• Specifications
• InstrumentedSurgicalTools

Naming Convention

• 019_SMULTIS001-1_SXX_CUT_SKN
• TRI_SUBJECTID_TOOL_ACTION_LOC

TOOL

• SXX-Scalpel
• FXX-Forceps
• RXX-Retractor
• SFX-Scalpel/Forceps

ACTION

• CUT = CUT
• EVE = EVERT
• WID = WIDEN
• CLO = CLOSURE
• RET = RETRACT
• SUT = SUTURE
• DIS = DISSECT
• PCH = PINCH

LOCATION

• SKN = SKIN
• SFI = SKIN FAT INTERFACE
• FAT = FAT
• FMI = FAT MUSCLE INTERFACE
• MUS = MUSCLE
• MBI = MUSCLE BONE INTERFACE

Supplies

• 3 instrumented tools
  • Scalpel + Indenter
  • Forceps
  • retractor
• 2 prong retractor for skin
• full size retractor for fat and muscle
• 2 allen wrenches to change scalpel blades
• 5 scalpel blades #15
• 2 4-0 sutures
• sharpie
• ruler
• calipers

Protocols

Strain Measurement

Hardware

1. Connect NI-USB-6289 to multis laptop.
2. Connect SCB 68A terminal hub to NI-USB-6289
3. Connect camera trigger to SCB 68A
   1. Connect both yellow wires to pins 55 and 66
   2. Connect both green wires to pins 33 and 22
   3. Both green and yellow wires are attached to a BCB cable
   4. The BCB cable connects to a splitter, which connects to each Vic3D camera
4. Connect analog synchronization signal to SCB 68A using instrumented ultrasound setup
   1. Use Connector 1 to connect to SCB 68A
   2. Connect the 1/4 stereo jack to a BCB cable
   3. Connect BCB cable to AI0 of the NI USB 6251
   4. Connect the NI USB 6251 to the Vic3D computer

Software

1. Open Vic-Snap
2. Set appropriate project path and Speckle name, the calibration name will automatically update
3. Click 'calibration images' button

4. Click Images > Synch Mode > Hardware

5. Click Images > TTL Capture > Low (trigger level) > Streaming (Capture)

6. Click Arm when ready (in TTL Capture window)
7. When armed and in Speckle images mode, the Multis computer will trigger capture and send synchronization signal simultaneously

Camera Setup

1. Set focus manually to surface of skin
2. Right click in camera viewport and select 'show focus/contrast'
3. Connect iPad (connected to wifi dongle MultisVIC3d network)
4. Show cross hairs on iPad and pick a point to align the center of each crosshair. This should be the center of the show focus contrast region.
5. Adjust polarized lens on each camera and light
   1. First optimize polarized lenses for undeformed state (maximum purple on focus/contrast)
   2. Next rotate each filter on the light sources 90 degrees so deformed tissue will not cause glare
6. Mark corners of specimen fixture with tape,
7. Push specimen fixture forward to make room for calibration
8. Calibrate by holding appropriately sized calibration plate at level of focus (leg surface) and capturing images while pivoting in all directions (20 images)
9. Select biggest calibration plate that will fit in camera view (cannot exceed)

Speckle Application

1. Shave and clean surface of skin
2. Apply foundation to mute surface reflection
3. Prepare the rubber speckle pad with ink, apply 3 times in 3 different orientations

Surgical Procedures

The following procedures are to be tested using the instrumented surgical tools. After each cut, tissue will be retracted for following cut.

1. TARE load cells
2. Place 3 dots at 0, 5, and 10cm in the target region after speckling
3. 0-Indent Skin - w/ Strain measurement
   • SXX_IND_SKN
   • Location: 5cm dot
   • Approach from lateral side of leg
4. 1-Pinch Skin - w/ Strain measurement
   • FXX_PCH_SKN
   • Location: 5cm dot
   • Approach from lateral side of leg. Start pinch with 3 mm width, pull gently upwards to 3-5mm
5. TARE load cells
6. 2-Cut Skin - w/ Strain measurement
   • SXX_CUT_SKN
   • Tool: Scalpel #15 blade
   • Location: 0 to 10cm dots
   • Procedure: Cut 10cm straight line in longitudinal bone direction (proximal to distal) at anterior central location of leg
   • Blade Orientation: Face perpendicular to tissue, cutting edge 45deg to tissue
   • Approach incision start by moving distal to proximal, cut proximal to distal (for all cutting). Place left hand to on proximal side of incision to stabilize the tissue.
7. Measure depth, length, width of cut
8. Approach SFI but do not puncture (non-instrumented)
9. Measure depth, length, width of cut
10. Attach new scalpel blade
11. 3-Cut Skin/Fat interface
    • SXX_CUT_SFI
    • Tool: Scalpel #15 blade
    • Procedure: Cut 10cm straight line in direction of first incision in same orientation. Place left hand to on proximal side of incision to stabilize the tissue.
12. Measure depth, length, width of cut

