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Robotic-Assisted Laparoscopic Partial Nephrectomy

Filed under: Cool Technology,Medical Adventures — dave @ 11:00 am 2013/12/15

That right there is a load of $20 words, but it’s just a fancy way of saying “cutting a chunk out of the kidney without the doctor having to stick his hands in in your side.” It also describes some pretty cool technology, and it’s what they call the procedure that I’ll be going through tomorrow. But before I get into that, a quick (and belated) update on what’s happened since my last post is in order…

I checked in at the Sanford Surgical Tower (no idea why it’s called a tower; it’s not) on October 22 for the biopsy on my kidney tumor, and the procedure went very smoothly. The results came in two days later; the tumor is just a run-of-the-mill renal cell carcinoma, and can be removed surgically. That was a big relief; the thought of another round of chemo and radiation was more than I wanted to think about. I could handle it, with God’s help and that of great friends & family and an even greater wife, but if I had my druthers… Nope. I did a happy dance when I got the news!

So with that news in my back pocket, we met with the surgeon, Dr. Ahrend, a few weeks ago to discuss the next step; surgery. The urologist I spoke with first, Dr. Hofer, said that I was a good candidate for robotic laparoscopic surgery instead of “open surgery”; open surgery for a nephrectomy, partial or full, involves an incision that follows the bottom of the ribcage from the chest around to the back, half way around the torso. That was the way they did things in the days before laparoscopy, and what they still do with some patients that don’t meet the physical requirements for a laparoscopic procedure. The surgeon needs full access to the kidney, and that just isn’t possible without a huge entry point like that. The beauty of laparoscopy, and robotic laparoscopy in particular, is that the surgeon can get that full access to the organ without having to make an incision big enough to see through and to get a pair of big mitts into. Laparoscopy lets the doc manipulate tools inside the patient while watching what’s going on by way of a video feed a pair of miniature cameras. Adding the robotic angle to it makes it almost like climbing right inside…

Dr. Ahrend is a pretty young guy (as can be seen in this KELO news bit) but he is also the best guy in the business in Sioux Falls. He’s done over 700 robotic procedures since residency, and makes it sound like mine will be somewhat routine. While chatting with him at the end of our appointment, he commented that he likes to tell his mom, “all those video games are finally paying off,” and that is a good (but not great) description of how he does the laparoscopic nephrectomy with the assistance of a pair of robotic “hands.”

The “robotic” part is a little misleading though; that term has connotations of the process happening somewhat autonomously, and this machine is anything but automatic. It’s more of a bionic surgery by remote control. The history of the procedure is pretty cool; I’m told it originated with the military, with the idea that a patient who was wounded on the front line could be operated on without having to be transported far, and the surgeon could work from a safe place far from the front line. So far it hasn’t been used in that capacity, but there has been at least one procedure done over a long distance; the surgeon was in New York and the patient in Strasbourg, Germany. The big problem that can keep something like that is latency, the amount of time it takes for a signal to get from the controller to the robotics and the return trip for whatever kind of feedback signal is used. Apparently it was acceptable in this experiment, and in a normal procedure where the surgeon is in the same room as the patient, it’s seldom a problem, but that’s the sort of thing that would keep a networking guy up all night.

When doing a robotic procedure like this, the surgeon has a stereoscopic view of things through a video feed from a pair of cameras that are inserted into the area being worked on. The console that he works from has a pair of video monitors with a divider down the middle to give the surgeon a 3-dimensional view of what’s going on inside; depth perception in the surgical site is crucial.

The tools that are used are remotely manipulated by the surgeon using specialized controllers in the console; much more sophisticated than any joystick or video game controller, because what’s being controlled is much more sophisticated than anything in any shoot-em-up/crash-em-up video game. And the stakes are much, much higher than any video game.

Notice the scale of the little scissor tool in the hand of the model, then watch the video below; the surgeon’s hand movements are scaled down while his view of the surgical site are magnified so that he has a better view of things and a higher degree of control over the tools he’s using.

This YouTube video is pretty fascinating to watch, as it gives a view of exactly what the surgeon sees through his live video feed, and lets you see the dexterity of the robotic tools. It’s especially interesting because the case is very similar to my own; a male patient in his 50′s with a 2 centimeter mass on the upper quadrant of the right kidney. The video is not for the faint of stomach, as you see all the blood and gore and cutting and yuck, but it’s very informative for the same reasons. You’ve been warned!

