As we thought about knife our heart fills with fear be reassured. No longer is surgery the brutal and hazardous experience faced by our forbear. Salutes to wonders such as laparoscopy,robotic solutions, and, more recently, the iKnife and the laser probe, surgical intervention is getting safer all the time.
People have been carrying out surgery for up to 11,000 years the archaeologists say. Cranial surgery, known as trephination, probably dates back to the Neolithic era. It involved drilling a hole in the skull of a living person. Speculation suggests it was done to cure disorders such as convulsions, fractures, headaches, and infections. The Ancient Egyptians used the same operation for "letting out" headaches and migraine.
The New England Journal of Medicine in 1812 offers accounts of procedures that would now be considered gruesome, such as passing a hook through a man’s pupil during the removal of a cataract, and using leeches for bloodletting.
In the present you have minimally invasive surgery where even a heart transplants now relatively routine work. According to the United Network for Organ Sharing (UNOS) from January 1988 to July 2016, 64,055 cardiac transplants have taken place in the United States.
Advances in minimally invasive surgery
One of the French gynecologists performed the first recognized laparoscopic surgery to remove a gallbladder in1987. From then, the practice has expanded rapidly.According to the U.S. Food and Drug Administration (FDA), over 2 million laparoscopic surgeries are carried out each year in the U.S.
A small tube with a light source and a camera passes through the body until it reaches the relevant part in the process laparoscopic or "keyhole"surgery. The areas that are need operating show up on a screen, while the surgeon works the tools through small openings.
The“Minimally invasive” procedures mean smaller incisions with less scarring, a lower risk of infection, shorter hospital stays, and reduced convalescence.
The Robotic surgery
The next stop is robotic surgery. A team of scientists in the year 2000 in Germany who were researching techniques for minimally invasive surgery announced that they had developed a system with two robotic arms that are controlled by a surgeon at a control console. They called it ARTEMIS.
In July 2000, the Da Vinci system was approved for use in the U.S. for cutting and surgery and it was the first robotic surgical system to get FDA approval, and its use has become relatively widespread.
The system has three components: a vision cart with a light source and cameras, a master console where the operating surgeon sits, and a moveable cart with two instrument arms and the camera arm.
The camera provides a true 3-D image that is displayed above the surgeon's hands,so the tips of the instruments seem like an extension of the control grips.Foot pedals control electrocautery, camera focus, instrument and camera arm clutches, and master control grips that drive the servant robotic arms at the patient's side.
There have been reports of errors and malfunctions, some of them fatal, and not everyone is convinced that robotic surgery really produces better patient outcomes.
The Laser ProbeA Laser Probe
Gregg Scheller is an engineer who developed the first multi-function aspirating laser probe with Dr. Stanley Chang. He also developed the first directional laser probe with Dr. Eugene De Juan. He developed the first Illuminated Laser Probe as well. The latest development is the “Steerable” Laser Probe.
The design of a simple straight laser probe is simple. It has about 5 parts. The laser built with a connector, a fiber optic fiber, a sheath covering the fiber, a handle, and a stainless steel tubing tip.
Conductor:This is an off-the-shelf item for many manufacturers, with suppliers supplying the components to a known specification. These are very precisely dimension devices, however. The connector’s job is therefore to center the optic on the focal spot precisely enough that it can capture all of the light and transmit it down the fiber. The 200 micron core and the 50 micron spot only allow a mismatch of 75 microns per side.
Fibers:Fibers can be constructed of a variety of materials. Most Laser-transmitting fibers use silica glass as the core transmitting material. This is then surrounded by a plastic or glass “cladding” that has an Index of Refraction that “holds” the light inside of the core material. Then, it is usually surrounded by a protective layer, sometimes called the “buffer”. There are also different fiber core diameter sizes. Depending on the manufacturer and, among other things, the amount of money that they are able to spend on the connector as described above, the diameter of the fiber in some products goes up to 300 microns. This allows a less precise laser, or lower tolerance (cheaper) parts in the connector to be used to save cost. Most precision products utilize 200micron core fiber.
Cladding:The choice of cladding material determines, to a large extent, the Numerical Aperture (NA) of the fiber. This NA describes the rate of beam divergences it exits the tip of the fiber. As you can envision, this also as a determining effect on the spot size at the Retina as well as determining how far from the Retina the tip of the probe is held. Katalyst products feature a low-beam divergence NA to allow the surgeon a smaller, more precise,spot and to also allow the tip to be further away from the Retina. Spot integrity at the Retina can also be a product of the way the fiber is optically finished on BOTH ends of the fiber. Some manufacturers finish fibers through a process called “cleaving”. This process involves stripping the protective fiber buffer off of the fiber assembly, stretching the fiber tight,and then nicking the fiber, usually with a diamond or sapphire blade. The fiber then “cleaves” at this point with the objective being a flat,optically-clean surface.
Handle and Tip: Not discussed yet is the handle and tip. Other than the Steerable™ Probe, nothing externally distinguishes the front tip of the probe other than the tip stiffness of the 25 and 27gaprobes.
Our probes feature a front tip material that is 50% stiffer than any competitor’s product. This is a result of a development effort that has resulted in Katalyst probes employing a custom-made tip material that no other competitor uses. Internally, the fiber that we choose to use features a Kevlar-like cladding material that remains intact to the tip. If you recall, this is what prevents the fiber from breakage. By choosing this type of fiber, Katalyst believes that it has fewer out-of-the-bag failures than its competitors, who use a cheaper fiber that must be stripped of itsTefzel buffer before polishing or cleaving.
Laser detection of brain tumors
Recently, researchers in the United Kingdom and Canada have paired up the iKnife with a laser probe to detect abnormal tissue during surgery to remove a brain tumor.
This technique used a near-infrared laser probe to determine whether tissue was cancerous or healthy by measuring light reflected off the tissue.
When they pointed the beam of light onto the exposed brain, molecules in the cells began to vibrate. As they did so, fiber optics in the probe collected the scattered light that was bouncing off the tissue.
By measuring the frequency of the vibrations, the scientists were able to tell which tissue was healthy and which was not. As with the iKnife, analysis took just seconds.