The Experts below are selected from a list of 285 Experts worldwide ranked by ideXlab platform
John M Gatti - One of the best experts on this subject based on the ideXlab platform.
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The use of stab incisions for instrument access in laparoscopic urological procedures.
The Journal of urology, 2004Co-Authors: Gregory R Hanson, Erik P Castle, Daniel J Ostlie, George W Holcomb, J Patrick Murphy, John M GattiAbstract:Traditional laparoscopic procedures use expensive Cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable Cannulas. All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional Cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 Cannulas were saved using our technique. At a cost to the patient of dollars 140 per cannula the overall cost saving was dollars 14,700 with an average saving of dollars 277 per case. Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of Cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.
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The use of stab incisions for instrument access in laparoscopic urological procedures.
Journal of Urology, 2004Co-Authors: Gregory R Hanson, Erik P Castle, Daniel J Ostlie, George W Holcomb, J Patrick Murphy, John M GattiAbstract:ABSTRACT Purpose: Traditional laparoscopic procedures use expensive Cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable Cannulas. Materials and Methods: All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional Cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. Results: A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 Cannulas were saved using our technique. At a cost to the patient of $140 per cannula the overall cost saving was $14,700 with an average saving of $277 per case. Conclusions: Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of Cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.
Gregory R Hanson - One of the best experts on this subject based on the ideXlab platform.
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The use of stab incisions for instrument access in laparoscopic urological procedures.
The Journal of urology, 2004Co-Authors: Gregory R Hanson, Erik P Castle, Daniel J Ostlie, George W Holcomb, J Patrick Murphy, John M GattiAbstract:Traditional laparoscopic procedures use expensive Cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable Cannulas. All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional Cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 Cannulas were saved using our technique. At a cost to the patient of dollars 140 per cannula the overall cost saving was dollars 14,700 with an average saving of dollars 277 per case. Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of Cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.
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The use of stab incisions for instrument access in laparoscopic urological procedures.
Journal of Urology, 2004Co-Authors: Gregory R Hanson, Erik P Castle, Daniel J Ostlie, George W Holcomb, J Patrick Murphy, John M GattiAbstract:ABSTRACT Purpose: Traditional laparoscopic procedures use expensive Cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable Cannulas. Materials and Methods: All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional Cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. Results: A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 Cannulas were saved using our technique. At a cost to the patient of $140 per cannula the overall cost saving was $14,700 with an average saving of $277 per case. Conclusions: Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of Cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.
Mark W Davies - One of the best experts on this subject based on the ideXlab platform.
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continuous infusion versus intermittent flushing to prevent loss of function of peripheral intravenous catheters used for drug administration in newborn infants
Cochrane Database of Systematic Reviews, 2005Co-Authors: Anndrea Flint, Diana Mcintosh, Mark W DaviesAbstract:Background The use of peripheral intravenous cannulae is common in newborn babies. Many of them require an intravenous line only for medications and not for fluid. Currently there is little uniformity in methods used to maintain cannula patency. Objectives The object of this review was to determine which method was better for maintaining intravenous lines used in neonates for intravenous medication only: intermittent flushing or continuous infusion Search methods We searched The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), CINAHL (from 1982 to June 2004) and MEDLINE (from 1966 to June 2004) . Selection criteria Randomised controlled trials comparing continuous infusion to intermittent flushing to maintain patency of intravenous Cannulas. Units of randomisation might include individual catheters or individual babies. Data collection and analysis Three reviewers independently assessed trial quality and extracted data. Main results Two studies were eligible for inclusion. In one study only one of our primary outcomes was available: the duration of cannula patency for the first cannula used per infant was slightly longer in the continuous infusion group, but not significantly so, with a mean difference of -4.3 hours (95% CI -18.2 to 9.7). In the second study, only one of our primary outcomes was available: the mean (SD) number Cannulas used per infant in the first 48 hours was less in the intermittent flush group with a mean difference of -0.76 Cannulas (95% CI -1.37 to -0.15). No results were available for any of our other primary outcomes: in the published report, results were reported per catheter rather than per infant, a number of infants received more than one intravenous catheter (39 infants received an unknown number of catheters). The overall duration of cannula patency was significantly longer in the intermittent flush group with a mean duration of patency in the intermittent flush group of 2.1 days (SD 1.0) compared with the continuous infusion group where the mean duration of patency was 1.0 days (SD 0.5) - Student's t test P value 0.0003. Authors' conclusions It is difficult to draw reliable conclusions given the way the data were analysed and reported in the two included studies. The reliability of the results is uncertain. However, given the caution in interpreting these data, it should also be noted that the use of intermittent flushes was not associated in either study with a decreased cannula life or any other disadvantages, thus lending some support for the use of intermittent flushing of Cannulas in a selected population in neonatal nurseries.
Noah J Cowan - One of the best experts on this subject based on the ideXlab platform.