Watching the video doesn’t give one a very good idea of how things are arranged for the surgery and where on the body the incisions are made. I’m told they make five incisions for the tools to be inserted, and from the photos & videos I’ve seen they go in from all directions. It would be interesting to attend a robotic surgery while conscious to see exactly how it’s set up and done.
Another pretty cool tool that Dr. Ahrend will be using is Firefly Fluorescence Imaging technology. With Firefly, a dye is injected into the bloodstream during surgery, and when a black light is used to illuminate the surgical site, normal tissue will fluoresce bright green, while cancerous tissue appears dark. Under normal lighting conditions it’s difficult to tell the difference between normal and cancerous tissues; the contrast that results with the Firefly dye and black light helps the surgeon know with a higher degree of certainty that all of the cancerous tissue has been removed. They also use ultrasound to help delineate the boundaries of the tumor, but adding Firefly to the surgeon’s tool belt helps immensely in making sure they get all of the tumor the first time, and don’t remove any more kidney tissue than is absolotely necessary.

Here’s another video from the Shawnee Mission Medical Center that demonstrates the use of Firefly, and gives a great demonstration of what happens before the surgeon starts digging around inside, and a good view of some of the equipment used.

That brings us to today, the day before surgery. All in all, I’m pretty relaxed about the whole thing. It’s a little weird (scary weird) seeing all of that and knowing it’s what they’ll be doing to me tomorrow, but I’m ok with it. After all I’ve learned about the procedure, it’s easy to forget how new this whole robotic thing is, but the doctor’s confidence in it is pretty contagious. And knowing that I don’t have to deal with the aftermath of open surgery is huge!

My biggest comfort in all of this though is knowing how many people are praying for us. It’s really a humbling thing being on the receiving end of all that, but the prayers really do make a difference. I am extremely grateful for each and every person lifting us up, and for their concern for us. God is faithful, and I trust that he will see us through this. As for the recovery, I’m really looking forward to some time off; I’m taking two weeks of medical leave from work. It seems like such a long time since I’ve had any time off from work where I wasn’t busy ahead of time getting ready for going somewhere. This time I’ll just be at home, resting. For now though the waiting is the hardest part. Nothing like a bit of anxiety over the procedure, mixed with fasting from everything but clear liquids for the 24 hours leading up to it, plus an enema waiting for me tomorrow morning. It’s gonna be a Monday like no other.

I’m actually looking forward to getting this surgery done and out of the way. I may be speaking too soon, but I think the surgery and recovery will be a walk in the park compared to chemo and radiation. The thing I’m really looking forward to is hearing the news that I’m cancer-free. That will be worthy of a celebration!


Here are some other links that I found to be of interest when researching this topic. Again, many of them show actual surgical procedures, so click with caution.

Information on kidney cancer
News4 da Vinci partial nephrectomy with Firefly
HD Robotic Partial Nephrectomy using “Firefly” Fluorescence Technology
Firefly Fluorescence Robotic Surgery With da Vinci
Robotic Partial Nephrectomy performed by Vipul Patel, MD

Temporal Distortion

Filed under: Cool Technology,Favorite Things,Fun! — dave @ 11:09 pm 2012/02/15

No, not the kind they talk about on Star Trek. Very cool nonetheless. Play the video below full-screen to get the full effect.

Temporal Distortion from Randy Halverson on Vimeo.

Now wasn’t that awesome?

via Neatorama and dakotalapse.com. Looks like I have a little exploring to do on dakotalapse…

Tiny Ponies All Around

Filed under: Cool Technology,Fun!,Just Stuff — dave @ 10:35 pm 2011/07/19

I was Googling (ok, doing a Google search) for something Apple-related this morning, and one of the results at the top of the list caught my eye:

There is a horse in the Apple Store and no one sees it but me.

I think, “Why?” What is the villain here that blinds all of these people to this situation? Am I nuts for thinking this is exceptional? Does anyone else see this? Did I accidentally drop acid and not realize? I must take a photo. I must verify later, when I’m not potentially tripping balls.

I think, “Would they notice if it were a tiger?” Or a lamb? Or an anaconda? What would it take to shake the haze from around their eyes? A sale sign? A new iPod Touch? Would they notice a new iPod Touch?

Are they just divinely focused? Are they meditating in a retail environment? Are they distracted by something shiny? There is so much shiny in the Apple Store. Is it enough to distract everyone from the little tiny horse that is at the Genius Bar?

Frank goes on to make an excellent observation;

Since then, John and I have a term called a “tiny pony.” It is a thing that is exceptional that no one, for whatever reason, notices. Or, conversely, it is an exceptional thing that everyone notices, but quickly grows acclimated to despite the brilliance of it all.

