Adductor spasmodic dysphonia is a rare voice disorder characterized by strained and strangled voice quality with intermittent phonatory breaks and adductory vocal fold spasms. Type 2 thyroplasty is an alternative treatment for spasmodic dysphonia, addressing hyperadduction by incising and lateralizing the thyroid cartilage. The most important points for successful type 2 thyroplasty is the stable maintenance of the gap in the incised thyroid cartilage using titanium bridges.To date, titanium bridges have not been utilized for type 2 thyroplasty in any institution overseas, and no large-scale trial was currently planned.The clinical trial reported here investigator-initiated clinical trial conducted with the goal of obtaining approval for use of titanium bridges in Japan.We were fortunate to have the device designated for priority review under the government of Japan's Sakigake system, which significantly reduces processing time.This presentation will introduce our Medical Device Development with the Sakigake system.

The market size of contact lens in Japan is the world's second largest, only behind the US market. The introduction and spread of disposable contact lenses have changed the main players of the industry in Japan from domestic companies to foreign companies and the business model of the industry from the tailor-made industry to the heavy capital intensive industry. This industry is supposed to be currently at a new phase with the increasing population of myopia and wide range of customer needs by aging societies.

I would like to explain SEED's strategy and business development model as a mid-sized contact lens manufacturer competing under the massive pressure from global players before to describing the history of innovation, recent diversified needs of consumers in the industry and the anticipated new functions of contact lenses.

A unique and major challenge to the development of advanced medical devices is adjusting the criteria for determining value among diverse interested parties that may include academia, industrialists, governments as well as patients. Hence, the pressure to harmonize scientific and ethical standards to allow the proper judgements to be made in different circumstances co-exists with the need to establish and develop reliable evaluation techniques. Waseda Institute for Medical Regulatory Science, founded in 2015, approaches these issues from a comprehensive perspective by performing tasks that range from formulating guidelines for advanced medical treatment, based on the foundations of life and medical sciences or medical engineering, to developing professional human resources. In parallel, we jointly established a graduate school for the Cooperative Major in Advanced Biomedical Sciences (Doctoral Program) specializing in medical regulatory science between Waseda University and Tokyo Women's Medical University.

EVAHEART is a highly-pulsed, low shear rate, centrifugal LVAD with excellent long term reliability. EVAHEAR 2 is greatly reduced in size and weight by laser welding and miniaturized motor. The diameter of the drive cable was reduced by 36.7% of the sectional area ratio. The lubrication condition of the mechanical seal was improved by surface modification, the rotational resistance remarkably stabilized. EVAHEART 2 was approved by PMDA in November 2017. Regarding overcoming of cerebrovascular disorder, we developed a tip less inflow cannula which can prevent blood flow stagnation completely. About overseas deployment: In China, EVAHEART was approved as "innovative medical device" in 2015, and clinical trial started in January 2018. Regarding the United States, clinical trial with EVAHEART 2 + tip less inflow cannula is approved by the FDA in February 2018, and a feasibility study is scheduled to be started at six institutions in sequence.

Stakeholders of Regulatory agency, academia and industry in Japan and the United States initiated the dialogue to promote a global clinical trial for developing the innovative medical devices in 2003, so called "Harmonization By Doing (HBD)". The purpose of this activity is to discuss the challenges and their solutions for accommodating the local regulations in both countries by utilizing the concrete examples, "by Doing". The activities made a great contribution to facilitate a global device development and to eliminate "device lag". "Harmonization By Doing for children (HBD for children)" which focuses on the development of pediatric devices started as one of the activities of HBD in 2016. In the activity, stakeholders are discussing the concrete solutions for early applications and approvals of pediatric devices. In the session, I will introduce experiences of review of medical devices and share our achievements.

Developing advanced medical devices and treatments within affordable costs and expediting patients' access to such medical therapies are expected in worldwide.

In the development of medical devices, identification, evaluation, and reduction of individual risks are indispensable in parallel with evaluation of probable benefits. Effects of patent characteristics and doctor's skill should be considered to maximize device performances and reduce risks. Clinical trials for market approval of innovative and first-in-human medical devices are limited in inclusion criteria, number of patient enrollment, and monitoring period. Thus, we have been challenging to develop innovative patient-oriented testing methodologies to accelerate medical device development, to evaluate safety and probable efficacy of medical devices, and to support scientific-based approval decision, which, we believe, will contribute to the acceleration of patients' access to new technologies. We are also engaged in developing guidance and standards to evaluate innovative medical devices and driving those global expansions.

