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Unit V
LIFE ASSISTING, THERAPEUTIC AND ROBOTIC DEVICES
Pacemakers – Defibrillators – Ventilators – Nerve and muscle stimulators – Diathermy – Heart
– Lung machine – Audio meters – Dialyzers – Lithotripsy - ICCU patient monitoring system -
Nano Robots - Robotic surgery – Advanced 3D surgical techniques- Orthopedic prostheses
fixation.

ARTIFICIAL PACEMAKERS
The rhythmic beating of the heart is due to the triggering pulses that originate in an area of
specialized tissue in the right atrium of the heart. This area is known as the sino-atrial node. In
abnormal situations, if this natural pacemaker ceases to function or becomes unreliable or if
the triggering pulse does not reach the heart muscle because of blocking by the damaged
tissues, the natural and normal synchronization of the heart action gets disturbed. When
monitored, this manifests itself through a decrease in the heart rate and changes in the
electrocardiogram (ECG) waveform. By giving external electrical stimulation impulses to the
heart muscle, it is possible to regulate the heart rate. These impulses are given by an electronic
instrument called a ‘pacemaker’.
A pacemaker basically consists of two parts: (i) an electronic unit which generates stimulating
impulses of controlled rate and amplitude, known as pulse generator, and (ii) the lead which
carries the electrical pulses from the pulse generator to the heart. The lead includes the
termination which connects to the pulse generator and the insulated conductors, which interface
with electrodes and terminate within the heart.
Types of Pacemakers
The classification of pacemakers into different types is based on the mode of application of the
stimulating pulses to the heart. External pacemakers are used when the heart block presents as
an emergency and when it is expected to be present for a short time. Internal pacemakers are
used in cases requiring long-term pacing because of permanent damage that prevents normal
self-triggering of the heart. In the latter case, the pacemaker itself may be implanted in the
body. The patient is able to move about freely and is not tied to any external apparatus.
Fixed Rate Pacemaker: This type of pacemaker is intended for patients having permanent
heart blocks. The rate is pre-set, say at 70 bpm. The rate can be varied externally in implanted
units by magnetically actuating a built-in relay. Since the fixed rate pacemaker functions
regardless of the patients’ natural heart rhythm, it poses a potential danger because of
competition between the patients’ rhythm and that of the pacemaker.
Demand Pacemaker: These pacemakers have gradually almost replaced the fixed rate
pacemakers because they avoid competition between the heart’s natural rhythm and the
pacemaker rhythm. The demand unit functions only when the R-R intervals of the natural
rhythm exceed a pre-set limit.

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Ventricular Synchronous Demand Pacemaker

The Figure shows a functional block diagram of a ventricular synchronous demand pacemaker.
The pulse generator has two functions, viz., pacing and sensing. Sensing is accomplished by
picking up the ECG signal. In the case of dual-chamber pacing, the P wave is also sensed. Once
the ECG signal enters the sensing circuit, it is passed through a QRS bandpass filter. This filter
is designed to pass signal components in the frequency range of 5-100 Hz, with a centre
frequency of 30 Hz.
This is followed by an amplifier and threshold detector which is designed to operate with a
detection sensitivity of 1–2 mV. Sensitivity of this order ensures reliable detection of cardiac
signals sensed on the electrodes which typically have amplitudes in the 1–30 mV range
depending on the electrode surface area and the sensing circuit loading impedance. A refractory
period (T1) is necessarily incorporated to limit the pulse delivery rate, particularly in the
presence of electromagnetic interference. It is meant to prevent multiple re-triggering of the
astable multivibrator following a sensed or paced contraction. The free-running multivibrator
provides a fixed rate mode with an interval of T2 via the output driver circuit. The output pulses
of a length T3 synchronous with input signals that fall outside the sensing refractory period
T1are thus delivered at the stimulating electrodes.

DEFIBRILLATORS
Ventricular fibrillation is a serious cardiac emergency resulting from asynchronous contraction
of the heart muscles. This uncoordinated movement of the ventricle walls of the heart may
result from coronary occlusion, from electric shock or from abnormalities of body chemistry.
Because of this irregular contraction of the muscle fibres, the ventricles simply quiver rather
than pumping the blood effectively. This results in a steep fall of cardiac output and can prove
fatal if adequate steps are not taken promptly. In fibrillation, the main problem is that the heart
muscle fibres are continuously stimulated by adjacent cells so that there is no synchronised
succession of events that follow the heart action.