There are so many tiny ponies in our lives today it’s not even funny. It may sound a bit cheesy, but I’ve often imagined how surreal the world would be to someone who was magically transported to now from the distant past, and how I might explain to them how some everyday things work. Those imaginings make me think about some of the things we take for granted in life… Like air conditioning. When I was a kid, A/C was a luxury that my family couldn’t afford, so I remember well the times we made it through the hot & humid summers in Sioux Falls with little more than fans and cold water and a swimming pool a ten-block walk from home. But when you think about how we can take a little bit of electricity and use it to beat back the heat and humidity… And how so few people actually understand how it works, but expect it to work on demand. That’s a tiny pony.

Or even clean water on demand in our homes. Not only do we have it running from taps, but we can adjust the temperature of that water for different uses. Another string of tiny ponies to make all that possible. Or how about cell phones, or computers, or any other bit of technology that we use and in some small or large way depend on for our daily routine. Tiny ponies every-stinkin’-where. And those tiny ponies don’t just happen; they are the result of herculean efforts made by people who have gone before us to to invent the gadget, to harness the energy, to design the system, to write the standards, to maintain the system… And most of the time we have no clue who is behind it all.

Frank closes his post with another excellent point;

When does the magic of a situation fade? When do we get acclimated to the exceptional? Is this how we get by? Would anything get done if we were constantly gobsmacked? Is this how we survive, how we stay sane? We define a pattern, no matter how exceptional, and acclimate ourselves to it?

I allow myself to get gobsmacked sometimes, and that’s probably a healthy thing.

Lunar Lander

Filed under: Cool Technology,Fun!,Geek — Tags: , , , — dave @ 11:34 pm 2011/05/30

Ian and I were watching 2001: A Space Odyssey just now, and the scene where the ship lands on the Moon reminded me of the old Atari Lunar Lander game I used to play (and play and play) at the arcades. (strangely, I seem to remember playing the game in my early high school years, but according to the Wikipedia article above, it didn’t come out until 1979. Hmmm…)

But after playing the online version on Atari’s site I wonder why I have such fond memories of it; it’s not easy. And the games are over pretty quickly. Back in the day you’d be plugging a quarter in it for every play, and you only start out with enough fuel for one or two landings. Maybe I liked it because I had so much invested in it. Or maybe it’s just my memory on its way out.

Much easier to enjoy now that there’s a Flash version online that’s free to play. And there are lots of other spin-offs from it as well, like this one from the University of Colorado at Boulder. Cool stuff.

Any chance I can have my quarters back?

Awesome Visible Shock Wave Video

Filed under: Cool Technology,Just Stuff — Tags: , , , , , , — dave @ 10:12 am 2011/01/25

This sort of thing has always fascinated me; a plane moving at supersonic speed leaves a shock wave in its wake. The sonic boom is one thing, and is pretty awesome to experience, but the visible shock wave is something else entirely! This video of the launch of an Atlas V rocket shows a visible shock wave that radiates out horizontally as the rocket ascends; it looks like waves in a pool after a rock was thrown in the middle. I’ve never seen anything like that before.

And this video has the same event but from a different camera & vantage point (it’s toward the end of the video, at about 2:20.) Lots of other good video footage in it that I’ve seen before, but still amazing.

When I was in the SD Air National Guard we had somewhat regular training exercises where we would do our jobs as if we were really at war. To add some realism, pilots & aircraft from other bases would often be recruited to play the aggressors. On the Saturday morning of one very memorable training exercise, an aggressor snuck in under the radar and screamed past the base at supersonic speed (or very near it.) I happened to be walking across the flight line as he flew over, and remember it distinctly; looked up & saw this F4 Phantom fly past silently but incredibly fast. A half-second later the shock wave hit, and it almost knocked me over it was so LOUD… Wow. Because I was on the flight line and he was dropping imaginary bombs and strafing the aircraft on the line with imaginary 20mm rounds as he flew past, I instantly became an imaginary casualty and spent the rest of the guard drill laying on a cot in the morgue. Cheery.

A Nocturnal Work Aid

Filed under: Cool Technology,Gadgets,Geek — dave @ 1:18 am 2010/11/29

I picked one of these headlamps up on sale at Lowe’s yesterday for $12 — it was the last of a Black Friday special on the shelf — and it’s already earned its keep, although my neighbors must think I’ve lost some marbles… Tonight Bryce & I spent the last hour of the day (11 to midnight!) hanging Christmas lights on the outside of the house (before the weather turns sour tomorrow) and yesterday I used it to finish up the front end rebuild under the 735i; finished that one up about 10 pm.

