Surgical Procedures, Operative Commons^™

Biomechanical Analysis Of Ligament Modelling Techniques And Femoral Component Malrotation Following Tka, Liam A. Montgomery

Electronic Thesis and Dissertation Repository

Previous studies have demonstrated that satisfaction and revision rates following total knee arthroplasty (TKA) are lower than those of comparable surgeries such as total hip replacements. A leading cause for these revisions is joint instability which may be due to improper ligament balancing or poorly aligned surgical implants. One of the methods used to investigate biomechanical forces and kinematics is computational modelling of the post-operative TKA knee.

A unique knee model was used to investigate the biomechanical and kinematic effects of ligament model complexity, as well as the effects of simulating ligament wrapping versus ignoring ligament wrapping. We then used …

Evaluation Of Root-End Resection With Conventional And Ultrasonic Methods: A Single-Blind, Randomized In-Vitro Study, Mohammad Al Shammaa, Roula S. Abiad, Nayer Abo Elsaad

BAU Journal - Creative Sustainable Development

The root-end resection is considered critical endodontic surgical procedure. Three millimeters of the root tip is resected and root-end cavity with parallel walls and comparable depth is cut to receive a root-end filling. The literature discussed dentinal cracks after root canal instrumentation and/or root dentine cutting. The aim of the present study was to assess cracks at root ends after resection with conventional versus ultrasonic techniques. Material and Methodology: Thirty-two extracted human lower premolar teeth with single root were used. Their root canals were prepared and received gutta-percha. Sixteen roots Group 1 were resected using tungsten carbide fissure burs, while …

Non-Invasive Peripheral Venous And Arterial Line Air Detector For Embolization Prevention, Alexandria Kwong, Kevin Shu, Dylan Meinster

Biomedical Engineering

The scope of this project includes designing a non-invasive bubble detector for peripheral venous and arterial lines. For minimally invasive cardiac procedures, arterial and venous access is necessary for these procedures as is constant flow through the tubing to prevent clotting and to administer drugs. Air bubbles are common in these lines and can be consequential if enough air is introduced into the human system. Air embolisms are the most common and relevant issues during these procedures. The goal of this device is to create an attachable detector for air bubbles in saline that can also terminate flow and alert …

Sol Retractor: Rapidly Deployable Film-Based C-Section Retractor, Casey Lee, Silas Cleveland, Jose Dolores Valdivieso, Joseph Perks

Honors Theses

Cesarean Sections (C-sections), a surgery conducted for baby delivery, can be divided into four distinct categories; Category 1 and 2 are considered emergency c-sections, and Category 3 and 4 are scheduled c-sections [2]. A comparative study from 2016 analyzed the difference of need for postoperative treatment between the Collins or the Alexis O retractor ( n = 100). The Alexis O C-Section retractor resulted in 19% of women requiring postoperative treatment, including medication, monitoring, and an extended stay at the hospital. The Collins resulted in 43% of the patients requiring postoperative treatment (p = 0.001) [5]. In emergency C-sections, surgical …

System Integration Of C-Arm Robotic Prototype Using Motion Capture Guidance For Accurate Repositioning, Alireza Yazdanshenas

Mechanical Engineering Theses

One of the important surgical tools in spinal surgery is the C-Arm X-ray System. The C-Arm is a large “C” shaped and manually maneuvered arm that provides surgeons and X-ray technicians the ability to take quick quality X-rays during surgery. Because of its five degrees of freedom, the C-Arm can be manually maneuvered around the patient to provide many angles and perspectives, ensuring surgical success.

This system works fine for most surgical procedures but falls short when the C-Arm must be moved out of the way for complicated surgical procedures.

The aim of this thesis is to develop an accurate …

Left Atrial Model, Borna Sobati, Sarah Porello, Tess Pate

Biomedical Engineering

The objective is to produce an electrophysiological model of an adult human left atrium. This model will be used to test mapping probe catheters used for locating cardiac arrhythmias against current technology used in practice. Dr. Chris Porterfield requested this model and other physicians or probe catheter manufacturers may also use this product in the future. Dr. Porterfield also discussed the possibility of future senior project groups using the model as a bench test for designing new catheter tips. The model will precisely simulate electrical behaviors of the heart in normal as well as arrhythmic conditions. Ideally, the model will …

The Effect Of Mechanical Agitator Geometry On Catheter Directed Thrombectomy, Sanghun Alex Lee

