patient recovery time. It is a surgical procedure done by using long reached tools and an
endoscopic camera to operate on the body though small incisions made near the point of
operation while viewing the live camera feed on a nearby display screen. Multiple camera
views are used in various industries such as surveillance and professional gaming to
allow users a spatial awareness advantage as to what is happening in the 3D space that is
presented to them on 2D displays. The concept has not effectively broken into the
medical industry yet. This thesis tests a multi-view camera system in which three cameras
are inserted into a laparoscopic surgical training box along with two surgical instruments,
to determine the system impact on spatial cognition, perceived cognitive workload, and
the overall time needed to complete the task, compared to one camera viewing the
traditional set up. The task is a non-medical task and is one of five typically used to train
surgeons’ motor skills when initially learning minimally invasive surgical procedures.
The task is a peg transfer and will be conducted by 30 people who are randomly assigned
to one of two conditions; one display and three displays. The results indicated that when
three displays were present the overall time initially using them to complete a task was
slower; the task was perceived to be completed more easily and with less strain; and
participants had a slightly higher performance rate.
Michael R. Harrison worked as a pediatric surgeon in the US throughout the late-twentieth century and performed many fetal surgeries, including one of the first successful surgeries on a fetus in utero, or while it is still in its gestational carrier’s body, also called open fetal surgery. A fetus is an organism developing inside of the uterus that is anywhere from eight weeks old to birth. Harrison hypothesized that open fetal surgery could correct developmental defects that may become fatal to the fetus at birth. After years of research, Harrison and his colleagues at the University of California, San Francisco, in San Francisco, California, performed surgery on the fetus of a woman in her seventh month of pregnancy to correct the fetus’s developmental defects. The surgery was successful, as the fetus developed into a healthy child. Harrison’s work led to advancements in fetal treatment techniques, such as a method to conduct open fetal surgery that will not harm the fetus or pregnant woman, as well as the establishment of one of the first fetal treatment centers in the US.
William Stewart Halsted was a surgeon at Johns Hopkins Hospital in Baltimore, Maryland, during the late 1800s and early 1900s. In 1894 Halsted described his procedure for treating breast cancer by removing the breast tissue, chest muscles, and lymph nodes in the armpit, a procedure he named radical mastectomy, and that became the standard of care for treating breast cancer until 1970. He also made contributions to other novel medical procedures such as gallbladder surgery, blood transfusions, antiseptic techniques, anesthesia use, and using plates and screws to hold bones in position when setting bone fractures. At Johns Hopkins Hospital, Halsted established a surgical training program in which he allowed medical students and surgical residents to shadow him and perform procedures under his guidance. In the twentieth century, similar training programs spread across the country and informed the standardization of medical training. Halsted devised a surgical treatment for breast cancer and reshaped the way physicians practiced medicine in the twentieth century, which resulted in better health outcomes through more careful surgical methods, especially in women with breast cancer.
James Marion Sims developed a treatment for vesico-vaginal fistulas in Montgomery, Alabama in the 1840s. Vesico-vaginal fistulas were a relatively common condition in which a woman's urine leaked into her vaginal cavity from her bladder, and many regarded the fistulas as untreatable during the early 1800s. After years of efforts to repair the fistulas with myriad tools, techniques, and procedures, Sims developed the speculum and a vaginal examination position later named for him. He also popularized the use of silver metal sutures to treat and cure women who had vesico-vaginal fistulas. Sims's surgical cure for vesico-vaginal fistulas eased both the social stigma and physical discomfort of many affected women. Though current treatments of vesico-vaginal fistulas have evolved since the nineteenth century, some of the basic principles utilized by Sims have been incorporated into present-day surgeries. In particular, Sims stressed the significance of continual bladder drainage after the operation.
In this work, plasmonic nanocomposites have been synthesized and used in laser tissue welding for ruptured porcine intestine ex vivo and incised murine skin in vivo. These laser-responsive nanocomposites improved tissue strength and healing, respectively. Additionally, a spatiotemporal model has been developed for laser tissue welding of porcine and mouse cadaver intestine sections using near-infrared laser irradiation. This mathematical model can be employed to identify optimal conditions for minimizing healthy cell death while still achieving a strong seal of the ruptured tissue using laser welding. Finally, in a model of surgical site infection, laser-responsive nanomaterials were shown to be efficacious in inhibiting bacterial growth. By incorporating an anti-microbial functionality to laser-responsive nanocomposites, these materials will serve as a treatment modality in sealing tissue, healing tissue, and protecting tissue in surgery.
This thesis scrutinizes CLE technology for its ability to provide real-time intraoperative in vivo and ex vivo visualization of histopathological features of the normal and tumor brain tissues. First, the optimal settings for CLE imaging are studied in an animal model along with a generational comparison of CLE performance. Second, the ability of CLE to discriminate uninjured normal brain, injured normal brain and tumor tissues is demonstrated. Third, CLE was used to investigate cerebral microvasculature and blood flow in normal and pathological conditions. Fourth, the feasibility of CLE for providing optical biopsies of brain tumors was established during the fluorescence-guided neurosurgical procedures. This study established the optimal workflow and confirmed the high specificity of the CLE optical biopsies. Fifth, the feasibility of CLE was established for endoscopic endonasal approaches and interrogation of pituitary tumor tissue. Finally, improved and prolonged near wide-field fluorescent visualization of brain tumor margins was demonstrated with a scanning fiber endoscopy and 5-aminolevulinic acid.
These studies suggested a novel paradigm for neurosurgery-pathology workflow when the noninvasive intraoperative optical biopsies are used to interrogate the tissue and augment intraoperative decision making. Such optical biopsies could shorten the time for obtaining preliminary information on the histological composition of the tissue of interest and may lead to improved diagnostics and tumor resection. This work establishes a basis for future in vivo optical biopsy use in neurosurgery and planning of patient-related outcome studies. Future studies would lead to refinement and development of new confocal scanning technologies making noninvasive optical biopsy faster, convenient and more accurate.