Robotikk innen kirurgi Hva skjer nå og i fremtiden? · Peter F. Nichol is chief medical officer,...

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Thomas Langø PhD, Chief Scientist, Medical Technology, SINTEF, Trondheim Coordinator @ Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs hospital, Research Unit Robotikk innen kirurgi Hva skjer nå og i fremtiden?

Transcript of Robotikk innen kirurgi Hva skjer nå og i fremtiden? · Peter F. Nichol is chief medical officer,...

Page 1: Robotikk innen kirurgi Hva skjer nå og i fremtiden? · Peter F. Nichol is chief medical officer, Medaware Systems. Visualization in MIS. Robotics in medicine Integrating Surgical

ThomasLangøPhD,ChiefScientist,MedicalTechnology,SINTEF,Trondheim

Coordinator@NorwegianNationalAdvisoryUnitforUltrasoundandImage-GuidedTherapy,St.Olavshospital,ResearchUnit

RobotikkinnenkirurgiHvaskjernåogifremtiden?

Page 2: Robotikk innen kirurgi Hva skjer nå og i fremtiden? · Peter F. Nichol is chief medical officer, Medaware Systems. Visualization in MIS. Robotics in medicine Integrating Surgical

Disclaimer• Nocommercialbindings

• OneSINTEF-projectrunning:

• CollaborationMedTechandMathematics&CyberneticsatSINTEFandNTNU.Noindustrypartners.FundedbytheResearchCouncilofNorway.Focusoncombiningnonlinearstateestimationtechniqueswithmachinelearningmethodstoestimateandpredictthemotionofmovingobjectsbasedoninputfromdifferentsensors,suchas3Dcamerasandultrasoundprobes,andusingthistoenableroboticarmstointeractwiththeobjectsthroughdynamicinteractioncontrol.Themethodswillbetestedonusecasesfrombothindustryandmedicine,andinthelattercasethefocuswillbeonautomatedultrasoundexaminationswithoutanyintervention.

• PreviousstrategicSINTEFprojectsatMedTechgrouptoinetgraterobotarm(UR5)withtheCustusXplatform.

• Onemajorpublicationonroboticsinsurgery:

• SzoldA,LangøT,BergamaschiR,LutzS,BroedersIAMJ,DankelmanJ,ForgioneA,MelzerA,MintzY,MoralesS,RhodesM,TreglohanJ,SatavaR,Chung-ngaiT,VilallongaR.EAES(EuropeanAssociationofEndoscopicSurgeons)ConsensusStatementontheUseofRoboticsinGeneralSurgery.SurgEndosc,2015,Feb;29(2):253-288.

• (Morethanaverageinterestindevelopingusefultechnologyfordiagnosticsandinterventions)

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Arobotisamachine—especiallyoneprogrammablebyacomputer—capableofcarryingoutacomplexseriesofactionsautomatically

Robot

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Mechatronics

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Roboticsforsurgery,not…foreverythingelse

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Evolutionofsurgery-towardsrobotics

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Briefhistory

• 1985:PUMA560,needleforabrainbiopsyusingCT

• 1988:Samerobotfortransurethralresection

• 1988:PROBOT(ImperialCollege)prostaticsurgery

• 1992:ROBODOCfromIntegratedSurgicalSystems:

• milloutfittingsinthefemurforhipreplacement

• 2000-1:

• ComputerMotionwiththeAESOP

• ZEUSRoboticSurgicalSystems

• IntuitiveSurgical,daVinciSurgicalSystem

Puma560,1985 PROBOT,1988

ROBODOC,1992

AESOP,1994

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Robotsforsurgery

ArtemisEberhardKarlsUniversity

RoboticSurgicalSimulator(RoSS)SimulatedSurgicalSystemsLLC,2009

CardioArmsGrifantini,2008

Orthopilot(2001,FDA)

TheRIO™RoboticArmInteractiveOrthopedicSystem(MAKOSurgicalCorp)

ZeusRoboticSurgicalSystemComputerMotion,Inc.FDA2001

SRI’sM7TelesurgicalRobotDLRMIRO

NeuroMate SofieSurgicalRobot

TheNavioPFSRoboticSurgicalSystemBlueBeltTech

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Surgical‘robot’vendors

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• Accuray• AesyntInc• AVRASurgicalRobotics• CambridgeMedicalRobotics• IMRIS• IRobot• Johnson&Johnson• KirbyLester• MAZORRobotics• Medrobotics• MedTech• Medtronic• NovaTractSurgical• Olympus• OmniGuideHoldings• Smith&Nephew• Stereotaxis• TransEnterix• VerbSurgical• VerilyLifeSciences

