Experimental study of angiography using vascular interventional robot-2(VIR-2) / 中华外科杂志

<p><b>OBJECTIVE</b>To verify the feasibility and safety of new vascular interventional robot system used in vascular interventional procedures.</p><p><b>METHODS</b>Vascular interventional robot type-2 (VIR-2) included master-slave parts of body propulsion system, image navigation systems and force feedback system, the catheter movement could achieve under automatic control and navigation, force feedback was integrated real-time, followed by in vitro pre-test in vascular model and cerebral angiography in dog. Surgeon controlled vascular interventional robot remotely, the catheter was inserted into the intended target, the catheter positioning error and the operation time would be evaluated.</p><p><b>RESULTS</b>In vitro pre-test and animal experiment went well; the catheter can enter any branch of vascular. Catheter positioning error was less than 1 mm. The angiography operation in animal was carried out smoothly without complication; the success rate of the operation was 100% and the entire experiment took 26 and 30 minutes, efficiency was slightly improved compared with the VIR-1, and the time what staff exposed to the DSA machine was 0 minute. The resistance of force sensor can be displayed to the operator to provide a security guarantee for the operation. No surgical complications.</p><p><b>CONCLUSIONS</b>VIR-2 is safe and feasible, and can achieve the catheter remote operation and angiography; the master-slave system meets the characteristics of traditional procedure. The three-dimensional image can guide the operation more smoothly; force feedback device provides remote real-time haptic information to provide security for the operation.</p>

Magnetic resonance spectroscopy-guided stereotactic biopsy for brain lesion / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of magnetic resonance spectroscopy (MRS) image in stereotactic biopsy for brain lesion.</p><p><b>METHODS</b>From April 2008 to April 2010, 126 cases (72 male and 54 female, aged from 10 to 82 years, mean 45 years) of brain lesion which were difficult to diagnose were divided into two groups by random number table, 62 cases were executed for MRI-guided frameless stereotactic biopsy (MRI group), 64 cases were executed for MRI and MRS-guided frameless stereotactic biopsy (MRS group). Operation used MRI and Three-dimensional MRS image to locate, and used frameless CAS-R-2 robots to carry out the positioning operating.</p><p><b>RESULTS</b>No surgery-related deaths and infections. Pathological diagnosis was 106 cases of brain tumors, 6 cases of inflammatory disease, 4 cases of tumor-like demyelinating disease and multiple sclerosis, 3 cases of neurodegenerative disease, 7 cases failed to obtain positive pathological diagnosis. The total rate of positive diagnosis was 94.4%, the positive rate in MRS-guided stereotactic biopsy group was 98.4% (63/64), the positive rate of conventional MRI-guided biopsy group was 90.3% (56/62), and there was statistically significant difference between the two groups (χ(2) = 3.92, P = 0.047). Four cases presented with postoperative complications, the complication rate was 3.2% (4/126); the complications were cerebral hemorrhage associated with aphasia, epilepsy, subcutaneous hematoma, gastrointestinal bleeding, which were improved after treatment.</p><p><b>CONCLUSIONS</b>MRS-guided stereotactic biopsy group has a higher positive rate than MRI-guided stereotactic biopsy group, indicating that this method can improve the positive rate of diagnosis, and thus will help to formulate treatment plan for brain lesion.</p>

Effects of low-frequency magnetic stimulation on proliferation and differentiation of human neural stem cells in vitro / 第二军医大学学报

