Surgical steps of bilateral axillo-breast approach robotic thyroidectomy.
\r\n\tGlobalization does not represent a pure and generous process for humanity or other species, but rather it implies social exclusion and also provokes situations of vulnerability in groups of people, forced exclusion, and apartheid: poor job opportunities, lack of access to education, worse socio-sanitary conditions. Specifically, it can be said that social segregation entails the apartheid of social groups of different ages, genders, and ethnicities; these groups live a reality manifested through the deepening of poverty, in terms of increased vulnerability of the poor and groups with little economic, social, cultural, labor and health stability.
\r\n\r\n\tThis book aims to talk about some topics that are neglected in the discourses of academic communities and political elites. The inequality process is deeply rooted among humans and is part of many people's lives in the form of modern apartheid, gender segregation, lack of health access, and cultural gap. All those structural inequality processes are the product of the biopower perpetuated and produced in the macrosystem, exosystem, mesosystem, and microsystem. For many people from the academy, the information-consuming public, and the society in general, it is a problem to talk about these processes, since they have either lost interest or have normalized the structural and social inequity. For this reason, we see it as transcendental to explain how this situation occurs from the most internal fibers to the most evident processes, intending to make it more visible and thus expose the situation for possible solutions.
",isbn:"978-1-83768-406-9",printIsbn:"978-1-83768-405-2",pdfIsbn:"978-1-83768-407-6",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"cefab077e403fd1695fb2946e7914942",bookSignature:"Ph.D. Yaroslava Robles-Bykbaev",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11473.jpg",keywords:"Wage Gap, Gender Segregation, Fundamental Human Rights, Health Access, Social Inequity Processes, Modern Apartheid, Resilience, Cultural Gaps, Globalization, Geopolitics of Social Inequality, Public Policies, Social Vulnerability",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"June 15th 2022",dateEndSecondStepPublish:"July 13th 2022",dateEndThirdStepPublish:"September 11th 2022",dateEndFourthStepPublish:"November 30th 2022",dateEndFifthStepPublish:"January 29th 2023",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"18 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr. Bykbaev is a member of the UNESCO Chair of Politecnica Salesiana University. She has contributed as co-author and author to approximately thirty scientific publications in the field of statistics, inclusive education, and social and cultural anthropology. These publications focus on the visibility of problems in the field of public health and focus on the creation of proposals to improve community health. Dr. Bykbaev is an active member of the NODO Ecuadorian Network of Women Scientists (REMCI).",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"313341",title:"Ph.D.",name:"Yaroslava",middleName:null,surname:"Robles-Bykbaev",slug:"yaroslava-robles-bykbaev",fullName:"Yaroslava Robles-Bykbaev",profilePictureURL:"https://mts.intechopen.com/storage/users/313341/images/system/313341.jpg",biography:null,institutionString:"Politecnica Salesiana University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"0",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"Politecnica Salesiana University",institutionURL:null,country:{name:"Ecuador"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"23",title:"Social Sciences",slug:"social-sciences"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:{id:"444316",firstName:"Blanka",lastName:"Gugic",middleName:null,title:"Mrs.",imageUrl:"https://mts.intechopen.com/storage/users/444316/images/20016_n.jpg",email:"blanka@intechopen.com",biography:"As an Author Service Manager, my responsibilities include monitoring and facilitating all publishing activities for authors and editors. From chapter submission and review to approval and revision, copyediting and design, until final publication, I work closely with authors and editors to ensure a simple and easy publishing process. I maintain constant and effective communication with authors, editors and reviewers, which allows for a level of personal support that enables contributors to fully commit and concentrate on the chapters they are writing, editing, or reviewing. I assist authors in the preparation of their full chapter submissions and track important deadlines and ensure they are met. I help to coordinate internal processes such as linguistic review, and monitor the technical aspects of the process. As an ASM I am also involved in the acquisition of editors. Whether that be identifying an exceptional author and proposing an editorship collaboration, or contacting researchers who would like the opportunity to work with IntechOpen, I establish and help manage author and editor acquisition and contact."}},relatedBooks:[{type:"book",id:"6926",title:"Biological Anthropology",subtitle:"Applications and Case Studies",isOpenForSubmission:!1,hash:"5bbb192dffd37a257febf4acfde73bb8",slug:"biological-anthropology-applications-and-case-studies",bookSignature:"Alessio Vovlas",coverURL:"https://cdn.intechopen.com/books/images_new/6926.jpg",editedByType:"Edited by",editors:[{id:"313084",title:"Dr.",name:"Alessio",surname:"Vovlas",slug:"alessio-vovlas",fullName:"Alessio Vovlas"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6942",title:"Global Social Work",subtitle:"Cutting Edge Issues and Critical Reflections",isOpenForSubmission:!1,hash:"222c8a66edfc7a4a6537af7565bcb3de",slug:"global-social-work-cutting-edge-issues-and-critical-reflections",bookSignature:"Bala Raju Nikku",coverURL:"https://cdn.intechopen.com/books/images_new/6942.jpg",editedByType:"Edited by",editors:[{id:"263576",title:"Dr.",name:"Bala",surname:"Nikku",slug:"bala-nikku",fullName:"Bala Nikku"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1591",title:"Infrared Spectroscopy",subtitle:"Materials Science, Engineering and Technology",isOpenForSubmission:!1,hash:"99b4b7b71a8caeb693ed762b40b017f4",slug:"infrared-spectroscopy-materials-science-engineering-and-technology",bookSignature:"Theophile Theophanides",coverURL:"https://cdn.intechopen.com/books/images_new/1591.jpg",editedByType:"Edited by",editors:[{id:"37194",title:"Dr.",name:"Theophile",surname:"Theophanides",slug:"theophile-theophanides",fullName:"Theophile Theophanides"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3161",title:"Frontiers in Guided Wave Optics and Optoelectronics",subtitle:null,isOpenForSubmission:!1,hash:"deb44e9c99f82bbce1083abea743146c",slug:"frontiers-in-guided-wave-optics-and-optoelectronics",bookSignature:"Bishnu Pal",coverURL:"https://cdn.intechopen.com/books/images_new/3161.jpg",editedByType:"Edited by",editors:[{id:"4782",title:"Prof.",name:"Bishnu",surname:"Pal",slug:"bishnu-pal",fullName:"Bishnu Pal"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3092",title:"Anopheles mosquitoes",subtitle:"New insights into malaria vectors",isOpenForSubmission:!1,hash:"c9e622485316d5e296288bf24d2b0d64",slug:"anopheles-mosquitoes-new-insights-into-malaria-vectors",bookSignature:"Sylvie Manguin",coverURL:"https://cdn.intechopen.com/books/images_new/3092.jpg",editedByType:"Edited by",editors:[{id:"50017",title:"Prof.",name:"Sylvie",surname:"Manguin",slug:"sylvie-manguin",fullName:"Sylvie Manguin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"371",title:"Abiotic Stress in Plants",subtitle:"Mechanisms and Adaptations",isOpenForSubmission:!1,hash:"588466f487e307619849d72389178a74",slug:"abiotic-stress-in-plants-mechanisms-and-adaptations",bookSignature:"Arun Shanker and B. Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"72",title:"Ionic Liquids",subtitle:"Theory, Properties, New Approaches",isOpenForSubmission:!1,hash:"d94ffa3cfa10505e3b1d676d46fcd3f5",slug:"ionic-liquids-theory-properties-new-approaches",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/72.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"314",title:"Regenerative Medicine and Tissue Engineering",subtitle:"Cells and Biomaterials",isOpenForSubmission:!1,hash:"bb67e80e480c86bb8315458012d65686",slug:"regenerative-medicine-and-tissue-engineering-cells-and-biomaterials",bookSignature:"Daniel Eberli",coverURL:"https://cdn.intechopen.com/books/images_new/314.jpg",editedByType:"Edited by",editors:[{id:"6495",title:"Dr.",name:"Daniel",surname:"Eberli",slug:"daniel-eberli",fullName:"Daniel Eberli"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"57",title:"Physics and Applications of Graphene",subtitle:"Experiments",isOpenForSubmission:!1,hash:"0e6622a71cf4f02f45bfdd5691e1189a",slug:"physics-and-applications-of-graphene-experiments",bookSignature:"Sergey Mikhailov",coverURL:"https://cdn.intechopen.com/books/images_new/57.jpg",editedByType:"Edited by",editors:[{id:"16042",title:"Dr.",name:"Sergey",surname:"Mikhailov",slug:"sergey-mikhailov",fullName:"Sergey Mikhailov"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"1373",title:"Ionic Liquids",subtitle:"Applications and Perspectives",isOpenForSubmission:!1,hash:"5e9ae5ae9167cde4b344e499a792c41c",slug:"ionic-liquids-applications-and-perspectives",bookSignature:"Alexander Kokorin",coverURL:"https://cdn.intechopen.com/books/images_new/1373.jpg",editedByType:"Edited by",editors:[{id:"19816",title:"Prof.",name:"Alexander",surname:"Kokorin",slug:"alexander-kokorin",fullName:"Alexander Kokorin"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"55664",title:"Bilateral Axillo-Breast Approach Robotic Thyroidectomy: Introduction and Update",doi:"10.5772/intechopen.68951",slug:"bilateral-axillo-breast-approach-robotic-thyroidectomy-introduction-and-update",body:'\nThyroid carcinoma is the most common endocrine malignancy. Although the treatment of choice for patients with thyroid carcinoma is conventional open thyroidectomy (OT), it inevitably leaves scarring in the neck because of the anatomical location of the thyroid. Thyroid carcinoma is especially prevalent in young women. The prognosis of thyroid carcinoma is favorable, which increases concerns related to quality of life in terms of postoperative neck scars. To avoid cosmetically unfavorable outcomes, a variety of remote approaches have been used in patients at low risk of recurrence. The two most common techniques are the transaxillary approach (TAA) and bilateral axillo-breast approach (BABA). BABA consists of two axillary incisions 0.8 cm in size and two circumareolar incisions, one left (0.8 cm) and one right (1.2 cm).
\nBABA endoscopic thyroidectomy is a modification of Axillo Bilateral Breast Approach (ABBA) developed by Shimazu et al. [1]. It was introduced at Seoul National University Hospital (SNUH) in 2004 and has since been used to treat a variety of benign and malignant thyroid diseases. Compared with OT, BABA Endoscopic Thyroidectomy (ET) yields comparable postoperative complication rates and thyroglobulin levels but with excellent cosmetic results [2, 3]. Based on these results, in 2008, we combined our unique BABA thyroidectomy technique with the fundamental advantages of the da Vinci robotic system. These advantages include a good operative view using high-definition three-dimensional imaging, an EndoWrist function that enables a high degree of freedom of motion, a tremor-filtering system, and a short learning curve. This enables precise surgical maneuvers to be performed in difficult and narrow workspaces, even though robotic thyroidectomy (RoT) is associated with some disadvantages including high cost, longer operation time, and lack of tactile sensation. In 2009, we reported our initial experiences with BABA RoT at SNUH, which was the first report of its use [4]. Since then, there have been many clinical studies assessing the surgical outcomes and safety of BABA RoT. In this chapter, we aim to introduce the detailed procedure of BABA RoT and review evidence from published studies regarding the technical, oncological, and functional safety and cosmetic outcomes of BABA RoT.
\nThe indications for BABA RoT are as follows: (1) a well-differentiated thyroid carcinoma such as papillary or follicular thyroid carcinoma <4 cm in diameter, regardless of preoperative lymph node (LN) involvement, (2) minimal invasion of the anterior thyroid capsule and strap muscle, (3) Graves’ disease (recommended for <100 ml in volume), (4) male patients who experienced difficulty with endoscope application, (5) a larger benign thyroid nodule or follicular neoplasm (5–8 cm) not eligible for treatment by a conventional endoscopic approach, and (6) obese patients (body mass index [BMI] >30), who cannot undergo endoscopy [4–10]. Absolute contraindications to RoT include patients with distant metastasis, thyroid malignancies that are likely to recur (e.g., medullary thyroid carcinoma, undifferentiated, or poorly differentiated thyroid carcinoma) and are located posteromedially and thus may be very close to the recurrent laryngeal nerve (RLN) or may have invaded into the tracheal wall and concomitant obvious breast malignancy [11, 12]. Thyroid nodules >8 cm in diameter or those in substernal goiters are also relative contraindications to RoT. BABA thyroid surgery does not involve the breast parenchyma in subcutaneous dissection after circumareolar incision. Consequently, previous breast-conserving surgery due to breast cancer or breast augmentation is not a contraindication to BABA RoT. In addition, Kim et al. recently reported that BABA RoT and lateral LN dissection were performed simultaneously in a thyroid carcinoma patient with preoperative cervical LN metastasis [13]. Therefore, BABA RoT is selectively applicable in patients with suspected lateral LN metastasis.
\nA robotic system requires more space than does either open or endoscopic surgery. Therefore, most hospitals have a dedicated robot operating room. The room is maintained such that surgery can be performed under aseptic conditions.
\nEndoscope: Φ10 mm, 30° endoscope
Thyroid pillow (Emtas, Seoul, Korea) (\nFigure 1\n)
EndoWrist instruments (\nFigure 2\n)
1 Maryland bipolar forceps, Φ8 mm
1 Prograsp TM forceps, Φ8 mm
1 Cautery hook, Φ8 mm
1 Harmonic®, Φ8 mm
Harmonic® (Ethicon Endo-surgery, Cincinnati, OH, USA)
Vascular tunneler (Gore-Tex) (\nFigure 3\n)
Trocars (\nFigure 4\n)
Endobag, 10 mm (\nFigure 5\n)
Suction-irrigator (\nFigure 6\n)
Other instruments (\nFigure 7\n)
OR Setup (\nFigure 8\n)
Thyroid pillow.
Endowrist instruments.
Vascular tunneler.
Trocars.
Endobag.
Suction-irrigator.
Peanut and thimble.
Schematic depiction and the view from above for the operating room setting on robotic thyroidectomy.
Under general anesthesia, the patient is placed in the supine position with a Q-pillow under the shoulder extending the head and neck and the arm resting alongside the body (\nFigure 9\n). Care should be taken not to overstretch the patient’s neck. Alternatively, Kang et al. suggested a “verticalizing maneuver (VM)” that lifts up the circumareolar sites as high as possible by surrounding the lower part of the lower breast with elastic bands [6]. This method positions the trocar axis more perpendicular, which reduces the blind spot in the lower neck during central compartment node dissection. The surgical field is prepared according to routine surgical maneuvers, and sterile drainage is performed using a universal drape package to expose the anterior neck, bilateral axilla, and lower contour of the breasts. The visual field of the patient’s face and endotracheal tube can be maintained by covering the patient’s head and face with a transparent plastic sheet (\nTable 1\n).