A clinical research doctor encounters variety of findings every day through clinical practice. Knowledge that is thought to be useful for future medical treatment among them will be discussed through academic presentations and then reported in the paper. Most clinical research doctors have not shown interest in how the content published at the conference will be utilized in subsequent research and development and commercialization. Many products have been developed under the initiative of the enterprise, but commercialization from doctor-led research has not been done much. It can be said that there is a low level of intellectual property literacy of clinical researchers in the background. We hope that by presenting our experiences in this presentation, it will be a catalyst to discuss future directions of industry-university collaboration.

Income from license agreement is an important way for academic researchers to obtain external funding without restriction of use. However, education for practical use of patent was little discussed in academic institute even in house practice of patent filing was well. This seminar defines invention types for patenting to monetize thus provides how to contact industries for licensing and negotiation technics.

As one of the mechanotransduction pathways, it has been suggested that load applied to tissue may deform cells in the tissue, nuclei in the cells, and then chromatin in the nuclei, and this may affect mRNA transcription. In this study, we have been studying how the deformation applied to artery wall is transferred to smooth muscle cells, nuclei, and finally chromatin to elucidate the mechanism of wall hypertrophy during hypertension. We measured microscopic deformation of thin-sliced rabbit thoracic aortas during tensile test and confirmed that the deformation was complex and heterogeneous and elongation of the nuclei was 40-50% smaller than that of the tissue. We also found that the shape and chromatin distribution of the nucleus changed drastically in artery tissue cultured in no load condition. It is suggested that nuclear deformation is different from tissue deformation and the nuclear morphology changes depending on their mechanical environment.

The aorta is stretched in the circumferential direction due to blood pressure. Although smooth muscle cells (SMCs) in the aorta have been thought to also undergo uniaxial circumferential stretch, it is debatable as they reside in a mechanically heterogeneous material composed of stiff elastin and collagens and compliant SMCs. We therefore investigated 3D deformation of a pressurized aortic tissue at a micrometer scale. Strain markers were made on elastic laminas of mouse thoracic aortas with a two-photon microscope. A local 3D strain tensor or aortic walls during pressurization was calculated. The result showed that physiological pressurization yielded some circumferential normal strain and zero normal longitudinal strain. Under the same pressurization, the radial-circumferential shear stain occurred. These results indicate that mechanical environment around SMCs in vivo is more complicated than expected.

Vascular smooth muscle cells (VSMCs) change their phenotype from contractile to synthetic under pathological conditions. A similar change is observed when VSMCs are isolated from the native tissue and placed in culture conditions. To understand smooth muscle pathophysiology, it is important to understand the mechanism of their phenotypic change. We previously found that actin stress fibers (SFs) in VSMCs have a mechanical interaction with the nucleus, and the internal forces of SFs were transmitted directly to the nucleus. Thus, it is possible that the nuclear-cytoskeletal interactions and their force transmission efficiently could be associated with VSMC differentiation. In this study, we developed a novel micro-grooved collagen substrate to control cell orientation similar to in vivo vascular tissue, and cultured VSMCs on this substrate to induce their contractile differentiation. Then we investigated the mechanical environment of the nucleus, and assessed the changes in the nuclear-cytoskeletal interactions during smooth muscle differentiation.

The purpose of the present study is to determine the tensile properties of repaired collagen fibrils in vitro. Fibrils were directly isolated from rat tail tendons by stirring in distilled water. The ends of two fibrils were closed. Type I collagen solution and reconstitution buffer were deposited on the closed point of these fibrils using a microinjector. Both the ends of the repaired fibril were wound onto the tips of two microneedles several times using micromanipulators. The fibril and tips were immersed in physiological saline solution. Then, the fibril was stretched to failure by moving the one microneedle. During tensile testing, the fibril was firmly attached to the tips of the microneedles, and broken at its repair site. The maximum load of repaired fibrils was about 30% of that of intact fibrils.

