Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty.

BACKGROUND: To enhance the reproducibility of aortic valve-sparing reimplantation and annuloplasty, we analyzed the topographic relationship between the ventriculoaortic junction (VAJ), basal ring (BR), and sinotubular junction (STJ). The root base thickness is also quantified. METHOD: Fifty-eight fresh human aortic valves were analyzed. The root was dissected to the limit where the aortic wall terminates into the cardiac structures (VAJ). Root height was measured externally from the STJ to the VAJ and internally from the STJ to the BR defined as the plane passing through the cusps nadir. The root base thickness was measured at the BR and orthogonal to the internal wall; except at the right coronary sinus, where it was measured between the BR internally and the VAJ externally. Measurements were taken at the middle of the 3 sinuses and commissures. RESULTS: The VAJ is at the same level as the BR from the noncoronary sinus (-0.1 ± 0.9 mm) to the left coronary sinus (0.5 ± 1.3 mm); it is above the BR from the left/right commissure (4.6 ± 1.4 mm) to the right/non commissure (2.5 ± 1.6 mm). The external root height was highest at the non/left commissure (21.5 ± 2.6 mm) followed by the right/non commissure (19.2 ± 2.3 mm) then the left/right commissure (15.7 ± 2.2 mm) (P < .05). The mean root base thickness was 3.2 mm, ranging from 1 ± 0 mm at the left/non commissure to 6.2 ± 1.2 mm at the right coronary sinus (P < .001). CONCLUSIONS: The VAJ is not planar; it is above the level of the BR from the left/right to the right/non commissure. As a consequence, the external height of the non/left commissure is greater than the other 2 commissures. These findings should be taken into consideration when performing aortic valve-sparing reimplantation or external annuloplasty.

3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity.

An original technique was developed to correct distal humerus malunion using a three-dimensional computer-assisted planning and a custom-made surgical guide. The technique was used in three cases (two with cubitus varus and one with cubitus valgus).A CT-scan of the distal humerus was obtained. The correction was simulated by software. A three-dimensional model of the patient's affected humerus was created by rapid prototyping, allowing creation of a surgical guide and premoulding of the osteosynthesis plate. At the time of surgery, the sterilised guide was placed on the surface of the bone to guide the saw blade. Osteosynthesis was performed using the moulded plate. At the latest follow-up, all three patients were asymptomatic and had regained full elbow mobility. Satisfying correction was obtained in all three cases. One complication was encountered: a postoperative infection that healed with plate removal and systemic antibiotic administration. Using an osteotomy guide facilitates three-dimensional humeral correction. This technique presents several benefits: it decreases the operating time and minimizes the surgical incision. Fluoroscopy is unnecessary during the procedure and accuracy is increased. Disadvantages are the time for planning and guide confection, the need of a CT-scanner and the increased cost.

Development and first in vivo trial of EvoLap, an active laparoscope positioner.

To determine essential specifications for an active endoscope holder, a survey of laparoscopic procedures was conducted. A review of the literature highlighted the advantages and limitations of existing scope-holding systems. From this analysis, basic requirements were listed for such devices. Pursuant to this, an ergonomic and user-friendly laparoscope manipulator was designed to assist the surgeon. A first in vivo procedure demonstrated feasibility of the device and its value in clinical practice, enabling surgeons to work more comfortably.

Design and preliminary in vivo validation of a robotic laparoscope holder for minimally invasive surgery.

BACKGROUND: Manual manipulation of the camera is a major source of difficulties encountered by surgeons while performing minimally invasive laparoscopic surgery. METHODS: A survey of laparoscopic procedures and a review of existing active and passive holders were conducted. Based on these analyses, essential requirements were highlighted for such devices. Pursuant to this, a novel active laparoscope manipulator was designed, paying particular attention to ergonomics and ease of use. Several trials on the pelvitrainer and a first in vivo procedure were performed to validate the original design of our device. RESULTS: Phantom experiments demonstrated ease of use of the robot and advantages of the intuitive joystick with omnidirectional displacements and speed control. The compactness of the device and image stability were appreciated during the surgical trial. CONCLUSIONS: A novel robotic laparoscope holder has been developed and produced. An in vivo trial proved its value in clinical practice, enabling surgeons to work more comfortably.