\nPosition and drape.
\n
| \n
Surgical steps of bilateral axillo-breast approach robotic thyroidectomy.
Guidelines are drawn along the following anatomical markings of the chest and neck: thyroid cartilage notch, cricoid cartilage (+), suprasternal notch (U), midline connecting them above, anterior border of the sternocleidomastoid muscle (SCM), superior border of the clavicle and 2 cm below the border, incisions (two circumareolar incisions at the superomedial margins and two axillary incisions using conventional skin wrinkles), and four trajectory lines from each of four skin incision sites to the cricoid cartilage and workspace (\nFigure 10\n). The dissecting area is bordered by the thyroid cartilage superiorly, 2 cm below the superior border of the clavicle inferiorly and just beyond the medial border of the SCM muscles laterally.
\nDrawing guideline.
Diluted (1:200,000) epinephrine solution is injected into the workspace below the platysma of the neck and subcutaneously into the anterior chest. A 23-G spinal needle is then used to check the intravenous puncture by pulling the syringe back slightly before injecting the solution (\nFigure 11a\n). At this time, it is possible to inject the solution more securely while avoiding puncturing the blood vessel by bending the needle slightly at an angle. A “pinch and raise” maneuver of the skin from the neck area facilitates injection of saline into the subplatysmal area (\nFigure 11b\n). This “hydrodissection” technique is used to create a saline pocket in the subplatysmal layer to reduce bleeding in the flap area and facilitate subsequent dissection. Additionally, Kang et al. previously reported that infiltration of the flap sites with a ropivacaine-saline solution (100 cc normal saline mixed with 3 mg/kg 0.1% ropivacaine) is a safe and effective method for reducing postoperative pain and postoperative analgesic need [14].
\nEpinephrine-mixed saline injection (a) 23 G spine needle (b) “pinch and raise” technique.
A circumareolar incision is made along the superomedial margin of each areola (\nFigure 12\n). First, a 12-mm incision is made on the right side to be used as a camera port, and the subcutaneous tissue is dissected using an electric cauterizer. Next, a straight mosquito hemostat, a long Kelly clamp, and a vascular tunneler are used to generate a subcutaneous narrow tunnel along the trajectory line for trocar insertion. Blunt dissection of the flap formed by hydrodissection begins at zone 2 and extends to zone 1 using a vascular tunneler. At this time, excessive force must not be used when performing blunt dissection near the sternal notch. Next, an 8-mm incision is made on the superomedial margin of the left areola, and blunt dissection of zones 1 and 2 is completed by repeating the same procedure described above.
\nSkin incision and blunt dissection.
After blunt dissection of the flap from the incision sites to the cricoid cartilage using the tunneler, the ports are inserted through the incision (\nFigure 13\n). The flap is located higher than the breast parenchyma so that it does not injure the patient’s breast. The 12-mm camera port is inserted through the right breast incision, and the 8-mm port is inserted through the left breast incision. At this time, the port insertion sites around the areola are encircled with Duoderm® to cover and protect the areolar after the port is inserted, prevent skin burns on the incision surface, and avoid air leakage. The workspace is maintained at low pressure (5–6 mmHg) by pumping CO2 gas through the 12-mm camera port [15]. The ultrasonic shear (Harmonic, Ethicon EndoSurgery Inc., Cincinnati, OH, USA) is inserted through the 8-mm port on the left areolar incision to meet the camera through the 12-mm port and to secure the field of view and remove the remaining trabeculae of the subcutaneous tissue. After creating a workspace in the anterior chest (zone 1 and/or 2), avoiding the firm area near the sternal notch, two 8-mm incisions are made, and the trocar is inserted along the axillary trajectory line.
\nFour ports insertion and sharp dissection with energy device.
After inserting the four ports, the operation bed is switched to a reverse Trendelenburg position of ~20–30°. The central columns of the robot carts and the camera arm are aligned with the camera port in a straight line, and the robot is docked to the port and connected via each of the four robot arms (\nFigure 14\n). The camera is inserted into the right areolar incision site port, and a monopolar electrocautery or ultrasonic shear is inserted into the left port. Graspers (ProGrasp forceps and Maryland forceps, Intuitive Surgical Inc., Sunnyvale, CA, USA) are inserted through both axillary ports, and further dissection is performed (\nFigure 15\n). This procedure completes the flap safely and effectively without bleeding. The border of the completed flap extends from the thyroid cartilage superiorly to 2 cm below the clavicle and to the point just beyond the medial margin of the SCM muscle. Recent reports suggested that subfascial layers likely cause less postoperative adhesion than do conventional subplatysmal layers in making flaps [16]. Anterior jugular vein ligation is necessary for dissections performed using the subfascial layer, which can be safely ligated near the sternal notch using an ultrasonic shear or a bipolar coagulator connected to Maryland forceps.
\nRobot docking.
Placement of robotic instruments.
The first step of BABA RoT is resection, performing a midline division of the strap muscle in a similar fashion to conventional OT (\nFigure 16\n). The midline between the strap muscles is identified and separated by monopolar electrocautery. At this time, the cervical fascia is opened from the suprasternal notch to the thyroid cartilage to expose the entire length of the strap muscle. For identifying the midline, it is helpful for confirming the boundary that the first assistant palpates the prominence of the thyroid cartilage and the suprasternal notch from the outside.
\nMidline division.
After verifying the trachea, isthmus, and cricothyroid membranes in the visual field, the isthmus is separated by ultrasonic shear or hook electrocautery (\nFigure 17\n). The trachea is easily identified by dissecting the soft tissue caudally from the thyroid isthmus, taking care not to injure the trachea. In addition, because there is a vessel in the upper border of the isthmus, care should be taken to avoid bleeding when dissecting. It is important to confirm the presence of isthmus lesions on preoperative images. If the tumor or nodule is located in the isthmus on the preoperative image, the lesion should be avoided, i.e., by using the paraisthmic line. Sometimes, the pyramidal lobes extend cranially to the level of the hyoid bone, and a thyroid duct cyst is detected incidentally. This structure should be removed for complete resection of the thyroid tissue; this procedure is possible with BABA RoT [17]. Furthermore, a delphian or prelaryngeal node between the cricothyroid muscles above the isthmus and a pretracheal node below the isthmus shoulder may be found during soft tissue dissection. If LN metastasis is suspected, it is possible to excise the LN and confirm metastasis intracorporeally using frozen biopsy [18]. This area always contains small blood vessels, but monopolar electrocautery allows hemostasis. Extra attention is needed to avoid injuring the cricothyroid muscles during dissection.
\nIsthmectomy, arrow; thyroid notch.
After isthmectomy and/or midline LN resection, the thyroid gland on the lesion side is retracted medially using ProGrasp forceps, and the strap muscle is retracted laterally using Maryland forceps to separate the strap muscle from the capsule of the thyroid gland (\nFigure 18\n). This dissection extends to the deep aspect of the gland to expose the lateral side of the thyroid gland. Upon lateral dissection, the middle thyroid vein is visible and is ligated using ultrasonic shears or Maryland forceps. Ultrasonic shears are useful to reduce unnecessary bleeding from the muscles and thyroid capsule during this process. The so-called “switching action,” which moves the thyroid gland in the medial direction in phase with two robotic arms, facilitates medial retraction of the thyroid gland. In addition, the thyroidectomy procedure may be facilitated by dissection of the medial side (peritracheal and cricoid cartilage) as well as the lateral side. Further dissection is then performed from the lower pole to the medial side of the trachea in accordance with the principle of capsular dissection.
