Microneedle-based transdermal drug delivery enables painless and efficient drug administration but is limited by insufficient mechanical strength and high insertion forces. Inspired by the efficient penetration capability of cactus spines, this study investigated the microstructure and biomechanics of natural cactus spines and bioinspired microneedles. Finite element analysis showed that a groove width of 50 μm produced the highest stress and strain. Solid bioinspired microneedles were fabricated by 3D printing, while dissolvable hyaluronic acid, chitosan, and gelatin microneedles were prepared using femtosecond laser-fabricated titanium molds and replica molding. Optimized laser parameters generated micropores approximately 500 μm deep. Mechanical tests showed insertion forces of 60-100 mN for solid microneedles, with the 50 μm groove design exhibiting the highest value. Among dissolvable microneedles, gelatin displayed the greatest mechanical strength, whereas hyaluronic acid demonstrated the best overall potential for transdermal drug delivery.

Radial endobronchial ultrasound (rEBUS) guided biopsy is highly effective for solitary pulmonary nodules exhibiting a bronchus sign. While ancillary techniques like cryobiopsy improve yields for lesions adjacent to the airway, nodules situated deeper within the lung parenchyma or behind stenotic, fibrotic airways often require specialised transbronchial access. Conventional transbronchial access tools are frequently limited by their large calibre, requiring bronchoscopes with wide working channels and complex, multi-step deployment that increases procedural complexity. We report our initial clinical experience with a novel, single-use transbronchial puncture dilatation catheter. This device features a flexible sheath with a tapered distal end and an integrated needle stylet, specifically designed to simplify bronchial wall penetration and parenchymal tunnelling via a thin bronchoscope with 2.0 mm working channel. We present two cases: a solitary pulmonary nodule lacking a bronchus sign and a second case involving a fibrotic, stenotic airway that precluded standard rEBUS probe insertion. In both instances, the novel catheter facilitated successful 'off-road' navigation, allowing for rEBUS verification and definitive sampling with cryoprobe and forceps. Both procedures were technically successful, yielding metastatic adenocarcinoma and caseating granulomatous inflammation, respectively. This case series explores the early clinical utility of this simplified transbronchial access tool and discusses its current limitations.

BF-UCP190F (Olympus) is a newly developed thin convex-probe endobronchial ultrasound (TCP-EBUS) bronchoscope, improving access to distal bronchi. We report two cases in which TCP-EBUS enabled successful endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the upper-lobar station 12U lymph node (#12U LN) via B[3] after conventional bronchoscopic forceps sampling failed to provide a definitive diagnosis. In the first case, forceps biopsy of a left upper lobe tumour was non-diagnostic; TCP-EBUS-guided EBUS-TBNA of the left #12U LN established lung adenocarcinoma with N1 involvement. In the second case, the initial bronchoscopy yielded only cytological evidence of carcinoma without histological confirmation; TCP-EBUS-guided sampling of the right #12U LN revealed metastatic small cell carcinoma. In both cases, the pathological diagnosis of EBUS-TBNA guided subsequent treatment. These cases suggest that BF-UCP190F expands the diagnostic range of bronchoscopy and may serve as a valuable rescue technique for sampling upper lobar hilar lymph nodes in clinical practice.

Objective Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard procedure for diagnosing mediastinal and hilar lymphadenopathy, its diagnostic yield for sarcoidosis remains suboptimal due to nodal fibrosis. Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) has emerged as a promising adjunctive technique; however, concerns remain regarding the potential for crush artifacts when using mini-forceps. This study aimed to evaluate the histological specimen quality, diagnostic utility, and safety of EBUS-IFB in patients with suspected sarcoidosis in a single institution.Methods We retrospectively analyzed 11 consecutive patients with suspected sarcoidosis who underwent EBUS-IFB after EBUS-TBNA at a single center. We assessed the specimen quality, diagnostic yield, and safety. Two pathologists independently evaluated the specimens using a validated scoring system focusing on the amount of cellular material, background blood, degree of cellular degeneration and trauma, and retention of normal architecture.Results EBUS-IFB yielded significantly higher-quality specimens than EBUS-TBNA (median total score, 7.0 vs. 4.0; p = 0.01). Notably, EBUS-IFB specimens demonstrated well-preserved tissue architecture without significant crush artifacts and significantly less blood contamination (p = 0.006). The overall diagnostic yield was 81.8% (9 of 11), and definitive diagnoses of sarcoidosis were obtained by EBUS-IFB alone in six cases. No procedure-related complications were noted.Conclusions Despite concerns regarding crush artifacts, EBUS-IFB provides high-quality, structurally intact histological specimens with minimal blood contamination compared to EBUS-TB. EBUS-IFB is a safe and effective adjunctive modality that successfully compensates for the limitations of fine-needle aspiration in sampling fibrotic lymph nodes.

