Tag Archives: surgery

Most appendicitis surgeries can be avoided with antibiotics, reports the largest trial yet on the subject

Antibiotics are an effective first-line treatment for most cases of appendicitis, according to the American College of Surgeons.

Image credits Steve Buissinne.

The decision is based on the results from the Comparing Outcomes of antibiotic Drugs and Appendectomy (CODA) trial, the largest randomized medical trial of appendicitis treatments ever performed. It included 25 hospitals across 14 states, totaling 1,552 patients with appendicitis. These participants were then randomized to undergo an appendectomy (surgery to remove the appendix) or follow an antibiotics course.

While both approaches had their advantages and downsides, the overall conclusion of the CODA trial is that both are safe to use and efficient in treating the condition.

Noninvasive is fine

“In the first three months after taking antibiotics for the condition, nearly 7 in 10 patients in the antibiotic group avoided an appendectomy. By four years, just under 50% had the surgery,” said Dr. David Flum, co-principal investigator and professor and associate chair of surgery at the University of Washington (UW) School of Medicine. “Other outcomes favored either antibiotics or surgery. Putting it all together, antibiotics look to be the right treatment for many, but probably not all, patients with appendicitis.”

“While there were advantages and disadvantages to each treatment, we found that both treatments are safe, and patients will likely value these outcomes differently based on their unique symptoms, concerns, and circumstances,” he adds.

The authors note that one of the most important factors regarding the efficacy of antibiotics for these patients was the presence of appendicoliths, calcified deposits found in about one-quarter of patients with acute appendicitis. Patients with appendicoliths had a higher chance of experiencing complications and a higher likelihood of needing an appendectomy during the first 30 days of treatment than their peers.

However, by the 90-day mark, this group of patients had no greater chance of needing an appendectomy than other appendicitis patients enrolled in the trial.

The percentage of patients in the antibiotics group who later underwent appendectomy was 40% at 1 year and 46% at the 2-year mark. This percentage was higher in patients with appendicoliths.

Overall, however, these findings are quite encouraging. Appendicitis is generally treated as an emergency, and the standard treatment approach is surgery, to have it removed. In most cases, even the suspicion that a patient might have appendicitis is cause enough for a doctor to send them into surgery, in a bid to avoid the possible complications caused by the rupturing of an inflamed appendix.

Needless to say, nobody likes undergoing surgery. The results of this trial show that antibiotics are an effective treatment option for a majority of cases. Patients and doctors should work together to discuss the best treatment approach. On the one hand, this would help improve the quality of life for appendicitis patients; on the other, it will free up medical resources which can be used on other essential surgeries.

“Given these results and new treatment guidelines, it is important for surgeons and patients to discuss the pros and cons of both surgery and antibiotics in deciding on the treatment that’s best for that person at that time,” said Dr. Giana Davidson, associate professor of surgery at UW and director of the CODA trial’s clinical coordinating center.

Towards that end, the CODA team put together an online decision-making tool for patients (http://www.appyornot.org) to help them better decide what option is right for them. The site includes videos in English and Spanish discussing the issue — other languages will be included in the future — to help inform them on the nuances of this choice.

“In the emergency setting, patients with appendicitis can make a treatment decision hurriedly,” Davidson said. “This online tool was built to help communicate the CODA results in laymen’s terms, and to spur a conversation between patients and surgeons about potential benefits and harms of each approach.”

The paper “Antibiotics versus Appendectomy for Acute Appendicitis — Longer-Term Outcomes” has been published in The New England Journal of Medicine.

COVID-19 might cancel more than 28 million surgeries worldwide

Credit: Pixabay.

One of the most insidious things about the coronavirus crisis is that it can ruin people’s lives without the virus needing to infect them. Whether it’s amplifying underlying mental illness due to isolation or losing one job when living paycheck-to-paycheck, the pandemic is disrupting livelihoods in a manner that hasn’t been seen before during our lifetimes.

Those who stand to lose the most are perhaps non-coronavirus patients who were about to undergo surgery. Indeed, as COVID-19 cases became the centerpiece of healthcares systems around the world, a staggering amount of surgeries have had to be canceled or postponed.

According to a new study led by researchers at the University of Birmingham in the UK, as many as 28.4 million elective surgeries around the world will be canceled in 2020.

This projection is based on activity — or lack of it — during a 12-week period of peak disruption to hospital services due to COVID-19. The model put together by the research team suggests that each additional week of disruption to hospital services results in a further 2.4 million canceled surgeries, some of which are for life-threatening afflictions like cancers.

“During the COVID-19 pandemics elective surgeries have been cancelled to reduce the risk of patients being exposed to COVID-19 in hospital, and to support the wider hospital response, for example by converting operating theatres in to intensive care units,” said Mr. Aneel Bhangu, Consultant Surgeon and Senior Lecturer at the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham.