\nLateral dissection of the thyroid gland.
After completing the lateral and medial dissections of the thyroid gland, the next step is dissection of the inferior portion of the thyroid gland (\nFigure 19\n). The lower pole of the thyroid gland is dissected bluntly using ultrasound scissors or Maryland forceps, because the inferior thyroid artery passes directly below or crosses over the recurrent laryngeal nerve before entering the thyroid gland. Therefore, the inferior thyroid artery can be used as an anatomical guide for exposing the recurrent laryngeal nerve.
\nDissection of the thyroid lower pole, arrow; inferior thyroid vein.
During dissection of the thyroid gland from the perithyroidal tissue, it is important to preserve the RLN and PTG (\nFigure 20\n). The RLN and PTG should be identified while carefully dissecting the inferolateral side of the thyroid gland. Once the RLN is found, a plane delineated just superficial to the nerve and the ligament of Berry is separated using ultrasonic shears. Dissection progresses in the cephalad direction to the point where the nerve enters the larynx. Near the ligament of Berry, careful dissection is needed to avoid traction or thermal injury to the RLN. It was reported that intraoperative neuromonitoring can help identify and preserve the RLN [19, 20]. In addition, Yu et al. introduced near-infrared light-induced indocyanine green fluorescence to identify the PTG during BABA RoT and reduce the risk of incidental parathyroidectomy [21]. If the nerve is not immediately exposed, the loose fibrous tissue needs to be further dissected from the inferior point of the artery near the tracheoesophageal groove. At this time, the inferior PTG, which can be used as a guide to the RLN, can be detected. The Zuckerkandl tubercle can also be used as a guide to the RLN. Therefore, the area under the Zuckerkandl tubercle requires caution when dissecting using Maryland forceps. Because the inferior thyroid vessels supply blood to the inferior PTGs, the inferior vessels should be ligated close to the thyroid to preserve blood flow. If preservation of the PTGs is not possible, reimplantation should be considered. The pectoralis major muscle is preferred for autotransplantation of the PTG.
\nPreservation of the recurrent laryngeal nerve and parathyroid gland.
With the retractor pulling the upper portion of the strap muscles in a cephalad direction and the trachea in a medial direction, ultrasonic shears are used to dissect the upper pole of the thyroid gland (\nFigure 21\n). The medial and lateral sides are dissected alternately to separate the upper pole of the thyroid gland. It is important to preserve the fascia of the cricothyroid muscle, because the external branch of the superior laryngeal nerve is closely related to the cricothyroid muscles [22]. Therefore, it is helpful to maintain the fascia using medial traction of the trachea during this procedure. In most cases, the posterior branch of the upper thyroid vessel, which supplies blood to the superior PTG, can be preserved by careful capsular dissection. There may be one or two small veins entering the posterior portion of the upper pole; these vessels should be identified and ligated carefully. Then, the terminal branches of the superior thyroid artery and vein should be identified and ligated carefully using ultrasonic shears. The three approaches to dissecting the upper thyroid gland are the (1) lateral, (2) anteromedial, and (3) posterior medial approaches. The lateral approach refers to gradual and careful dissection of the strap muscles attached to the thyroid gland. The anteromedial approach to the thyroid upper pole corresponds to extending the space between the thyroid gland and the anterior portion of the cricothyroid muscle. The posteromedial approach involves coming in close contact with the superior thyroid vessels along the ligament of Berry and cricothyroid fascia.
\nDissection of thyroid upper pole, arrow, superior thyroid artery.
After complete dissection of the thyroid gland from the trachea, the specimen is wrapped in an endoplastic bag (LapBag; Sejong Medical, Seoul, Korea) and removed through the left axillary port (\nFigure 22\n). If the incision of the left axilla is insufficient to extract the specimen, the incision can be widened using a knife. Once the specimen is extracted, it is diagnosed by analyzing intraoperative frozen sections and used to determine the extent of the operation required.
\nSpecimen removal using endobag.
If the frozen section is confirmed as malignant, central LN dissection (therapeutic or prophylactic) should be performed (\nFigure 23\n). Care should be taken to avoid injury to the recurrent laryngeal nerve by central compartment dissection. The contralateral lobe is handled in the same way. As shown in the figure, the operator has a comfortable and symmetrical view of the surgical field using BABA.
\nCentral lymph node removal using thimble.
After the thyroidectomy is completed, the operative field is irrigated with warm saline. Hemostasis is performed carefully, and fibrin sealant (Tisseel®; Baxter Healthcare Corporation, Westlake Village, CA, USA) is then applied if necessary. The antiadhesive material is placed between the trachea and strap muscle and then between the skin and fascia. The midline between the two strap muscles is closed by a continuous running suture (\nFigure 24\n). Then, one or two Jackson-Pratt drains are inserted into the thyroid pockets through the opposite or bilateral axillary incisions; however, drainless BABA thyroidectomy was reported to be feasible [23]. It was also reported that a ropivacaine solution can be instilled into the skin flap before skin closure to reduce postoperative pain and the requirement for analgesia [24]. Finally, the skin of both breasts and the axilla are sutured by the knot-burying technique using an absorbable ligature.
\nMidline closure.
Central compartment dissection, arrow long; left recurrent laryngeal nerve, arrow short; left superior and inferior parathyroid glands.
After completion of thyroidectomy on the lesion side, ipsilateral neck LN dissection is performed. For therapeutic central LN dissection, it is particularly important to avoid RLN injury, preserve the PTG, and achieve complete resection of the suspected LN. In advance, it is useful to have a spacious field of vision to expose the central LNs and major structures. Kang et al. reported that blind spots are reduced using a deep-seated LN approach around the central compartment below the sternal notch via a VM that repositions the pivot point of the robot arm as high as possible [6]. In addition, Kim et al. reported that the addition of a snake retractor to the axillary trocar site enhances the central view and increases the number of resected LNs [23].
\nFor complete and safe central LN dissection, an understanding of the anatomical relationship among the thymus, lower PTG, and soft tissues containing the LNs is needed. The vertical inferior thyroid veins running along the thymus help to indicate the dissection plane. The central compartment LN is located deeper vertically than the plane of these veins and the thymus. The inferior PTG is located on the superficial plane, usually within or near the thymus. Thus, preserving the thymus helps reduce the risk of hypoparathyroidism (hypoPTH). Usually, the central LN is separated, with preservation of the thymus and the inferior PTG, and removed from the carotid artery in the medial direction. If a PTG is accidentally removed along with the resected tissue containing the central LN, autotransplantation into the pectoralis major is recommended. The RLN should be carefully monitored and preserved at this stage. Therefore, a nerve-monitoring device connected to a monopolar electrocautery is helpful for identifying the RLN.
\nThe procedures related to BABA robotic lateral neck dissection are essentially similar to those of the open method and have been reported previously [13]. First, this procedure requires a larger skin flap than that required for conventional thyroidectomy, with the boundaries being the inferior border of the submandibular glands cranially, the mandible angle superiorly, and the anterior edge of the trapezius muscle posteriorly. The fascia between the sternothyroid muscles and the SCM muscles is incised. After the medial and lateral borders of the SCM muscle are fully exposed, the SCM muscle is pulled upward using a #0 polydioxanone suture (Ethicon, San Angelo, TX, USA) and fixed. In the level IV dissection, the transverse cervical artery and phrenic nerve are identified, and the level II dissection is extended until the posterior belly of the digastric muscle preserves the spinal accessory nerve. The direction of the camera port can be changed such that the dissecting field of view is secured and pulled further cranially when necessary. It can also be helpful to rotate the camera port slightly clockwise or counterclockwise.