Consequently, control over the normal sequence of cell action cannot be captured by ordinary
stimuli. Ventricular fibrillation can be converted into a more efficient rhythm by applying a
high energy shock to the heart. This sudden surge across the heart causes all muscle fibres to
contract simultaneously. Possibly, the fibres may then respond to normal physiological pace
making pulses. The instrument for administering the shock is called a defibrillator.

The basic circuit diagram of a DC defibrillator is shown in Figure below. A variable auto-
transformer T1 forms the primary of a high voltage transformer T2. The output voltage of the

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transformer is rectified by a diode rectifier and is connected to a vacuum type high voltage
change-over switch. In position A, the switch is connected to one end of an oil-filled 16 micro-
farad capacitor. In this position, the capacitor charges to a voltage set by the positioning of the
auto-transformer. When the shock is to be delivered to the patient, a foot switch or a push
button mounted on the handle of the electrode is operated. The high voltage switch changes
over to position ‘B’ and the capacitor is discharged across the heart through the electrodes.

VENTILATORS
Respiration is the process of supplying oxygen to and removing carbon dioxide from the
tissues. These gasses are carried in the blood, oxygen from the lungs to the tissues and carbon
dioxide from the tissues to the lungs. The gas exchanges in the lungs are called external
respiration and those in the tissues are called internal respiration. There is a very delicate
balance between the absorption and excretion of oxygen and carbon dioxide in the lungs and
tissues, and this balance is maintained by the respiratory or breathing activity.
When artificial ventilation needs to be maintained for a long time, a ventilator is used.
Ventilators are also used during anaesthesia and are designed to match human breathing
waveform/pattern. These are sophisticated equipment with a large number of controls which
assist in maintaining proper and regulated breathing activity. For short-term or emergency use,
resuscitators are employed. These depend upon mechanical cycle operation and are generally
light-weight and portable. The main function of a respirator is to ventilate the lungs in a manner
as close to natural respiration as possible. Since natural inspiration is a result of negative
pressure in the pleural cavity generated by the movement of the diaphragm, ventilators were
initially designed to create the same effect. These ventilators are called negative-pressure
ventilators.
Modern ventilator machines consist of two separate but inter-connected systems: the pneumatic
flow system and an electronic control system. Figure 33.12 shows a block diagram of a typical
ventilator. The pneumatic flow system enables the flow of gas through the ventilator. Oxygen
and medical grade air enter the ventilator at 3.5 bar (50 psi) pressure through built-in 0.1 micron
filters. The normal operating range is 2 to 6 bar or 28 to 86 psi. These gasses enter the
air/oxygen mixer where they combine at the required percentage and reduced in pressure to
350 cm H2O. The gasses then enter a large reservoir tank which holds about 8 litres of mixed
gasses, when compressed to 350 cm H2O. An electronically controlled flow valve proportions
the gas flow from the reservoir tank to the patient breathing circuit. In some ventilators, an air
compressor is used in place of a compressed air tank. The primary objective of the device is to
ensure proper level of oxygen in the inspiratory air and deliver a tidal volume according to the

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clinical requirements. As the gasses leave the ventilator, they pass by an oxygen analyser, a
safety ambient air inlet valve and a back-up mechanical over pressure valve. The ambient valve
provides the patient the ability to breathe room air when the ventilator fails or the pressure in
the patient circuit drops below –10 cm of H2O.

In the patient breathing circuit is a bi-directional flow sensor to measure the gas flows.
The exhaled gasses exit through an electronically controlled exhalation valve located at the
ventilator. With the introduction of microprocessors for control of metering devices,
electromechanical valves have gained popularity. The microprocessor controls each valve to
deliver the desired inspiratory air and oxygen flows for mandatory and spontaneous ventilation.
A high pressure valve is used to provide safety in case the pressure in the patient circuit exceeds
110 cm of H2O.

The electronic control system may use one or more microprocessors and software to
perform monitoring and control functions in a ventilator. These parameters include setting of
the respiration rate, flow waveform, tidal volume, oxygen concentration of the delivered breath,
peak flow and PEEP. The PEEP selected in the mandatory mode is only used for control of
exhalation flow.

