Monthly Archives: October 2006

First Report- DITM Creator Awarded First Prize For New “X-Ray Vision” Tumor Surgery Technique

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Left side:Regular View-No Disease Seen

Right Side:new system-disease is dark indigo and bright green

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the “firefly effect” Disease glows green!

BREAKING NEWS FROM DOCINTHEMACHINE-Reported Here First

Docinthemachine creator Steven F. Palter, MD, Medical and Scientific Director of Gold Coast IVF, has won First Prize for Technical Achievement in Video for his study of a new laparoscopic technology that can be used to diagnose endometriosis. The prize was awarded today during the 62nd annual meeting of the American Society of Reproductive Medicine (ASRM) on October 23rd at the New Orleans Convention Center

Gold Coast IVF press release of system and award

The new “keyhole” surgery technique enables surgeons to see tumors and other pathologies, including endometriosis not otherwise visible. In traditional laparoscopy, the telescope provides the same view as would be seen with the naked eye. In the new method, highly specific filters are incorporated into the light system and telescope so that surgeons can see the tiny amounts of fluorescent light that all living human tissues give off when illuminated, a phenomenon called “autofluorescence”.

The system illuminates tissues with short wavelength blue light (380-450 nm). The tissues absorb this light and then release it as longer wavelength green light (>470 nm).

Normal and diseased tissues give off different amounts of light. Areas of disease that block fluorescence are seen as dark indigo areas, whereas those that emit fluorescence glow like a firefly. With this new surgical technique I can see disease that is otherwise invisible and treat the patient more effectively.

My study reported on the use of the autofluorescence system for the diagnosis of endometriosis, a potentially debilitating disease that affects 5.5 million women in the United States, causing infertility and chronic pelvic pain. We found additional disease using the system in 63% of the women with endometriosis examined.

The system, manufactured by Karl Storz Endoscopy-America, is based on technology that has previously been used to detect lung cancer. This study represents its first use for laparoscopic examination of the pelvic and abdominal cavities in the US. It is not yet approved for general use in the US. The next step I have planned are further ther studies to evaluate the system as a potential diagnostic tool for ovarian cancer and its metastases – a silent killer of women.

Related Posts and Videos of System:

Initial post on system with surgical photos

Description of how autofluorescence laparoscopy works

Video of how AF laparoscopy works

Surgical Video of how systems works- fluorescent views

First ever video of the “firefly effect”

Additional intraoperative video fluorescent vs. white light

Another Update: More awards!  I am honored to report my follow-up work on this technology has won three additional medical society prizes: First Place at the Society of Laparoendoscopic Surgeons (SLS), First Place Best New Instrument Kott award at AAGL, and Golden Laparoscope award at AAGL

Still Another Update- Next Generation: Read more on the augmented abilities of surgeons and the future revolution in surgery here.

More original research from DITM on new cause of infertility

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How The Autofluorescence System Works- Description

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reduced-af.gifreduced autofluorescence

hyperfluor.gifincreased autofluorescence

Steven Palter, MD, creator of DITM just posted breaking news on his prize winning “x-ray vision” autofluorescent endoscopy system. Here is a summary of how the system works.

A specialized laparoscopy system was designed based upon the same general principle as fluorescence spectroscopy. In contrast to reflection, where light bounces unchanged off of a surface structure, in fluorescence the light is absorbed and then released at a different wavelength (color). When certain tissues are illuminated with light energy from short wavelength (380 – 430 nm) light, the absorbed energy is emitted as light at a longer wavelength (475-800 nm) and is observed as fluorescent light of a different color. The fluorescent light can be observed using special optical filters designed to block the background light and allow the fluorescent light to be viewed.

This fluorescence occurs in the same fashion during illumination with ordinary white light but becomes lost and invisible due to the much brighter illuminating white light. This system allows the selective visualization of the low intensity autofluorescent signals by filtering out the other bright light wavelengths that are in white light. No additional wavelengths of light are used.

Tissues illuminated with regular light emit a small amount of differently colored fluorescent light which is often not seen since the overall illuminating white light is so much brighter. By applying specific filters to the illumination light the amount of fluorescent light emitted can be maximized. By using observation filters, the large amount of illuminating light can be filtered out and the small amount of colored fluorescent light made to stand out and be more easily seen. Since connective tissues and surface epithelia have background autofluorescence (AF), pathologic lesions that grow on the surface of an epithelial layer (such as the peritoneum) may stand out compared with normal tissue when viewed in this manner by having a different light pattern than the normal tissue.