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mechanics of precurved tube continuum robots
IEEE Transactions on Robotics, 2009Co-Authors: Robert J Webster, Joseph M Romano, Noah J CowanAbstract:This paper presents a new class of thin, dexterous continuum robots, which we call active Cannulas due to their potential medical applications. An active cannula is composed of telescoping, concentric, precurved superelastic tubes that can be axially translated and rotated at the base relative to one another. Active Cannulas derive bending not from tendon wires or other external mechanisms but from elastic tube interaction in the backbone itself, permitting high dexterity and small size, and dexterity improves with miniaturization. They are designed to traverse narrow and winding environments without relying on ldquoguidingrdquo environmental reaction forces. These features seem ideal for a variety of applications where a very thin robot with tentacle-like dexterity is needed. In this paper, we apply beam mechanics to obtain a kinematic model of active cannula shape and describe design tools that result from the modeling process. After deriving general equations, we apply them to a simple three-link active cannula. Experimental results illustrate the importance of including torsional effects and the ability of our model to predict energy bifurcation and active cannula shape.
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closed form differential kinematics for concentric tube continuum robots with application to visual servoing
International Symposium on Experimental Robotics, 2009Co-Authors: Robert J Webster, Joseph M Romano, John P Swensen, Noah J CowanAbstract:Active Cannulas, so named because of their potential medical applications, are a new class of continuum robots consisting of precurved, telescoping, elastic tubes. As individual component tubes are actuated at the base relative to one another, an active cannula changes shape to minimize stored elastic energy. Here, we derive the differential kinematics of a general n-tube active cannula while accounting for torsional compliance. We experimentally validate the Jacobian using a three-link prototype in a simple stereo visual servoing scheme.
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ISER - Closed-Form Differential Kinematics for Concentric-Tube Continuum Robots with Application to Visual Servoing
Experimental Robotics, 2009Co-Authors: Robert J Webster, Joseph M Romano, John P Swensen, Noah J CowanAbstract:Active Cannulas, so named because of their potential medical applications, are a new class of continuum robots consisting of precurved, telescoping, elastic tubes. As individual component tubes are actuated at the base relative to one another, an active cannula changes shape to minimize stored elastic energy. Here, we derive the differential kinematics of a general n-tube active cannula while accounting for torsional compliance. We experimentally validate the Jacobian using a three-link prototype in a simple stereo visual servoing scheme.
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Kinematics and calibration of active Cannulas
2008 IEEE International Conference on Robotics and Automation, 2008Co-Authors: Robert J Webster, Joseph M Romano, Noah J CowanAbstract:Active Cannulas are remotely actuated thin continuum robots with the potential to traverse narrow and winding environments without relying on "guiding" environmental reaction forces. These features seem ideal for procedures requiring passage through narrow openings to access air-filled cavities (e.g. surgery in the throat and lung). Composed of telescoping concentric pre-curved elastic tubes, an active cannula is actuated at its base by translation and axial rotation of component tubes. Using minimum energy principles and Lie Group theory, we present a framework for the kinematics of multi-link active Cannulas. This framework permits testing of the hypothesis that overall cannula shape locally minimizes stored elastic energy. We evaluate in particular whether the torsional energy in the long, straight transmission between actuators and the curved sections is important. Including torsion in the kinematic model enables us to analytically predict experimentally observed bifurcation in the energy landscape. Independent calibration procedures based on bifurcation and tip and feature positions enable model parameter identification, producing results near ranges expected from tube material properties and geometry. Experimental results validate the kinematic framework and demonstrate the importance of modeling torsional effects in order to describe bifurcation and accurately predict active cannula shape.
George W Holcomb - One of the best experts on this subject based on the ideXlab platform.
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The use of stab incisions for instrument access in laparoscopic urological procedures.
The Journal of urology, 2004Co-Authors: Gregory R Hanson, Erik P Castle, Daniel J Ostlie, George W Holcomb, J Patrick Murphy, John M GattiAbstract:Traditional laparoscopic procedures use expensive Cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable Cannulas. All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional Cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 Cannulas were saved using our technique. At a cost to the patient of dollars 140 per cannula the overall cost saving was dollars 14,700 with an average saving of dollars 277 per case. Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of Cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.
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The use of stab incisions for instrument access in laparoscopic urological procedures.
Journal of Urology, 2004Co-Authors: Gregory R Hanson, Erik P Castle, Daniel J Ostlie, George W Holcomb, J Patrick Murphy, John M GattiAbstract:ABSTRACT Purpose: Traditional laparoscopic procedures use expensive Cannulas to facilitate the insertion and removal of laparoscopic instruments. We report our experience with limited access stab incisions for the insertion of instruments into the peritoneal cavity during laparoscopic urological procedures to minimize the use of disposable Cannulas. Materials and Methods: All patients undergoing laparoscopic urologic procedures using stab incisions, as performed by us, from November 1999 through March 2003 were included. Procedures included nephrectomy, partial nephrectomy, varicocelectomy, nephroureterectomy, orchiopexy and adrenal procedures. A single cannula was used for telescope access. In select cases additional Cannulas were used for unique instruments or specimen manipulation/extraction. Abdominal wall stab incisions were used for the remaining instruments. Stab incisions were closed with a Steri-Strip (3M Healthcare, St. Paul, Minnesota) at the skin level only. Results: A total of 53 procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with the use of stab incisions. A total of 105 Cannulas were saved using our technique. At a cost to the patient of $140 per cannula the overall cost saving was $14,700 with an average saving of $277 per case. Conclusions: Laparoscopic urological procedures can be performed effectively and safely with stab incisions for instrument access. There are significant cost savings related to the elimination of Cannulas. We believe that our technique of stab incisions for instrument access is equivalent to the traditional cannula approach and should be used when possible.