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Safe Hb Concentration Measurement during Bladder Irrigation Using Artificial Intelligence

Gerd Reis, Xiaoying Tan, Lea Kraft, Mehmet Yilmaz, Dominik Stephan Schoeb, Arkadiusz Miernik
2021 Sensors  
We have developed a sensor for monitoring the hemoglobin (Hb) concentration in the effluent of a continuous bladder irrigation. The Hb concentration measurement is based on light absorption within a fixed measuring distance. The light frequency used is selected so that both arterial and venous Hb are equally detected. The sensor allows the measurement of the Hb concentration up to a maximum value of 3.2 g/dL (equivalent to ≈20% blood concentration). Since bubble formation in the outflow tract
more » ... nnot be avoided with current irrigation systems, a neural network is implemented that can robustly detect air bubbles within the measurement section. The network considers both optical and temporal features and is able to effectively safeguard the measurement process. The sensor supports the use of different irrigants (salt and electrolyte-free solutions) as well as measurement through glass shielding. The sensor can be used in a non-invasive way with current irrigation systems. The sensor is positively tested in a clinical study.
doi:10.3390/s21175723 pmid:34502612 fatcat:hff3ddtx2vddnnrledstgqlvxe

Radiomics Applications in Renal Tumor Assessment: A Comprehensive Review of the Literature

Rodrigo Suarez-Ibarrola, Mario Basulto-Martinez, Alexander Heinze, Christian Gratzke, Arkadiusz Miernik
2020 Cancers  
Radiomics texture analysis offers objective image information that could otherwise not be obtained by radiologists′ subjective radiological interpretation. We investigated radiomics applications in renal tumor assessment and provide a comprehensive review. A detailed search of original articles was performed using the PubMed-MEDLINE database until 20 March 2020 to identify English literature relevant to radiomics applications in renal tumor assessment. In total, 42 articles were included in the
more » ... analysis and divided into four main categories: renal mass differentiation, nuclear grade prediction, gene expression-based molecular signatures, and patient outcome prediction. The main area of research involves accurately differentiating benign and malignant renal masses, specifically between renal cell carcinoma (RCC) subtypes and from angiomyolipoma without visible fat and oncocytoma. Nuclear grade prediction may enhance proper patient selection for risk-stratified treatment. Radiomics-predicted gene mutations may serve as surrogate biomarkers for high-risk disease, while predicting patients' responses to targeted therapies and their outcomes will help develop personalized treatment algorithms. Studies generally reported the superiority of radiomics over expert radiological interpretation. Radiomics provides an alternative to subjective image interpretation for improving renal tumor diagnostic accuracy. Further incorporation of clinical and imaging data into radiomics algorithms will augment tumor prediction accuracy and enhance individualized medicine.
doi:10.3390/cancers12061387 pmid:32481542 pmcid:PMC7352711 fatcat:lif5qvsixjfr7at4xrnkedzxna

Training in robotics: The learning curve and contemporary concepts in training

Christian Bach, Arkadiusz Miernik, Martin Schönthaler
2014 Arab Journal of Urology  
To define the learning curve of robot-assisted laparoscopic surgery for prostatectomy (RALP) and upper tract procedures, and show the differences between the classical approach to training and the new concept of parallel learning. This mini-review is based on the results of a Medline search using the keywords 'da Vinci', 'robot-assisted laparoscopic surgery', 'training', 'teaching' and 'learning curve'. For RALP and robot-assisted upper tract surgery, a learning curve of 8-150 procedures is
more » ... ed, with most articles proposing that 30-40 cases are needed to carry out the procedure safely. There is no consensus about which endpoints should be measured. In the traditional proctored training model, the surgeon learns the procedure linearly, following the sequential order of the surgical steps. A more recent approach is to specify the relative difficulty of each step and to train the surgeon simultaneously in several steps of equal difficulty. The entire procedure is only performed after all the steps are mastered in a timely manner. Recently, a 'warm-up' before robotic surgery has been shown to be beneficial for successful surgery in the operating room. There is no clear definition of the duration of the effective learning curve for RALP and robotic upper tract surgery. The concept of stepwise, parallel learning has the potential to accelerate the learning process and to make sure that initial cases are not too long. It can also be assumed that a preoperative 'warm up' could help significantly to improve the progress of the trainee.
doi:10.1016/j.aju.2013.10.005 pmid:26019925 pmcid:PMC4434504 fatcat:ntqm4zpdojbbncgga5m66pcu6u