“Although essential, cancellations place a heavy burden on patients and society. Patients’ conditions may deteriorate, worsening their quality of life as they wait for rescheduled surgery. In some cases, for example cancer, delayed surgeries may lead to a number of unnecessary deaths.”

Overall, around 73% of all planned surgeries worldwide would be canceled during a peak 12-week disruption due to COVID-19.

The most frequently canceled or postponed surgeries are orthopedic-related procedures, which would amount to 6.3 million surgeries. Canceled cancer-related surgeries would number around 2.3 million globally.

Earlier this week, another study found that the crisis has dramatically reduced the number of organ transplants. In the United States, the drop in the number of transplants from deceased donors was about 50% while France experienced a staggering 91% drop in transplants.

This year may see even more disruption to potentially life-saving surgeries if countries experience a second wave of infection on par or worse than seen in February and March.

In the UK alone, it is estimated that 516,000 surgeries have been canceled, 36,000 of which were cancer procedures.

The researchers estimate that it would take the UK 11 months to clear the backlog of canceled or postponed surgeries if the NHS somehow manages to increase the number of surgeries performed each by 20% compared to pre-pandemic activity.

“Each additional week of disruption to hospital services results in an additional 43,300 surgeries being cancelled, so it is important that hospitals regularly assess the situation so that elective surgery can be resumed at the earliest opportunity,” said Dr. Dmitri Nepogodiev, Research Fellow at the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham.

“Clearing the backlog of elective surgeries created by COVID-19 will cost the National Health Service at least £2 billion. The Government must ensure that the NHS is provided with additional funding and resources to ramp up elective surgery to clear the backlog.”

The findings were reported in the British Journal of Surgery.

Remote-controlled microrobots could be the future of medicine

One of the primary goals in the modern medical field is to create microrobots that can enter the human body and replace invasive and complicated surgery procedures. These robots could optimize the field of medicine by giving scientists and doctors the ability to deliver drugs at specific locations and perform precise operations.

Image credit Pixabay

Image credit Pixabay

Along with researchers from the Swiss Federal Institute of Technology in Zurich (ETHZ), scientists from the Ecole Polytechnique Fédérale de Lausanne (EPFL) have created such devices. The team created soft, flexible and motor-less microrobots that mimic the Trypanosoma brucei bacterium. The unique devices are composed of biocompatible hydrogel and magnetic nanoparticles that give them their unique shape and allow them to move and swim in the presence of an electromagnetic field.

The team begins the manufacturing process by placing nanoparticles inside layers of a biocompatible hydrogel. Afterwards, they apply an electromagnetic field, which results in the orientation of the nanoparticles at different regions of the robot.

Polymerization follows in order to “solidify” the composition of the hydrogel and the robot is then placed in water, where it folds into a unique shape that is dependent on the orientation of the nanoparticles inside of the gel. The final form represents the 3D architecture of the microrobot.

After the final step of the manufacturing process, these microrobots can be exposed to an electromagnetic field to make them swim or to heat to cause them to change shape and unfold. Ultimately, the final product – which possesses a bacterium-like flagellum – mirrors the T. brucei bacterium that is responsible for causing sleeping sickness.

“We show that both a bacterium’s body and its flagellum play an important role in its movement,” said Selman Sakar of the EPFL and co-author of the study. “Our new production method lets us test an array of shapes and combinations to obtain the best motion capability for a given task. Our research also provides valuable insight into how bacteria move inside the human body and adapt to changes in their microenvironment.”

Much more research is still needed until these microrobots are ready to traverse the human body to determine any potential side effects, but the promise and benefits that they could bring to the field of medicine is immense.

Journal Reference: Soft micromachines with programmable motility and morphology. 25 July 2016. 10.1038/ncomms12263

star-surgeon

This robot sutures surgical incisions like a STAR: it’s better than doctors

Human dexterity and patience are limited resources, and even the best surgeons are sometimes faced with their limits. A robot, however, doesn’t tire and can theoretically cut and suture in places the human hand can’t ever reach. Thanks to robots, surgery has gone a long way their introduction in the ’80s making operations safer and less invasive. Now, surgical robots are starting to migrate from assisting to leading roles, which is where experts say they will really shine.

star-surgeon

Credit: John Hopkins

At the forefront of this medical revolution is the Smart Tissue Autonomous Robot, or STAR. Heralded as the very first fully autonomous surgical bot, STAR stitched up a pig’s small intestines all by itself with no instructions from doctors. What’s more, STAR scored better than the human surgeons who had to perform the same task.

Paging Dr. STAR

STAR was developed by Johns Hopkins University researchers — a team that includes computer scientists, robotic engineers, and medical professionals. They say that STAR isn’t meant to replace surgeons (yet). Rather, STAR is a pioneering work that demonstrates that supervised autonomous robot surgeons can get the job done.