Related Posts and Videos of System:

Initial post on system with surgical photos

Description of how autofluorescence laparoscopy works

Video of how AF laparoscopy works

Surgical Video of how systems works- fluorescent views

First ever video of the “firefly effect”

Additional intraoperative video fluorescent vs. white light

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How AF System Works- Video

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I have posted about my Prize winning work on autofluorescent laparoscopy to diagnose disease. This video demonstrates the mechanism by which the system works.[youtube]SN6huqm5fh0[/youtube]

Related Posts and Videos of System:

Initial post on system with surgical photos

Description of how autofluorescence laparoscopy works

Video of how AF laparoscopy works

Surgical Video of how systems works- fluorescent views

First ever video of the “firefly effect”

Additional intraoperative video fluorescent vs. white light

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Prize AF System Video of Endometriosis

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I have posted a series of posts today about my prize-winning video from the American Society for Reproductive Medicine (ASRM). This video demonstrates the laparoscopic view of endometriosis using the new autofluorescent system.[youtube]n6aBjwsVUjg[/youtube]

Related Posts and Videos of System:

Initial post on system with surgical photos

Description of how autofluorescence laparoscopy works

Video of how AF laparoscopy works

Surgical Video of how systems works- fluorescent views

First ever video of the “firefly effect”

Additional intraoperative video fluorescent vs. white light

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First Ever Video of “Firefly” Effect

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Next in my series of video clips demonstrating my prize winning study from the ASRM. This video shows the first ever demonstration of hyperfluorescent endometriosis lesions seen using the autofluorescent system.[youtube]H3a6jw6GMfA[/youtube]

Related Posts and Videos of System:

Initial post on system with surgical photos

Description of how autofluorescence laparoscopy works

Video of how AF laparoscopy works

Surgical Video of how systems works- fluorescent views

First ever video of the “firefly effect”

Additional intraoperative video fluorescent vs. white light

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Another Video of Prize Autofluorescence System

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This is another video of the use of autofluorescent laparoscopy to visualize endometriosis from my ASRM prize winning presentation.[youtube]6ucZWis8M4M[/youtube]

Related Posts and Videos of System:

Initial post on system with surgical photos

Description of how autofluorescence laparoscopy works

Video of how AF laparoscopy works

Surgical Video of how systems works- fluorescent views

First ever video of the “firefly effect”

Additional intraoperative video fluorescent vs. white light

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New 3D Microendoscope- Analysis of How It Differs and Its Potential

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Thanks to medgadget for reporting on Massachusetts General Hospital investigators development of a three-dimensional miniature endoscope.  This is a topic near and dear to my heart since the first medical device development I did was on microendoscopes back in 1994.  This new scope is fundementally different from traditional scopes. 

As the press release reports:

Standard miniature endoscopic devices – which give physicians access to hard-to-reach internal organs and structures – utilize bundles of optical fibers to supply light to and transmit images from the areas of interest. Larger endoscopes that use image sensors to produce high-quality, two-dimensional images can be a centimeter or more in diameter. Existing miniature endoscopes using smaller fiber bundles may be more flexible but have difficulty producing high-quality images.

The new device developed at MGH-Wellman uses a technology called spectrally encoded endoscopy (SEE). Multicolored light from a single optical fiber – introduced through a probe about the size of a human hair – is broken into its component colors and projected onto tissue, with each color illuminating a different part of the tissue surface. The light reflected back is recorded, and the intensity of the various colors decoded by a spectrometer, which analyzes the wavelengths of light. Another device called an interferometer, which calculates structural information based on the interaction between two waves of light, provides the data required to create three-dimensional images.

Types of Scopes I Use and a Brief History of Microendoscopes:

As a fertility specialist, my surgical practice is almost entirely endoscopic.  Traditional endoscopes are simple telescopes with either a series of lenses or rod-lens combinations.  They require a large amount of light and are commonly in the 5 to 10 mm size range.  My work initially focused on the development of “microendoscopes” which I defined as those sub-5mm.  Standard lens scopes can be effectively made down to 3mm as surgical tools but become very fragile in this size and break easily.  The next innovation was the development of “fiberscopes”.  These telescopes consisted of a series of fiberoptic image and light carrying bundles with proximal and diatal lenses.  In some cases the distal lens was not convex but of the GRIN type.  I saw the scopes progressively improve from 1500 fibers to 15,000 to 30,000 then to 50,000.  Each successive generation yieded better resolution.  To a real extent these fibers where like pixels.  As the number of fibers went down the image became more pixelated and had poorer resolution and light throughput. 