McKelvey School of Engineering Theses & Dissertations

Venous thromboembolism (VTE) is a vascular disease in which a blood clot forms inside of a vein, most often deep in the legs, groin, or arm. Two types of VTE exist, deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a clot in a deep vein forms, risking embolism and causing swelling as the clot obstructs blood flow. An embolism occurs when a part or all the thrombus breaks off and travels in the circulation, getting lodged in the lungs. A pulmonary embolism is a very serious medical condition and can be fatal if not treated immediately. Current …

Tibiotalar Arthrodesis: Development Of A Novel Jig And Alignment Guide, Adam Mathew Ropchan

Electronic Thesis and Dissertation Repository

Tibiotalar arthrodesis is a surgical procedure, used for the treatment of end-stage ankle arthrosis and instability. There are dozens of described procedures in the literature, all with varying rates of success. Two of the most common reasons for reoperation in tibiotalar arthrodesis are nonunion and infection; few studies have established any associations between patient/surgical factors and reoperation for nonunion and infection.

The first part of this thesis focuses on determining the rate of reoperation to the ipsilateral lower limb and if any patient/surgical factors are associated with reoperation for nonunion and infection. The second part of this thesis turns attention …

Migration Resistance Of Esophageal Stents: The Role Of Stent Design, Hozhabr Mozafari, Pengfei Dong, Shijia Zhao, Yonghua Bi, Xinwei Han, Linxia Gu

Department of Mechanical and Materials Engineering: Faculty Publications

Objective: Stenting is one of the major treatments for malignant esophageal cancer. However, stent migration compromises clinical outcomes. A flared end design of the stent diminishes its migration. The goal of this work is to quantitatively characterize stent migration to develop new strategies for better clinical outcomes.

Methods: An esophageal stent with flared ends and a straight counterpart were virtually deployed in an esophagus with asymmetric stricture using the finite element method. The resulted esophagus shape, wall stress, and migration resistance force of the stent were quantified and compared.

Results: The lumen gain for both the flared stent and the …

A Novel Hybrid Imaging System To Aid In Surgical Decision Making, Lawrence Yip, Madeleine Van De Kleut, Ivan Kosik, Astrid Chamson-Reig, Jeffrey Jl Carson

Western Research Forum

Background:

Breast cancer accounts for 25% of all cancer cases among women. In breast-conserving surgery, a common treatment, the tumour is excised with a healthy tissue margin. However, detection of the margin can be difficult. Current techniques to guide excision are often insufficient, and re-excision can occur up to 25% of the time.

Methods:

Photoacoustic imaging is a hybrid imaging modality that combines the advantages of optical imaging and ultrasound while using safe non-ionizing light. This project involves the development of a novel imaging system with a new scanner design to overcome common limitations and provide images to aid in …

Utility Of Ultrasound/Photoacoustic Imaging For Accurate Catheter Tracking And Temperature Monitoring During Endovenous Laser Ablation, Ayushi Jharia, Keerthana Palani, Yan Yan

Research Opportunities for Engineering Undergraduates (ROEU) Program 2016-17

Laser ablation is a treatment method that uses light energy through a catheter inserted into a vein to induce localized heat to close the diseased blood vessels. Ultrasound (US) imaging has been used for catheter visualization and tracking. US has limitations for tracking the accurate location of the fiber tip inside small perforating veins such as angular dependency and comet tail artifacts. We propose a robust and accurate method for fiber tip tracking using combined US and Photoacoustic (PA) imaging to overcome the existing limitations.

Neurosurgical Ultrasound Pose Estimation Using Image-Based Registration And Sensor Fusion - A Feasibility Study, Utsav Pardasani

Electronic Thesis and Dissertation Repository

Modern neurosurgical procedures often rely on computer-assisted real-time guidance using multiple medical imaging modalities. State-of-the-art commercial products enable the fusion of pre-operative with intra-operative images (e.g., magnetic resonance [MR] with ultrasound [US] images), as well as the on-screen visualization of procedures in progress. In so doing, US images can be employed as a template to which pre-operative images can be registered, to correct for anatomical changes, to provide live-image feedback, and consequently to improve confidence when making resection margin decisions near eloquent regions during tumour surgery.