“Even though we surgeons take pride in our craft at doing procedures, to have a machine that works with us to improve outcomes and safety would be a tremendous benefit,” said  Peter Kim, associate surgeon in chief at Children’s National Health System in Washington.

Until recently, surgery bots have been used as a surgeon’s ‘third arm’ — an extension of human dexterity. The leading product in the field right now is the da Vinci system, which is mainly used to  perform hysterectomies and prostate removals. The da Vinci is so sensitive that it can even stitch a grape but, at the end of the day,  it’s a human surgeon who is in control while seated comfortably at a console viewing a 3-D image of the surgical field.

Few have dared leave complex soft tissue surgery at the hand of robots. That’s because soft tissue moves and changes shape in a seemingly unpredictable manner, and a surgeon always needs to adapt and respond to make a quality suture.

STAR can respond well because it has ‘surgeon’s eyes’. Near-infrared fluorescent (NIRF) are placed inside the soft tissue, like the intestines in our case, then STAR’s  NIRF camera can track those markers to keep focus on its target. Although it was programmed by humans to work based on the best surgeon’s techniques, STAR made its own surgical plan and adjusted it as the tissue moved and wiggled.

You can see on the screens in the background how STAR keeps focus of its target. Credit: John Hopkins

You can see on the screens in the background how STAR keeps focus of its target. Credit: John Hopkins

To be fair, STAR had a bit of help during the trials. The trial is called  intestinalanastomosis, and involves stitching an intestine that’s been cut through. It’s like repairing a garden hose, said Ryan Decker, the senior engineer on the team. Both STAR and human surgeons had to perform the task on ex vivo tissue in the lab, as well as on in vivo tissue in an anesthetized pig. In 40 percent of the trials, STAR was assisted by a human offering guidance of some sort, like pulling a loose thread and such. In 60 percent of the trials, STAR was fully autonomous.

“The mode we’re operating under is supervised autonomy,” said team member Axel Krieger of Children’s National. “The surgeon is overseeing and has the opportunity at any time to stop the robot and take over.” At a moment when tissue is being pierced or a delicate transition is imminent, he said, “I’m sure they wouldn’t be comfortable going off and taking a coffee break.”

KIM likens STAR with autonomous cars, like Tesla Motor’s autopilot feature.

“Now driverless cars are coming into our lives,” Kim said for IEEE. “It started with self-parking, then a technology that tells you not to go into the wrong lane. Soon you have a car that can drive by itself.”

The research appeared in the journal Science Translational Medicine.

 

BYU Professor of Mechanical Engineering Spencer Magleby looks over origami-inspired surgical devices. Credit: Mark Philbrick

Using origami, scientists are making the smallest surgical tools yet

Mechanical engineers at Brigham Young University are combining the versatility of origami with mechanical know-how to produce the smallest surgical tools. Their spatial resolution is so large that soon we could make incisions so subtle that they heal themselves, without sutures. All of this without compromising surgical quality.

BYU Professor of Mechanical Engineering Spencer Magleby looks over origami-inspired surgical devices. Credit: Mark Philbrick

BYU Professor of Mechanical Engineering Spencer Magleby looks over origami-inspired surgical devices. Credit: Mark Philbrick

“The whole concept is to make smaller and smaller incisions,” said Larry Howell, a mechanical engineering professor at Brigham Young. “To that end, we’re creating devices that can be inserted into a tiny incision and then deployed inside the body to carry out a specific surgical function.”

The traditional way of going about making surgical tools has been the same for centuries, and right now the industry has reached its limits as far as miniaturization is concerned. By relying on the deflection inherent in origami to create motion, BYU researchers have eliminated key parts previously thought indispensable like pin joints. One day, these sort of origami-inspired tools could become so sensitive that things as small as nerves could be manipulated.

BYU student Jason Dearden helps with the origami-inspired research at BYU. Credit: Mark Philbrick

BYU student Jason Dearden helps with the origami-inspired research at BYU. Credit: Mark Philbrick

One  robotically-controlled forceps developed at BYU can pass through a whole just 3 millimeters in size. Another device, called the  D-Core, starts off flat then expands to two rounded surfaces that roll akin to spinal disc motion.

Considering how small the tools are, and consequently the incisions made, humans are also stressed to their limits. That’s why BYU is working closely with companies like Intuitive Surgical, the makers of the da Vinci Surgical System — a surgical robot. We previously showed readers how precise da Vinci can be as the machine stitched a grape. “The origami-inspired ideas really help us to see how to make things smaller and smaller and to make them simpler and simpler,”  said Spencer Magleby from BYU.

