The Laprotek surgical system and the next generation of robotics.
The Brock Rogers Surgical Laprotek System is poised to extend the surgeon's reach into the future of advanced, minimally invasive procedures.
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The Brock Rogers Surgical Laprotek System is poised to extend the surgeon's reach into the future of advanced, minimally invasive procedures.
The former Special Assistant to the Director on Biomedical Technology, Defense Advanced Research Projects Agency (DARPA), COL RM Satava, notes "Predicting the future trends in any profession jeopardizes the credibility of the author." Thus, we have attempted to outline current systems and prototype models in testing phases. Technologic advances will enable enhanced care of trauma patients. In the acute care setting, they also will affect the educational system in theory and practice.
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The aim of this study was to analyse whether automatic milking has an effect on reproduction in dairy cows. Probably the most important consequence of automatic milking is an increased milking frequency. More frequent milking means more production and thereby an extra threat for the energy balance during the first months of lactation. A deep negative energy balance (NEB) is often followed by negative effects on fertility. However, tested under experimental circumstances, automatic milking with a frequency not higher than 3 times/day and with an individual management and feeding system has benefits for production and very little negative effects on reproduction. Experimental farms with automatic milking systems have fertility figures that do not differ from experimental farms with conventional milking systems. Additional and more data of automatic milking under farm conditions has to be collected and evaluated before the effect on fertility can be assessed with more certainty.
Typically, pharmacokinetic studies in mice require one animal per time point, thus resulting in differences due to dosing error, animal to animal variation and more importantly the euthanasia of a large number of animals. A method for the determination of pharmacokinetic data from serially bled mice to support early drug discovery is described. Sample analysis relies on liquid chromatography coupled with tandem mass spectrometry permitting robust and reproducible analysis requiring approximately 3 min per sample. Several parameters are discussed including the method of sample collection, preparation and analysis. The use of serially bled mice has lead to a remarkable reduction in animal usage and a corresponding reduction in compound required for such experiments. Using conventional methodology, a nine-point pharmacokinetic curve with four animals per time point would require 36 mice. With the method described below, only four mice in total are used and euthanasia is not required, permitting reuse after several weeks recovery and washout. Also, pharmacodynamic-pharmacokinetic correlation is possible and is demonstrated using a mouse model of diabetes.
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Despite its current popularity and relative success, endoscopic reconstruction of the anterior cruciate ligament (ACL) using a bone-patellar tendon-bone (BPTB) graft has not yet been perfected. Using a recently developed robotic/UFS testing system, we assessed the overall stability of porcine knees following ACL reconstruction with different sites of tibial graft fixation--proximal, central, and distal. Testing of the intact knee was performed first to determine the normal anterior-posterior (A-P) displacements and in situ forces of the ACL under 110 N of anterior tibial loading of 30 degrees, 60 degrees, and 90 degrees of knee flexion. The knee was then reconstructed with a BPTB autograft, and the distal end of the graft was fixed sequentially at three different locations in each specimen--proximal, central, distal. A-P testing was repeated for each fixation site, and the resulting knee kinematics and the in situ forces of the grafts were compared to the intact case. The site of tibial fixation was demonstrated to have a significant effect on the resulting anterior displacement and internal rotation of the tibia as well as the in situ forces of the graft. Proximal fixation produced the most stable knee (A-P displacements reduced to 120% of intact at 30 degrees and 170% at 90 degrees), becoming significantly less stable with more distal fixation. These results suggest that proximal graft fixation may provide the most acute stability of the reconstructed knee.
The aim of these studies was to compare the effects of several prostaglandin agonists on adenylyl cyclase activity in embryonic bovine tracheal (EBTr) cells, transformed human nonpigmented ciliary epithelial (NPE) cells and National Cancer Bank (NCB-20) cells. These cell types have been shown to express DP, EP2 and IP prostaglandin (PG) receptors, respectively. Cyclic AMP (cAMP) generation was measured by manual and semi-automated radioimmunoassay (RIA) techniques. ZK118182 (EC50 = 10-27 nM), PGE2 (EC50 = 21-27 nM) and PGI2 (EC50 = 3.5-4 nM) had the highest potency at the DP, EP2 and IP receptors, respectively. A plot of potency (EC50) values generated with both techniques showed a high degree of correlation for all three receptors. These studies provide further characterization of prostanoid receptor functional responses in three cell types and demonstrate the advantages of a semi-automated RIA method for the analysis of the second messenger cAMP.
A right thoracotomy is a well-known alternative for midsternotomy to have access to the left atrium. The Port-Access (Heartport, Inc, Redwood City, CA) approach is an invaluable option to avoid cracking of ribs and cartilage. EndoCPB (Heartport, Inc) and Endo-Aortic Clamp (Heartport, Inc) allows installation of the extracorporeal circulation and cardiac arrest from the groin. Videoassistance and shafted instruments help the surgeon to perform the surgery through a 5 x 2-cm port and fulfill the main goals of minimally invasive cardiac surgery, comfort, cosmesis, and fast rehabilitation. From February 1997 to November 1998, 75 patients (40 men/35 women) had either Port-Access mitral valve repair (n = 41) or replacement (n = 33) for a variety of reasons: myxoid degeneration (n = 45), rheumatic disease (n = 21), chronic endocarditis (n = 4), annular dilatation (n = 2), and sclerotic disease (n = 2). One valve was replaced because of an ingrowing myxoma. There was one closure of a paravalvular leak. The mean age was 59.3 years of age (range, 32 to 83 years). Most patients had normal ejection fractions but different grades of mitral valve insufficiency and were in NYHA class II. One 71-year-old patient died after reoperation on postoperative day 1 for failed repair. Two patients had conversion to sternotomy and conventional ECC for repair of a dissected aorta. One patient died, one patient suffered a minor cerebrovascular deficit. Three patients had prolonged intensive care unit (ICU) stays for respiratory insufficiency, 5 patients underwent revision for bleeding. Mean ICU stay was 2.5 days; and mean hospital stay, 9 days (range, 4 to 36). A significant difference between the first 30 and last 38 patients in terms of length of stay in the ICU and the hospital was noticed. Two late mitral valve replacements for chronic endocarditis after repair occurred. One patient had medical therapy for endocarditis after mitral valve replacement. The debut of Port-Access mitral valve surgery may be nerve-racking; the routine is a smooth and sure surgery with maximum comfort, a very discrete scar, and a fast rehabilitation. There were no paravalvular leakages nor myocardial infarctions. Cerebrovascular accidents owing to thromboembolic phenomena, vascular lower limb or wound complications were not seen. Port-Access mitral valve surgery is a very important investment in the future of cardiac surgery. Some learning curve pitfalls were associated with the process of starting this revolutionary technique.
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