Fast Surgical Algorithm for Cutting with Liver Standard Triangulation Language Format Using Z-Buffers in Graphics Processing Unit

Application of the cavitron ultrasonic surgical aspirator (CUSA) for gynecological laparoscopic surgery using the rabbit as an animal model

Decalcification of a Heavily Calcified Common Femoral Artery and its Bifurcation with a Cavitron Ultrasonic Surgical Aspirator

The harmonic scalpel (HS) and cavitron ultrasonic surgical aspirator (CUSA) are two common techniques for liver parenchymal transection (LPT). The second International Consensus Conference on laparoscopic liver resection (LLR) recommended the utilization of the HS for superficial layer LPT and the CUSA for deep layer LPT. Some centers currently employ the HS for deep-layer LPT. However, the potential effect of HS during deep layer transection in LLR remains unclear. The study aims to investigate the feasibility, safety, and efficiency of HS in LLR compared with CUSA. This is a study protocol for a randomized controlled trial (RCT). This RCT will be carried out at West China Hospital of Sichuan University from January 2024 to December 2025. Consecutive patients who underwent LLRs during this period will be recruited based on the specified inclusion and exclusion criteria. The participants will be randomly allocated to the HS group or the CUSA group. The primary outcome is intraoperative blood loss. Secondary outcomes include parenchymal transection velocity, operative time, conversion rate, postoperative hospital stays, hospital cost, morbidity, and mortality. Subgroup analysis will be performed according to liver cirrhosis. The corresponding statistical approach will be used for statistical analysis. The trial has been reviewed and approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University, on January 19, 2024. This study will clarify the feasibility, safety, and efficiency of HS for LPT in LLRs. The results will provide more reliable clinical evidence for the selection of LPT devices in LLRs. The study protocol was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on April 26, 2024, ChiCTR2400083493. The protocol version is V2.0.

Postoperative vesicourethral function after ultrasonic surgical aspirator-assisted surgery of gynecologic malignancies

Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials

A large amount of blood flows in and out of the liver through the inflow system consisting of the portal vein and hepatic artery within the Glissonean cord and the outflow system constituted by the hepatic veins. During liver parenchymal dissection, useful methods to maintain a dry operative field are to control the inflow system with the Pringle maneuver and the outflow system by managing the central venous pressure. Additionally, mature techniques of dissecting the liver parenchyma, which can prevent injury to the blood vessels and appropriately and promptly stop bleeding, are fundamental. Similar to archaeological excavation, in which buried remains are unearthed and exposed in intact form, the Glissonean cords and hepatic veins buried in the liver parenchyma should be exposed or isolated without causing injury to these structures during liver parenchymal dissection. The cavitron ultrasonic surgical aspirator (CUSA) is useful as a surgical device for excavation because it has multiple functions in one device. However, there have been no systematic guidelines on how to use it effectively during hepatectomy. We herein describe how to use the CUSA, based on our knowledge and experiences.

Valve repair and calcium debridement in patients with calcific aortic stenosis, using the Cavitron Ultrasonic Surgical Aspirator (CUSA), results in a reduction in the aortic valve gradient while potentially avoiding long-term problems inherent to prosthetic valves. Invasive followup data in these patients has not previously been reported. Ten patients in whom CUSA debridement was performed underwent cardiac catheterization prior to and 8.0 +/- 2.5 months following the procedure. Compared to baseline, the aortic valve area significantly increased from 0.75 +/- 0.2 to 1.1 +/- 0.3 cm2 (p = 0.009) and the mean gradient was significantly reduced from 54 +/- 21 to 27 +/- 21 mmHg (p = 0.02) at followup. No significant change was noted in cardiac output, ejection fraction, left ventricular end systolic or diastolic volumes or left ventricular end diastolic pressure. However, 6 patients were found to have at least one grade worsening of aortic regurgitation. The development of increased aortic insufficiency in many patients after CUSA aortic valve debridement will likely limit this procedure's clinical utility.

Resection of advanced stage neuroblastoma with the cavitron ultrasonic surgical aspirator

Axillary osmidrosis is an uncomfortable condition that can be a personal or social handicap. The objective was to present the treatment of osmidrosis with the Cavitron ultrasonic surgical aspirator (CUSA). Fifteen patients (3 males and 12 females) underwent surgery for bilateral axillary osmidrosis with the CUSA. The outcome of this operation with the CUSA was evaluated by the patients themselves according to the following criteria. Postoperative improvement was evaluated as good when the odor was decreased by >75%, fair when it was decreased by > or =50 and < or =75%, and poor when it was decreased by <50%. A total of 15 patients (3 males and 12 females) were evaluated. Eight patients (53.3%) had a good result, 6 patients (40%) had a fairly good result, and 1 patient (6.7%) had a poor result. None of the patients experienced any complications, such as skin necrosis, infection, or serous cyst. One dissatisfied patient underwent reoperation and achieved a good result after the second procedure. This treatment of osmidrosis with the CUSA achieves satisfactory therapeutic efficacy.

