A simple and miniaturized optical tactile sensor for integrating with robotic and manual minimally invasive surgery graspers is proposed in this study. For better miniaturization, the sensing principle of constant-bending-radius light intensity modulation was replaced with a variable-bending-radius modulation principle, and the pertinent theoretical formulation was derived. Afterward, a finite element model of the sensor was optimized using response surface optimization technique. The optimized sensor design was 14.0 mm long, 1.8 mm wide and 4 mm high. Next, the sensor was prototyped using SLA 3D printing technique. Also, the sensor was calibrated using a rate-dependent learning-based support-vector-regression algorithm. Calibration was 96% linear with a goodness-of-fit of 93% and mean absolute error of 0.085±0.096 N. Furthermore, the sensor was tested under cyclic triangular compression with a 3 sec pause between loading and unloading as well as manual grasping. Mean absolute error of 0.12±0.08 N, the minimum force of 0.14 N, and repeatability of 0.07 N showed the acceptable performance of the proposed sensor for surgical applications. Moreover, the sensor showed the capability of working under combined dynamic and static loading conditions with low hysteresis, i.e., 0.057 $\frac {N}{\textit {cycle}}$ .

Miniaturized Optical Force Sensor for Minimally Invasive Surgery With Learning-Based Nonlinear Calibration

Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Background Artificial reality technologies are currently being explored as potential options to improve surgical education. Previous studies have primarily examined the efficacy of artificial reality in laparoscopic procedures, but to our knowledge, none have been performed in orthopaedically relevant procedures such as intramedullary tibial nailing, which calls for more versatile large-scale movements. Questions/purposes Does a virtual reality simulator with or without a standard technique guide result in (1) a higher proportion of participants who completed the insertion of an intramedullary tibial nail in a synthetic bones model and (2) greater procedural accuracy than does training with a technique guide alone? Methods Twenty-five first- and second-year medical students without prior exposure to intramedullary tibial nail insertion were recruited. Participants were randomly assigned to the technique guide control group (n = 8), the virtual reality group (n = 8), or the virtual reality and technique guide group (n = 9). The technique guide was adapted from a commercially available technique guide, which participants in the assigned groups could use to prepare as much as desired. The virtual reality simulation was based on the same procedure, and we used a commercially available virtual reality simulator that we purchased for this task. Participants in the virtual reality experimental groups completed the simulation on three separate sessions, at a set interval of 3 to 4 days apart. After 10 to 14 days of preparation, all participants attempted to insert an intramedullary nail into an intact, compact bone-model tibia that lacked surrounding soft tissue. Participants were given written hints if requested, but no other assistance was given. A procedure was considered complete if the nail and screw were properly placed. Procedural accuracy was defined as the number of incorrect steps normalized out of the 16 possible performed. After the procedure, one orthopaedic surgeon assessed a blinded video of the participant performing it so the assessor could not recognize the individual or that individual's gender. Additionally, the assessor was unaware of which group each participant had been randomized to during the evaluation. Results A higher proportion of participants in the virtual reality group (6 of 8) and the virtual reality and technique guide group (7 of 9) completed the intramedullary nail than did participants in the technique guide group (2 of 8; p = 0.01). There was no difference in completion between the virtual reality groups (p = 0.89). Participants in the virtual reality and virtual reality and technique guide had fewer normalized incorrect steps than did participants in the technique guide group (3.2 ± 0.1 of 16 and 3.1 ± 0.1 of 16 versus 5.7 ± 0.2 of 16, respectively; p = 0.02 for comparisons of virtual reality groups to technique guide, p = 0.63 between the virtual reality group). Conclusions Virtual reality increased both procedural accuracy and the completion proportion compared with a technique guide in medical students. Based on our findings, virtual reality may help residents learn the procedural workflow and movements required to perform surgical procedures. Future studies should examine how and when exactly the technology can be applied to residencies and its impact on residents. Level of evidence Level I, therapeutic study.

Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial.

Haptic devices have a high potential for delivering tailored training to novices. These devices can simulate forces associated with real-world tasks, or provide guidance forces that convey task completion and learning strategies. It has been shown, however, that providing both task forces and guidance forces simultaneously through the same haptic interface can lead to novices depending on guidance, being unable to demonstrate skill transfer, or learning the wrong task altogether. This paper presents a novel solution whereby task forces are relayed via a kinesthetic haptic interface, while guidance forces are spatially separated through a cutaneous skin stretch modality. We explore different methods of delivering cutaneous based guidance to subjects in a dynamic trajectory following task. We next compare cutaneous guidance to kinesthetic guidance, as is traditional to spatially separated assistance. We further investigate the role of placing cutaneous guidance ipsilateral versus contralateral to the task force device. The efficacies of each guidance condition are compared by examining subject error and movement smoothness. Results show that cutaneous guidance can be as effective as kinesthetic guidance, making it a practical and cost-effective alternative for spatially separated assistance.