The micorprocessor utilizes the above parameters to compute the desired inspiratory
flow trajectory. The system consists of monitors for pressure flow and oxygen fraction. The
sensors are connected to electronic processing circuits which makes them available for digital
readouts. The signals are also compared with pre-set alarm levels so that if they fall outside a
pre-determined normal range, alarms are sounded.

The pressure sensors are normally of semiconductor strain gauge type placed in a bridge
configuration. For measurement of fraction of oxygen in the inspired air, a fuel cell type oxygen
sensor is used. This sensor generates a current proportional to pO2.As this sensor is temperature
sensitive, compensation for its operating temperature is included in the circuit. Usually, a
thermistor is used to carry out this function. The flow sensor usually consists of a variable
orifice and by measuring the pressure drop across the variable orifice, the patient flows can be
calculated.

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DIATHERMY
High frequency currents, apart from their usefulness for therapeutic applications, can also be
used in operating rooms for surgical purposes involving cutting and coagulation. The frequency
of currents used in surgical diathermy units is in the range of 1–3 MHz in contrast with much
higher frequencies employed in short-wave therapeutic diathermy machines. This frequency is
quite high in comparison with that of the 50 Hz mains supply. This is necessary to avoid the
intense muscle activity and the electrocution hazards which occur if lower frequencies are
employed.

The power levels required for electro-surgery are below the threshold of neural stimulation
provided that the diathermy frequency is in the radio-frequency range. When the frequency is
at least 300 kHz, both the faradic and the electrolytic effects are largely eliminated during the
flow of current through the human tissue. This then allows the exclusive utilization of the
thermal effect in high frequency surgery providing both the applications for cutting and
coagulation. For their action surgical diathermy machines depend on the heating effect of
electric current. When high frequency current flows through the sharp edge of a wire loop or
band loop or the point of a needle into the tissue, there is a high concentration of current at this
point. The tissue is heated to such an extent that the cells which are immediately under the
electrode, are torn apart by the boiling of the cell fluid. The indifferent electrode establishes a
large area contact with the patient and the RF current is therefore, dispersed so that very little
heat is developed at this electrode. This type of tissue separation forms the basis of electro-
surgical cutting.

Electro-surgical coagulation of tissue is caused by the high frequency current flowing through
the tissue and heating it locally so that it coagulates from inside. The coagulation process is

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accompanied by a grayish-white discoloration of the tissue at the edge of the electrode. The
term ‘fulguration’ refers to a superficial tissue destruction without affecting deep-seated
tissues. This is undertaken by passing sparks from a needle or a ball electrode of small diameter
to the tissue. When the electrode is held near the tissue without touching it, an electric arc is
produced, whose heat dries out the tissue. Fulguration permits fistulas and residual cysts to be
cauterized and minor haemorrhages to be stopped.

LITHOTRIPSY
Urinary stone disease:
It is caused when the urine, for various reasons, becomes super-saturated with particular salts
which may then crystallize out of solution forming a stone-like substance. Of the four main
types of stones, the most common (about70%) are salts of calcium, comprising either calcium
oxalate or calcium phosphate or combinations of both salts. They can cause very intense pain
and may ultimately lead to renal failure through infection of the urinary tract.
Lithotripsy:
Lithotripsy is the use of high-energy shock waves to fragment and disintegrate kidney stones.
The shock wave, created by using a high-voltage spark or an electromagnetic impulse, is
focused on the stone. This shock wave shatters the stone and this allows the fragments to pass
through the urinary system.

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Shock-wave lithotripsy machines currently in the market vary in terms of several operational
factors such as the energy source, the focusing system and stone localization system. In general,
the main components of a lithotriptor system are:

• Focused shock-wave source;

• Means for acoustic coupling of the shock-wave to the body;
• Imaging modalities for stone localization and therapy control;
• A patient table with either the table or the shock-wave source movable in three dimensions;
• System for the measurement of physiological variables and their monitoring; and
• Trigger generation and control system.

Schematic diagram of a lithotriptor System

Focused acoustic shock-wave source:
These shock-waves are generated by an emitter outside the body and transmitted as pulsed
longitudinal waves through a fluid coupling medium and the body tissue to the target, the
concrement to be destroyed. Shock-waves are unharmonic and non-linear acoustic phenomena,
characterized by an extremely steep change in pressure amplitude, the shock front. It is
generally accepted that an ideal shock-wave for extracorporeal lithotripsy shows a shock front
only in the compressional part of the pulse up to a peak pressure, followed by decay.