In spite of the potential for tracked ultrasound to improve many neurosurgical procedures, it …

Improved Sensitivity To Fluorescence For Cancer Detection In Wide-Field Image-Guided Neurosurgery, Michael Jermyn, Yoann Gosselin, Pablo A. Valdes, Mira Sibai, Kolbein Kolste

Dartmouth Scholarship

In glioma surgery, Protoporphyrin IX (PpIX) fluorescence may identify residual tumor that could be resected while minimizing damage to normal brain. We demonstrate that improved sensitivity for wide-field spectroscopic fluorescence imaging is achieved with minimal disruption to the neurosurgical workflow using an electron-multiplying charge-coupled device (EMCCD) relative to a state-of-the-art CMOS system. In phantom experiments the EMCCD system can detect at least two orders-of-magnitude lower PpIX. Ex vivo tissue imaging on a rat glioma model demonstrates improved fluorescence contrast compared with neurosurgical fluorescence microscope technology, and the fluorescence detection is confirmed with measurements from a clinically-validated spectroscopic probe. Greater PpIX …

Initial Validation Of A Novel Method Of Presurgical Language Localization Through Functional Connectivity (Fcmri), Stephanie M. Noble, Dustin Scheinost, Susan Y. Bookheimer, Patricia Walshaw, R Todd Constable, Christopher F. Benjamin

Yale Day of Data

OBJECTIVE: Neurosurgery is potentially curative in chronic epilepsy but can only be offered to patients if the surgical risk to language is known. Clinical functional magnetic resonance imaging (fMRI) is an ideal, noninvasive method for localizing language cortex yet remains to be validated for this purpose. We have recently presented a novel method for localizing language cortex. Here we present a preliminary evaluation of this method’s validity. We hypothesized language regions identified using this novel method would demonstrate stronger functional connectivity than randomly generated set of proximal networks. METHOD: fMRI data were collected from sixteen temporal lobe patients …

Review Of Fluorescence Guided Surgery Visualization And Overlay Techniques, Jonathan T. Elliott, Alisha V. Dsouza, Scott C. Davis, Jonathan D. Olson, Keith Paulsen, David Roberts, Brian Pogue

Dartmouth Scholarship

In fluorescence guided surgery, data visualization represents a critical step between signal capture and display needed for clinical decisions informed by that signal. The diversity of methods for displaying surgical images are reviewed, and a particular focus is placed on electronically detected and visualized signals, as required for near-infrared or low concentration tracers. Factors driving the choices such as human perception, the need for rapid decision making in a surgical environment, and biases induced by display choices are outlined. Five practical suggestions are outlined for optimal display orientation, color map, transparency/alpha function, dynamic range compression, and color perception check.

Dynamic Simulation And Neuromuscular Control Of Movement: Applications For Predictive Simulations Of Balance Recovery, Misagh Mansouri Boroujeni

Doctoral Dissertations

Balance is among the most challenging tasks for patients with movement disorders. Study and treatment of these disorders could greatly benefit from combined software tools that offer better insights into neuromuscular biomechanics, and predictive capabilities for optimal surgical and rehabilitation treatment planning. A platform was created to combine musculoskeletal modeling, closed-loop forward dynamic simulation, optimization techniques, and neuromuscular control system design. Spinal (stretch-reflex) and supraspinal (operational space task-based) controllers were developed to test simulation-based hypotheses related to balance recovery and movement control. A corrective procedure (rectus femoris transfer surgery) was targeted for children experiencing stiff-knee gait and how this procedure …

Quantitative Spatial Frequency Fluorescence Imaging In The Sub-Diffusive Domain For Image-Guided Glioma Resection, Mira Sibai, Israel Veilleux, Jonathan T. Elliott, Frederic Leblond, Brian Wilson

Dartmouth Scholarship

Intraoperative 5- aminolevulinic acid induced-Protoporphyrin IX (PpIX) fluorescence guidance enables maximum safe resection of glioblastomas by providing surgeons with real-time tumor optical contrast. However, visual assessment of PpIX fluorescence is subjective and limited by the distorting effects of light attenuation and tissue autofluorescence. We have previously shown that non-invasive point measurements of absolute PpIX concentration identifies residual tumor that is otherwise non-detectable. Here, we extend this approach to wide-field quantitative fluorescence imaging by implementing spatial frequency domain imaging to recover tissue optical properties across the field-of-view in phantoms and ex vivo tissue.

Femtosecond Laser Beam Propagation Through Corneal Tissue: Evaluation Of Therapeutic Laser-Stimulated Second And Third-Harmonic Generation, William R. Calhoun Iii

Theses and Dissertations

One of the most recent advancements in laser technology is the development of ultrashort pulsed femtosecond lasers (FSLs). FSLs are improving many fields due to their unique extreme precision, low energy and ablation characteristics. In the area of laser medicine, ophthalmic surgeries have seen very promising developments. Some of the most commonly performed surgical operations in the world, including laser-assisted in-situ keratomileusis (LASIK), lens replacement (cataract surgery), and keratoplasty (cornea transplant), now employ FSLs for their unique abilities that lead to improved clinical outcome and patient satisfaction.