Prospects and Challenges of Artificial Intelligence and Computer Science for the Future of Urology

Rodrigo Suarez-Ibarrola, Arkadiusz Miernik
2020 World journal of urology  
. * Rodrigo Suarez-Ibarrola rodrigo.suarez@uniklinik-freiburg.de Arkadiusz Miernik arkadiusz.miernik@uniklinik-freiburg.de 1 Department of Urology, Faculty of Medicine, University of Freiburg -Medical  ... 
doi:10.1007/s00345-020-03428-0 pmid:32910230 fatcat:4qsin7rajrghpbrvfyk6mhxnai

Reasons for new MIS. Let's be fair: iTIND, Urolift and Rezūm

Rodrigo Suarez-Ibarrola, Arkadiusz Miernik, Christian Gratzke, Dominik S Schoeb
2020 World journal of urology  
To review and discuss the literature regarding iTIND, Urolift and Rezūm and investigate the precise clinical indications of all three different approaches for their application in benign prostatic hyperplasia (BPH) treatment. The PubMed-Medline and Cochrane Library databases were screened to identify recent English literature relevant to iTIND, Urolift and Rezūm therapies. The surgical technique and clinical results for each approach were summarized narratively. iTIND, Urolift and Rezūm are
more » ... and effective minimally invasive procedures for the symptomatic relief of lower urinary tract symptoms (LUTS) due to BPH. iTIND requires the results of ongoing prospective studies, a long-term follow-up and a comparison against a reference technique to confirm the generalizability of the first pivotal study. Urolift provides symptomatic relief but the improvements are inferior to TURP at 24 months and long-term retreatments have not been evaluated. Rezūm requires randomized controlled trials against a reference technique to confirm the first promising clinical results. However, clinical evidence from prospective clinical trials demonstrates the efficacy and safety of these procedures in patients with small- and medium-sized prostates. Although iTIND, Urolift, and Rezūm cannot be applied to all bladder outlet obstruction (BOO) cases resulting from BPH, they provide a safe alternative for carefully selected patients who desire symptom relief and preservation of erectile and ejaculatory function without the potential morbidity of more invasive procedures.
doi:10.1007/s00345-020-03453-z pmid:32960328 pmcid:PMC8332552 fatcat:shzbpvzh5fav7l4fxph5yqx4ou

Metabolic Imaging by Simultaneous FLIM of NAD(P)H and FAD

Wolfgang Becker, Lukas Braun, Rodrigo Suarez-Ibarrol, Arkadiusz Miernik
2020 Current Directions in Biomedical Engineering  
AbstractWe describe a metabolic imaging system based on simultaneous recording of lifetime images of NAD(P)H and FAD. The system uses one-photon excitation by ps diode lasers, scanning by galvanometer mirrors, confocal detection, and two parallel TCSPC FLIM recording channels. Two lasers, with wavelengths of 375nm and 410 nm, are multiplexed to alternatingly excite NAD(P)H and FAD. One FLIM channel detects in the emission band of NAD(P)H, the other in the emission band of FAD. For both
more » ... the data analysis delivers images of the amplitudes of the decay components, a1 and a2. We show that these are robust parameters to characterize the metabolic state of cells. FLIM results obtained from excised human-bladder tissue were in perfect agreement with histology.
doi:10.1515/cdbme-2020-3064 fatcat:6qwkcum7s5b6dae74w4x73bwfa

Incidental prostate cancer after holmium laser enucleation of the prostate—A narrative review

