A Metal Detector for Clip Location Tracking of Stomach and Colon Cancer during Laparoscopic Surgery
Round 1
Reviewer 1 Report
General comments:
The authors performed an animal study to evaluate the efficacy of their designed clips and clip detector for tumor location during laparoscopic gastric and colonic surgeries. The highly accurate with fast detection of the clips attests to the usefulness of their innovations, so that future clinical studies may be expected to confirm the findings of this experimental study.
Minor points:
From an industrial point of view, this article appears to be rationale and applicable. However, for clinicians, potential disadvantages (limitations) may be considered; for example, the possible risk of using magnetic field power during surgery in humans. The authors are encouraged to describe the disadvantages as well as advantages of their innovations in the manuscript.
Author Response
Comment 0 :
The authors performed an animal study to evaluate the efficacy of their designed clips and clip detector for tumor location during laparoscopic gastric and colonic surgeries. The highly accurate with fast detection of the clips attests to the usefulness of their innovations, so that future clinical studies may be expected to confirm the findings of this experimental study.
Answer 0 :
Thank you very much for your positive evaluation of my paper. I will do my best to answer your comments.
Comment 1 :
From an industrial point of view, this article appears to be rationale and applicable. However, for clinicians, potential disadvantages (limitations) may be considered; for example, the possible risk of using magnetic field power during surgery in humans. The authors are encouraged to describe the disadvantages as well as advantages of their innovations in the manuscript.
Answer 1 :
Thank for your good comments. You asked a very important and realistic question for the update of my paper. thank you so much. I positively agree with your groundbreaking comment and have incorporated it into the discussion. The above is recorded on lines of 329-358 (sky blue). And, Here's the answer:
If N clips are used, magnetic coupling interference may occur depending on the spacing between the clips. In other words, if the distance (d) between clips becomes longer, the magnetic field intensity is attenuated (α: attenuation of magnetic field intensity) by the distance (d2) as shown in Equation (4), and interference can be reduced. However, if the spacing between the clips becomes narrower, the magnetic field intensity increases by the distance (d2), which may lead to greater interference [23].
In the course of animal experiments, we attached only one clip when attaching the clip to the stomach or colon as shown in Figure 17. And we use the detector to find one clip position. So there was no interference problem. However, the problem of interference between clips seems to have to be tested by increasing the number of clips. Therefore, we plan to test for interference by increasing the number of clips in the future. If there is an interference problem, we plan to solve it through additional research.
Also, since the detector for detecting the clip is a magnetic field component induced by the coil, it has been confirmed that it does not interfere with the surrounding forceps.
Finally, the method of this study is 2.27V (5.52 mW / 2.2μT) at 11.33 kHz. That is, our method uses a magnetic field with a very weak strength, so it is analyzed that there is no adverse effect on the human body. That is, the voltage, power, and magnetic flux density generated by the detector to detect the last clip are 2.27V, 5.52mW, and 2.2 μT (@ 11.33-11.335kHz), respectively. In the recommendations of ICNIRP, the republic of Korea recommends that the exposure limit of human electromagnetic waves be within the range of 3.0-150 kHz, with a voltage of 87V or less and 5A/m (magnetic flux density: 6.25μT) [24, 25]. Therefore, the proposed detector is analyzed to have no adverse effect on the human body to detect the clip. In addition, since the medical magnetic field used for human diagnosis and treatment is harmless to the human body, most studies have been conducted for the application of MRI, magnetic field therapy, capillary circulation state examination, and capsule endoscopy diagnostic kit [26-29]. Of course, if a high-density, strong pulsed magnetic field (more than 100 μT) is used (even for a short time), it stimulates the nervous system, reduces blood volume, and causes muscle pain due to muscle stiffness [25], [30, 31].
Finally, the voltage, power and magnetic flux density of the result (lines of 280-281 (green)) are 2.27V, 5.52mW and 2.2μT (@ 11.33-11.335kHz) respectively. In particular, in lines of 166-168 (yellow), KSC IEC 60479−2 (adult) and KSC IEC 61200−413 (child) are within 20 kHz and 20 mA, so they are considered relatively safe [18, 19]. Therefore, it is judged that the developed detector can be used for medical purposes.
Author Response File: 
Author Response.docx
Reviewer 2 Report
This is an interesting paper describing a method to locate and track cancer within the stomach and colon.
The paper is well presented with both simulation and animal experimental results. Although the conclusion is very promising for saving time in detecting the tumor, it is not clear whether the setup time has been included or not. It takes time to set clip on the tumor area. This also needs to be included to compare with other methods mentioned. Also, it will be good to comment on how secure the clip can stay in the target position. To detect the tumor in three dimensions, will it need four clips to be located? If multiple clips are needed, how they can be tracked at the same time? After the surgery, how the clips will be removed?
I am looking forward to seeing the answers to these questions.
Author Response
Comment 0 :
This is an interesting paper describing a method to locate and track cancer within the stomach and colon.
Answer 0 :
Thank you very much for your positive evaluation of my paper. I will do my best to answer your comments.
Comment 1 :
The paper is well presented with both simulation and animal experimental results. Although the conclusion is very promising for saving time in detecting the tumor, it is not clear whether the setup time has been included or not. It takes time to set clip on the tumor area. This also needs to be included to compare with other methods mentioned. Also, it will be good to comment on how secure the clip can stay in the target position. To detect the tumor in three dimensions, will it need four clips to be located? If multiple clips are needed, how they can be tracked at the same time? After the surgery, how the clips will be removed?
I am looking forward to seeing the answers to these questions.
Answer 1 :
I sincerely thank you for your generous compliment. In addition, Thank for your good comments. You asked a very important and realistic question for the update of my paper. thank you so much. I positively agree with your groundbreaking comment and have incorporated it into the discussion. Please refer to lines of 36-372 (gray) Here's the answer:
The clip used for endoscopy was originally developed and used for hemostasis and puncture closure [8]. For many researchers or surgeons, the time to attach one clip (within 1 minute) is very short. However, standard methods such as India ink tattooing method and self-blood injection method injection therapy inject in 4 directions [32]. Also, this method is time consuming because it uses two endoscopic syringes.
Because the clip is used for perforation, it usually remains mounted within the organ for 5-7 days (or even years) after the clip is placed. However, safety is not an issue as most of them are excreted through the bowels.
Because the clip is used for perforation, it usually remains mounted within the organ for 5-7 days (or even years) after the clip is placed. However, safety is not an issue as most of them are excreted through the bowels.
If N clips are used, magnetic coupling interference may occur depending on the spacing between the clips. (Please refer to lines of 329 - 343 (blue sky)) In other words, if the distance (d) between clips becomes longer, the magnetic field intensity is attenuated (α: attenuation of magnetic field intensity) by the distance (d2) as shown in Equation (4), and interference can be reduced. However, if the spacing between the clips becomes narrower, the magnetic field intensity increases by the distance (d2), which may lead to greater interference [23].
In the course of animal experiments, we attached only one clip when attaching the clip to the stomach or colon as shown in Figure 17. And we use the detector to find one clip position. So there was no interference problem. However, the problem of interference between clips seems to have to be tested by increasing the number of clips. Therefore, we plan to test for interference by increasing the number of clips in the future. If there is an interference problem, we plan to solve it through additional research. Also, since the detector for detecting the clip is a magnetic field component induced by the coil, it has been confirmed that it does not interfere with the surrounding forceps.
When the operation is finished, the clip is delivered to the pathology department along with the lesion. Therefore, there is no need to separately remove the clip.
Author Response File: Author Response.docx