IntuitiveSurgical(daVinci)VerbSurgicalMedtronicTINAVIMedicalTechnologiesAKTORmedGmbHROBOTICSurgeryAurisSurgicalRoboticsStrykerTitanMedicalBrainLAB…

Page 10: Robotikk innen kirurgi Hva skjer nå og i fremtiden? · Peter F. Nichol is chief medical officer, Medaware Systems. Visualization in MIS. Robotics in medicine Integrating Surgical
Page 11: Robotikk innen kirurgi Hva skjer nå og i fremtiden? · Peter F. Nichol is chief medical officer, Medaware Systems. Visualization in MIS. Robotics in medicine Integrating Surgical

Technologyforabettersociety

2µm

• mindrereisingforpasientene• desentraliseringavhelsetjenester• egentligfjernstyringavenarmsomholderproben• tohjernerogfirehendersomstyrerettapparat…

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•AutonomousUSimaging•TeleoperatedUSimaging•Human-robotcooperation

robot-assisted US imaging

Robot-assistedUSimaging

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Robotsandpeopleworktogetherinthefutureworkplaces

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Roboticsurgery,Robotically-assistedsurgery,Mechatronics,Mechanicaltele-manipulator,…

daVincisurgicalsystem

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CompetitiontodaVinciisemerging

Senhance™SurgicalRoboticSystem

-laparoscopiccolorectalandlaparoscopicgynecologicsurgery

FDAin2017

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CompetitiontodaVinciisemerging

Flex®RoboticSystemforScarfree™ColorectalProcedures

FDAin2017

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CompetitiontodaVinciisemerging

SPORTSurgicalSystem

FDA:2019anticipated

-broadapplicationsofsingleandmulti-quadrantsurgeriespreviouslynotpossiblewithcurrentroboticsolutions

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daVinciinuse

• 200.000surgeriesconductedin2012,mostcommonlyforhysterectomiesandprostateremovals

• 2016fiscalyear;IntuitiveSurgicalreportedrevenueof$670million

• Roboticsurgerygenerallycostsanywherefrom$3.000to$6.000morethantraditionallaparoscopicsurgery

• “Withinfiveyears,oneinthreeU.S.surgeries—morethandoublecurrentlevels—isexpectedtobeperformedwithroboticsystems,”(Fortunemagazine,2016)

• In2016:3.803unitsworldwide–2.501inUSA,644inEurope,476inAsia,and182intherestoftheworld(http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-faq)

https://en.wikipedia.org/wiki/Da_Vinci_Surgical_System

http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-faq
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• ECRIInstitute(nonprofitorganization)analyzedmorethan4.000studiesonroboticsurgery:

• evidenceisn’tstrongenoughtodetermineifarobotisbetterthantraditionalminimallyinvasivesurgery

• evidenceindicatesthatit’sbettercomparedtoopensurgery

daVinciinuse

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“ThedaVincirobot-assistedsurgerydeviceisasolutioninsearchofaproblem—butonehellofamarketingmachine”

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Roboticsinsurgery

• Thereisnohigh-qualityevidencetoinformthecomparativeeffectivenessofLRPorRARPcomparedtoORPforoncologicaloutcomes.Urinaryandsexualqualityoflife-relatedoutcomesappearsimilar.

• Overallandseriouspostoperativecomplicationratesappearsimilar.Thedifferenceinpostoperativepainmaybeminimal.MenundergoingLRPorRARPmayhaveashorterhospitalstayandreceivefewerbloodtransfusions.Allavailableoutcomedatawereshort-term,andthisstudywasunabletoaccountforsurgeonvolumeorexperience.

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Robotic-AssistedvsLaparoscopicRadicalNephrectomy

• Theproportionofradicalnephrectomiesusingrobotic-assistedoperationsincreasedfrom1.5%in2003to27.0%in2015

• Althoughtherewasnosignificantdifferencebetweenrobotic-assistedvslaparoscopicradicalnephrectomyinmajorpostoperativecomplications,robotic-assistedprocedureswereassociatedwithlongeroperatingtimeandhigherdirecthospitalcosts.