Minimally invasive techniques allow tissue sampling while limiting procedural invasiveness. This study compared the quality of biopsy samples obtained through laparoscopically guided core needle (16 G or 18 G), laparoscopic pancreatic forceps or laparoscopic cup forceps with teeth for sampling non-grossly enlarged cecocolic lymph nodes in dog cadavers. Three techniques were performed in randomized order across 17 fresh cadavers, collecting three specimens per technique (153 total specimens, yielding 51 technique-level histological assessments). Sample collection time, observer-reported perceived difficulty, and a composite histological sample-adequacy score (0-14) were evaluated. Core needle biopsy required longer collection time than both forceps techniques (adjusted p = 0.002 for both comparisons). Perceived difficulty was lowest for pancreatic forceps, followed by cup forceps with teeth, and highest for core needle biopsy (all adjusted p ≤ 0.004). Both pancreatic forceps and cup forceps with teeth yielded higher composite adequacy scores than core needle biopsy (adjusted p = 0.019 and 0.006, respectively), whereas the two forceps did not differ (p = 0.504). Core needle biopsy was associated with greater fragmentation, lower structural preservation, and more histopathological changes limiting interpretation. Exploratory comparisons showed no differences between 16 G and 18 G needles. In this cadaveric model, both laparoscopic forceps techniques provided shorter collection times, lower perceived difficulty, and superior histological sample adequacy than laparoscopically guided core needle biopsy. Clinical safety and disease-specific diagnostic performance warrant further evaluation.

Robot-assisted thoracic surgery(RATS) is increasingly used in difficult surgeries because of its excellent operability with three-dimensional stereoscopic visual fields and multiple joints. RATS is useful for suture procedures, but not for ligation procedures due to lack of sense of touch, which is needed for precise power adjustment. In this report, we describe bronchoplasty with RATS in a case of right upper lobe resection. A large needle driver and Cadiere forceps were used with the right and left hands, respectively, as instruments for bronchorrhaphy. Barbed suture(V-Loc 180 closure device, 3-0, 15 cm)with a looped thread end was used to minimize the number of ligations for bronchorrhaphy. The 3-0 suture was selected to avoid the risk of cutting a thread. Continuous suture was performed using each of two threads for the semiperimeter of the bronchus clockwise and counterclockwise from the deepest part, and the two threads were ligated where they met. The bronchus was tightened slowly at each stitch, and the last three stitches were made with the bronchus opened. Finally, the threads were carefully pulled to tighten the bronchus. This case indicates that robot-assisted bronchoplasty with continuous suture can be performed safely with no stress.

Robot-assisted thoracic surgery(RATS) has become widely adopted as a standard minimally invasive approach for lung cancer surgery. While bronchoplasty has traditionally been performed via thoracotomy or video-assisted thoracic surgery(VATS), its application under robotic assistance remains limited, and practical experience has yet to be fully established. Our institution introduced RATS in 2018 and has accumulated substantial experience with standardized surgical procedures. After sufficient experience was obtained, bronchoplasty using the da Vinci system was introduced in a planned manner for carefully selected cases in which pneumonectomy could be avoided. To date, four cases of planned robotic bronchoplasty have been performed. Simple bronchial stump closure and unintentional bronchial injury repair were excluded from this series. Bronchial anastomosis was performed using either 4-0 Prolene or 4-0 PDS Stratafix, selected according to anatomical conditions. The high-definition three-dimensional visualization and articulated instruments provided by the robotic system allowed precise needle control and uniform suture placement. Continuous suturing was primarily employed, with careful attention to tension control and accurate mucosal alignment. Stable operative fields were achieved through a cooperative team-based approach, in which the assistant consistently managed exposure, suction, hemostasis, and stapling procedures. All procedures were completed robotically without conversion to thoracotomy. No intraoperative complications or bronchial anastomosis-related postoperative complications, including leakage or stenosis, were observed. Postoperative courses were uneventful in all cases. Although our experience is limited, these findings suggest that robotic bronchoplasty can be safely performed when appropriate patient selection, standardized techniques, and close collaboration between the console surgeon and assistant are ensured. Further accumulation of cases is necessary to clarify the role of robotic bronchoplasty in lung cancer surgery.

Percutaneous balloon compression is an established treatment of medically refractory trigeminal neuralgia and remains a commonly performed percutaneous procedure for patients requiring immediate pain relief. Historically, the procedure was standardized through dedicated commercial instrument kits designed for trigeminal balloon rhizotomy, facilitating technical reproducibility across centers. However, the withdrawal of the Food and Drug Administration-approved Mullan percutaneous trigeminal ganglion microcompression set from the medical supplies market in 2016 created a supply gap that required surgeons to adapt their procedural workflows to alternative instrumentation. In the absence of dedicated commercial kits, multiple technical adaptations have emerged, resulting in heterogeneity in technical execution across centers. Contemporary practice has shifted toward modular configurations assembled from widely available instruments, often combined with adjunctive imaging technologies. These adaptations aim to preserve procedural reproducibility while maintaining accessibility across different practice settings. However, considerable variability persists, with approaches ranging from proprietary bundled systems to modular and technology-assisted workflows. Despite this variability, most contemporary series describe a broadly consistent technical approach consisting of a 3 to 5 Fr Fogarty balloon catheter introduced through a 13 to 16 gauge percutaneous needle using the classical Hartel approach under fluoroscopic guidance. Within this framework, recent refinements in foramen ovale localization, including the "H-figure" fluoroscopic landmark, may further improve procedural efficiency and reduce radiation exposure. Balloon inflation is typically performed using volume-based techniques with fluoroscopic confirmation of the characteristic pear-shaped balloon configuration within Meckel's cave, whereas quantitative pressure monitoring is infrequently reported and limited to isolated cases. This narrative review aimed to characterize current percutaneous balloon compression practice in the postcommercial kit era and to determine whether a reproducible procedural framework has emerged despite the absence of dedicated, standardized kits.