The application of FSLs in medical therapeutics is a recent development, and although …

Design And Development Of A Miniature In Vivo Surgical Robot With Distributed Motor Control For Laparoendoscopic Single-Site Surgery, Eric J. Markvicka

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Paradigm shifts in invasiveness, recovery time, cosmesis, and cost have been seen within the field of general surgery through major advances in surgical technology. Some of the most advanced types of general surgery now include Minimally Invasive Surgery (MIS), LaparoEndoscopic Single-Site (LESS) surgery, and Natural Orifice Translumenal Endoscopic Surgery (NOTES). One of the newest and rapidly developing catalysts is robotic platforms. Such platforms have improved ergonomics and control, increased workspace and dexterity, and have surpassed the efficacy of many non-robotic platforms such as traditional laparoscopic surgical tools. This thesis presents the design and development of a four-degree-of-freedom (4- DOF) miniature …

Evaluating Human Performance For Image-Guided Surgical Tasks, Matthew Kenneth Kramers

Electronic Thesis and Dissertation Repository

The following work focuses on the objective evaluation of human performance for two different interventional tasks; targeted prostate biopsy tasks using a tracked biopsy device, and external ventricular drain placement tasks using a mobile-based augmented reality device for visualization and guidance. In both tasks, a human performance methodology was utilized which respects the trade-off between speed and accuracy for users conducting a series of targeting tasks using each device. This work outlines the development and application of performance evaluation methods using these devices, as well as details regarding the implementation of the mobile AR application. It was determined that the …

Towards Highly-Integrated Stereovideoscopy For In Vivo Surgical Robots, Jay Carlson

Department of Electrical and Computer Engineering: Dissertations, Theses, and Student Research

When compared to traditional surgery, laparoscopic procedures result in better patient outcomes: shorter recovery, reduced post-operative pain, and less trauma to incisioned tissue. Unfortunately, laparoscopic procedures require specialized training for surgeons, as these minimally-invasive procedures provide an operating environment that has limited dexterity and limited vision. Advanced surgical robotics platforms can make minimally-invasive techniques safer and easier for the surgeon to complete successfully. The most common type of surgical robotics platforms -- the laparoscopic robots -- accomplish this with multi-degree-of-freedom manipulators that are capable of a diversified set of movements when compared to traditional laparoscopic instruments. Also, these laparoscopic robots …

Fluid Powered Miniature In-Vivo Robots For Minimally Invasive Surgery (Mis), Abolfazl Pourghodrat

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Minimizing the invasiveness of surgery is believed to improve patient outcomes. Bleeding, infection, and pain are major concerns in surgery afflicting patients for decades. Minimally invasive techniques have come into play to reduce these concerns and smooth the evolution of abdominal surgery to a scarless process where nearly all surgeries can be performed without a skin incision. Technology continually advances the frontier of development of novel surgical devices to implement less invasive surgical techniques.

Fusion of robotics and Minimally Invasive Surgery (MIS) has created new opportunities to develop diagnostic and therapeutic tools. Surgical robotics is advancing from externally actuated systems …

Joint Reaction Force And Contributions Of Surrounding Muscles To Knee Joint Load During Stair Ascent In Total Knee Replacement Patients And Healthy Individuals, Robert Jacob Rasnick

Masters Theses

Total knee replacement (TKR) is commonly used to correct end stage knee osteoarthritis (OA) of the knee joint. Unfortunately, difficulty with stair climbing has been seen to exist, prolonging the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future research. The outcome of a TKR is intended to reestablish normal motion and loading of the knee. Musculoskeletal modeling provides a means to accurately approximate joint loading and the corresponding muscle contributions during a movement.

The purpose of the present study was to examine …

Utilizing Fast Spin Echo Mri To Reduce Image Artifacts And Improve Implant/Tissue Interface Detection In Refractory Parkinson’S Patients With Deep Brain Stimulators, Subhendra N. Sarkar, Pooja R. Sarkar, Efstathios Papavassiliou, Rafael Rojas

Publications and Research

Introduction. In medically refractory Parkinson’s disease (PD) deep-brain stimulation (DBS) is an effective therapeutic tool. Postimplantation MRI is important in assessing tissue damage and DBS lead placement accuracy. We wanted to identify which MRI sequence can detectDBS leads with smallest artifactual signal void, allowing better tissue/electrode edge conspicuity.