Objective: To investigate the effects of different magnetic simulations on cell proliferation, cell cycle, apoptosis, and cell differentiation of human fetal neural stem cell in vitro. Methods: Isolated neural stem cells were exposed to magnetic stimulation (with a frequency of 0.5 Hz, a wave wide of 72 μs and an intensity of 1.44 Tesla) once daily for 3 days. The cells were divided into three groups according to the pulses of magnetic stimulation each time: A group (thirty pulses each time), B group (sixty pulses each time), C group (ninety pulses each time) and D group (control group). MTT assay was applied to detect the proliferation activity of the neural stem cells, and flow cytometry was employed to detect the effect of magnetic stimulation on cell cycle, cell apoptosis, and cell differentiation. Results: The D values of neural stem cells in A, B, and C groups were significantly higher than those in the control group 24 to 48 hours after stimulation(P<0.05), indicating a slightly promoted proliferation of neural stem cells after magnetic stimulation. The proportions of G0/G1 phase cells of A, B, and C groups were less than those of the control group, and the proportion of G2/M-phase cells was higher than that of the control group. The proportions of β-tuberlin positive neurons in A, B, and C groups were higher than those in the control group as demonstrated by flow cytometry, and the proportion of neurons increased from 21.70% to 34.17% (P<0.05). Conclusion: Under proper condition, magnetic simulation can slightly promote cell proliferation and can induce neural stem cell differentiation into neurons in vitro, which may benefit neural function reconstruction.

Experimental study of angiography using vascular interventional robot / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility and safety of vascular interventional surgery by using vascular interventional robot system (VIRS).</p><p><b>METHODS</b>VIRS included image navigation systems and body propulsion systems, and adopted a master-slave structure. The surgeon sat at the master site, sending controlling instructions to the robot fixed at the slave site, and then the robot translated these instructions into catheter motion. A 3D vascular model was reconstructed so that the surgeon can perform surgical planning easily. In glass model and animal experiments, the surgeon remotely controlled VIRS, which inserted a catheter into predefined targets, and the catheter positioning error and robotic surgery time were measured.</p><p><b>RESULTS</b>The robot was initially tested on a glass vascular model. Under robotic manipulation, the catheter could enter an arbitrary branch of the vascular model. The catheter positioning error was less than 1 mm. Then robotic interventional surgery was performed successfully in ten adult dogs. The renal artery and the vertebral artery angiography carried out smoothly without complication. Experiment took 35 minutes, and the time what staff exposed to the digital subtraction angiography (DSA) machine was 0 minute.</p><p><b>CONCLUSION</b>Vascular interventional surgical robot system is safe and feasible, and can achieve the catheter remote operation, meet the requirements of angiography basically.</p>

Clinical analysis of 1434 cases of frameless stereotactic operation / 中华外科杂志

<p><b>OBJECTIVE</b>Stereotactic operations were performed using a frameless stereotactic instrument manufactured by CAS-R-2 instead of traditional stereotactic frame. The aim of this study was to assess the clinical usefulness, accuracy and safety of frameless stereotactic instrument.</p><p><b>METHODS</b>The clinical data of 1434 patients was retrospectively reviewed. The mean age was 30.7 years (from 0.2 to 89.0 years). Each patient underwent frameless CT/MRI image-guided stereotactic surgery by this robot system from January 1997 to January 2006. The accuracy of position and improvement of symptom were observed. The averaged period of followed-up was 24 months (from 3 to 48 months).</p><p><b>RESULTS</b>The surgical procedures were performed successfully in all cases. All targets were pointed accurately at first time during the operation. The total effective rate was 93.3% without serious operation related complications.</p><p><b>CONCLUSIONS</b>Compared with the traditional stereotactic operations, this method has some advantages, such as releasing the patient's pain, convenience the doctors, extending the range of indications and increasing the safety and effective of operation.</p>

Clinical application of robotic tele-manipulation system in stereotactic surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical usefulness, accuracy, and safety of tele-manipulation for frameless stereotactic surgery using the CAS-R-5 robot system.</p><p><b>METHODS</b>We prospectively evaluated 32 patients underwent tele-manipulation of frameless stereotactic operations from Sep. 2005 to Sep. 2006. Tele-manipulations were performed via a digital data network by a neurosurgeon in Beijing while the patients were located in Yan'an. The distance is 1300 kilometers away. The accuracy of location and improvement of symptom were observed after operation. The period of follow-up was from 3 to 14 months (the average was 12 months).</p><p><b>RESULTS</b>The surgical operations in 32 cases were successful. Remote fiducial registration was performed with a mean accuracy of 1. 50 mm and the standard difference were 0.32 mm between the planned and actual target. There were no complications.</p><p><b>CONCLUSIONS</b>Diagnosis and treatment for intracranial disease by tele-manipulation frameless stereotactic surgeries are reliable and safe.</p>