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Objective: During nerve-sparing robot-assisted radical prostatectomy (RARP) bipolar electrocoagulation is often used but its use is controversial for the possible thermal damage of neurovascular bundles. Aim of the study was to evaluate the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled, CO2-rich environment modelling the laparoscopy conditions.. Methods: We manufactured a sealed plexiglass chamber (SPC) equipped with sensors to reproduce experimentally the environmental conditions of pneumoperitoneum during RARP. We evaluated in 64 pig musculofascial tissues (PMTs) of approximately 3 cm3 × 3 cm3 × 2 cm3 the spatial-temporal thermal distribution in the tissue and the correlation with the electrosurgery-induced tissue damage in a controlled CO2-rich environment modeling the laparoscopy conditions. Critical heat spread of bipolar cauterizing during surgical procedure was assessed by the employment of a compact thermal camera (C2) with a small core sensor (60 × 80 microbolometer array in the range 7-14 µm). Results: Bipolar instruments used at 30 W showed a thermal spread area of 18 mm2 when applied for 2 s and 28 mm2 when applied for 4 s. At 60 W, bipolar instruments showed a mean thermal spread and 19 mm2 when applied for 2 s; and 21 mm2 when applied for 4 s. Finally, histopathological analysis showed that thermal damage is distributed predominantly on the surface rather than in depth. Conclusions: The application of these results is very interesting for the definition of an accurate use of bipolar cautery during nerve-sparing RARP. It demonstrates the feasibility of using miniaturized thermal sensors, thus addressing the potential for next developments regarding the design of thermal endoscopic devices for robotic use.

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PURPOSE: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.

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Background: The first modern cystoscope was developed with the invention of rod lens and optical fibers in the 1960s. Since then, many advances have been made in functionality and camera image analysis. The cost of purchasing equipment and volume of the endoscopic tower remains a challenge and a barrier to the spread of cystoscopy. Urinary tract injury is a significant complication in women undergoing gynecologic surgery. Selective intraoperative cystoscopy at laparoscopic hysterectomy or complex pelvic surgery is valuable for recognizing lower urinary tract injuries. We have developed a novel wireless cystoscope for performing diagnostic and operative cystoscopy. Methods: The new wireless cystoscopic setup consists of a rigid cystoscope 4 mm, 30° that joins a modified action camera to a c-mount adapter f 18-35 mm and a portable led light source. Results: The new setup has so far been effectively used in more than 50 diagnostic cystoscopies and pigtail catheter replacements without complications. Two cases performed with the new setup are presented in the video. Conclusions: The new cystoscopic setup has the advantage of a wireless video camera, 4K ultraHD, and is easy setup. Due to its low cost and portability, the wireless cystoscope is easy to obtain and use. Also, it is invaluable and ergonomic in managing the integrity or pathology of the bladder, urethra, and ureters.

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PURPOSE: Surgical treatments for low-rectal cancer require careful considerations due to the low location of cancer in rectums. Successful surgical outcomes highly depend on surgeons' ability to determine clear distal margins of rectal tumors. This is a challenge for surgeons in robot-assisted laparoscopic surgery, since tumors are often concealed in rectums and robotic surgical instruments do not provide tactile feedback for tissue diagnosis in real time. This paper presents the development and evaluation of an intraoperative ultrasound-based augmented reality framework for surgical guidance in robot-assisted rectal surgery. METHODS: Framework implementation consists in calibrating the transrectal ultrasound (TRUS) and the endoscopic camera (hand-eye calibration), generating a virtual model and registering it to the endoscopic image via optical tracking, and displaying the augmented view on a head-mounted display. An experimental validation setup is designed to evaluate the framework. RESULTS: The evaluation process yields a mean error of 0.9 mm for the TRUS calibration, a maximum error of 0.51 mm for the hand-eye calibration of endoscopic cameras, and a maximum RMS error of 0.8 mm for the whole framework. In the experiment with a rectum phantom, our framework guides the surgeon to accurately localize the simulated tumor and the distal resection margin. CONCLUSIONS: This framework is developed with our clinical partner, based on actual clinical conditions. The experimental protocol and the high level of accuracy show the feasibility of seamlessly integrating this framework within the surgical workflow.

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Surgical cameras are prevalent in modern operating theatres and are often used as a surrogate for direct vision. Visualisation techniques (e.g. image fusion) made possible by tracking the camera require accurate hand-eye calibration between the camera and the tracking system. The authors introduce the concept of 'guided hand-eye calibration', where calibration measurements are facilitated by a target registration error (TRE) model. They formulate hand-eye calibration as a registration problem between homologous point-line pairs. For each measurement, the position of a monochromatic ball-tip stylus (a point) and its projection onto the image (a line) is recorded, and the TRE of the resulting calibration is predicted using a TRE model. The TRE model is then used to guide the placement of the calibration tool, so that the subsequent measurement minimises the predicted TRE. Assessing TRE after each measurement produces accurate calibration using a minimal number of measurements. As a proof of principle, they evaluated guided calibration using a webcam and an endoscopic camera. Their endoscopic camera results suggest that millimetre TRE is achievable when at least 15 measurements are acquired with the tracker sensor ∼80 cm away on the laparoscope handle for a target ∼20 cm away from the camera.