\n\n\nTable 2\n shows the technical safety parameters for BABA RoT. Below, we describe various surgical complications, including RLN paralysis and hypoPTH, the most important factors for thyroidectomy.
\n\n\nTable 2\n shows the incidences reported to date of transient and permanent RLN injury during BABA RoT [6, 8, 23, 25–28]. These studies were published in Korea. In most studies, transient RLN damage was defined as hoarseness or vocal fold paralysis of <6 months. The reported incidence of transient RLN injury in patients undergoing BABA RoT ranges from 1.4 to 14.2%, and most studies have reported an incidence of <7%. Particularly, permanent RLN injuries were observed in <1% of patients, which is an excellent result, comparable to that of conventional OT. \nTable 3\n shows the results of five studies that compared RoT with OT or ET; these studies reported no difference in incidence between transient and permanent RLN injuries [6, 25, 27, 29, 30]. Therefore, the technical safety of BABA RoT for RLN preservation has been demonstrated sufficiently. These results were also validated in several meta-analyses of studies that included BABA and TAA methods, with the exception of one study [31–35].
\nFirst author, year | \nNo. of samples (total cases) | \nVC palsy*\n | \nVC palsy¶\n | \nHypoPTH*,ǂ\n | \nHypoPTH¶,ǂ\n | \nBleeding | \nChyle leak | \n
---|---|---|---|---|---|---|---|
Kim, 2011 [25]ǂ\n | \n69 (69) | \n1.4% | \n0% | \n33.3% | \n1.4% | \n0% | \n1.4% | \n
Lee, 2013 [8] | \n1026 (872) | \n14.2%ǂ\n | \n0.2%ǂ\n | \n39.1% | \n1.5% | \n0.4% | \nNA | \n
Kim, 2014 [6] | \n123 (100) | \n4.9% | \n0% | \n29% | \n0% | \n0% | \nNA | \n
Lee, 2015 [26] | \n100 (88) | \n3.0% | \n0% | \n21.6% | \n0% | \n0% | \n0% | \n
Kim, 2015 [23] | \n300 (143) | \n2.6% | \n0% | \n23.1% | \n1.4% | \n0.3% | \n0.6% | \n
Cho, 2016 [27] | \n109 (99) | \n6.4% | \n0.9% | \n33.0% | \n1.8% | \n0.9% | \n0% | \n
Bae, 2016 [28] | \n118 (91) | \n3.3%ǂ\n | \n0%ǂ\n | \n35.2% | \n2.2% | \n0% | \nNA | \n
Technical safety of performing bilateral axillo-breast approach robotic thyroidectomy.
Transient.
Permanent.
For total thyroidectomy cases.
Note: No.: number; VC: vocal cord; hypoPTH: hypoparathyroidism; NA: not available.
First author, year | \nNo. of pts. (RoT vs. OT) | \nNo. of TT (RoT vs. OT) | \nEvaluation | \nTransient palsy (%) (RoT vs. OT) | \nPermanent palsy (%) (RoT vs. OT) | \n
---|---|---|---|---|---|
Kim, 2011 [25]ǂ\n | \n69 vs. 138 | \n69 vs. 138 | \nLaryngoscopy | \n1.4 vs. 0.7 (0.615) | \n0 vs. 0 (1.000) | \n
Kim, 2014 [6] | \n123 vs. 392 | \n100 vs. 364 | \nLaryngoscopy | \n4.9 vs. 6.1(0.607) | \n0 vs. 0.3 (1.000) | \n
Kwak, 2015 [29] | \n206 vs. 634 | \n157 vs. 544 | \nStroboscopy | \n0.5 vs. 0.9 (0.363) | \nNA | \n
Cho, 2016 [27] | \n109 vs. 109*\n | \n– | \nLaryngoscopy | \n6.4 vs. 5.5 (0.775) | \n0.9 vs. 0.9 (1.000) | \n
\n | \n\n | \n\n | \n\n | \n\n | \n\n | \n
Kim, 2011 [25]ǂ\n | \n69 vs. 95 | \n69 vs. 95 | \nLaryngoscopy | \n1.4 vs. 2.1 (0.757) | \n0 vs. 2.1 (0.623) | \n
Kim, 2016 [30] | \n289 vs. 289*\n | \n114 vs. 114 | \nMedical record ± laryngoscopy | \n4.5 vs. 3.8 (0.677) | \n0.7 vs. 0.3 (1.000) | \n
Comparison of recurrent laryngeal nerve palsy between bilateral axillo-breast approach robotic thyroidectomy (RoT) and open thyroidectomy (OT) or endoscopic thyroidectomy (ET).
After propensity score matching.
For total thyroidectomy cases.
Notes: No.: number; pts: patients; NA: not available; TT: total thyroidectomy.
\n\nTable 2\n shows the incidence of transient and permanent hypoPTH after BABA RoT [6, 8, 23, 25–28]. The definition of hypoPTH varies but is generally defined according to parathyroid hormone and calcium levels and hypocalcemic symptoms. In most studies, permanent hypoPTH was defined as the need for medication for at least 6 months. The incidence of transient hypoPTH in patients undergoing BABA RoT was 22–39%, and the incidence of permanent hypoPTH in patients undergoing the total thyroidectomy was <3%. This is an important indicator of the technical safety of BABA RoT, which is comparable to traditional OT. Furthermore, in five studies that compared RoT and OT (\nTable 4\n), the incidence of transient or permanent hypoPTH was similar between RoT and OT, suggesting that BABA RoT is a more appropriate method for total thyroidectomy [6, 25, 27, 29, 30].
\nFirst author, year | \nNo. of pts.(RoT vs. OT) | \nNo. of TT (RoT vs. OT) | \nDefinition of transient hypoPTH | \nTransient (%) (RoT vs. OT) | \nPermanent (%) (RoT vs. OT) | \n
---|---|---|---|---|---|
Kim, 2011 [25] | \n69 vs. 138 | \n69 vs. 138 | \nPTH normalized within 6 months | \n33.3 vs. 27.5 (0.484) | \n1.4 vs. 2.9 (0.873) | \n
Kim, 2014 [6] | \n123 vs. 392 | \n100 vs. 364 | \nSerum calcium <4.0 mEq/L | \n29.0 vs. 22.0 (0.161) | \n0 vs. 0 (0.000) | \n
Kwak, 2015ǂ [29] | \n206 vs. 634 | \n157 vs. 544 | \niCa <4.4 mg/dL or PTH < 8 pg/mL | \n14.6 vs. 15.0 (0.296) | \nNA | \n
Cho, 2016ǂ [27] | \n109 vs. 109*\n | \n– | \nPTH <13 pg/mL | \n33.0 vs. 26.6 (0.374) | \n1.8 vs. 1.8 (1.000) | \n
\n | \n\n | \n\n | \n\n | \n\n | \n\n | \n
Kim, 2011 [25] | \n69 vs. 95 | \n69 vs. 95 | \nPTH normalized within 6 mo | \n33.3 vs. 25.3 (0.340) | \n1.4 vs. 3.2 (0.851) | \n
Kim, 2016ǂ [30] | \n289 vs. 289*\n | \n114 vs. 114 | \nPTH <5 pg/mL | \n38.6 vs. 33.3 (0.408) | \n0.9 vs. 1.8 (1.000) | \n
Comparison of hypoparathyroidism between bilateral axillo-breast approach robotic thyroidectomy (BABA RoT) and open thyroidectomy (OT) or endoscopic thyroidectomy (ET).