Methods. Using an IRB approved protocol 8 advanced PDpatientswere imagedwithinMRconditional safety guidelines at lowRF power (SAR ≤ 0.1 W/kg) in coronal plane at 1.5T by various sequences.The image slices were subjectively evaluated for diagnostic quality and the lead contact diameters were compared to identify a sequence least affected by metallic leads.

Results …

A Novel Signal Processing Method For Intraoperative Neurophysiological Monitoring In Spinal Surgeries, Krishnatej Vedala

FIU Electronic Theses and Dissertations

Intraoperative neurophysiologic monitoring is an integral part of spinal surgeries and involves the recording of somatosensory evoked potentials (SSEP). However, clinical application of IONM still requires anywhere between 200 to 2000 trials to obtain an SSEP signal, which is excessive and introduces a significant delay during surgery to detect a possible neurological damage. The aim of this study is to develop a means to obtain the SSEP using a much less, twelve number of recordings. The preliminary step involved was to distinguish the SSEP with the ongoing brain activity. We first establish that the brain activity is indeed quasi-stationary whereas …

Measurement And Description Of Dynamics Required For In Vivo Surgical Robotics Via Kinematic Methods, Jacob G. Greenburg

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

With the goal of improved recovery times and reduced trauma to the patient there has been a substantial shift in the medical community’s demand for minimally invasive surgical (MIS) techniques. With the standardization of MIS becoming more commonplace in the medical field there are still many improvements that are desired. Traditional, manual methods of these surgeries require multiple incisions on the abdomen for the tools and instruments to be inserted. The more recent demand has been to localize the incisions into what is being referred to as a Laparoendoscopic Single-Site (LESS) surgery. Furthermore, the manual instruments that are commonly used …

An Assessment Of Novel Biodegradable Magnesium Alloys For Endovascular Biomaterial Applications, Dharam Persaud-Sharma

FIU Electronic Theses and Dissertations

Magnesium alloys have been widely explored as potential biomaterials, but several limitations to using these materials have prevented their widespread use, such as uncontrollable degradation kinetics which alter their mechanical properties. In an attempt to further the applicability of magnesium and its alloys for biomedical purposes, two novel magnesium alloys Mg-Zn-Cu and Mg-Zn-Se were developed with the expectation of improving upon the unfavorable qualities shown by similar magnesium based materials that have previously been explored. The overall performance of these novel magnesium alloys has been assessesed in three distinct phases of research: 1) analysing the mechanical properties of the as-cast …

Experimental Assessment Of The Impact Of Asymptomatic Gas Emboli On The Vessel Wall, Linxia Gu, Eric L. Cutler

Department of Mechanical and Materials Engineering: Faculty Publications

Quantitative evaluation of shear stress in the vessel wall due to the presence of asymptomatic gas emboli is lacking. The goal of this work was to assess the impact of chronic asymptomatic gas emboli on the risk of atherosclerosis through a custom-built cardiovascular flow simulator. Gas bubbles were created by forced air from a syringe pump. The influences of embolism injection rate, pulse rate, and time-averaged flow rate on the wall mean shear stress were investigated at resting and elevated heart rate conditions. The recorded pressure and volumetric flow rate from 24 experimental settings with four repetitions each were used …

An Integrated Computer-Aided Robotic System For Dental Implantation, Xiaoyan Sun, Yongki Yoon, Jiang Li, Frederic D. Mckenzie

Electrical & Computer Engineering Faculty Publications

This paper describes an integrated system for dental implantation including both preoperative planning utilizing computer-aided technology and automatic robot operation during the intra-operative stage. A novel two-step registration procedure was applied for transforming the preoperative plan to the operation of the robot, with the help of a Coordinate Measurement Machine (CMM). Experiments with a patient-specific phantom were carried out to evaluate the registration error for both position and orientation. After adopting several improvements, registration accuracy of the system was significantly improved. Sub-millimeter accuracy with the Target Registration Errors (TREs) of 0.38±0.16 mm (N=5) was achieved. The target orientation errors after …

Detection Of Microcracks During Bone Cutting Using Acoustic Emission Techniques, Ashkan Safari, Ger Reilly, Brendan Mccormack

Conference Papers

Surgeons may use a number of cutting instruments such as osteotomes and chisels to cut bone during operative procedures. The initial loading of cortical bone during the cutting process results in the formation of microcracks in the vicinity of the cutting zone with main crack propagation to failure occurring with continued loading; microcracking acts as a stimulus for main crack formation and has also been shown to occur during the propagation of the main crack. It has also been reported that Acoustic Emission (AE) is generated due to microcrack formation and crack growth, prior to, and during final fracture in …