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The best radiation dose vs image quality was found for the i-CAT.

PurposeSmaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. The proposed trainer combines the benefits of box trainer technology and virtual reality systems. Face and content validation studies are presented and a use-case highlights the benefits of having embedded sensors.MethodsFace and content validity of the developed setup was assessed by asking surgeons from the field of fetal MIS to accomplish specific tasks on the trainer. A small use-case investigates whether the trainer sensors are able to distinguish between an easy and difficult scenario.ResultsThe trainer was deemed sufficiently realistic and its proposed tasks relevant for practicing the required motor skills. The use-case demonstrated that the motion and force sensing capabilities of the trainer were able to analyze surgical skill.ConclusionThe developed trainer for fetal laser surgery was validated by surgeons from a specialized center in fetal medicine. Further similar investigations in other centers are of interest, as well as quality improvements which will allow to increase the difficulty of the trainer. The comprehensive sensing appeared to be capable of objectively assessing skill.

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The initial stability of cementless total hip arthroplasty (THA) implants is obtained by an interference fit that allows osseointegration for a long term secondary stability of the implant. Yet, finding the insertion endpoint that corresponds to an appropriate initial stability is currently often based on a number of subjective experiences of the orthopedic surgeon, which can be challenging. In order to assist the orthopedic surgeons in their pursuit to find this optimal initial stability, this study aims to determine whether the analysis of sound that results from the implant insertion hammer blows can be used to objectively monitor the insertion process of cementless THA implants. An in vivo study was conducted. The experimental results revealed vibro‐acoustic behavior sensitive to implant seating, related to the low frequency content of the response spectra. This sensitive low‐frequency behavior was quantified by a set of specific vibro‐acoustic features and metrics that reflected the power and similarity of the low‐frequency response. These features and metrics allowed monitoring the implant seating and their convergence agreed well with the endpoint of insertion as determined by the orthopedic surgeon. Intraoperative fractures caused an abrupt and opposite change of the vibro‐acoustic behavior prior to the notification of the fracture by the orthopedic surgeon. The observation of such an abrupt change in the vibro‐acoustic behavior can be an important early warning for loss of implant stability. The presented vibro‐acoustic measurement method shows potential to serve as a decision supporting source of information as it showed to reflect the implant seating.