Osteoarthritis (OA) is most common degenerative joint disease in orthopaedic field. It is important for the prevention of OA progression to detect at early stage. Because of non-invasive advantages of laser irradiation, Raman spectroscopy is known to be useful tool for the analysis of material at ultra-structural level. The aim of this study are to observe the mechanical behaviors of biomolecules in cartilage matrix by using Raman spectroscopy and to investigate the relationships of each Raman peak of cartilage matrix between the Raman shift and stress state. By using the Raman spectroscopy, The Raman bands of proline, phenylalanine, amide I and hydroxyproline significantly shifted to positive direction under tensile stress. From the results, it could be experimentally confirmed that these biomolecules in cartilage matrix act important mechanical roles by using Raman spectroscopy. Therefore, this study could indicate the possibility of Raman spectroscopy for mechanical evaluation of cartilage matrix of osteoarthritis.

Many of the elderly are predisposed to develop osteoarthritis (OA), although it is quite difficult to diagnose the early-grade OA even by latest imaging modalities. The purpose of this study is to verify the diagnostic potential of early OA using D-OCSA, which is a visualizing method of the mechanical properties of cartilage from OCT images. ex vivo animal experiments applying D-OCSA were carried out using rabbit's OA cartilage caused by amputation of the rabbit's knee ACL. D-OCSA can show the attenuation coefficient distribution of compressive strain rate during stress relaxation, which can observe further increase in attenuation only for early OA cartilage. Therefore, it can be seen that there occurs a loss of visco-elastic properties as compared to normal cartilage. In summary, D-OCSA system could be effective to assessments of the early OA as "Micro Mechanical Biopsy"

Bone tissue is a composite material composed of apatite and collagen. The rigidity of the tissue is depending on the apatite content and crystal alignments. Demineralization of bone provides the flexibility of the tissue. Therefore fracture characteristics could be improved by optimizing the mineral content. On the other hand, a mineral attraction method with voltage application was proposed in our previous study. The apatite content adjustment is expected to use for optimization of mechanical properties of the tissue. In this study, the apatite adjustment methods were applied to the cancellous bone specimens cut out from bovine femurs. The elastic modulus of cancellous bone tissue decreased during demineralization process. Although there was little effect in macroscopic mechanical property, mineral crystal depositions were observed on the surfaces of trabecular bones in the results of voltage application to the bone specimens located in the apatite-neutralizing solution.

In this study, to investigate the thresholds of toe bone fracture, we conducted an impact test on porcine trotter and developed several risk curves to evaluate the probabilities of the bone fracture. The test was conducted using a drop-weight impact test device under impact velocity of 1.7 m/s to 2.6 m/s on 37 test specimens. An AE (Acoustic Emission) sensor attached to the metacarpal bone was used to investigate the time of fracture. Statistical analysis was performed to determine the relationships between fracture occurrence and load, energy, as well as impulse. The values of load, energy, and impulse at 50% probability might be considered as the thresholds of fracture. Comparison to previous studies shows that the fracture loads under impact velocity of up to approximately 3.0 m/s were found to be similar.

A normal bone-tendon insertion at the rotator cuff of the shoulder has a hierarchical structure consisting of four layers: tendon, fibrocartilage, mineralized cartilage, and bone. However, this structure is missing in a repaired insertion after reconstructive surgery. The alternation in bone-tendon insertion after the surgery is considered to cause the reduction of mechanical strength in the repaired insertion; however, the difference in material constitution between intact and repaired insertion is not fully understood. Therefore, in this study, we applied the Raman spectroscopic measurement to compare the distribution of chemical composition of bone-tendon insertion with and without the reconstructive surgery. We obtained Raman spectra along a traverse across the supraspinatus tendon-to-humerus insertion of a rat rotator cuff repair model and analyzed mineral content and collagen quality. Changes in bone mineral density and mechanical properties after the surgery were also examined to interpret the Raman spectra.

Knowledge of the behavior of articular cartilage contact is one of the requirements in designing artificial joints that reproduce precise finger functions. The thumb has a different role from the other fingers, and when one of the other fingers moves, the thumb moves to the opposite position, enabling pinching and grasping, which are essential to activities of daily living (ADLs). The interphalangeal (IP), metacarpophalangeal (MCP), and trapeziometacarpal (TMC) joints give the thumb more degrees of freedom than the other fingers. The purpose of the present in vivo study was to clarify the static three-dimensional articular cartilage contact behavior of the thumb IP and MCP joints in positions of the thumb commonly used in ADLs (i.e., pinch and grasp positions) and also to analyze the changes of the articular cartilage contact area and movements three-dimensionally using magnetic resonance imaging.

