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Existing challenges in surgical education (See one, do one, teach one) as well as the Covid-19 pandemic make it necessary to develop new ways for surgical training. This is also crucial for the dissemination of new technological developments. As today’s live transmissions of surgeries to remote locations always come with high information loss, e.g. stereoscopic depth perception, and limited communication channels. This work describes the implementation of a scalable remote solution for surgical training, called TeleSTAR (Telepresence for Surgical Assistance and Training using Augmented Reality), using immersive, interactive and augmented reality elements with a bi-lateral audio pipeline to foster direct communication. The system uses a full digital surgical microscope with a modular software-based AR interface, which consists of an interactive annotation mode to mark anatomical landmarks using an integrated touch panel as well as an intraoperative image-based stereo-spectral algorithm unit to measure anatomical details and highlight tissue characteristics.We broadcasted three cochlea implant surgeries in the context of otorhinolaryngology. The intervention scaled to five different remote locations in Germany and the Netherlands with lowlatency. In total, more than 150 persons could be reached and included an evaluation of a participant’s questionnaire indicating that annotated AR-based 3D live transmissions add an extra level of surgical transparency and improve the learning outcome.

Introduction: This study focuses on the quantification of and current guidelines on the hazards related to needle positioning in prostate cancer treatment: (1) access restrictions to the prostate gland by the pubic arch, so-called Pubic Arch Interference (PAI) and (2) needle positioning errors. Next, we propose solution strategies to mitigate these hazards. Methods: The literature search was executed in the Embase, Medline ALL, Web of Science Core Collection*, and Cochrane Central Register of Controlled Trials databases. Results: The literature search resulted in 50 included articles. PAI was reported in patients with various prostate volumes. The level of reported PAI varied between 0 and 22.3 mm, depending on the patient's position and the measuring method. Low-Dose-Rate Brachytherapy induced the largest reported misplacement errors, especially in the cranio-caudal direction (up to 10 mm) and the largest displacement errors were reported for High-Dose-Rate Brachytherapy in the cranio-caudal direction (up to 47 mm), generally increasing over time. Conclusions: Current clinical guidelines related to prostate volume, needle positioning accuracy, and maximum allowable PAI are ambiguous, and compliance in the clinical setting differs between institutions. Solutions, such as steerable needles, assist in mitigating the hazards and potentially allow the physician to proceed with the procedure. This systematic review was performed in accordance with the PRISMA guidelines. The review was registered at Protocols.io (DOI: dx.doi.org/10.17504/protocols.io.6qpvr89eplmk/v1). [ABSTRACT FROM AUTHOR]

Objective: There are widespread shortages of personal protective equipment as a result of the COVID-19 pandemic. Reprocessing filtering facepiece particle (FFP)- type respirators may provide an alternative solution in keeping healthcare professionals safe. Design: Prospective, bench-to-bedside. Setting: A primary care-based study using FFP-2 respirators without exhalation valve (3M Aura 1862+ (20 samples), Maco Pharma ZZM002 (14 samples)), FFP-2 respirators with valve (3M Aura 9322+ (six samples) and San Huei 2920V (16 samples)) and valved FFP type 3 respirators (Safe Worker 1016 (10 samples)). Interventions: All masks were reprocessed using a medical autoclave (17min at 121°C with 34min total cycle time) and subsequently tested up to three times whether these respirators retained their integrity (seal check and pressure drop) and ability to filter small particles (0.3– 5.0 µm) in the laboratory using a particle penetration test. Results: We tested 33 respirators and 66 samples for filter capacity. All FFP-2 respirators retained their shape, whereas half of the decontaminated FFP-3 respirators showed deformities and failed the seal check. The filtering capacity of the 3M Aura 1862 was best retained after one, two and three decontamination cycles (0.3 µm: 99.3%±0.3% (new) vs 97.0±1.3, 94.2±1.3%or 94.4±1.6; p<0.001). Of the other FFP-2 respirators, the San Huei 2920 V had 95.5%±0.7% at baseline vs 92.3%±1.7% vs 90.0±0.7 after one-time and two-time decontaminations, respectively (p<0.001). The tested FFP-3 respirator (Safe Worker 1016) had a filter capacity of 96.5%±0.7% at baseline and 60.3%±5.7% after one-time decontamination (p<0.001). Breathing and pressure resistance tests indicated no relevant pressure changes between respirators that were used once, twice or thrice. Conclusion: This small single-centre study shows that selected FFP-2 respirators may be reprocessed for use in primary care, as the tested masks retain their shape, ability to retain particles and breathing comfort after decontamination using a medical autoclave. [ABSTRACT FROM AUTHOR]

