Context [Formula: see text] During laparoscopic sacrocolpopexy, vaginal vault prolapse is repaired by restoring the anatomical state of the vagina with a surgical mesh. A vaginal manipulator is placed inside the vagina to provide proper exposure to the surgeon for fixation of the mesh on the vaginal surface and vault by laparoscopy. Vaginal vault manipulation is done manually by an assistant and long operation times lead to fatigue, inconsistent application of tensioning forces and possibly vaginal rupture. This work describes a novel force sensor designed to be integrated in a vaginal manipulator to measure interaction forces between the vaginal vault and the manipulator. Content [Formula: see text] The sensor is characterized and tested in lab-environment. After receiving ethics committee approval two first-in-woman studies have been conducted. Both the force and pose of the instrument were recorded. Conclusions [Formula: see text] The force sensor showed to be suited to measure vaginal vault interaction forces and will be embedded in a robotic system for vaginal vault manipulation. Up to now, no previous research has quantified these interaction forces. Quantifying these forces and providing feedback cues to the surgeon is of particular interest, especially as a means to avoid vaginal rupture due to over-tensioning. A total of 30 interventions will be recorded.

A variety of neurological syndromes has been described in neuroborreliosis: cranial nerve palsies, radiculopathy, axonal neuropathy, stroke, parkinsonism, transverse myelitis, supranuclear palsy, Guillain-Barré syndrome, ... We report a case of neuroborreliosis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper and lower limbs with proximal and distal pareses and atrophies as well as bulbar dysarthria and dysphagia. During the course of the disease the patient developed the clinical picture of a meningoencephalitis. After initiating ceftriaxone treatment the patient showed a complete recovery. In endemic regions for Lyme disease, in all neurological syndromes neuroborreliosis has to be excluded.

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During laparoscopic sacrocolpopexy, pelvic organ prolapse is repaired by suturing one side of a synthetic mesh around the vaginal vault while stapling the other end to the sacrum, restoring the anatomical position of the vagina. A perineal assistant positions and tensions the vault with a vaginal manipulator instrument to properly expose the vaginal tissue to the laparoscopic surgeon. A technical difficulty during this surgery is the loss of depth perception due to visualization of the patient's internals on a 2D screen. Especially during precise surgical tasks, a more natural way to understand the distance between the laparoscopic instruments and the surgical region of interest could be advantageous. This work describes an exploratory study to investigate the potential of introducing 3D visualization into this surgical intervention. More in particular, experimentation is conducted with autostereoscopic display technology. A mixed reality setup was constructed featuring a virtual reality model of the vagina, 2D and 3D visualization, a physical interface representing the tissue of the body wall and a tracking system to track instrument motion. An experiment was conducted whereby the participants had to navigate the instrument to a number of pre-defined locations under 2D or 3D visualization. Compared to 2D, a considerable reduction in average task time (−42.9 %), travelled path lenght (−31.8 %) and errors (−52.2 %) was observed when performing the experiment in 3D. Where this work demonstrated a potential benefit of autostereoscopic visualization with respect to 2D visualization, in future work we wish to investigate if there also exists a benefit when comparing this technology with conventional stereoscopic visualization and whether stereoscopy can be used for (semi-) automated guidance during robotic laparoscopy.

Background: Laparoscopic sacrocolpopexy is the preferred procedure for restoring vaginal vault prolapse. An assistant uses a vaginal manipulator to position and tension the vault such that the surgeon can dissect the bladder, rectum and vault to eventually suture a synthetic mesh used to suspend the vagina to the longitudinal anterior vertebral ligament. Vaginal vault manipulation requires application of high forces for long periods of time.Methods: This work quantifies the task by measuring and analyzing the interaction forces and the workspace during vaginal vault manipulation. From the measurements we developed a uniaxial model, expressing the increase in interaction force and stiffness of the vagina. By adapting the model parameters, the difference in interaction force and stiffness between moderate and severe prolapse are predicted.Findings: For moderate prolapse the average interaction force and stiffness start at 2.56 N and 0.11 N mm −1 in the tensionfree state, and go up to 20.14 N and 0.53 N mm −1 after complete insertion of the instrument. For severe degrees of prolapse, tissue interaction is much lower starting at 1.68 N and 0.06 N mm −1 while staying limited to 12.20 N and 0.30 N mm −1 at full extension.