Paper: Michael R. Morgan et al. Towards developing product applications of thick origami using the offset panel technique, Mechanical Sciences (2016). DOI: 10.5194/ms-7-69-2016

Using ultrasound to operate on the brain

A preliminary study from Switzerland, published this month in the Annals of Neurology, proved the effectiveness of a new method of non-invasive brain surgery: using a newly-developed operating device that relies on ultrasound, in conjunction with magnetic resonance imaging (MRI), allowed neurosurgeons to precisely remove small pieces of brain tissue in nine patients suffering from chronic pain without removing skin or skull bone. Researchers now plan to test it on patients with other disorders, such as Parkinson’s. Neal Kassell, neurosurgeon at the University of Virginia, not directly involved in the study.

A patient undergoing treatment with the new HIFU system, under surveilance by an MRI machine.
Image via medgadget

“The groundbreaking finding here is that you can make lesions deep in the brain–through the intact skull and skin–with extreme precision and accuracy and safety,” says Neal Kassell, neurosurgeon at the University of Virginia, not directly involved in the study and chairman of the Focused Ultrasound Surgery Foundation.

High-intensity focused ultrasound (HIFU) is not the type of ultrasound used for diagnostics, or parental screening. Rather, the focused, high-intensity ultrasound beams are used to heat up and destroy pieces of diseased tissue. Currently, HIFU is used to remove small benign uterine tumors, known as fibroids, and it’s being clinically tested for removal of breast tumors and cancer tumors. Israeli company InSightec however has experimented with HIFU devices used for brain surgery, and the success of the recent Switzerland trials attest to the efficacy of the method.

When surgery feels like a hole in the head

The study involved treating nine patients suffering from acute, debilitating chronic pain that did not respond to medication, using the new technology. In such cases, the treatment is the destruction of a small piece of the thalamus, that relays messages between different brain areas. Traditionally, one of two methods can be applied to achieve this:

  1. Drill a hole in the skull, and insert an electrode intro the brain — a method known as radiofrequency ablation.
  2. Deliver a beam of focused, ionizing radiation into the targeted tissue — a method called radiosurgery.

Now, unsurprisingly, most patients choose option number 2. Kassell says that the HIFU method has several advantages over radiosurgery, as the effects of radiation on tissue can take weeks to months to manifest, whereas the thermal approach is immediate.

“The precision and accuracy [are] considerably greater with ultrasound, and it should be in principle safer in the long run,” he adds.

One downside of HIFU is that, compared to more invasive electrode neurosurgeries is that it cannot functionally test if the treated area is the correct one. With radiofrequency ablation, neurosurgeons can stimulate the cells using the electrode to verify if he or she has identified the piece of the brain responsible for the patient’s motor problems, and then destroy that piece of tissue.

“Not every functional neurosurgeon will accept this [method], because you cannot do a test before the lesion is made,” says Ferenc Jolensz, director of the Division of MRI and Image Guided Therapy Program at Brigham and Women’s Hospital in Boston.

Jolensz and collaborator Seung-Schik Yoo are currently trying to develop methods to use HIFU to modulate brain activity in a localized area, which would enable functional testing of the target area before it is destroyed. Jolensz is also studying HIFU for brain surgery and has tested the technology on four patients with brain tumors, though the results have not yet been published.

Sounds like a cure

The biggest development challenge designers had to overcome was figuring out how to focus the beams through the skull bone — its structure attenuates sound vibration and distorts their path, making the method at least ineffective, and at its worst, dangerous for the patient. InSightec’s solution was to build an array of more than 1,000 ultrasound transducers, allowing each to be individually focused.

Focused ultrasound beams heat a target in the brain, while real-time images captured by the scanner give the neurosurgeon immediate feedback on the procedure.
Image technologyreview

“You take a CT scan of the patient’s head and tailor the acoustic beam to focus through the skull,” says Eyal Zadicario, head of InSightec’s neurology program.

The device also has a built-in cooling system to prevent the skull from overheating from the vibrations.

Depending on the condition being treated, the ultrasound beams are focused on specific points in the brain which absorbs the energy and converts it to heat — about 130 degrees Fahrenheit (54.5 Celsius) of heat, to be precise, killing the cells in a region of about 10 cubic millimeters around the treated point. To ensure that the right spot is being targeted, an MRI scanner is employed at the same time as the ultrasounds.

“Thermal images acquired in real time during the treatment allow the surgeon to see where and to what extent the rise in temperature is achieved,” says Zadicario.

And it works. In the study, all of the nine patients reported immediate pain relief after the procedure and needed no time to convalesce

“Two patients had a glass of Proseco [wine] with us,” says Ernst Martin, director of the Magnetic Resonance Center at the University Children’s Hospital Zurich and lead author of the study.