Purpose: Accurate and precise needle placement is of utmost importance in interventional radiology. However, targeting can be challenging due to, eg, tissue motion and deformation. Steerable needles are a possible solution to overcome these challenges. The present work studied the clinical need for steerable needles. We aimed to answer three subquestions: 1) What are the current challenges in needle placement? 2) What are allowable needle placement errors? and 3) Do current needles need improvement and would steerable needles add clinical value? Methods: A questionnaire was administered at the Annual Meeting of ­Cardiovascular and Interventional Radiology Society of Europe in 2016. In total, 153 respondents volunteered to fill out the survey, among them 125 (interventional) radiologists with experience in needle placement. Results: 1) Current challenges in needle placement include patient-specific and technical factors. Movement of the target due to breathing makes it most difficult to place a needle (90%). 2) The mean maximal allowable needle placement error in targeted lesions is 2.7 mm. A majority of the respondents (85%) encounter unwanted needle bending upon insertion. The mean maximal encountered unwanted needle bending is 5.3 mm. 3) Needles in interventional radiology need improvement, eg, improved needle visibility and manipulability, according to 95% of the respondents. Added value for steerable needles in current interventions is seen by 93% of the respondents. Conclusion: Steerable needles have the potential to add clinical value to radiologic interventions. The current data can be used as input for defining clinical design requirements for technical tools, such as steerable needles and navigation models, with the aim to improve needle placement in interventional radiology. [ABSTRACT FROM AUTHOR]

A range of complex percutaneous procedures, such as biopsy or regional anesthesia, rely heavily on accurate needle insertion. Small variations in the mechanical properties of the pierced tissue can however cause deviations from the projected needle path and can thus result in inaccurate placement of the needle. Navigation of a rigid needle towards the target tissue is traditionally based on the surgeons capacity to interpret small variations in the needle insertion force. A more accurate measurement of these small force variations enables improvement in needle targeting, can potentially aid in enhancing force feedback in robotic needle placement and can provide valuable information on tissue-tool interaction. In this study we investigated several concepts for the design of a force sensor based on a fiber-optic Fabry-Pérot interferometer to measure needle-tissue interaction forces on the tip of a 18 G needle, where special attention was given to concepts for a sensor with (1), an intrinsic low cross-sensitivity to temperature and (2), elementary design and fabrication. Three concepts, using either a quartz capillary, an Invar capillary or a thin polyimide film as the force sensitive element were prototyped and subjected to both static and dynamic testing. The force transducer based on a quartz capillary presented the lowest cross-sensitivity to temperature (12mN/°C) and good accuracy (maximum measurement error of 65mN/10N) in a measurement of static forces. However, limited strength of the sensor is expected to prevent usage of the quartz capillary in small diameter needles. The concepts for a sensor based on an Invar capillary or a thin polyimide film proved a higher cross-sensitivity to temperature (50mN/°C and 220mN/°C, respectively) and higher maximum measurement error (350mN/10N, 800mN/10N), comparable to those of FBG-based sensors reported in literature, but are likely to be more suitable for integration in very small biopsy needles. [ABSTRACT FROM AUTHOR]

Purpose: Accurate and precise needle placement is of utmost importance in interventional radiology. However, targeting can be challenging due to, eg, tissue motion and deformation. Steerable needles are a possible solution to overcome these challenges. The present work studied the clinical need for steerable needles. We aimed to answer three subquestions: 1) What are the current challenges in needle placement? 2) What are allowable needle placement errors? and 3) Do current needles need improvement and would steerable needles add clinical value?, Methods: A questionnaire was administered at the Annual Meeting of Cardiovascular and Interventional Radiology Society of Europe in 2016. In total, 153 respondents volunteered to fill out the survey, among them 125 (interventional) radiologists with experience in needle placement., Results: 1) Current challenges in needle placement include patient-specific and technical factors. Movement of the target due to breathing makes it most difficult to place a needle (90%). 2) The mean maximal allowable needle placement error in targeted lesions is 2.7 mm. A majority of the respondents (85%) encounter unwanted needle bending upon insertion. The mean maximal encountered unwanted needle bending is 5.3 mm. 3) Needles in interventional radiology need improvement, eg, improved needle visibility and manipulability, according to 95% of the respondents. Added value for steerable needles in current interventions is seen by 93% of the respondents., Conclusion: Steerable needles have the potential to add clinical value to radiologic interventions. The current data can be used as input for defining clinical design requirements for technical tools, such as steerable needles and navigation models, with the aim to improve needle placement in interventional radiology., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms. The length, the steepness relative to the skin, and the distance between the parallelograms were varied. The influence of the chosen point of insertion of the needle on the range of angles at which the epidural and subarachnoid space could be reached was studied. The optimal point of insertion was defined as the point where this range is the widest. The geometrical model clearly demonstrated, that the range of angles at which the epidural or subarachnoid space can be reached, is dependent on the point of insertion between the tips of the adjacent spinous processes. The steeper the spinous processes run, the more cranial the point of insertion should be. Assuming that the model is representative for patients, the performance of neuraxial blockade using a midline approach might be improved by choosing the optimal point of insertion.