One of the most exciting projects I worked on was the development of the “falloposcope” which was a 0.55 scope that could pass down the inside of the human fallopian tube and see fine scars that werte otherwise missed in women with infertility

My Use of Microendoscopes for Awake Surgery:

At this point, I began to use these scopes for office-based surgery under local or no anesthesia.  My idea was to reduce costs and speed recovery by using tiny telescopes to diagnose disease.  The concept caught on and I became the Director of the Yale Office Laparoscopy .  I was teaching twice monthly courses to doctors from around the world who eagerly adopted the technology.  I used a 2mm laparoscope which is still used today and then helped develop a 2mm hysteroscope to look inside the uterus.  These instruments were so small that the patients could be awake and watch my view of their insides as I operated! Our motto was “where the patient is a part of the surgical team”.  Here is a review of a new procedure I developed called “conscious pain mapping”. 

Fast Forward to Today:

I am very excited about recent reports of tiny scopes to look inside the breast or into the spine or into the brain.  I belive microendoscopes will continue to evolve. This report is impoin that this is a new type of endoscope that uses a different mechanism for providing the image.  The system allows radically smaller scopes and potentially provides a 3D image.  THis opens up the potential for remote imaging and for computer modification of the images- the two topics I belive define the future of endoscopic surgery.   

Check back on monday for major breaking news from docinthemachine of a new type of endoscope that makes invisible disease visible…..

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Thought Control Surgery- Brain Hacking to Come

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I have written about the brain gate computer brain interface before.  The company has now announced its use by a patient with ALS. 

Cyberkinetics Neurotechnology Systems, Inc. Cyberkinetics) announced that Leigh R. Hochberg, M.D., Ph.D., Principal Investigator in the pilot trial of the BrainGate Neural Interface System (BrainGate), presented preliminary findings from the trial’s first participant with ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) in his presentation at the Annual Meeting of the Society for Neuroscience in Atlanta

This tecnology is expanding.  For now the focus is on neurodegenerative illness and spinal cord injuries.  There is no doubt in my mind that this technology will be expanded to enhancement use and recreation in the future.  As I heard a DARPA doc say ” what if your daughter comes and says, Dady I want to be the fastest runner in the world, cut off my legs and give me bionics?”.  Do you doubt for a minute that if what I call  ”brain-hacking” becomes availabe there will not be a line to plug-in?

See also my related posts on:

use by monkey to feed itself by robot arm with thoughts

the matrix plug-in becomes real

 

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New No Incision Surgery- Amazing Case Study of Procedure Looking For a Use

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Cnn reports today from a national meeting of bariatric surgeons.  They describe a keynote talk of the future of non-incisional surgery called NOTES- that has NO REAL USE YET!  This is the Alien stomach buster operation I have written about.  This is an amazing case study on technology looking for a use in medicine.  Several meetings I have attended have been abuzz withtalk of how to use it and what is it s potential.  Just read between the lines of the CNN piece and you will see that neither the doctor nor the big medical equipment compnay has a clear use of the technology.  I know a surgeon on the medical advisory board of one of the big surgical compnaies who talked to me in the ER about this last week while we waited for lab results to come back on one of our patients. He talked to me of working in their lab trying to figure out a use for the technology. A leading general surgeon I have worked with is going onsabattical to travel to india to see what uses NOTES may have.  Just amazing all this hype and no clear use yet.  I eagerly wait to see if one will be found or if I can imagine one to invent… 

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Air Force Developing Morphing Aircraft – Idea For New Surgical Tools

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Researchers are aiming to find ways to enable aircraft to change shape during flight to improve performance or efficiency.

Modern materials are enabling engineers to take a fresh look at the idea of aircraft that can flex, twist or change shape to make them more maneuverable. NASA and the Defense Department are funding research programs to explore ideas.

Scientists hope to gain a better understanding of the basic physics of the components and subsystems that will be needed for the next generation of aircraft. The research includes evaluating flexible-skin concepts that have been proposed to enable wings to change shape, improving tools for simulating how morphing structures behave in flight, and looking at using devices within the wing skins to recover or “harvest” energy as the wings move.

I have toyed with a concept like this for years for surgical endoscopy tools. I can imagine two scenarios:

1) first is the concept of assembling tools inside a body cavity. I first thought of this when I was developing tools for microlaparoscopy (surgery with 2mm instruments) in the mid-90′s. Since I could not get many instruments I needed in that size we thought about somehow assembling them inside the body

2) a morphing instrument just like these aircraft. We are so fixated on static instruments. There is no reason we should think so conventionally. Why not develop an instrument that can change its configuration to meet different needs.

Just like the transformers surgical tools can be mutifunction in the future.

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