Apart from a feeling a few seconds of tingling or dizziness, and one reported case of a brief headache as the targeted tissue heated up, there were no side effects after the surgery.

“This will give a lot of impetus for manufacturers of focused ultrasound equipment to get interested in the brain,” says Kassell.

An experimental version of InSightec’s ultrasound device is currently being tested in five medical centers around the globe. In addition to using it with Parkinson’s patients and those who suffer other movement disorders, scientists plan to test the technology as a treatment for brain tumors, epilepsy, and stroke.

One downside of HIFU compared to the more invasive neurosurgeries performed with an electrode is that surgeons are unable to functionally test whether they have targeted the correct part of the brain. During traditional surgery for Parkinson’s, for example, the neurosurgeon stimulates the target area with the electrode to make sure he or she has identified the piece of the brain responsible for the patient’s motor problems, and then kills that piece of tissue.

 

da vinci surgery

Watch this robotic surgical system stitch a grape

da vinci surgery

With grace and steady robotic clippers, this high-end remote controlled surgical system was used to stitch a piece of skin back over the exposed flesh of a grape. Like a pro, the Da Vinci Surgical System – named after the famous renaissance genius who first inspired working robots –  can be seen in this amazing video putting the final touch, tying a knot, then using its scissor-hand to cut the loose thread.  Job done!

da vinci surgery

da vinci surgery

The Da Vinci Surgical System isn’t exactly new, though. It first received the FDA’s approval in 2000 and since then more than 2,100 of the systems have delivered to clinics and hospitals where they’re used mainly to  perform hysterectomies and prostate removals.

da vinci surgery

da vinci surgery

It’s easy to praise it as wonder robot, but right now it’s just fancy (albeit powerful) surgical Swiss knife. The brain is still a human surgeon who remotely operates  while seated comfortably at a console viewing a 3-D image of the surgical field. The surgeon’s fingers grasp the instrument controls below the display with wrists naturally positioned relative to his or her eyes. Then, the Da Vinci technology seamlessly translates the surgeon’s movements into precise, real-time movements of surgical instruments inside the patient.

The da VinciTM Surgical System consists of a surgeon's console, a patient-side cart, a high performance vision system and proprietary instruments from Intuitive Surgical, Inc.

The da VinciTM Surgical System consists of a surgeon’s console, a patient-side cart, a high performance vision system and proprietary instruments from Intuitive Surgical, Inc.

If this technology has been around for 15 years now, what can expect to see in development today or a couple of years from now, for that matter? Well, automated surgical bots, for one. Ever opportunistic when it comes to innovative tech, Google has partnered with health giant  Johnson & Johnson to develop surgical robots that use artificial intelligence.

Making them safe is another big challenge which needs to be addressed. As “robot surgeons” permeate hospitals more and more – and this seems quite inevitable – so do security concerns. For instance, University of Washington researchers hacked a next generation teleoperated surgical robot — one used only for research purposes — to test how easily a malicious attack could hijack remotely-controlled operations in the future.

Gifs via MIC

suspended_animation

Neither dead or alive: the suspended animation trial

suspended_animation

Suspended animation in the Alien movie.

For the half-dead arriving at hospitals, like the unfortunate who suffer gunshot wounds or lose a lot of blood some other way, there’s very little doctors can do. There are so little life saving procedures and surgeries that can be performed, and doctors need their patients at least a few more hours to be alive for most of these to work. It can be frustrating, but if doctors at  UPMC Presbyterian Hospital in Pittsburgh, Pennsylvania are right, this all may change and a new, bold and frightening at the same time procedure might become common in operating rooms all around the world. This is suspended animation.

Half past dead

The procedure involves  replacing all of a patient’s blood with a cold saline solution, which rapidly cools the body and stops almost all cellular activity. It seems counter intuitive to empty all the blood in a person’s body because it lost too much blood in the first place, but according to the physicians it might work.

“We are suspending life, but we don’t like to call it suspended animation because it sounds like science fiction,” says Samuel Tisherman, a surgeon at the hospital, who is leading the trial. “So we call it emergency preservation and resuscitation.”

It might work because the cold saline solution effectively cools the body putting it in a new state, where some structural problems that arise at normal body temperature (37 °C) can be solved more easily. For instance, at normal temperature if  blood stops flowing in the body following heart failure, then valuable oxygen can’t reach the cells who need it to produce energy. Without oxygen, the most valuable cells in the human body, the brain cells, stop functioning and death follows, and it only takes 5 minutes of oxygen deprivation.

At lower temperatures, cells need less oxygen to produce energy, which in turns slows down all chemical reactions. This is why sometimes people who fall into icy lakes can be revived even half an hour after they stop breathing. In normal conditions they would have been long dead, but because the body first entered  hypothermia, the brain still continued to function.