Mehmet Yilmaz, Tuncay Toprak, Rodrigo Suarez‐Ibarrola, August Sigle, Christian Gratzke, Arkadiusz Miernik
2021 Andrologia  
Prostate cancer can be detected incidentally after surgical therapy for benign prostatic obstruction such as holmium laser enucleation of the prostate (HoLEP), thus called incidental prostate cancer (iPCa). We aimed to review the studies on iPCa detected after HoLEP and investigate its prevalence. A detailed search of original articles was conducted via the PubMed-MEDLINE, Web of Science, Wiley Online Library and Cochrane Library databases in the last 10 years up to 1 May 2021 with the
more » ... search string solely or in combination: "prostate cancer", "prostate carcinoma", "holmium laser enucleation of the prostate" and "HoLEP". We identified 19 articles to include in our analysis and divided them into six main categories: HoLEP versus open prostatectomy and/or transurethral resection of the prostate in terms of iPCa, oncological and functional outcomes, the role of imaging modalities in detecting iPCa, predictive factors of iPCa, the role of prostate-specific antigen kinetics in detecting iPCa and the management of iPCa after HoLEP. We found that the iPCa after HoLEP rate ranges from 5.64% to 23.3%. Functional and oncological outcomes were reported to be encouraging. Oncological treatment options are available in a wide range.
doi:10.1111/and.14332 pmid:34837229 fatcat:mo3bce72uzd4zk7wyukvquwcle

Wireless Acoustic-Surface Actuators for Miniaturized Endoscopes

Tian Qiu, Fabian Adams, Stefano Palagi, Kai Melde, Andrew Mark, Ulrich Wetterauer, Arkadiusz Miernik, Peer Fischer
2017 ACS Applied Materials and Interfaces  
This is an extended and revised edition of IWDE 92-06. Comments and corrections are gratefully accepted. This file may be used and printed, but for personal or educational purposes only.
doi:10.1021/acsami.7b12755 pmid:29148713 pmcid:PMC5730945 fatcat:h7rbbpg7zbejbpptffkbteil4a

Laser procedures in the treatment of BPH: a bibliometric study

Anja C. Reichelt, Rodrigo Suarez-Ibarrola, Thomas R. W. Herrmann, Arkadiusz Miernik, Dominik S. Schöb
2020 World journal of urology  
Miernik has received research funding from the Federal Ministry of Education and Research (BMBF), DE, coverage of travel expenses from the German Association of Urology (DGU), DE, European Association  ... 
doi:10.1007/s00345-020-03532-1 pmid:33263795 pmcid:PMC8405477 fatcat:amkijtv2fvh7vk7nv3ghi7xaiq

Robotic stone surgery – Current state and future prospects: A systematic review

Philippe F. Müller, Daniel Schlager, Simon Hein, Christian Bach, Arkadiusz Miernik, Dominik S. Schoeb
2018 Arab Journal of Urology  
Miernik: Protocol/project development, data analysis, manuscript and figure writing/editing, supervision. Schoeb: Protocol/project development, data analysis, manuscript, figure writing/editing.  ... 
doi:10.1016/j.aju.2017.09.004 pmid:30140470 pmcid:PMC6104666 fatcat:dxpdyexydjg63bemxxvzb23kay

Modified salvage endoscopic combined intrarenal surgery in a single functional kidney with refractory staghorn stone

Rodrigo Suarez-Ibarrola, Moaaz Abdulghani Obaid, Arkadiusz Miernik
2019 Urology Case Reports  
doi:10.1016/j.eucr.2018.11.011 pmid:30505687 pmcid:PMC6258101 fatcat:iydzz3v43ngpjmosiynmjpxm34

Holmium laser vaporization and percutaneous removal of a migrated endothelialized biliary self-expanding metal stent

Arthur Schmidt, Rodrigo Suarez-Ibarrola, Robert Thimme, Julius Mueller, Alexander Heinze, Arkadiusz Miernik
2019 VideoGIE  
DISCLOSURE Dr Miernik is an advisor to Richard Wolf GmbH and to Lisa laser OHG. The other authors disclosed no financial relationships relevant to this publication.  ... 
doi:10.1016/j.vgie.2019.01.014 pmid:31193940 pmcid:PMC6545356 fatcat:vykx2hpwpfhxfnbwvanoy4yq5m