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Representation of Shock wave form pulse

The three basic types of shock-wave sources for lithotripsy are:
1. Plasma explosion method;
2. Electromagnetic system;
3. Piezo-ceramic system.

These excitation sources are coupled with the following focusing methods:
(a) Ellipsoidal reflector;
(b) Focusing with an acoustic lens; and
(c) Self-focusing source.
Plasma Explosion Method: In this method, a capacitor is discharged across two opposing
electrodes placed at the first focus of a partial ellipsoid of rotation in a bath tub. A conducting
plasma channel is formed between the electrodes and expands with supersonic velocity. The
resulting compression wave in the water is a shock-wave with a steeply rising front.

Electromagnetic System: The construction of the shock tube and a cross-section of single-layer
helically wound coil is also shown. The coil and a flat electrically insulated metal membrane
placed on it form the actual oscillation generator. When an electrical current pulse is sent
through the coil, it produces a rapidly increasing magnetic field intensity which induces eddy
currents in the homogeneous metal membrane. The eddy currents also produce a magnetic field
which, according to the law of electromagnetic induction, is opposed to that of the coil. The
membrane is repelled and transmits the released mechanical impetus to the water column. A
wave travels from the membrane, becoming a shock-wave after passing through the focusing
lens

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Piezo-ceramic System: The piezo-electric principle operates by simultaneously driving several

hundred piezo elements mounted on a spherical dish, thus providing self-focusing spherical
waves

Imaging: X-ray fluoroscopy as well as ultrasound B-scan are used as sole imaging procedures
in lithotripsy. For pre-treatment diagnosis and for immediate and long-term control after the
shock-wave treatment, X-ray imaging is undisputedly the optimal modality. For optimal
fluoroscopy, two X-ray generators and image intensifiers are used at different imaging planes.
The radiological image appears on the high resolution computer screen mounted on the control
panel. Using digital image control, the computer can enhance the contrast of the calculus, and
can also save an entire series of images on the magnetic media during the treatment.

PATIENT TABLE:
In most systems for the treatment of kidney and urinary stones, shock-wave sources are
arranged below the structures supporting the patient. For aiming the focus at the concrement,
either the table with the patient is moved or, after an approximate positioning, the shock-wave
source is adjusted. With two symmetrically arranged shock-wave sources, the patient lies in a
supine position independent of whether the left or right kidney is treated. The patient table is
motorized that enables movement in all three directions.

HEART LUNG MACHINE

The heart-lung machine is a mechanical pump that maintains a patient’s blood circulation and
oxygenation during heart surgery by diverting blood from the venous system, directing it
through tubing into an artificial lung (oxygenator), and returning it to the body. The oxygenator
removes carbon dioxide and adds oxygen to the blood that is pumped into the arterial system.

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The blood pumped back into the patient’s arteries is sufficient to maintain life at even the most
distant parts of the body as well as in those organs with the greatest requirements (e.g., brain,
kidneys, and liver). To do this, up to 5 litres (1.3 gallons) or more of blood must be pumped
each minute. While the heart is relieved of its pumping duties, it can be stopped, and the
surgeon can perform open-heart surgery that may include valve repair or replacement, repair
of defects inside the heart, or revascularization of blocked arteries.

Structure and Function of the Heart–Lung Machine (HLM)

The HLM cover two important organ functions:-
1. Pump function of the heart
2. Gas exchange function of the lungs

 It must ensure a sufficient perfusion volume that corresponds to the normal cardiac
output of the patient under anaesthetic.
 An adequate perfusion pressure (50–90 mmHg)
 It must also ensure sufficient oxygenation, elimination of CO2, and control of the
blood temperature.

The following components make up the basic equipment of the HLM that is used during
modern cardiac surgery:

1. Blood pumps
2. Oxygenator
3. Tubing system with various tubing diameters
4. Blood filters with various functions
5. Cardiotomy reservoir
6. Cannulae and intracardiac suction tubes

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Blood Pumps and Their Function

De Bakey blood pumps are based on the displacement principle and deliver blood through a
tubing segment from the pump housing using rotating rollers.

The roller pump consists of :-

1. Rotating pump arm with two attached cylindrical rollers
2. Pump housing into which a semicircular silicone tubing segment is inserted and then secured
using special tubing inserts.