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Spatially Separating Haptic Guidance From Task Dynamics Through Wearable Devices

Many modern advancements have taken place in dentistry that have exponentially impacted the progress and practice of dentistry. Augmented reality (AR) and virtual reality (VR) are becoming the trend in the practice of modern dentistry because of their impact on changing the patient’s experience. The use of AR and VR has been beneficial in different fields of science, but their use in dentistry is yet to be thoroughly explored, and conventional ways of dentistry are still practiced at large. Over the past few years, dental treatment has been significantly reshaped by technological advancements. In dentistry, the use of AR and VR systems has not become widespread, but their different uses should be explored. Therefore, the aim of this review was to provide an update on the contemporary knowledge, to report on the ongoing progress of AR and VR in various fields of dental medicine and education, and to identify the further research required to achieve their translation into clinical practice. A literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for articles in peer-reviewed English-language journals published in the last 10 years up to 31 March 2021, with the help of specific keywords related to AR and VR in various dental fields. Of the total of 101 articles found in the literature search, 68 abstracts were considered suitable and further evaluated, and consequently, 33 full-texts were identified. Finally, a total of 13 full-texts were excluded from further analysis, resulting in 20 articles for final inclusion. The overall number of studies included in this review was low; thus, at this point in time, scientifically-proven recommendations could not be stated. AR and VR have been found to be beneficial tools for clinical practice and for enhancing the learning experiences of students during their pre-clinical education and training sessions. Clinicians can use VR technology to show their patients the expected outcomes before the undergo dental procedures. Additionally, AR and VR can be implemented to overcome dental phobia, which is commonly experienced by pediatric patients. Future studies should focus on forming technological standards with high-quality data and developing scientifically-proven AR/VR gadgets for dental practice.

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Augmented Reality and Virtual Reality in Dentistry: Highlights from the Current Research

Haptic Feedback, Force Feedback, and Force-Sensing in Simulation Training for Laparoscopy: A Systematic Overview

Training in Basic Laparoscopic Surgical Skills: Residents Opinion of the New Nintendo Wii-U Laparoscopic Simulator

To analyze outcomes of nationwide local audits of uterine rupture to draw lessons for clinical care.

Lessons learned from the perinatal audit of uterine rupture in the Netherlands: A mixed‐method study

OBJECTIVE
To evaluate the incidence, diagnostic management strategies and clinical outcomes of women with spontaneous haemoperitoneum in pregnancy (SHiP) and reassess the definition of SHiP.


DESIGN
A population-based cohort study using the Netherlands Obstetric Surveillance System (NethOSS).


SETTING
Nationwide, the Netherlands.


POPULATION
All pregnant women between April 2016 and April 2018.


METHODS
This is a case study of SHiP using the monthly registry reports of NethOSS. Complete anonymised case files were obtained. A newly introduced online Delphi audit system (DAS) was used to evaluate each case, to make recommendations on improving the management of SHiP and to propose a new definition of SHiP.


MAIN OUTCOME MEASURES
Incidence and outcomes, lessons learned about clinical management and the critical appraisal of the current definition of SHiP.


RESULTS
In total, 24 cases were reported. After a Delphi procedure, 14 cases were classified as SHiP. The nationwide incidence was 4.9 per 100 000 births. Endometriosis and conceiving after artificial reproductive techniques were identified as risk factors. No maternal and three perinatal deaths occurred. Based on the DAS, adequate imaging of free intra-abdominal fluid, and identifying and treating women with signs of hypovolemic shock could improve the early detection and management of SHiP. A revised definition of SHiP was proposed, excluding the need for surgical or radiological intervention.


CONCLUSIONS
SHiP is a rare and easily misdiagnosed condition that is associated with high perinatal mortality. To improve care, better awareness among healthcare workers is needed. The DAS is a sufficient tool to audit maternal morbidity and mortality.

Evelien M. Overtoom

Papers

Haptic Feedback, Force Feedback, and Force-Sensing in Simulation Training for Laparoscopy: A Systematic Overview

Training in Basic Laparoscopic Surgical Skills: Residents Opinion of the New Nintendo Wii-U Laparoscopic Simulator

Lessons learned from the perinatal audit of uterine rupture in the Netherlands: A mixed‐method study

Spontaneous Haemoperitoneum in Pregnancy: Nationwide Surveillance and Delphi Audit System.