The trial

This isn’t exactly new information. Doctors have known this for a long time, which is why before some surgeries ice packs are placed on the body and the blood is circulated through a cooling system. This process takes time and preparation however. If a patient barges through the hospital door more dead than alive, there’s little surgeons can do.

 “If a patient comes to us two hours after dying you can’t bring them back to life. But if they’re dying and you suspend them, you have a chance to bring them back after their structural problems have been fixed,” says surgeon Peter Rhee at the University of Arizona in Tucson, who helped develop the technique.

The real innovation comes into play here. First cold saline solution is flushed through the heart and up the brain, where oxygen is most critical. Doctors do this by clamping the heart’s lower region while a catheter is placed into the aorta to carry the saline. Later, the clamp is removed so the saline can be pumped throughout the body. The whole technique, which is a lot more complicated than it sounds, still takes only 15 minutes and drops the patient’s body temperature to 10 °C. There’s no blood in the body, no breathing, no brain activity – the patient’s clinically dead. It’s incredibly freaky, but for some patients it’s all they’ve got.

So can it be done? In 2002 the technique was first demonstrated by Hasan Alam at the University of Michigan Hospital in Ann Arbor and colleagues on pigs.  The animals were sedated and a massive haemorrhage induced, to mimic the effect of multiple gunshot wounds. Their blood was drained and replaced by either a cold potassium or saline solution, rapidly cooling the body to around 10 °C. After the injuries were treated, the animals were gradually warmed up as the solution was replaced with blood. Typically, the heart started beating by itself after blood was circulated back, some however needed a jump-start. Following the procedure, there was no visible physiological or brain damage. 

“After we did those experiments, the definition of ‘dead’ changed,” says Rhee. “Every day at work I declare people dead. They have no signs of life, no heartbeat, no brain activity. I sign a piece of paper knowing in my heart that they are not actually dead. I could, right then and there, suspend them. But I have to put them in a body bag. It’s frustrating to know there’s a solution.”

Because there are little metabolic reactions in the body at such a low temperature, the patient can be resurrect in a two-hour window, compared to five minutes at normal temperature.

The next step is to do it on humans, and soon enough the doctors at UPMC Presbyterian Hospital will have their shot. The team there will be paged when the ideal patient enters the hospital door – the patient will have suffered a cardiac arrest after a traumatic injury, and will not have responded to attempts to start their heart. Typically, such a patient only has a 7% chance of survival. The technique will be tested on 10 people, and the outcome compared with another 10 who met the criteria but who weren’t treated this way because the team wasn’t on hand. Then after refining, the technique will be tested again on 10 patients that fit the profile. Detailed results will then follow.

The patients involved in the surgery will most likely suffer from near fatal wounds for which there is no alternative treatment. Because the patient will most likely storm in the operating room, there will be little time to notify the family and ask for approval. The trial will go ahead, however, because the US Food and Drug Administration considers it to be exempt from informed consent.

All this talk of suspended animation begs another question, and some of you may already be pondering – what about hibernation. Could we use the same technique to freeze our consciousness and travel to far away worlds? As it is now, the saline technique might keep a human body in suspended animation for up to two hours. You’d need years, decades actually for interstellar flight, but that’s not to say that it’s no possible. It may actually be, but we haven’t decoded all the mechanisms required. In fact, part of the solution may be right out our alley – the lemurs. I recommend you read on this piece to find out more.

Nabil Simaan testing a surgical robot that he designed. (Joe Howell / Vanderbilt)

Sensitive robots to dramatically improve machine-assisted surgery

More than on one occasion, the Enterprise’s chief medical officer Dr. Leonard McCoy laments how barbaric surgeons of the XXth century must have been to actually cut patients during surgery. While many of Star Trek’s memorabilia are far from having become reality, medicine has made important strides forward in some aspects comparable to Doc. McCoy’s methods. A working tricorder might soon breach the realm of SciFi, and as far as modern surgery is concern we’re finally nearing the age where the hand directed scalpel will become obsolete.

Doctors today use the best technology at their disposal to perform minimally invasive surgery. Using lasers, finely tuned and precise robots and myriad of sensors, surgeons can perform a minimal amount of cuts to reach their objectives and thus avoid risks of displacing important tissue or blood vessels. Actually, it’s now possible for the best doctors at a hospital in the US to remotely perform surgery on a patient in India all via the internet, for instance.

It’s truly remarkable, yet there are some tradeoffs to conventional surgery. For one, surgeons lose the type of  awareness they have during open surgery like feeling pressure on organs and vital blood vessels. A team of researchers directed by Nabil Simaan, associate professor of mechanical engineering at Vanderbilt University, was recently awarded a $3.6 million grant part of the National Robotics Initiative to develop a new kind of machine intelligence that will assist doctors by increasing surgery awareness through the use of sensitive robots.