After propensity score matching.
Including lobectomy cases.
Notes: No.: number; pts: patients; TT: total thyroidectomy; NA: not available; iCa: ionized calcium.
Among the other complications, bleeding and chyle leak are described in \nTable 2\n. Bleeding was reported in four out of seven studies with no cases and in the remaining three studies <1% [6, 8, 23, 25–28]. The incidence of chyle leak was low in the two studies that reported this complication (1.4 and 0.6%, respectively) [23, 25]. Postoperative bleeding and hematoma are potentially fatal complications of thyroidectomy, because reoperation may be necessary to resolve the airway compression caused by hematoma. Otherwise, unlike TAA, brachial plexus and tracheal injury have not been reported in BABA RoT [36].
\nThe clinical parameters used to assess oncological safety after thyroidectomy include the number of retrieved LNs in the neck, stimulated thyroglobulin (sTg) level, and radioactive iodine (RAI) uptake on whole-body scan (WBS). Both the sTg level and RAI uptake reflect the surgical completeness of thyroidectomy.
\nAs the main indication of BABA RoT, papillary thyroid carcinoma frequently exhibits loco-regional metastasis into the surrounding cervical LNs. Therefore, LN dissection is performed for therapeutic or prophylactic purposes in most institutions, and the number of resected LNs is an indicator of the oncological safety associated with RoT [37, 38]. In all previous studies except for Kim et al. [25], the number of central neck LNs retrieved by RoT was statistically lower than that by OT [6, 23, 27, 29]. Nevertheless, the total LN count was five to nine, which is considered to exceed the minimum level of adequacy for LN dissection in the central compartment (\nTable 5\n). Only one study has compared RoT with OT in terms of the number of LNs excised during BABA robotic lateral neck dissection for locally advanced cancer, but no significant difference was observed (RoT vs. OT; 12.8 vs. 12.7 LNs) [13]. However, the currently available data indicate that BABA RoT is not superior to OT in terms of the number of central LNs retrieved.
\nFirst author, year | \nNo. cases. (RoT vs. OT) | \nLN number (RoT vs. OT) | \nNo. RAI cases (RoT vs. OT) | \nsTg after 1st RAI ablation (RoT vs. OT) | \nProportion of cases with sTg <1.0 ng/mL (RoT vs. OT) | \n
---|---|---|---|---|---|
Kim, 2011 [25] | \n69 vs. 138 | \n4.7 vs. 4.8 (0.802) | \n– | \n0.8 vs. 0.8 (0.978) | \nNA | \n
Lee, 2011 [39] | \n174 vs. 237 | \nNA | \n174 vs. 237 | \n1.4 vs. 1.2 (0.998) | \n69.1% vs. 68.6% (0.924) | \n
Kim, 2014 [6] | \n123 vs. 392 | \n8.7 vs. 10.4 (0.006) | \n37 vs. 148 | \n1.4 vs. 1.2 (0.652) | \n75.7% vs. 76.4% (0.931) | \n
Kim, 2015 [23] | \n300 vs. 300 | \n6.7 vs. 8.9 (<0.001) | \n68 vs. 130 | \n0.8 vs. 1.8 (0.001) | \n86.6% vs. 67.6% (0.004) | \n
Kwak,2015 [29] | \n206 vs. 634 | \n5.9 vs. 8.4 (0.001) | \n– | \nNA | \nNA | \n
Cho, 2016 [27] | \n126 vs. 689 | \n3.6 vs. 5.1 (<0.001) | \n67 vs. 52 | \n0.25 vs. 0.2* (0.954) | \nNA | \n
Bae, 2016 [28] | \n118 (RoT) | \n\n | 67 | \n0.6*\n | \n\n |
\n | \n|||||
\n | \n\n | \n\n | \n\n | \n\n | \n|
Schlumberger, 2012 [40] | \n652 | \nConventional open | \n– | \n48.3% | \n|
Mallick, 2012 [41] | \n110 | \nConventional open | \n3.8*\n | \n21%ǂ\n | \n|
Lombardi, 2007 [42] | \n152 | \nMinimally invasive video-assisted | \n5.5 | \n21% | \n|
Choi, 2012 [43] | \n99 | \nEndoscopic BABA | \nNA | \n40.3% | \n|
Tae, 2014 [44] | \n62 vs. 183 | \nGasless unilateral axillo-breast | \n10.2 vs. 3.9 ( <0.001) | \nNA | \n|
Lee, 2014 [45] | \n43 vs. 51 | \nTransaxillary | \n4.9 vs. 4.2 (0.674) | \nNA | \n
Oncological safety: comparison of surgical completeness between bilateral axillo-breast approach robotic thyroidectomy (BABA RoT) and open thyroidectomy (OT).
Median.
sTg < 2.0 ng/mL.
Notes: NA: not available; RAI: radioactive iodine; No.: number; LN: lymph node; sTg: stimulated thyroglobulin.
The surgical completeness of resection in thyroid carcinoma is generally assessed by measurements of serum thyroglobulin levels after RAI ablation and RAI uptake on posttherapeutic WBS [46, 47]. sTg levels are measured prior to RAI ablation combined with elevated thyroid stimulating hormone (TSH) treatment, via either thyroid hormone withdrawal or recombinant human TSH injection. Increased sTg levels after total thyroidectomy suggest the presence of remnant thyroid tissue. Therefore, a low sTg level is a reliable surrogate marker for the amount of remnant thyroid tissue after total thyroidectomy. \nTable 5\n shows the results of studies that measured sTg levels after the first RAI ablation following RoT or OT. Five studies reported no statistically significant difference in sTg levels between RoT and OT [6, 23, 25, 27, 39] Compared with the sTg levels (mean, 4.9–10.2; median, 3.8) following OT, endoscopic surgery, or TAA [41, 42, 44, 45], the mean (0.8–1.4) and median sTg levels (0.2–0.6) following BABA RoT were remarkably lower [6, 23, 25, 27, 28, 39]. In addition, the proportion of patients with a sTg level <1.0 ng/mL was much higher: 65–87% after BABA RoT [6, 23, 39] compared with 21–48% after other approaches [40–43] (reported in previous studies). In two meta-analyses performed by Wang et al. and Son et al., there was no statistically significant difference between RoT and OT in terms of sTg levels [33, 35]. However, in another meta-analysis performed by Lang et al., sTg levels were significantly higher after robotic compared with open surgery, which was more pronounced after TAA compared with BABA RoT [48].
\nRemnant thyroid tissue can also be measured by RAI thyroid uptake on WBS. Lee et al. reported that RAI uptake on the initial WBS was similar in the BABA RoT and OT groups after propensity score matching (the two groups were matched using a total of eight factors, including three demographic and five pathological characteristics) to minimize selective bias [39]. This study is the first report to systematically analyze the surgical completeness of BABA RoT and OT. Statistical techniques were applied to improve comparison of the two groups; therefore, this was a meaningful attempt to overcome the limits of a retrospective study design.