Evaluation of in vivo articular contact behavior at the radiocarpal joint is important for understanding the biomechanical functions under physiological loading. The objective of this study was to assess in vivo articular contact behavior between the radius and scaphoid and between the radius and lunate using an image matching technique. Four wrist joints of four normal male subjects were enrolled in this study. Biplanar X-ray images were taken during dorsal/ palmar flexion and ulnar/radial deviation of the wrist joint. Positions of the bones were determined by fitting 3D bone models reconstructed using CT scan data with the biplanar X-ray images. The articular contact was estimated from occlusion between the cartilage models created using MRI scan data. The distributions of contact area and the contact point locations varied markedly with wrist position. The present result would be able to provide a fundamental knowledge about the biomechanics of the wrist joint.

Total hip arthroplasty (THA) has various problems to be resolved. For example, joint dislocation is one of the most common deuteropathies associated with THA. In the present study, we focused on the pull-out force as a shape parameter for preventing the dislocation, and the pull-out forces were calculated using the finite element method (FEM). Firstly, we determined the relationship between the height of acetabular cup over half sphere line (inset part) and the maximum pull-out force. Secondly, we compared between analytical and experimental values. From the analytical results, the maximum pull-out force increased with the increase of the inset height. The analytical value was similar to the experimental one. Therefore, we suggested that the height of inset is a significant parameter in order to optimally design the artificial hip joint with a structure for preventing the dislocation.

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As the progress of medical technology and the advance of medical device, patient safety and improvement of problem solving ability and minimum skill level have been increasing required for healthcare providers. To cope with this situation, Nipro opened a medical training facility, iMEP (institute of MEdical Practice) for healthcare providers in October, 2014. iMEP plays an important role in developing user-oriented products through the trainings conducted in iMEP where Nipro is able to consider and face technical challenges together with clinicians. Additionally, iMEP notices us where Nipro is standing now and our roles in medical field as a medical device manufacturer by engaging in practical trainings while Nipro products are usually involved with a limited medical field in advanced clinical practices.

The effect of outlet angle and cross-sectional area of the impeller flow path on hemo-compatibility was investigated in a monopivot centrifugal blood pump using computational fluid dynamics analysis. Blood damage index and stagnant surface area around the pivot were compared among impeller models with different outlet angle and flow path number or cross-sectional area under the extracorporeal circulation condition. As a result, smaller outlet angle caused lower blood damage index in the pump because high shear region around the flow path outlet dissolved. But it decreased washout flow rate which increased stagnant surface area around the pivot that will deteriorate pump anti-thrombogenicity. Larger flow path number or cross-sectional area also caused lower blood damage index because high shear region around the flow path outlet dissolved. Meanwhile, it increased the washout flow rate which decreased stagnant surface area around the pivot that will improve pump anti-thrombogenicity.

(Introduction) The research on medical engineering has been in various fields with many approaches. On the other hand, nursing skills has also developed separately from medical, in some aspect, it should be developed together.(Object) However, we have worked and studied with co-medical including nursing staff for over 20 years, but there were many problems at that time, and we analyzed these. One of this reason is a point of view was different. We believe that these information are beneficial for future technological development.(Analytical method) For example, we have been studied about fluid change of tissue make for treatment, this theme was interested in medical and nursing, sharing information on control and electric phenomena on body was extremely difficult.(Conclusion) It is not a bad thing to have a different viewpoint, sometimes receiving unexpected remarks. It is important to know that others are good at or not good at.

The amended act on the protection of personal information was enforced on March 2017. The enforcement also triggered amendment of related regulations including "Ethical Guidelines for Medical and Health Research Involving Human Subjects." As the most of research in medical and biomedical engineering should be performed under the guideline, the researches should modify their research plan or processes to fit the new guideline. This lecture is to explain how we should change.

Writing a scientific paper is one of the important means of communication to the research community. Review is necessary to ensure the reliability and readability of a paper. Required time until acceptance greatly depends on the reported results, the readability and so on. Also, each journal has its own submission guidelines. A paper which does not follow them might be rejected. In this lecture, points to writing a scientific paper and the submission guidelines are explained.