These headlamps are just a huge help in working on a car, and so much better than the old-fashioned trouble light. Wearing it on my forehead, it puts the light right where it needs to be without a light fixture getting in the way, as is the case with a trouble light. I turn my head, the light goes with it so I can see what I’m looking at. I haven’t used it during the day, but it would even being a huge help then; if I’m under a car it seems the light is never good, and this thing will do the same trick then.

My new headlamp has three lighting modes,

  • Bright 1-watt LED spot; ~ 45 lumens, 11 hour run time
  • 2 bright Nichia LED’s flood; ~ 28 lumens, 50 hour run time
  • 2 bright red night vision LED and 75 hour run time

About the only thing I don’t like about it is the switch; it’s a push-button switch on the top of the lamp. One click turns on the 1-watt LED, second click turns on the red LEDs, third click turns on the flood light, and the fourth turns it off. The switch is also a bit difficult to click, which may be a defect of some sort with my particular unit. But the don’t-likes are pretty minor issues; all in all it’s a great little tool.

I do think I’ll put some day-glow orange or pink paint on it though so it doesn’t get lost like my last headlamp did.

If Four Wheels Is Good, Three Must Be Better

Filed under: Cars!,Cool Technology,Favorite Things — dave @ 4:19 pm 2010/11/04

The 1933 Morgan Super Sport

The old Morgan trikes have always been appealing to me; just the right mix of quirky & sporty. Throw on a leather helmet and goggles, and you’ve got the perfect Sunday drive right there. What’s not to love about them? And the motor hanging off the front end… That is just so cool.

There have been rumors circulating for a while that Morgan was planning to revive the 3 wheeler, and now they’ve confirmed it; the 2011 Morgan Threewheeler is officially for real. The car(?) will reportedly have a Mazda-built transmission coupled with an 1800cc Harley Davidson v-twin motor hanging off the front axle, just like the old timer. This one won’t have the wood frame, but it will be able to get up to 60 mph in about 4 1/2 seconds, topping out at about 115 mph. That more than makes up for the loss of character the wood would’ve brought.

The images Morgan is showing on its website appear to be of a real vehicle, but views of the engine appear to be generic CAD renderings, so it’s not clear that a real car has been built & tested

Building a car LoCost 7-style — using this or that from other production vehicles — has always been a dream of mine, and the three-wheel design has always been in the back of my head; with 3 wheels instead of 4, the vehicle is classified as a motorcycle, so it’s much easier to get registered & licensed & insured. But this thing might turn that dream on it’s head. Why reinvent the wheel? Of course, it all depends on what it will cost.

One thing about the car’s specs that I’m dying to find out is what their ‘Bomb release’ style start button looks like. Hmmm…

What Changes Will The Next 18 Years Bring?

Filed under: Computers,Cool Technology,Geek,Mac Stuff,Old Things — dave @ 10:01 am 2010/03/23

I was digging through my Sitemeter visitor stats a few days ago, and noticed again with a bit of wonder that one of the posts that consistently sees a fair bit of traffic is the one about the 68000 dash 30fx computer I have at home. The dash 30fx a monster of a Macintosh clone that was built without Apple’s blessing in the early ’90′s. The manufacturer got away with it by building the computer around the logic board of a IIfx purchased from Apple. The IIfx was no slouch in its day, but the 30fx stepped things up to the next rung, but at a high price.

dash_30fx_front_sm.jpg

You can read more about that relic in the old post, but seeing a bump in interest on that page made me wonder whether some of that traffic might be driven by some new chatter about those computers. So I did a little searching, and came up with several Google Books hits that I hadn’t seen before. One of them was a Network World article from June 15, 1992:
network_world_29_1992_06-15

The part that got me…

The network had to be Ethernet-based in order to accommodate the Macintosh equipment. But the bandwidth constraints of a conventional Ethernet LAN were insufficient for transmitting images ranging from 100M to 300M bytes in size.

That’s a blast from the past. I remember the days of 10baseT ethernet all too well, when pushing a 100MB file over an AppleTalk network would take a matter of minutes, and 300MB… Start the transfer and go take a coffee break! It makes me feel a bit old. The digital prepress shop described in the article sounds amazingly similar to to our shop at CCL where we used the dash 30fx along with a IIfx, some Quadra 950′s, a LaserWriter, a couple of Sun SPARCstation 2s (which served as raster image processors (RIPs) for a DuPont Crosfield imagesetter). Our operation was a lot smaller than the one described in the article, as we only had one Crosfield — they had ten. They may have had more equipment, but still dealt with the same constraints in moving data around the network.

