purpose of this literature review is to offer a panorama of the existing prediction methods and software with a comparison of their reliability and to propose a series of still pending issues. Various software are available for surgical planning and for the prediction of tissue displacements, but their reliability is still an unknown variable in respect of the accuracy needed by surgeons. Maxilim, Dolphin and other common planning software provide a realistic result, but with some inaccuracies in specific areas of the face; it also is not totally clear how the prediction is obtained by the software and what is the theoretical model they are based on. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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Other

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15 pages, 6224 KiB

Open AccessFeature PaperConcept Paper

A New Concept Compliant Platform with Spatial Mobility and Remote Actuation

by Nicola Pio Belfiore

Appl. Sci. 2019, 9(19), 3966; https://0-doi-org.brum.beds.ac.uk/10.3390/app9193966 - 21 Sep 2019

Cited by 1 | Viewed by 3438

Abstract

This paper presents a new tendon-driven platform with spatial mobility. The system can be obtained as a monolithic structure, and its motion is based on the concept of selective compliance. The latter contributes also to optimizing the use of the material by avoiding parasitic deformations. The presented platform makes use of lumped compliance with three different kinds of elastic joints. An analysis of the platform mobility based on finite element analysis is provided together with an assembly mode analysis of the equivalent pseudo-rigid body mechanism. Surgical operations in laparoscopic environments are the natural fields of applications for this device. Full article

(This article belongs to the Special Issue Engineering for Surgery)

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