JAMA.2017;318(16):1561-1568.doi:10.1001/jama.2017.14586

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Robotic-AssistedvsConventionalLaparoscopicSurgeryonRiskofConversiontoOpenLaparotomyAmongPatientsUndergoingResectionforRectalCancer

• Amongpatientswithrectaladenocarcinomasuitableforcurativeresection,robotic-assistedlaparoscopicsurgery,ascomparedwithconventionallaparoscopicsurgery,didnotsignificantlyreducetheriskofconversiontoopenlaparotomy.

• Thesefindingssuggestthatrobotic-assistedlaparoscopicsurgery,whenperformedbysurgeonswithvaryingexperiencewithroboticsurgery,doesnotconferanadvantageinrectalcancerresection.

JAMA.2017;318(16):1569-1580.doi:10.1001/jama.2017.7219

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PossibleadvantagesofRoboticsurgery• Shorterhospitalization

• Reducedpainanddiscomfort

• Fasterrecoverytimeandreturntonormalactivities

• Smallerincisions,resultinginreducedriskofinfection

• Reducedbloodlossandtransfusions

• Minimalscarring

• Advantagesforsurgeonsusingroboticsurgeryinclude:

• Greatervisualization

• Enhanceddexterity,nofulcrumeffect

• Greaterprecision

• Surgeoncansit,lessrestraining

• Handtremorsfiltered,scaledmotion

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PossibledisadvantagesofRoboticsurgery• Longeroperatingtime

• Learningcurve

• Lackofstudiesonlongtermresults

• Costs-1.8millUSDanddisposables2.000USDperprocedure

• Noconsistentprotocolstoproperlydeterminewhichpatientsarethebestcandidatesforthevariousroboticprocedures

• Arcing;electricalcurrentsleakoutofthedeviceduringsurgerycausingsparks

• Disdvantagesforsurgeons/researchersusingroboticsurgeryinclude:

• Immobileandweighsmorethanhalfatonne

• Proprietarysoftware

• Madeforremotetelesurgery(awayfrompatient)

• (Almost)nohapticfeedback(forceofinstruments)

• Non-ergonomicneckandtrunkangle(armrestheighthasalimitedadjustmentrange)

• =>Increasedcognitiveload

Intuitiveisadefendantinapproximately50lawsuitsallegingproductliability

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Roboticsinsurgery-othercriticalviews…• Robotintroducedin2000.Unlikethecellphone,ithasnotevolvedintoabetter,sleekertechnologyand

itisn’tcheaper.

• Therobotrepresentsanattempttoaddresstheergonomiccrisisinsurgery(forsurgeons)?

• Iftherewereanadvantageinprecisionorgettingintosmallspaces,itwouldshowupinthedata?

• Intherapidlyevolvingenvironmentofvalue-basedmedicine(outcomepercost)therobotloses…

• Hospitalspayannualsix-figuremaintenancefee.Aftertenyears,theinitialcostofthepurchasehasdoubled!

• Reprocessingarobot:approx.of4.5hoursoflabor.Usuallymore.• mostgoodreprocessingtechscanturnoverinstrumentsfor13ORsinthesametimeittakestoreprocessoneroboticcaseinoneOR

• Instrumentamortization.Breakanarmoranattachment,add$40Ktoyoursix-figurebillfortheyear.Incontrast,ahigh-qualitylaparoscopicinstrumentwillcostaround$1Ktoreplace.

PeterF.Nicholischiefmedicalofficer,MedawareSystems

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VisualizationinMIS

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Robotics in medicine Integrating Surgical Systems for Autonomy in the future OR

“Penelope” – robotic scrub nurseMichael Treat MD, Columbia Univ, NYC. 2003

da VinciSurgical master-slave “robot” system

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FromtraditionalsurgerytosmallerproceduresoutsidetheOR

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Futureofroboticsurgery-tailoredinstruments

http://microsure.nl

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Futureofroboticsurgery-tailoredinstruments

CambridgeMedicalRoboticsVersiussystemcapabilitytooperateacrossallfoursurgicalquadrants,allowingittobeusedingynaecology,urology,upperGIandcolorectalsurgery