The authors evaluated the histological effects of the 2-μm thulium laser on meningioma tissue, comparing them to the results obtained using bipolar forceps and an ultrasonic aspirator. The authors analyzed nine samples of intracranial meningiomas. Four slices were obtained for every sample, and one incision was performed on each slice. Two incisions were made with a 2-μm thulium laser (one set to a 6 W and another set to a 12 W power level). One incision was made using a bipolar forceps and the other using an ultrasonic aspirator. Tissue was addressed and analyzed. Upon microscope analysis, three zones of laser action were identified: (A) a central crater; (B) a vaporized zone; and (C) a shrunken layer. These three layers were measured and compared. When addressed with the laser, all nine meningiomas presented a crater having an average depth of 1 mm. Three layers were clearly distinguished and measured: A (average depth: 0.8 mm at 6 W and 1.24 mm at 12 W); B (average depth: 0.32 mm at 6 W and 0.72 mm at 12 W); and C (average depth: 0.39 mm at 6 W and 0.44 mm at 12 W). On slices treated with bipolar forceps incisions, only zones B and C were identified. Ultrasonic aspirator incisions showed a deeper A zone (average depth: 2.93 mm), no B zone, and a tiny C zone (average depth: 0.16 mm). Thulium laser can be safely used for the surgical removal of intracranial meningiomas; beyond 2 mm under the surface of action, no tissue alterations were found. The lesions produced on meningiomas were characterized by vaporization and shrinking. When compared with bipolar forceps, the thulium laser offers cutting precision and vaporization of the tissue. When compared to the cavitron ultrasonic surgical aspirator (CUSA), the laser offers shrinking and coagulation of small vessels.

Objective To investigate the safety and effect of precise pedicle transection in anatomical hepatic segmentectomy of hepatocellular carcinoma(HCC). Methods Sixty HCC patients, who underwent hepatic segmentectomy in Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to April 2010, were enrolled in this prospective non-randomized controlled study. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into 2 groups according to the procedure of hepatectomy: the precise pedicle transection group(precise group) and the traditional surgery group(traditional group) with 30 cases in each group. There were 25 males and 5 females in the precise group with the mean age of (51±14) years old and 23 males, 7 females in the traditional group with the mean age of (52±12) years old. Three-dimensional reconstruction was performed in patients of precise group by multi-slice spiral computed tomography (MSCT). The anatomic constructions of hepatic pedicle branches and intersegmental branch of hepatic vein of liver segment to be resected were evaluated precisely. The liver parenchyma was split using precise clamping and the pedicle of liver segment was transected. The intersegmental branch of hepatic vein was positioned by ultrasonic as the section of liver parenchyma and single or combined segmental resection was performed. Patients in the traditional group received conventional preoperative examination and evaluation. The tumor was positioned by ultrasonic during the operation and the liver segment to be resected was confirmed according to the anatomical mark of liver. The liver parenchyma was split using cavitron ultrasonic surgical aspirator(CUSA) and the pedicle was transected finally, single or combined segmental resection was completed. The comparison of measurement data of preoperative, intraoperative and postoperative between two groups was conducted using t test. The comparison of classification data was conducted using Chi-square test or Fisher definite probability test. Results There was no significant difference in the patients' preoperative data, amount of intraoperative bleeding, blood transfusion, duration of surgery, surgical procedures, postoperative liver function indexes as well as postoperative length of hospital stay(P>0.05). The length of tumor incisal edge in the precise group and traditional group were(2.3±0.7)cm, (1.5±0.6)cm respectively, and significant difference was observed between two groups (t=4.950, P 0.05]. Conclusions The precise pedicle transection has the same safety as the conventional surgery in anatomic hepatic segmentectomy of HCC. It can reduce the incidence of postoperative complications, ensure negative tumor incisal edge, reduce the postoperative recurrence rate and improve the curative rate for HCC. Key words: Carcinoma, hepatocellular; Precise hepatectomy; Hepatectomy, dissection; Treatment outcome

Dural detachment from the brain in cranial reoperations has been accomplished previously by selective coagulation and the cutting of brain-dural adhesions. The results of ultrasonic aspiration during tumor surgery or brain cutting procedures led the authors to speculate that the detachment of the dura mater from brain tumors by applying the Cavitron ultrasonic surgical aspirator (Valleylab, Boulder, CO [formerly Cavitron, Inc., Stamford, CT]) to the brain-dura mater interface could be used to reduce bleeding and facilitate dural opening during cranial reoperations. Ten patients underwent a second craniotomy for epilepsy surgery (five cases of extended temporal lobectomy and five cases of extended extratemporal lesionectomy). The use of ultrasonic aspiration and its effects on brain separation from the dura mater were examined. Intraoperative use of the Cavitron ultrasonic surgical aspirator during dural opening produced immediate blanching of the dura mater and enhanced visualization of the cortical surface without distortion of the brain anatomy. Incremental dural opening and brain visualization is achieved by careful application of ultrasonic aspiration directly into the brain-dura limit, producing immediate regional dural devascularization. Use of this technique reduces cortical and dural bleeding and enhances the ease and effectiveness of brain visualization.