The rotating rollers alternately compress the tubing segment and deliver the liquid contained
in the tubing in accordance with the rotational speed and direction. The exact adjustment of the
two rollers determines the delivery. The rollers move outward symmetrically and block the
inserted tube evenly to reduces erythrocyte damage caused by shear stress or direct crushing.
Centrifugal Pumps use centrifugal forces to transport the blood instead of tubing compression.

Oxygenator:-

The artificial lung, also called the oxygenator, takes on the lung function during ECC and is
therefore responsible for the exchange of vital gases. The membrane oxygenators are now used
as standard components. They contain a semipermeable membrane in the shape of a
microporous hollow fiber. This liquid-impermeable membrane separates the gas side from the
bloodstream. Due to the partial pressure gradients, O2 and CO2 diffuse through the
microporous membrane Today, most membranes are made of polypropylene or polyethylene
and permit operating times of 6–8 h. The oxygenator must be able to oxygenate about 5 litres
per minute of venous blood from 65% oxygen saturation to above 95% oxygen saturation
before the blood enters the body systems.

Blood filters are integrated into the ECC system mainly to avoid microembolisms caused by
autologous effect , foreign particles, and microbubbles. Cannulae are the interface between the
ECC system and the vascular system of the patient. They are inserted into the relevant vessels
by a surgeon, where they are secured and deaerated before their sterile connection to the tubing
system of the HLM.

ICCU PATIENT MONITORING SYSTEM

An intensive care unit (ICU), also known as an intensive therapy unit or intensive
treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or
health care facility that provides intensive treatment medicine.
Intensive care units cater to patients with severe and life-threatening illnesses and injuries,
which require constant, close monitoring and support from specialist equipment and
medications in order to ensure normal bodily functions.
Common conditions that are treated within ICUs include acute (or adult) respiratory distress
syndrome (ARDS), trauma, multiple organ failure and sepsis.
Hospitals may have ICUs that cater to a specific medical specialty or patient, such as those
listed below:

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Types of ICU:
General
 Medical Intensive Care Unit
 Surgical Intensive Care Unit
 Medical Surgical Intensive Care Unit
Specialized
 Neonatal Intensive Care Unit
 Coronary Care Unit
 Burn Intensive Care Unit
 Neurosurgery Intensive Care Unit
 Trauma Intensive Care Unit

EQUIPMENT AND SYSTEMS

Common equipment in an ICU needed and used to reduce pain and prevent secondary
infections are:
 mechanical ventilators to assist breathing through an endotracheal tube or
a tracheostomy tube
 cardiac monitors including those problems equipment for the constant monitoring of
bodily functions
 web of intravenous lines, feeding tubes, nasogastric tubes,
 suction pumps
 drains, and catheters
 a wide array of drugs to treat the primary condition(s) of hospitalization.
 Medically induced comas
 analgesics
 induced sedation

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NANO-ROBOTS:
Nano Robotics: Nano Robotics is the technology of creating machines or robots close to the
microscopic scale of a nanometer (10−9 meters). Nanorobotics refers to nanotechnology – an
engineering discipline for designing and building nanorobots. These devices range from 0.1-
10 micrometers and are made up of nano scale or molecular components.
Nano Robots: Nanorobots are nano devices used for the purpose of maintaining and protecting
the human body against pathogens. Nanorobots are implemented by using several components
such as sensors, actuators, control, power, communication and by interfacing cross-special
scales between organic inorganic systems. Nowadays, these nanorobots play a crucial role in
the field of Bio-Medicine particularly in
 Treatment of cancer
 Cerebral Aneurysm
 Removal of kidney stones
 Elimination of defected parts in the DNA structure

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Approaches in development of Nano robots:

Biochip:
In molecular biology, biochips are essentially miniaturized laboratories that can perform
hundreds or thousands of simultaneous biochemical reactions. Biochips enable researchers to
quickly screen large numbers of biological analytes for a variety of purposes, from disease
diagnosis to detection of bioterrorism agents. In a digital microfluidic biochip, a group of
(adjacent) cells in the microfluidic array can be configured to work as storage, functional
operations, as well as for transporting fluid droplets dynamically.