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Electromechanicaltool HumanExtensions,Israel

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Futureofroboticsurgery-automaticcameracontrol AutoLap,Israel

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Futureof‘robotic’surgery-tailoredinstruments

http://www.laparasurgical.com

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Therapyfromwithintubes-Flexibleendoscopy

•Cardiacsurgery•GIsurgery(endoluminalsurgery)•Gynaecology•Urology•ENT•Neurosurgery•Vascularsurgery(endovascular)

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Flexibleplatforms-Mainchallenge…

Madefordiagnosis,notsurgery

April2nd,2007,Marescauxetal,IRCAD

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Flexibleplatforms-Instrumentplatform

EndoSAMURAI,Olympus

Roboticflexibleendoscopyplatformsindevelopment

NeoGuidesystem

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Singleincisionroboticplatforms

SurgiBot

SpiderSurgery

VirtualIncision

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Flexibleplatforms-Instrumentplatform

Medrobotics,FlexRoboticsSystem,FDAclearedJuly2015

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Robot-AssistedEndovascularCatheterization

RAFII-TARIetal.CurrentandEmergingRobot-AssistedEndovascularCatheterizationTechnologies:AReview.AnnalsofBiomedicalEngineering,Vol.42,No.4,April2014(Ó2013)pp.697–715

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Futureofroboticsurgery Magellanroboticsystem,HansenMedical

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Futureofroboticsurgery-Opensource

Opensourceplatform

TheRavensystem

TheRavenisanopen-architecturesurgicalrobotforlaparoscopicsurgeryresearchfromAppliedDexterity.Ithastwocable-driven7DOFarms(6DOF+grasp).Itisintendedtofacilitatecollaborativeresearchonadvancesinsurgicalrobot

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Futureofroboticsurgery http://bionics.seas.ucla.edu

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RobotassistedproceduresinMIT

Courtesy:AØstvik,SINTEF/NTNU,EHofstad,SINTEF

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Cognitiverobotics

http://www.zividlabs.com

Accuratereal-time3Dcolorcamera

KunstigintelligensDyplæring

Maskinlæring

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USguidedFUS

CourtesyAMenciassi,Pisa,www.futuraproject.eu

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Futureofroboticsurgery TwenteUniv.,TheNetherlands

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Futureofroboticsurgery TwenteUniv.,TheNetherlands

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FromtraditionalsurgerytosmallerproceduresoutsidetheOR

Nanoroboticist Metin Sitti shows the tiny robot that cantake pictures, biopsy, and deliver medicine inside of you

http://nanolab.me.cmu.edu/projects/capsules/SoftMagneticCapsule.shtml

www.vector-project.com

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GII2015 GlobalInnovation

Index(GII)isanannualrankingofcountriesbytheircapacityfor,andsuccessin,innovation

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GII2017 GlobalInnovation

Index(GII)isanannualrankingofcountriesbytheircapacityfor,andsuccessin,innovation

Røros

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Technology for a better society

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Technologyforabettersociety


EUROPEAN COMMISSION EURO-MEDITERRANEAN …uest.ntua.gr/archive/medaware/reports/61c_Monitoring_Control.pdf · EUROPEAN COMMISSION EURO-MEDITERRANEAN PARTNERSHIP Development of Tools

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International Success Stories in Wastewater Treatment and Reuse MEDAWARE.

International Success Stories in Wastewater Treatment and Reuse MEDAWARE.

Weight-loss surgery sjukhus/Kirurgi... · before the operation, unless your doc-tor has given you other instructions. On the morning of the operation you must only take the drugs

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Kjeveortopedisk behandling uten kirurgi av barn og unge ... · Sitering Larun L, Dalsbø TK, Lund Håheim L, Kirkehei I, Reinar LM. Kjeveortopedisk behandling uten kirurgi av barn

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Dansk Selskab for Skulder- og Albue Kirurgi DSSAK Årsmødedssak.ortopaedi.dk/wp-content/uploads/2018/04/...The patient: indications and considerations Cases and Discussion Hans Viggo

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Evaluation of the Turkish Reuse Standards and the ...uest.ntua.gr/archive/medaware/publications/Gokcay C[1... · Evaluation of the Turkish Reuse Standards and the Compliance Status