Soft Urinary Bladder Phantom for Endoscopic Training

Eunjin Choi, Frank Waldbillig, Moonkwang Jeong, Dandan Li, Rahul Goyal, Patricia Weber, Arkadiusz Miernik, Britta Grüne, Simon Hein, Rodrigo Suarez-Ibarrola, Maximilian Christian Kriegmair, Tian Qiu
2021 Annals of Biomedical Engineering  
AbstractBladder cancer (BC) is the main disease in the urinary tract with a high recurrence rate and it is diagnosed by cystoscopy (CY). To train the CY procedures, a realistic bladder phantom with correct anatomy and physiological properties is highly required. Here, we report a soft bladder phantom (FlexBlad) that mimics many important features of a human bladder. Under filling, it shows a large volume expansion of more than 300% with a tunable compliance in the range of 12.2 ± 2.8 – 32.7 ±
more » ... 4 mL cmH2O−1 by engineering the thickness of the bladder wall. By 3D printing and multi-step molding, detailed anatomical structures are represented on the inner bladder wall, including sub-millimeter blood vessels and reconfigurable bladder tumors. Endoscopic inspection and tumor biopsy were successfully performed. A multi-center study was carried out, where two groups of urologists with different experience levels executed consecutive CYs in the phantom and filled in questionnaires. The learning curves reveal that the FlexBlad has a positive effect in the endourological training across different skill levels. The statistical results validate the usability of the phantom as a valuable educational tool, and the dynamic feature expands its use as a versatile endoscopic training platform.
doi:10.1007/s10439-021-02793-0 pmid:34002287 pmcid:PMC8455490 fatcat:x6pshmrpkrgbhbykl5njapksvi

Evaluation of the Ginsburg Scheme: Where Is Significant Prostate Cancer Missed?

August Sigle, Cordula A Jilg, Timur H Kuru, Nadine Binder, Jakob Michaelis, Markus Grabbert, Wolfgang Schultze-Seemann, Arkadiusz Miernik, Christian Gratzke, Matthias Benndorf, Rodrigo Suarez-Ibarrola
2021 Cancers  
Systematic biopsy (SB) according to the Ginsburg scheme (GBS) is widely used to complement MRI-targeted biopsy (MR-TB) for optimizing the diagnosis of clinically significant prostate cancer (sPCa). Knowledge of the GBS's blind sectors where sPCa is missed is crucial to improve biopsy strategies. We analyzed cancer detection rates in 1084 patients that underwent MR-TB and SB. Cancerous lesions that were missed or underestimated by GBS were re-localized onto a prostate map encompassing Ginsburg
more » ... ctors and blind-sectors (anterior, central, basodorsal and basoventral). Logistic regression analysis (LRA) and prostatic configuration analysis were applied to identify predictors for missing sPCa with the GBS. GBS missed sPCa in 39 patients (39/1084, 3.6%). In 27 cases (27/39, 69.2%), sPCa was missed within a blind sector, with 17/39 lesions localized in the anterior region (43.6%). Neither LRA nor prostatic configuration analysis identified predictors for missing sPCa with the GBS. This is the first study to analyze the distribution of sPCa missed by the GBS. GBS misses sPCa in few men only, with the majority localized in the anterior region. Adding blind sectors to GBS defined a new sector map of the prostate suited for reporting histopathological biopsy results.
doi:10.3390/cancers13102502 pmid:34065418 pmcid:PMC8160743 fatcat:y363vj4ur5bfpepsdxj4b5odvi

Soft 3D-Printed Phantom of the Human Kidney with Collecting System

Fabian Adams, Tian Qiu, Andrew Mark, Benjamin Fritz, Lena Kramer, Daniel Schlager, Ulrich Wetterauer, Arkadiusz Miernik, Peer Fischer
2016 Annals of Biomedical Engineering  
Arkadiusz Miernik: Study conception and design, drafting of manuscript, manuscript writing/editing, and supervision, critical revision.  ...  Arkadiusz Miernik: a patent application of the presented work has been filed Consultant contract with Schoelly Fiberoptic GmbH, Denzlingen, Germany (unrelated to the presented work).  ... 
doi:10.1007/s10439-016-1757-5 pmid:27830490 pmcid:PMC5362658 fatcat:afzd7fyvs5hvxokp2bcgqw2xxq
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