Nubots
Nubot refers to "nucleic acid robots". Nubots are organic molecular machines at the nanoscale.
Scientists say that the DNA structure can provide means to assemble 2D and 3D
nanomechanical devices. DNA based machines can be activated using small molecules,
proteins and other molecules of DNA, thus giving rise to Nubots.
Positional Nanoassembly:
Positional assembly is a high-precision form of self-assembly . Self-assembly is, in turn, one
of the components of molecular manufacturing , a branch of nanotechnology that involves the
use of nanoscale (extremely small) tools and processes to build objects, devices, and systems
at the molecular level. Nanotechnology is a field of engineering that deals with design,
manufacture, and control on a scale of a few nanometers (nm) or less, where 1 nm = 10 -9
meters.

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Usage of Bacteria:
This approach makes use of biological microorganisms, such as Escherichia coil bacteria. So
this model uses a flagellum for propulsion purpose. The use of electromagnetic fields is to
control the motion of biological integrated device and its limited applications.

Nanorobots Applications:
1. Nanorobotics in Surgery
Surgical nanorobots are introduced into the human body through vascular systems and other
cavities. Surgical nanorobots act as semi-autonomous on-site surgeon inside the human body
and are programmed or directed by a human surgeon. This programmed surgical nanorobot
performs various functions like searching for pathogens, and then diagnosis and correction of
lesions by nano-manipulation synchronized by an on-board computer while conserving and
contacting with the supervisory surgeon through coded ultrasound signals.
2. Diagnosis and Testing
Medical nanorobots are used for the purpose of diagnosis, testing and monitoring of
microorganisms, tissues and cells in the blood stream. These nanorobots are capable of noting
down the record, and report some vital signs such as temperature, pressure and immune
system’s parameters of different parts of the human body continuously.
3. Nanorobotics in Gene Therapy
Nanorobots are also applicable in treating genetic diseases, by relating the molecular structures
of DNA and proteins in the cell. The modifications and irregularities in the DNA and protein
sequences are then corrected (edited). The chromosomal replacement therapy is very efficient
compared to the cell repair. An assembled repair vessel is inbuilt in the human body to perform
the maintenance of genetics by floating inside the nucleus of a cell.Supercoil of DNA when
enlarged within its lower pair of robotic arms, the nanomachine pulls the strand which is
unwounded for analysis; meanwhile the upper arms detach the proteins from the chain. The
information which is stored in the large nanocomputer’s database is placed outside the nucleus
and compared with the molecular structures of both DNA and proteins that are connected
through communication link to cell repair ship. Abnormalities found in the structures are
corrected, and the proteins reattached to the Deoxy Nucleic Acid chain once again reforms into
their original form.
4. Nanorobots in Cancer Detection and Treatment
The current stages of medical technologies and therapy tools are used for the successful
treatment of cancer. The important aspect to achieve a successful treatment is based on the
improvement of efficient drug delivery to decrease the side-effects from the chemotherapy.

ROBOTIC SURGERY
Robotic surgery, computer assisted surgery are terms for technological developments that
use robotic systems to aid in surgical procedures. Robotically-assisted surgery was developed

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to overcome the limitations of pre-existing minimally-invasive surgical procedures and to

enhance the capabilities of surgeons performing open surgery. In Robotic surgery there is
Less trauma on the body, Minimal scarring, and Faster recovery time.

Robotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that
instead of operating on patients through large incisions, we use miniaturized surgical
instruments that fit through a series of quarter-inch incisions. When performing surgery with
the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments
are mounted on three separate robotic arms, allowing the surgeon maximum range of motion
and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that
guides the surgeon during the procedure.

Robotic surgery may be used for a number of different procedures, including:

 Coronary artery bypass.
 Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or
important body organs.
 Gallbladder removal.
 Hip replacement.
 Hysterectomy.
 Kidney removal.
 Kidney transplant.
 Mitral valve repair.
Advantages
 Surgeon has enhanced view of the internal organs
 Easier to attach nerve endings
 Fewer physician required in operating room

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 Smaller risk for infection

Disadvantages
 The question of safety
 High procedure cost
 Requires rigorous maintenance procedures

ADVANCED 3D SURGICAL TECHNIQUES:

The indications for minimally invasive surgery continue to expand worldwide, with endoscopic
surgery currently regarded as standard treatment in many surgical fields. The prototype of a
three-dimensional [3D] system for endoscopic surgery was developed during the early 1990s
to overcome the lack of depth perception on a two dimensional [2D] display. The prototype,
however, was not widely used because of the poor quality of the image and visual side effects.
Advances in the technology have now allowed the development of 3D endoscopic systems with
high-definition resolution that are commercially available. We discuss the development, basic
studies, present status, and future of 3D endoscopic systems, including their advantages and
disadvantages. Although further improvements are needed for more advanced surgery, the
rapid advances being experienced in 3D endoscopic system will hopefully overcome the
remaining problems quickly and provide the ultimate version of minimally invasive surgery.