Nabil Simaan testing a surgical robot that he designed. (Joe Howell / Vanderbilt)

Nabil Simaan testing a surgical robot that he designed. (Joe Howell / Vanderbilt)

Surgeons compensate their lack of awareness though precise mapping of their cuts’ trajectory. This is achieved using tools like MRI, X-ray imaging and ultrasound to map the internal structure of the body before they operate, as well as  miniaturized lights and cameras to provide them with visual images of the tissue immediately in front of surgical probes during operation.

Simaan and his team seek to take things to the next level by providing some kind of sensory feedback comparable to touch. Their plan is adding various kind of sensors and integrate the information these provide with  pre-operative information like the maps mentioned before to produce  dynamic, real time maps that precisely track the position of the robot probe and show how the tissue in its vicinity responds to its movements.

Surgery of the future

Adding pressure sensors to robot probes will provide real time information on how much force the probe is exerting against the tissue surrounding it. Such sensor data can also feed into computer simulations that predict how various body parts shift in response to the probe’s movement. Also, the team will  generate models that estimate locations of hidden anatomical features such as arteries and tumors .

At the heart of this initiative is a technique called Simultaneous Localization and Mapping that allows mobile robots to navigate in unexplored areas.  Actually, with all of these in place some surgical procedures will become semi-automatic like  tying off a suture, resecting a tumor or ablating tissue.   These maps will form the foundation of the Complementary Situation Awareness (CSA) framework.

“We will design the robot to be aware of what it is touching and then use this information to assist the surgeon in carrying out surgical tasks safely,” Simaan said.

The designs Simaan and his team will produce in their project might have applications that move beyond medicine. The researchers envision their CSA framework being used to disarm a bomb or by a human user operating a robotic excavator to dig out the foundation of a new building without damaging the underground pipes or by rescue robots searching deep tunnels for injured miners.

“In the past we have used robots to augment specific manipulative skills,” said Simaan. “This project will be a major change because the robots will become partners not only in manipulation but in sensory information gathering and interpretation, creation of a sense of robot awareness and in using this robot awareness to complement the user’s own awareness of the task and the environment”

Facial transplant recipient Richard Lee Norris immediately after the operation (left), and seven months later (right).

Most comprehensive face transplant patient doing well after seven months

Facial transplant recipient Richard Lee Norris immediately after the operation (left), and seven months later (right).

Facial transplant recipient Richard Lee Norris immediately after the operation (left), and seven months later (right).

A while ago I reported about one of the most astonishing medical stories, when Richard Lee Norris, a terribly disfigured young male, received the most comprehensive face transplant in history. During the procedure, both jaws, teeth, facial soft tissue from the scalp to the neck and sensory muscles indispensable to facial expression were replaced. After seven months the results are staggering, and the patient is doing better as each day passes.

The  37-year-old Richard Lee Norris was severely mutilated following a gun accident in 1997, when he lost his lips, nose and was left with a limited movement of his mouth. In March of this year the patient received the most comprehensive facial transplant to date over the course of a tiresome 36 hours procedure. Here’s a photo of Norris before his surgery (warning! very graphic).

“For the past 15 years I lived as a recluse hiding behind a surgical mask and doing most of my shopping at night when less people were around,” Norris said, according to a news release from the University of Maryland Medical Center, where the procedure was performed in March. “I can now go out and not get the stares and have to hear comments that people would make.”

Currently, Norris can smile and show facial expressions, and also smell, taste and eat. The motor function on the right side of his face is about 80 percent of normal and motor function on the left side is about 40 percent, according to his doctors, but he’s currently continuing to show progress.

Transplant recipient 37-year-old Richard Lee Norris of Hillsville, Virginia seen in three different stages of his live. Left: pre-accident; middle: before transplant; right: after. (c) University of Maryland Medical Center

Surgeons perform most extensive full face transplant, including jaws, teeth, tongue and facial muscles

Plastic surgeons at University of Maryland performed the most complex facial reconstruction surgery to date, which included the replacements of both jaws, teeth, facial soft tissue from the scalp to the neck and sensory muscles indispensable to facial expression.

Transplant recipient 37-year-old Richard Lee Norris of Hillsville, Virginia seen in three different stages of his live. Left: pre-accident; middle: before transplant; right: after. (c) University of Maryland Medical Center

Transplant recipient 37-year-old Richard Lee Norris of Hillsville, Virginia seen in three different stages of his life. Left: pre-accident; middle: before transplant; right: after. (c) University of Maryland Medical Center

The procedure was part of a 72 hour transplant marathon, aftern an anonymous donor generously donated his face and organs in a heroic act. Over the course of just a few days, the medical staff at University of Maryland Medical Center performed several transplant surgeries which saved the lives of five people.