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Generell kirurgi på hjemmekino ... · inkludert noen anastomoser og stomier, samt torakotomi (tilgang), men ikke lever-, pancreas- eller rektumkirurgi. I et eget appendiks ... patologi,

Generell kirurgi på hjemmekino ... · inkludert noen anastomoser og stomier, samt torakotomi (tilgang), men ikke lever-, pancreas- eller rektumkirurgi. I et eget appendiks ... patologi,

dsgh.dkdsgh.dk/images/guidelines/wordversion/Cirrose kirurgi 2…  · Web viewMurashita T, Komiya T, Tamura N, Sakaguchi G, Kobayashi T, Furukawa T, et al. Preoperative evaluation

dsgh.dkdsgh.dk/images/guidelines/wordversion/Cirrose kirurgi 2…  · Web viewMurashita T, Komiya T, Tamura N, Sakaguchi G, Kobayashi T, Furukawa T, et al. Preoperative evaluation

Workshop: Fysioterapi som alternativ til kirurgi · Workshop: Fysioterapi som alternativ til kirurgi • "I den senere tid har pressen referert til studien som hevder at fysioterapi

Workshop: Fysioterapi som alternativ til kirurgi · Workshop: Fysioterapi som alternativ til kirurgi • "I den senere tid har pressen referert til studien som hevder at fysioterapi

uest.ntua.gr - Unit of Environmental Science and Technologyuest.ntua.gr/archive/medaware/reports/Re…  · Web view · 2014-11-20Bacterial Bed HATTANE- OCP 3 600 375 136 875 BOUJNIBA

uest.ntua.gr - Unit of Environmental Science and Technologyuest.ntua.gr/archive/medaware/reports/Re…  · Web view · 2014-11-20Bacterial Bed HATTANE- OCP 3 600 375 136 875 BOUJNIBA

Trombocytos - reaktiv eller essentiell? · Aspleni/post-splenektomi Malignitet Nylig kirurgi, trauma eller blodförlust Nefrit/nefros Pankreatit Hemolytisk anemi Läkemedel - Adrenalin

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Title - UESTuest.ntua.gr/archive/medaware/Abstract India 08.doc · Web viewIn several cases the wastewater is not properly treated due to the fact that the construction cost of efficient

Title - UESTuest.ntua.gr/archive/medaware/Abstract India 08.doc · Web viewIn several cases the wastewater is not properly treated due to the fact that the construction cost of efficient

What do Danish doctors think? - selskaberne.dk · Urologi. UNHAPPY SPECIALITES ... Patologisk anatomi og cytologi. Reumatologi. Kirurgi. Diagnostisk radiologi. pathology . rheumatology.

What do Danish doctors think? - selskaberne.dk · Urologi. UNHAPPY SPECIALITES ... Patologisk anatomi og cytologi. Reumatologi. Kirurgi. Diagnostisk radiologi. pathology . rheumatology.

Development of Tools and Guidelines for the Promotion of ...uest.ntua.gr/archive/medaware/reports/Report_task_61a_.pdf · MEDAWARE- Task 6: “Guidelines for monitoring” 6 DESCRIPTION

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Ca. recti - kirurgi for radiologer

Ca. recti - kirurgi for radiologer

Recorded in DXD 24bit/352.8kHz 5.1 DTS HD MA 24/192kHz 9.1 ... · Ko Matsushita, Knut Nystedt, Franz Xaver Biebl and Kim André Arnesen Hva skjer når samisk musikktradisjon møter

Recorded in DXD 24bit/352.8kHz 5.1 DTS HD MA 24/192kHz 9.1 ... · Ko Matsushita, Knut Nystedt, Franz Xaver Biebl and Kim André Arnesen Hva skjer når samisk musikktradisjon møter

The role of dissolved aluminum in silica chemistry for ...uest.ntua.gr/archive/medaware/meda_conference/entypa/DES_sample.pdf · RO) water treatment processes. Norman et al. [7] described

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Future opportunities related to food waste What’s ...matsvinn.no/wp-content/uploads/2016/10/8-Hva-skjer-i-Europa-ForMat... · Future opportunities related to food waste ... •

Future opportunities related to food waste What’s ...matsvinn.no/wp-content/uploads/2016/10/8-Hva-skjer-i-Europa-ForMat... · Future opportunities related to food waste ... •