Note: Orient forceps in each trial with left tip near center of incision

1. 4-Forceps - Widening
   • FXX_WID_SFI
     • Tool: Forceps
     • Procedure: Pinch tissue at incision, widen tissue 2 cm (central to medial)
     • Purpose: imitate opening of incision to explore region
2. Measure depth, length, width of cut
3. 5-Forceps - Closing approximation
   • FXX_CLO_SFI
   • Tool: Forceps
   • Procedure: Pinch tissue at incision, bring incision together (close it)
   • Purpose: pulling tissue together after incision to approximate edges before suturing
4. 6-Forceps - Everting
   • FXX_EVE_SFI
   • Tool: Forceps
   • Procedure: Pinch tissue at incision, lift tissue will twisting forceps (clockwise) and opening incision apprx 1-2 cm
   • Purpose: evert tissue for suture insertion
5. Measure depth, length, width of cut
6. TARE load cells
7. 7-Suturing: Skin layer w/ SFI
   • SXX_SUT_SFI
   • Note: Prepare suture up to point of closure of first knot, but do not close
   • attach one end to instrumented scalpel (remove blade and tie around bolt using a surgeon's knot)
   • grasp non-instrumented forceps with the thread from the instrumented end
   • pull both ends, one with non-instrumented, the other with instrumented, to complete first knot.
   • Pulling Direction: orient instrumented attachment to lateral side (pull laterally)
8. Cut and remove suture
9. Measure depth, length, width of cut
10. TARE load cells
11. 8-Cut Fat
    • SXX_CUT_FAT
    • Tool: Scalpel
    • Procedure: Cut fat only to a depth 3/4 the length of the blade, 10cm distance
12. 9-Retract Fat
    • RXX_RET_FAT
    • Tool: Retractor
    • Procedure: Insert retractor, pull skin and fat away from incision 2cm. Use non-instrumented retractor for opposing side
    • Pulling Direction: Parallel to surface and perpendicular to incision, medial to lateral
13. Measure depth, length, width
14. Approach FMI (non-instrumented)
15. Attach new scalpel blade
16. Measure depth, length, width
17. 10-Cut through FMI into Muscle
    • SXX_CUT_FMI
    • Tool: Scalpel #15 blade
    • Procedure: While retracting, cut 10cm straight line in direction of first incision in same orientation to a depth 3/4 the length of the blade
18. Measure depth, length, width
19. 11-Retract Muscle
    • RXX_RET_MUS
    • Tool: Retractor
    • Procedure: use 9-Retract Fat
20. Measure depth, length, width
21. Attach new scalpel blade
22. 12-Cut Muscle
    • SXX_CUT_MUS
    • Tool: Scalpel #15 blade
    • Procedure: Cut muscle only to a depth half the length of the blade, 10cm distance
23. Measure depth, length, width
24. 13-Retract Muscle
    • RXX_RET_MUS
    • Tool: Retractor
    • Procedure: use 9-Retract Fat
25. Measure depth, length, width
26. Cut to bone (non-instrumented)
27. Measure depth, length, width
28. 14-Retract Muscle (include all tissue down to bone surface)
    • RXX_RET_MBI
    • Tool: Retractor
    • Procedure: use 9-Retract Fat
29. Measure depth, length, width
30. 15-Forceps Dissection Fat and Muscle
    • SFX_DIS_FMI
    • Tool: Forceps + Scalpel
    • Procedure: Pinch tissue at midpoint of incision (medial side of incision), open incision and separate tissue with scalpel
31. Measure depth, length, width
32. 16-Forceps Dissection Skin and Fat
    • SFX_DIS_SFI
    • Tool: Forceps + Scalpel
    • Procedure: Pinch tissue at midpoint of incision (medial side of incision), open incision and separate tissue with scalpel using the following protocols
33. Measure depth, length, width

Data transfer

• On the load cell computer, zip the raw data for this subject. The folder can be found in c:\sMULTIS data.

• The zipped folder can be transferred to MIDAS (http://cobicore.lerner.ccf.org/midas/community/7) using the secure wireless connection. The data will be saved in the path /Private. The folder may be unzipped, but leave original zipped folder.

• VIC3D data is first compressed on the VIC3D computer under the Documents folder. It must be transferred to an external hard drive and uploaded via a networked computer to MIDAS under the relevant donorID folder, where it remains zipped.

Output

All raw data can be found at http://cobicore.lerner.ccf.org/midas/community/7

• Configuration and data directories are located in the path /Private/SMULTISXXX-1/, where XXX is the unique subject identifier (i.e., 001, 002, 003, etc.)

Next step: DataAnalysis