For the first time in the world, a team of over 150 nurses and professional staff have performed a full face transplant at the end of an agonizing 36-hour operation which occurred on March 19-20, 2012 at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center.

“We utilized innovative surgical practices and computerized techniques to precisely transplant the mid-face, maxilla and mandible including teeth, and a portion of the tongue. In addition, the transplant included all facial soft tissue from the scalp to the neck, including the underlying muscles to enable facial expression, and sensory and motor nerves to restore feeling and function,” explains Dr. Eduardo Rodriquez, associate professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. “Our goal is to restore function as well as have aesthetically pleasing results.”

The face transplant recipient is 37-year-old Richard Lee Norris, who was severely mutilated following a gun accident in 1997, when he lost his lips, nose and was left with a limited movement of his mouth. Since then, Norris has performed numerous reconstructive surgeries, culminating with this extraordinary feat of modern medicine

“The future of medicine depends on rapid translation of research and creating high-performing teams. The face transplant is a perfect example of the life-changing options we can provide for our patients when we combine the expertise of our research and clinical teams to pursue procedures that would have seemed unfathomable not so long ago,” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president of medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.

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The self-propelled wirelessly powered prototype developed by Stanford scientists, 3mm wide and 4mm long, showed resting upon one of the researcher's hand. (c) Stanford University

Revolutionary wireless powered tiny device can swim through blood streams

Implantable medical devices, capable of delivering drugs or performing micro-surgery from inside the body, have been the subject of scientific research for decades now. A number of exciting prototypes have been developed in the past few years, as miniaturization allowed it, however reliability flaws rendered them unpractical. A new tiny device developed by Stanford electrical engineers, was presented this week at the International Solid-State Circuits Conference by lead researcher Ada Poon, which is powered without wires or batteries and is small enough to travel through human blood streams.

“Such devices could revolutionize medical technology,” said Poon, an Electrical Engineering Assistant Professor. “Applications include everything from diagnostics to minimally invasive surgeries.”

The self-propelled wirelessly powered prototype developed by Stanford scientists, 3mm wide and 4mm long, showed resting upon one of the researcher's hand. (c) Stanford University

The self-propelled wirelessly powered prototype developed by Stanford scientists, 3mm wide and 4mm long, showed resting upon one of the researcher's hand. (c) Stanford University

In front of the conference audience, Poon demonstrated the working device, just a few millimeters in size and wirelessly powered, capable of controlled motion through a fluid, including blood. This could be the first of a new class of working medical implants, which could deliver drugs, perform analyses, and perhaps even zap blood clots or remove plaque from sclerotic arteries all from inside the human body. Since its power is derived wirelessly using electromagnetic radio waves, the device escapes all the reliability issues other implants meant for similar applications encountered. No batteries or wires means that the device can travel through the blood stream without risk of power failure and a dramatic scale down in size (batteries amount to most of the volume of such devices).

“While we have gotten very good at shrinking electronic and mechanical components of implants, energy storage has lagged in the move to miniaturize,” said co-author Teresa Meng, a professor of electrical engineering and computer science. “This hinders us in where we can place implants within the body and also creates the risk of corrosion or broken wires, not to mention replacing aging batteries.”

A tiny surgeon inside your blood vessels

Scientists have been trying to devise such medical wirelessly powered implants for 50 years now, but it seems the approach taken in the past was wrong, all because of one flawed assumption – that the human tissue is a good electrical conductor. Couldn’t been farther from the truth. With this inaccurate model in mind, high-frequency waves dissipate in the human tissue, dissipating as the device travels further.

Poon took a different approach, and considered the human tissue as a dielectric, a type of insulator – quite the opposite of previous assumptions! In a dielectric, the signal is conveyed as waves of shifting polarization of atoms within cells, which renders radio waves propagation possible. Moreover, the human tissue has been found to be “low-loss” dielectric, which means signal loss is minimal. Again, the opposite of past assumptions. These have all been demonstrate experimentally and mathematically.

“When we extended things to higher frequencies using a simple model of tissue, we realized that the optimal frequency for wireless powering is actually around one gigahertz,” said Poon, “about 100 times higher than previously thought.”

This revelation was instrumental to the researchers’ development, since it allowed them to build the device 100 times smaller and yet deliver the power needed by the medical device. This is why the antenna is just 2mm in size – small enough to travel through blood streams.

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Two types of self-propelled devices were developed and demoed. One generates direction force to push itself forward by driving electrical current directly through the blood stream, allowing for velocity of around half a centimeter per second. The other, moves similar to the way a kayaker paddles upstream, switching current back and forth through a wire loop.

“There is considerable room for improvement and much work remains before such devices are ready for medical applications,” said Poon. “But for the first time in decades the possibility seems closer than ever.”

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