Developments and Basic Study of the Three-Dimensional Display

When the prototype of the 3D system was first used for endoscopic surgery, the surgeons
themselves sometimes developed side effects such as headaches, ocular fatigue, and dizziness
caused by the heavy active shutter glasses and the poor quality in the 3D images. Another
roadblock to its use was the high purchase cost, which kept it from becoming commercially
available. Hence, the earlier 3D systems were not widely used. Birkett reported greater comfort
with the new light-polarizing glasses compared to the earlier active shutter glasses.

Our purpose was to provide more depth perception for endoscopic surgeons than what had been
provided with 3D endoscopic systems using a plain display [3DP]. In addition, our 3DD system
does not require a shutter mechanism in the glasses, which often causes significant side effects
as well as dark images when using the prototype of the 3DP system. To aid in evaluating the
efficacy of the Cyber Dome, we designed and applied six new tasks as well as the conventional
tasks of suturing and knot tying. We evaluated the effects of the novel 3DD system on
endoscopic surgery and compared the results with those attained using a conventional 2D
system, with particular focus on depth perception. We found that the 3DD system significantly
improved depth perception based on its ability to perform the six new tasks. Its use also reduced
the execution time and the number of errors in suturing and knot tying.

Present Status of 3D Endoscopic Systems

HD systems are often used in conventional 2D endoscopic systems to provide extremely high
resolution for the surgeon. Currently, however, 3D endoscopic systems with HD resolution
have become commercially available from several vendors.

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ORTHOPEDIC PROSTHESES FIXATION

Orthopedic prostheses fixation: Internal fixation is an operation in orthopedics that involves
the surgical implementation of implants for the purpose of repairing a bone. Among the most
common types of medical implants are the pins, rods, screws and plates used to anchor
fractured bones while they heal.
The fixation of orthopedic implants has been one of the most difficult and challenging
problems. The fixation can be achieved via: (a) direct mechanical fixation using screws, pins,
wires, etc.; (b) passive or interference mechanical fixation where the implants are allowed to
move or merely positioned onto the tissue surfaces; (c) bone cement fixation which is actually
a grouting material; (d) biological fixation by allowing tissues to grow into the interstices of
pores or textured surfaces of implants; (e) direct chemical bonding between implant and tissues;
or (f) any combination of the above techniques. Some of the important fixation methods are as
follows:
a. Interlocking Nails: Interlocking nail (ILN) fixation is a method of fracture repair
that capitalizes on the inherent strengths of intramedullary (IM) pin fixation.
From an overall biomechanical standpoint, a fixation device is strongest when
it follows the central axis of the long bone. As the device is moved away from
the central axis, the device is less able to withstand cyclic bending loads and is
more susceptible to fatigue failure.
b. Hip Prosthesis: Hip replacement is surgery for people with severe hip damage.
During a hip replacement operation, the surgeon removes damaged cartilage
and bone from your hip joint and replaces them with new, man-made parts.
c. Internal fixation allows shorter hospital stays, enables patients to return to
function earlier, and reduces the incidence of nonunion (improper healing) and
malunion (healing in improper position) of broken bones. The implants used for
internal fixation are made from stainless steel and titanium, which are durable
and strong. If a joint is to be replaced, rather than fixed, these implants can also
be made of cobalt and chrome. Implants are compatible with the body and rarely
cause an allergic reaction.

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i) Plates are like internal splints that hold the broken pieces of bone
together. They are attached to the bone with screws. Plates may be
left in place after healing is complete, or they may be removed (in
select cases).
ii) Screws are used for internal fixation more often than any other type
of implant. Although the screw is a simple device, there are different
designs based on the type of fracture and how the screw will be used.
Screws come in different sizes for use with bones of different sizes.
Screws can be used alone to hold a fracture, as well as with plates,
rods, or nails. After the bone heals, screws may be either left in place
or removed.

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