\nSince RoT requires formation of a larger skin flap than that does OT, there is concern that the postoperative neck and chest pain will be greater after RoT. In a prospective study, Chai et al. reported no significant difference in the postoperative pain score for the throat, anterior neck, posterior neck, or back at 1, 2, 3, and 14 days postoperatively between the BABA RoT (
Author, year | \nStudy design | \nNumber subjects (patients vs. controls) | \nAnalgesic | \nParameters | \n
---|---|---|---|---|
Bae et al. 2015 [24] | \nPRCT | \n108 (54 vs. 54) | \nRopivacaine, postoperative | \nVAS score, analgesic requirements, and adverse events | \n
Ryu et al. 2015 [51] | \nPRCT | \n55 (28 vs. 27) | \nLevobupivacaine spray, postoperative | \nPain score, need for PCA, other adverse effects | \n
Kang et al. 2015 [14] | \nPRCT, double-blind | \n34 (17 vs. 17) | \nRopivacaine, preincision | \nVAS score, bottom hit counts from PCA, need for fentanyl, CRP levels, BP, and HR | \n
Postoperative pain management after BABA RoT.
Notes: PRCT, prospective randomized controlled trial; VAS, visual analog scale; PCA, patient-controlled anesthesia.
Postoperative voice quality after BABA RoT, independent of RLN injury, has been assessed in two studies. In 2015, Bae et al. assessed the VHI-10 score before surgery and 2 weeks, 3 months, and 6 months postoperatively [28]. After adjusting for the effect of time, they concluded that the mean Korean VHI-10 score during the postoperative 6 months increased initially but tended to decrease thereafter; there was no significant difference (
There is concern regarding potential changes in the sensation of skin flaps caused by the more extensive dissection with BABA techniques compared with OT. In a prospective study by Kim et al., 19 patients underwent skin flap sensory assessments preoperatively and at 1 and 3 months postoperatively [52]. After BABA thyroidectomy, anterior chest paresthesia was normalized completely by 3 months. These results suggest that BABA has minimal adverse effects on anterior chest sensation.
\nThe cosmetic outcome of the BABA technique involves practically no scarring, because this method transfers the anterior neck scar to four small hidden areas (the bilateral axilla and breasts), leaving the neck free of scars (\nFigure 26\n) [4]. Despite the early phase, we have already reported cosmetic satisfaction with endoscopic BABA according to a simple questionnaire [2]. Using an in-depth survey performed by a psychology consultant to evaluate neck scarring and psychological distress in patients who underwent BABA RoT, Koo et al. reported that the degree of scarring was significantly lower in the RoT group than the OT group (
Postoperative wound after 6 months.
The application of ET for Graves’ disease has been controversial. The major limitation is that it is not easy to control bleeding in cases of large hypervascular thyroid glands using nonflexible endoscopic instruments in a narrow two-dimensional field of view. Use of the surgical robot system has helped to overcome these limitations by introducing three-dimensional high-definition images and EndoWrist functions, which have resulted in more meticulous bleeding control. With recent technological advances and accumulation of experience, Kwon et al. reported successful results with comparable complication rates in 30 patients with Graves’ disease [7]. There were no major complications, such as bleeding, open conversion, or permanent RLN injury, except for one case of permanent hypoPTH. In a subsequent article, Kwon et al. compared the safety of BABA RoT with that of OT in patients with Graves’ disease (
Obesity is associated with various medical comorbidities that pose technical and clinical challenges, especially during surgery. For example, since a high BMI is a risk factor for various surgical complications, a retrospective study analyzed the influence of obesity on the surgical outcome of BABA RoT (
Globally, water scarcity is considered one of the prime issues in the upcoming decades. Almost 2.1 billion people are lacking access to clean and fresh water [1]. Figure 1 shows the water-stressed areas in the world. Middle East, Asia, South America, and some parts of Africa face water scarcity. Therefore, many studies have been investigated to supply enough water with cheaper, and portable methods [3, 4]. These methods include desalination, wastewater treatment, sewage recycling, and water harvesting from the atmosphere. The energy consumption in desalination systems is very high that is almost 50% of the cost, and make this technology inappropriate in most situations [5]. Also, seawater desalination is not suitable for remote areas and has many environmental problems. Thus, portable systems with less energy consumption are needed. Atmospheric water harvesting can be considered as a potential resource of fresh water in remote areas [6]. For this purpose, many researchers have introduced innovations for water production from humid air technology. This can be done by many ways i.e., using vapor compression cycle (VCC) [7, 8, 9, 10], thermoelectric cooling (TEC) [11, 12], absorption/adsorption refrigeration [13, 14], wind power with VCC [15], using solar chimneys [16, 17], using membranes [18, 19], and using adsorbent materials [20, 21, 22, 23, 24, 25, 26, 27]. Figure 2 summarized the various technologies investigated in the literature for producing water from the humid air. The purpose of all these technologies is to produce water and are using worldwide depending on the conditions and the requirements. Among all these technologies, desiccant based atmospheric water harvesting (AWH) shows a great potential to extract enough amount of drinkable water with less energy consumption [6]. The adsorption based AWH is possible in dry and desert regions with the lowest relative humidity. This technology utilizes renewable energy sources (solar, wind, and low-grade biomass) which ultimately lead towards the cheapest and most efficient systems. This chapter focuses on the fundamentals and principles of adsorption based AWH. The progress and perspectives and associated adsorption based AWH systems are also discussed in this study. Moreover, energy-efficient desiccant materials along with the recently developed new generation MOFs for AWH are also highlighted in this study. The main purpose of this chapter is to introduce the importance of AWH by employing various efficient desiccant materials.
World map showing the water-stressed areas by 2040 reproduced from [
Summary of various technologies for water production from humid air available in the literature [
Atmospheric water harvesting could be considered as a huge renewable source of water that can provide enough amount of water, but unfortunately is ignored [29]. Conventional water harvesting was started first when a Russian forester built a stone condenser during 1905 and 1912 and was considered as the early Greek dew condenser [30, 31]. Ziebold tested with this type of condenser and named as “the aerial wells”, but unfortunately, this project was failed and the expected amount of water was not produced due to the low thermal conductivity and low heat capacity [32]. In 1957, a review was carried out on the absorption of water by the plants [33]. Since then several studies have been carried out focusing on the fog and dew harvesting by the plants and animals [34].
Modern AWH shifted towards the innovations, methods, and technologies that can provide a significant amount of water in remote areas [35]. As mentioned earlier in the introduction section, various new methods have been proposed for AWH i.e., VCC, TEC, using membrane and adsorbent materials. Among these, the fog water was first collected with the help of nets in 1956 [36]. Shi et al. replaced these traditional meshes with vertically arranged wires to avoid the problems of clogging [37]. Dew water collection considered as the alternative approach because it is not majorly affected by climatic conditions and can provide water in most of the ambient environment [38]. A lot of advancements have been done in the designs of active condensers after the commercialization of mechanical refrigerators in the 1980s. The desiccant based dew water harvesting was taken into consideration in the Nineteenth century, in which the various desiccant materials capture the moisture from the atmosphere during the night, and then releases the moisture in vapor form during the day. This method has been proved the most energy-efficient and reliable technology because it employs solar energy and can provide water anywhere and anytime in the world.