Graphics processing units (GPUs) 1 have enjoyed increasing popularity in recent years, which benefits from, for example, general-purpose GPU (GPGPU) for parallel programs and new computing paradigms, such as the Internet of Things (IoT). GPUs hold great potential in providing effective solutions for big data analytics while the demands for processing large quantities of data in real time are also increasing. However, the pervasive presence of GPUs on mobile devices presents great challenges for GPGPU, mainly because GPGPU integrates a large amount of processor arrays and concurrent executing threads (up to hundreds of thousands). In particular, the root causes of performance loss in a GPGPU program can not be revealed in detail by current approaches. In this article, we propose MiC (Multi-level Characterization), a framework that comprehensively characterizes GPGPU kernels at the instruction, Basic Block (BBL), and thread levels. Specifically, we devise Instruction Vectors (IV) and Basic Blocks Vectors (BBV), a Thread Similarity Matrix (TSM), and a Divergence Flow Statistics Graph (DFSG) to profile information in each level. We use MiC to provide insights into GPGPU kernels through the characterizations of 34 kernels from popular GPGPU benchmark suites such as Compute Unified Device Architecture (CUDA) Software Development Kit (SDK), Rodinia, and Parboil. In comparison with Central Processing Unit (CPU) workloads, we conclude the key findings as follows: (1) There are comparable Instruction-Level Parallelism (ILP); (2) The BBL count is significantly smaller than CPU workloads—only 22.8 on average; (3) The dynamic instruction count per thread varies from dozens to tens of thousands and it is extremely small compared to CPU benchmarks; (4) The Pareto principle (also called 90/10 rule) does not apply to GPGPU kernels while it pervasively exists in CPU programs; (5) The loop patterns are dramatically different from those in CPU workloads; (6) The branch ratio is lower than that of CPU programs but higher than pure GPU workloads. In addition, we have also shown how TSM and DFSG are used to characterize the branch divergence in a visual way, to enable the analysis of thread behavior in GPGPU programs. In addition, we show an optimization case for a GPGPU kernel from the bottleneck identified through its characterization result, which improves 16.8% performance.

Cowden syndrome (CS) is an autosomal dominant condition that is relatively rare. CS patients can have tumors derived from all three germlines. They can present with mucocutaneous hamartomas or other benign tumors, and have an increased risk of malignancies of the thyroid, breast, kidney, GI tract, and skin.In our clinic, a 40-year-old CS patient presented for thyroidectomy after fine needle aspiration was suspicious for papillary thyroid carcinoma (PTC). Another major concern was the cosmetic appearance of her lips, which were diffusely covered with small hamartomas. We were able to remove these in a novel manner using a cavitron ultrasonic surgical aspirator (CUSA; Integra Lifesciences, Princeton, NJ, USA). Using the CUSA tangential to the lip surface allowed for removal of the hamartomas in a way that created a smooth and cosmetically appealing outcome for the patient. The use of an ultrasonic surgical aspirator is a novel way to cosmetically treat hamartomas of the lip for CS patients.

Nowadays graphics processing units (GPUs) have become popular parallel computing platforms known as General-Purpose GPU (GPGPU) computing. GPUs thereby are chosen by some security researchers as cryptographic accelerators to secure massive volumes of transactions. However, their security issues are ignored in spite of their popularity and performance. There are some possible information leakages faced with malicious attacks or even in the normal GPU computing. Our objective is to secure the confidentiality of cryptographic keys in GPU computing environments and provide easy-to-use programming with few constraints. In this paper, we propose a prototype in Linux, a system of GPGPU computing solution empowered by GPU virtualization technology, which keeps encrypted keys in guest machine to protect secret keys from leakage even in the event of full system compromise. With the API interception and redirection of CUDA, applications in Virtual Machines (VMs) can access the GPU device in a transparent way. Besides, we use virtio, a dedicated virtual I/O device, to transfer data between virtual and host machines in high performance. In our current study, we evaluate our prototype with the GPU implementation of ECC. We show that it can protect private keys of GPU cryptographic computation and it also incurs low performance penalty compared with the native environment, therefore demonstrating the prototype is secure and requires reasonable overhead.