Family planning, sexual activity and contraception in hereditary hemorrhagic telangiectasia:a European survey study

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) can influence the quality of life and social relationships, mostly due to epistaxis, but the topics of family planning, sexual activity and contraception have not been investigated to date. This study aimed to gain more insight: what is the influence of HHT on family planning, sexual activity and contraception? METHODS: This multi-language European survey study included a patient's and partners' version of a questionnaire designed specifically for this study. HHT patients were informed about the study through HHT expert centres, social media and websites of patient associations. Data collection took place between March- May 2023. RESULTS: The survey was completed by 572 patients with a definite HHT diagnosis, based on genetic confirmation or ≥ 3 Curaçao criteria. In most patients, HHT did not affect relationship decisions (n = 353, 62%), decisions concerning pregnancy and children (n = 287, 50%) and sexual activity (n = 315, 57%). However, 28% of HHT patients (n = 157) did experience effect on sexual activity and may benefit from improved epistaxis management and better awareness of their partners. CONCLUSIONS: HHT did not affect family planning decisions and sexual activity in most patients, but approximately a quarter of patients experienced effect on sexual activity caused by epistaxis.</p

Development of the First Force-Controlled Robot for Otoneurosurgery

Objective: In some surgical specialties, e.g. orthopedics, robots are already used in the operating room for bony milling work. Oto- and otoneurosurgery may also greatly benefit by robotic enhanced precision. Study Design: Experimental study on robotic milling on oak wood and human temporal bone specimen. Methods: A standard industrial robot with a 6 degrees-of-freedom serial kinematics was used with force feedback to proportionally control the robot speed. Different milling modes and characteristic path parameters were evaluated to generate milling paths based on CAD geometry data of a cochlear implant and an implantable hearing system. Results: The best suited strategy proofed to be the spiral horizontal milling mode with the burr held perpendicularly to the temporal bone surface. In order to avoid high grooves, the distance in between paths should equal half the radius of the cutting burr head. Due to the vibration of the robot’s own motors, a rather high oscillation of the standard deviation of forces was encountered. This oscillation dropped drastically to nearly 0 N, when the burr head reached contact with the dura mater due to its damping characteristics. The cutting burr could be moved a long time on the dura without damaging it, because of its rather blunt head. The robot moved the burr very smoothly according to the encountered resistances. Conclusion: This is the first development of an functioning robotic milling procedure for otoneurosurgery with force-based speed control. It is planned to implement ultrasound-based local navigation and to perform robotic mastoidectomy