It is generally known that cell behavior is influenced by 3D shape of culture substrate. In this study, we investigated the influence of the conical inner surface of culture substrate on cell behavior. Conical inner surfaces with various apex angles were molded on PDMS substrate. MC3T3-E1 and F-2 cells were used as examples of mesenchymal and epithelial cells, respectively. Cell nuclei were stained and imaged every 30 min for 24 h to observe cell movement. The smaller the apex angle becomes in the conical inner surface, the more cells traveled in the radial direction than in the circumferential direction for both cell types. We also investigated the effect of curvature radius. We used curvature radius on the conic section that is perpendicular to the conical generatrix. A significant correlation between cell traveling velocity and curvature radius was shown.

The present study has investigated a relationship between cellular tension and functional responses to an inflammatory cytokine, interleukin-1b (IL-1b). Tenocytes from rabbit Achilles tendon were cultured on an array of PDMS-made micropillars with a 3 um diameter and 4 or 8 um heights, whereby cellular tension of tenocytes can be modulated depending on the stiffness of the micropillars. The cells were cultured on the micropillars with the presence of IL-1b at a concentration of 0, 1, 10 or 100 pM. The cells subjected to the same experiment on glass substrate were assigned to control samples. It was demonstrated that the IL-1b stimulation upregulated the gene expression of collagenase in tenocytes on micropillar substrates, and a higher expression was observed on the softer, 8 um micropillars compared to the 4 um micropillars. Cell morphology was also changed by the IL-1b administration, although the effects of cellular tension was not clearly exhibited.

Subtype cardiomyocytes (ventricular, atrial, and pacemaker) are required for the cardiac regenerative medicine. In this study, hydrogels made from goat ventricular ECM (vECM gels) were used as culture substrate for differentiating human iPS cells into cardiomyocytes. EDAC was used as crosslinker to modulate the mechanical properties of these gels. Four types of gels indicated by vECM concentration-EDAC concentration as 7.5mg/ml-10mM, 12.5mg/ml-30mM, 12.5mg/ml-100mM, and 15.0mg/ml-50mM were fabricated. Monolayer culture and differentiation of human iPS cells were firstly conducted on Matrigels and then replated on vECM gels. It was found that the ventricular marker MLC2v showed the highest expression on 7.5mg/ml-10mM gels, atrial marker MLC2a showed the highest expression on 12.5mg/ml-100mM gels, and the expression of pacemaker marker HCN4 showed no difference among the four types of vECM gels.

Recently, it has been established that mesenchymal stem cells (MSCs) memorize the history of mechanical dose from culture environment, which essentially affect the lineage specifications. To ensure stemness of MSCs in maintaining subculture, accumulation of such mechanical dose should be avoided in order to inhibit the lineage bias. For this issue, we have tried to develop cell culture hydrogels whose surface has heterogeneous distribution of elasticity, and to make MSCs move nomadically among different region of elasticity in a certain short duration. In this report, we have established complete design of the microelastically-patterned gels to realize the nomadic movement of MSCs and quasi-oscillatory input of mechanosignals to the MSCs. After culture of MSCs on the gels for 4days, the highest up-regulation of APC gene was first found from comprehensive analysis for gene expression with DNA microarray, which is deeply related to Wnt signaling and cell motility.

Engineering three-dimensional tissue can give advance a cell therapy and an in vitro models for pharmaceufical research. Our laboratory has fabricated sheet-shaped cells by lowering temperature from culture surfaces grafted temperature responsive polymer and attempted to fabricate thick tissue by layering cell sheets. However, the scaling up of tissue is limited due to the lack of vessels supplying oxygen and nutrition. We report a new strategy for constructing perfusable vascularized tissues using a bioreactor having collagen-based microchannels.A co-cultured cell sheets, which contain NHDF, HUVEC were prepared. The co-cultured cell sheet was placed on the collagen-gel with microchannels perfused with the culture medium. After cultivation, microscopically observation demonstrated that endothelial cells formed tubelar structure in the co-cultured cell sheets and collagen gel. Perfusable vascularized three-dimansional tissue was constructed by cell sheet technology and the perfusion bioreactor system. These results confirmed a route to fabricate in vitro engineered an organ.

