Triple lumen central line cross section11/10/2023 ![]() The revolution from conventional open surgery to Minimally Invasive Surgery (MIS) has been fueled by the desire to perform surgical procedures while avoiding the morbidity of conventional surgical wounds ( 5). ![]() These slender instruments replace the standard surgical tools and the surgeon's hands and eyes in performing different tasks, such as cutting, manipulating, and compressing tissues. In MIS, long and slender instruments are used to perform the procedure. Introduction The Challenge of Minimally Invasive Surgeryįollowing the introduction of laparoscopic cholecystectomy by Mouret in France ( 1), the use of minimally invasive approaches has rapidly changed the performance of surgical procedures in a wide range of surgical specialties, including general surgery, urology, gynecology, thoracic surgery, plastic surgery, and cardiac surgery ( 2– 4). With the development of the Wave catheter, first steps have been made toward high force application through slender shafts. The number of strikes until puncture was approximately constant at 80 ± 5.4, 76.7 ± 2.6, and 77.7 ± 3.9 for the different stroke frequencies. It was found that the time until puncture decreased from 80 ± 5.4 s to 7.8 ± 0.4 s, for a stroke frequency of 1–10 Hz, respectively. In a proof-of-principle experiment, we illustrated that the Wave catheter was able to penetrate a phantom model of a coronary Chronic Total Occlusion (CTO) manufactured out of hydroxyapatite and gelatin. ![]() The handle allows for single-handed operation of the catheter with easy adjusting of the input impulse characteristic, including frequency (1–10 Hz), time and number of strokes using a solenoid actuator, and easy connection of an off-the-shelf inflator for catheter filling. The catheter uses high-speed pressure waves to transfer high-force impulses through a slender flexible shaft consisted of a flat wire coil, a double braid, and a nylon outer coating. In an effort to allow for high force application in slender instruments, in this study, we have investigated using a hydraulic pressure wave (COMSOL model) and developed an innovative 5F cardiac catheter ( L = 1,000 mm) that allows for applying high forces up to 9.0 ± 0.2 N on target tissues without buckling. With the ongoing miniaturization of surgical instruments, the ability to apply large forces on tissues for resection becomes challenging and the risk of buckling becomes more real.
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