Journal: Expert review of medical devices
Biodegradable stents overcome some of the problems encountered with self-expanding metal stents. They main advantage over self-expanding metal stents is that endoscopic removal is not needed. Single biodegradable stents are often only temporarily effective in patients with a refractory benign esophageal stricture, as in the majority dysphagia recurs. If this occurs, sequential biodegradable stent placement may be an effective alternative to avoid the burden of serial dilations. In the future, it can be expected that (covered) biodegradable stents will be available to treat benign esophageal perforations/leaks, but also that they will be used for treating malignant indications combined with other (palliative) modalities, such as bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.
Bone-anchored hearing devices have evolved over recent years. This article provides an overview of the device history, indications, evolution of surgical technique, evidence for benefit and focuses on the challenges that are faced in the pediatric population.
This paper reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic devices that provide wrists or wrist-like dexterity within the patient. Many of these devices aim to provide dexterity conceptually similar to the EndoWrist instruments of the da Vinci surgical robot, but without requiring computers and motors. The motivation is to provide high-dexterity instruments at a lower cost than current surgical robots offer. In this paper we review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two.
The benefits and disadvantages of pulsatility in mechanical circulatory support devices have been argued since before the first use of cardiopulmonary bypass (CPB) with a nonpulsatile pump. The debate over the superiority of either pulsatile or nonpulsatile perfusion during CPB persists, but recently, the evidence in favor of pulsatile perfusion during CPB is increasing. Complications associated with chronic nonpulsatile flow in patients implanted with left ventricular assist devices have renewed interest in generating pulsatility with these devices. Area discussed: Here we review the definition of pulsatility, the outcomes of CPB using pulsatile and nonpulsatile pumps, and how best to produce and assess pulsatility. Those information were identified through online database and direct extraction of single studies cited in previously identified manuscripts. Expert commentary: The newer generation of biocompatible pulsatile pumps that can generate physiologic pulsation may prove beneficial during temporary support for short use during CPB or intermediate support for cardiogenic shock.
Driven by healthcare cost and home healthcare need, the development of remote monitoring technologies is poised to improve and revolutionize healthcare delivery and accessibility. This paper reviews the recent progress in the field of remote monitoring technologies that may have the potential to become the basic platforms for telemedicine. In particular, key techniques and devices for monitoring cardiorespiratory activity, blood pressure and blood glucose concentration are summarized and discussed. In addition, the US FDA approved remote vital signs monitoring devices currently available on the market are presented.
Introduction Anastomotic leak (AL) after colorectal surgery is a devastating complication; decreased blood perfusion is an important risk factor. Surgeons rely on subjective measures to assess bowel perfusion. Fluorescence imaging (FI) with indocyanine green (ICG) provides a real-time objective assessment of intestinal perfusion. Areas Covered A Pubmed search using the terms ‘fluorescence imaging’, ‘indocyanine green’, ‘colon and rectal surgery’ was undertaken. Sixteen articles between 2010 to present were identified. Main outcomes were leak rate reduction, change in surgical plan, and technical feasibility. Change in surgical strategy due to FI was recorded in 11 studies. Two case control studies showed overall reduction of 4% and 12% in AL rate and one showed no change in AL rate between groups. Expert Commentary According to the available literature, FI is technically feasible and alters surgical strategy in a non-negligible number of patients possibly effecting AL rates.
Consumer sleep tracking devices such as fitness trackers and smartphone apps have become increasingly popular. These devices claim to measure the sleep duration of their users and in some cases purport to measure sleep quality and awaken users from light sleep, potentially improving overall sleep. Most of these devices appear to utilize data generated from in-built accelerometers to determine sleep parameters but the exact mechanisms and algorithms are proprietary. The growing literature comparing these devices against polysomnography/ actigraphy shows that they tend to underestimate sleep disruptions and overestimate total sleep times and sleep efficiency in normal subjects. In this review, we evaluate the current literature comparing the accuracy of consumer sleep tracking devices against more conventional methods used to measure sleep duration and quality. We discuss the current technology that these devices utilize as well as summarize the value of these devices in clinical evaluations and their potential limitations.
Introduction: Right heart failure (RHF) in patients with a left ventricular assist device (LVAD) carries a poor prognosis although the treatment strategy including mechanical circulatory support for the failing right ventricle (RV) has not been well established. Areas covered: In this review, we describe an overview of RHF post-LVAD implant including natural history, prevalence, pathophysiology, outcomes, and challenges to predict RHF post-LVAD implant. Then, we focus on right ventricular assist devices (RVADs) and their clinical outcomes. Recently developed percutaneous RVADs are the major advance in this field. Finally, we discuss future perspectives to overcome limitations of the current treatment options. Expert opinion: In the absence of dedicated RVAD system RHF post-LVAD implant may have been undertreated. Now that dedicated percutaneous RVADs have emerged, surgeons are encouraged to use these new devices to improve outcomes of LVAD therapy. As experience accumulates, we should be able to establish the best possible strategy to treat early RHF post-LVAD implant. Late RHF is another form of RHF post-LVAD implant and has been underappreciated. Further research is mandatory to clarify the mechanism and risk factors. There are still unmet needs for a dedicated implantable RVAD for a subset of patients who need long-term RV support.
Background: Elastomeric infusion pumps are widely used in the delivery of parenteral medications in the home, but real-life conditions may not match calibration or standardised testing conditions. This study investigated the impact of changes in infusion pump height and/or back pressure on infusion pump function. Research design and methods: Volume delivered after one day, infusion duration, average and peak flow rates and time spent within stated accuracy were determined for four elastomeric and one electronic pump using gravimetric technique. Experiments were repeated after altering the height of the pump relative to the output (±40cm, ±20cm) and/or adding a back pressure (10-30mmHg) to the output of an attached catheter. Results: Under ideal operating conditions, the flow rate deviated from that specified by the manufacturer and between 88.5% and 99% of the total infusion volume was delivered. Varying the height or applying back pressure led to further changes in average flow rates and the volume of infusion solution delivered by the elastomeric pumps, but had little effect on the electronic pump. Conclusions: Clinicians should consider potential impact on drug delivery, safety and therapeutic effect for home infusion patients given variations in infusion pump performance observed in this study.
Introduction: This review uses a head-to-toe approach, a standardized approach similar to the format used by clinicians during the physical examination, to highlight important differences between children, adolescents and adults. The assessment of a pediatric patient is significantly different from an adult and the heterogeneity of the pediatric population requires knowledge of the inter- and intra-subpopulation differences in growth and development for all organ systems. Areas covered: A search of the English medical literature (PubMed and EMBASE) resulted in identification and review of articles that reported medical device use in the pediatric population based on specific organ systems. The review highlights unique considerations for the pediatric population with respect to growth and development as well as important physiologic and maturational differences between children and adults pertaining to the use of medical devices. Expert opinion: Children have unique medical device needs; adult devices are often adapted or configured to address these unmet needs. It is important that clinicians, and those who manufacture and design medical devices for the pediatric population, have a heightened awareness of the varied pediatric subpopulations (neonates to adolescents) with respect to growth and development, and the adjustments needed to ensure safe and effective use of devices for their unique needs.