The second near-infrared window ranged between 1 and 1.5 micron, NIR-II, has advantages for deep tissue imaging with extrinsic fluorophores due to lacking autofluorescence, low light absorption, and reduced scattering. Most of the proposed probes were used for labeling with antibodies. As a new application, we plan to monitor electrical activity in a living tissue noninvasively using membrane potential dye with NIR-II fluorescence. So we need the excitable cell culture system to screen a candidate of such dyes. In contrast to neuron and skeletal muscle cell, cardiomyocytes showed a relative slow response with depolarization during several thousand milliseconds. Using cardimyocytes primary culture and iPS cardiomyocytes, quantum dots were evaluated. Furthermore C2C12 skeletal myoblasts were morphologically differentiated to myotubes under the optimal conditions, and the electrical stimulation-induced contraction of the myotubes was monitored optically. This myotube system would permit screening for potential dye in NIR-II.

Although cardiac tissue equivalent reconstructed in vitro would be useful for treatment of cardiac diseases, its twitch stress is markedly lower than that in native myocardium. Polyunsaturated fatty acid (PUFA), which is not synthesized in mammalian, mediates various functions in tissues including myocardium. However, conventional culture medium contains little lipid. We previously found that some PUFAs contents in cultured rat cardiomyocytes were significantly lower than those in neonatal myocardium, and that contractile performance of the cultured cardiomyocytes can be elevated with PUFA supplementation. In the present study, we evaluated effects of simultaneous supplementation of docosahexaenoic (DHA) and arachidonic (AA) acids on the performance. Four days after the onset of supplementation of 10 μM DHA and 20 μM AA, the performance was significantly higher (P<0.05) than that in cells without the supplementation. The results suggest that PUFAs supplementation may be crucial on the improvement of contractile performance in cultured cardiomyocytes.

Vascularization of engineered tissues in vitro and in vivo remains a key problem in translation of engineeredtissues to clinical practice. Growth factor signalling can be prolonged by covalent tethering, thuswe hypothesized that covalent immobilization of vascular endothelial growth factor (VEGF-165) toa porous collagen scaffold will enable rapid vascularization in vivo. Covalent immobilization may bepreferred over controlled release or cell transfection if the effects are desired within the biomaterialrather than the surrounding tissue.

Object. Pulsed water jet surgical instrumentation is intended to achieve both maximal lesion resection and functional maintenance through preservation of fine vessels and minimal surrounding damage. On the other hands, Increased uniformity of incision depth is critical problem to exclude the potential occurrence of dissemination.Methods. This system consisted of a pump chamber driven by a piezo actuator, a stainless steel tube, and a nozzle. The relationship between jet output, jet frequency, jet nozzle diameter, distance between nozzle and the target, rupture stress and uniformity of incision depth. The excision was quantitatively evaluated using high speed camera.Result. It is suggested that the jet output, jet frequency, jet nozzle diameter, distance between nozzle and target, rupture stress and uniformity of incision depth are involved.

Object. ADPJ (piezo actuator-driven pulsed water jet) is intended to achieve both maximal lesion resection and functional maintenance through preservation of fine vessels and minimal surrounding damage. We have study with short-straight-nozzle, but, I'm studying with long-flexible nozzle (=catheter) for using under flexible endoscopes. The present study evaluated the change of pulsed water jet under catheterMethods. First, engineering experiment, I measured pulsed water jet speeds(=jet speeds) with a high speed camera, changing the catheter length, inner diameter and bending. Second, Phantom model experiment, I used a gelatin as a phantom model. I cut it moving at constant speed with ADPJ and measured the depth of the excision, changing the catheter length. Results. jet speeds and the excision depth decreased depending on the length of catheter. The graph of Inner diameter-jet speeds peaked at one point. Bending had less effects on jet speeds than length and inner diameter.

Object. The purpose of present study is to report the safety and efficacy of piezo actuator-driven pulsed water jet (ADPJ) system in neurosurgery and spinal cord surgery. Methods. The ADPJ system have been used as a part of standard procedure for brain and spinal cord pathologies after approval from internal review board of Tohoku University Hospital. Results. The system have been used in 5 malignant glioma, 6 meningioma, 1 callosotomy for intractable epilepsy, 1 cerebrovascular disease, and 5 spinal cord tumor. There was no complication related to the use of the system. Tissue could be dissected under preservation of fine arteries (diameter 200 microns). The present power was not enough for certain pathologies, especially for hard lesions.Conclusion. Although additional effort to enhance efficacy is necessary, present study indicated that the ADPJ have possibility to become novel surgical tools to assist maximal lesion removal and preserving postoperative function.