I started work for CCL in 1991, and moved to the graphics department about a year later. I worked in traditional stripping, proof & platemaking for a while before transferring to the digital art department. Not long after getting in the door, the department’s tech guy decided to venture out on his own & started a digital imaging company. I was “promoted” to fill his shoes, providing tech support for the department in addition to my regular duties. In that position, one of my first tasks/learning opportunities was to move a couple of pieces of equipment around in the department, which involved making a couple of changes on the old thinnet daisy chain network. I started the job on a Friday afternoon after everybody else had left, and could not get it working again. Thinnet was as quirky as it gets; throughput may have been slow, but reliability & configuration flexibility were awful. That made the speed less of an issue I guess.

One of the projects my predecessor had started but hadn’t finished was upgrading the network in the department to 10Base-T twisted pair ethernet. The network drops were in place and most of the pieces were there, but we were still waiting on a few last pieces so we weren’t quite ready to pull the trigger on it. The trouble I had that evening helped me decide we were ready enough, so I blasted forward with the 10Base-T and figured I’d deal with the missing pieces afterward. I didn’t see much hope in getting the thinnet working, so even if I spent the whole weekend finishing the project up, I figured I could spend the same time with the thinnet and still end up with a slow dodgy network that might still not work. That turned out to be one of the best decisions I ever made. I had everything installed and working in less than an hour (after screwing around with the thinnet for four hours just trying to get it to work.) The few devices still on thinnet stayed on a little sub-network, with a Mac bridging the two segments. We limped along like that for a week or so until the rest of the equipment showed up, but just having things working — and working at five times the previous network speed — made it more than worthwhile. My boss was impressed!

I learned a lot on that first 10Base-T ethernet network; the 10 megabit speed in AppleTalk, combined with those early machines made image processing pretty time consuming. In 1992, pushing a 100MB file around the network indeed took a while, plus disk space was very expensive, so all kinds of extra work went into making things as compact as possible. Even on the state-of-the-art RIP running on that 90MHz Sparc 20 workstation, an eight-page layout literally took hours to process before it would begin imaging. A lot of times, we’d set up a layout, send it to the RIP and let the RIP chew on it overnight; if we somehow made a mistake somewhere along the line (it happened; not often, but it happened) we’d have to fix the foible & start all over again. Even before the job went to the RIP we’d examine the Quark, Illustrator & Photoshop files trying to find places we could streamline things a bit; Photoshop images that were scaled and/or rotated in Quark or Illustrator would take extra RIP time, so we’d take the time to re-do those files in Photoshop so they would be placed at 100% with no rotation.

Now though, eighteen years later, with RIPs running multiple 3GHz processors (with multiple cores), 4GB of memory, and gigabit ethernet, that same eight-page spread takes a matter of minutes to send to the RIP and for the RIP to process it. And modern operating systems, gigabit ethernet NIC’s and faster hardware make file transfers of several gigabytes pretty much a non-issue. Then there is disk space; one of the first purchases I had to make was a 1GB SCSI hard drive to replace one that had died in a Macintosh Quadra 950. I don’t remember exactly what I paid for it, but I know it was in the neighborhood of $1,000. Now you can buy a 1 terabyte drive for under $100! So with disk space so cheap and network transfer speeds so fast, the time we spent trimming file sizes and optimizing placement seems a total waste.

The years I’ve spent in this business have pretty much flown by At this point in my career, I’m probably in it for the duration. But thinking about how much things have changed since I started back in 1992 really makes me wonder what kind of changes and improvements the next 18 years will bring; cheaper, faster, smarter…

Pagani Zonda R

Filed under: Cars!,Cool Technology — dave @ 12:38 am 2010/03/14

I think I have a new favorite car; the Pagani Zonda. And this awesome piece of marketing magic does a fantastic job of making me want one. Not that I ever will, but… Enjoy.

I had never really heard of this car before buying a copy of Ambrosia Software’s Redline for the kids last Christmas; the Zonda is one of the downloadable add-ons for the game, and it’s one of the fastest & best handling cars in the game. Kinda makes sense, since it’s essentially a street-legal Formula 1 race car.

I Want Me An iPad

Filed under: Computers,Cool Technology,Gadgets,Geek,Mac Stuff — dave @ 4:50 pm 2010/01/27

Apple just introduced the iPad, and I want one. You can read about all the details and watch the demo movie in lots of places, so I won’t spend any time on that…

I just want one.

ipad

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