Atmospheric air is a mixture of nitrogen, oxygen, and argon gas, and water vapors with varying contents. The relative humidity (Φ), absolute humidity (ω), and the dew point temperature (Td) are considered as the most essential parameters of the air which can be used as the source of water. The relative humidity (Φ) represents the ratio of the partial pressure of water vapor (Pw) to the saturation pressure (Ps), while the absolute humidity (ω) represents the maximum amount of water that can be extracted from the air. The relative humidity can be expressed using (Eq. (1)) found in the literature [39, 40].
where, Φ represents the relative humidity, Pw denotes the partial pressure of water vapor, and Ps represents the saturation pressure. The relation between relative humidity, absolute humidity, temperature, and total air pressure can be described using (Eq. (2)) found in the literature [40].
The dew point temperature (Td) can be determined from (Eq. (2)) by solving for T at Φ = 1 for given air pressure and absolute humidity. The water vapor saturation pressure (Ps) at any temperature (T) can be described using (Eq. (3)), while the total air pressure (P) can be described using (Eq. (4)) found in the literature [40].
Total air pressure (P) is the sum of the partial pressure of dry air (Pa) and the vapor pressure of water in the air (Pw). The moist air enthalpy can be described using (Eqs. (5)–(7)) given in the literature [40].
where Ha term represents the enthalpy of dry air, Hwv term represents the enthalpy of the presence of water vapor, and Cp,a denotes the heat capacity of air (kJ kg−1 C).
Adsorption based AWH is unique in its way that it utilizes the desiccant materials to capture water vapors from the air and shows higher thermal efficiencies as compared to the traditional AWH systems. The main advantage is that the desiccant materials can be regenerated by solar thermal energy and the condensation process can occur at ambient conditions [41, 42]. Figure 3 shows the adsorption based AWH process which consists of two stages. In the first stage, the desiccant material in contact with the ambient air at night which adsorbs the water vapors. In the second stage, the desiccant material is packed into a closed system where a significant amount of heat is provided to regenerate the desiccant material. Due to the regeneration process, the material desorbs the water vapors, and the collected vapors will be condensed into liquid form. With this approach, the AWH can be possible in low relative humidity areas. A lot of advancement has been done in the material designs, and system developments. Figure 4 shows the dual-stage AWH device mechanism and prototype introduced in the literature [44]. A novelty in this device was that two adsorbent layers were used to improve the water production per day. The latent of condensation from the upper stage was used for the desorption purpose of the bottom stage. With this approach, the thermal efficiency can be improved, and this system can become more suitable for daily purposes. AQSOA Z01, zeolite material was experimentally tested and showed that a prototype can harvest up to 0.77 L/m2/day with an 18% increase as compared to the single-stage AWH device [44]. The results found that a temperature of 90°C on the solar absorber area can give a maximum water production for AQSOA Z01.
Adsorption-based AWH process consists of two stages. (a) Adsorption stage (water vapors from the ambient air adsorbed in the adsorbent). (b) Desorption stage (water vapors desorbed from the adsorbent and condensed into liquid form) [
Illustration of dual stage adsorption based AWH device. (a) Mechanism of dual stage adsorption based AWH in which adsorption process occurs during night when ambient air in contact with the adsorbent layer, while the desorption process occurs during day when device is closed, and heat is supplied to regenerate the adsorbent layer. (b) Dual stage AWH prototype consists of convection cover, solar absorber, adsorbent layer, and condenser [
Adsorption based AWH is a vital technology that can provide cost-effective water in arid areas. The vapor concentration in this technology can be achieved through desiccant materials which ad/absorb and desorb the water vapors from the air [45]. In this context, efficient desiccant materials are a key research priority and various materials have been developed. First, it was believed that the solid desiccant AWH systems can extract enough amount of water but requires a large amount of material which makes these systems very expensive [46]. Also, the operating costs of air blowers to circulate the air for both adsorption and desorption purposes make this system less attractive. However, the development of next-generation MOFs, nano-porous organic materials, and various composite desiccant materials shows great potential for AWH systems. Figure 5 shows the recent progress in adsorption based AWH systems. Ideal desiccant material should possess the required properties of stability, hydrophilicity, and pore diameter. Adsorption capacities and densities are of great importance in any practical application [51, 52]. The desiccant materials with type IV and type V isotherms are most suitable for this application [43]. During the adsorption process, the materials adsorption capacity should linearly increase with relative humidity, while in the desorption process, the materials desorption capacity should drop steeply with the increased temperature. In this regard, progress has been made and Kallenberger et al. developed a composite material by incorporating the calcium chloride into an alginate-derived matrix [53]. The water uptake capacity of this material was almost linear with relative humidity and when adsorption temperature increases to 65°C, the water uptake capacity drops which shows that the desiccant material can be regenerated at low temperatures. Also, recently developed MOFs show this type of flexibility to harvest enough amount of water at the lowest relative humidity conditions [27, 54]. After the desorption process, the inlet air of the condenser is the outlet air of the desorber. It is worth noting that both the desorption and condensation temperature should be carefully chosen to balance the specific water production per day per unit collector area (SWP), and the specific energy consumption per unit mass water production (SEC). In this regard, Tu et al. developed a powerful tool to determine the proper desorption and condensation temperature [46]. Figure 6 shows the optimal condensing temperature on the psychrometric chart in which the inlet air of the condenser is denoted by I (Ti, di), and the condensation states of the humid air are denoted by the stars on the saturated line. The tangent of the angle (θ) and SEC can be described using (Eqs. (8) and (9)) given in the literature [46].
Adsorption based AWH systems published in the literature. (a) Solar glass desiccant box type system [
The optimal condensing temperature on the psychrometric chart developed in the literature [
It is noted that when the line through the point I (Ti, di) is tangent to the saturated line, then the angle (θ) is at the smallest value, and therefore the condensing temperature at given inlet conditions for a minimum value of SEC can be obtained at the tangent point. An appropriate heat source and airflow rate can be chosen to find the optimum outlet air conditions of the desorber by using this tool.
Energy efficient materials must have high capacity of adsorbing and desorbing water from the air [55]. Heidari et al. investigated a novel desiccant based evaporative cooling system for production of water [56]. The results showed that the silica gel-based system can harvest up to 585 L of water during a week. Milani et al. investigated a small scale air cooled silica gel based wheel dehumidifier for extraction of water from the atmosphere [57]. It was found that the system can generate more than 5.2 L of water per day in the ambient conditions of Sydney. A simulation model on TRNSYS was also built and found that the system can generate a cumulative of 18.5kL of water in the ambient conditions of Abu Dhabi, 10kL of water in London, and 13.8kL for the ambient conditions of Sydney. Similarly, various desiccant materials based on the hygroscopic salts were also investigated to produce water from humid air. Table 1 shows the silica gel and hygroscopic salts-based materials used in atmospheric water harvesting systems. Hamed et al. investigated a system based on sandy bed impregnated with calcium chloride for atmospheric water harvesting [59]. The system was exposed to ambient air to absorbs the water vapors in the night and the desiccant material was covered with the glass layer where regeneration process will occur, and water vapors condensed into liquid form. It was found that the system can provide 1 L per m2 of water per day. Wang et al. investigated a semi open system with a novel composite sorbent of LiCl with active carbon felt (ACF) for water production from humid air [61]. The system was tested at different experimental conditions and found that 14.7 kg, 13.6 kg, and 12.5 kg of water was obtained at conditions of 85%, 75%, and 65% relative humidity, respectively.
Adsorbent | Material | Quantity | Water harvesting capacity | Reference |
---|---|---|---|---|
Silica gel | Desiccant wheel | 585 L during a week | [56] | |
Hygroscopic salts | CaCl2/cloth | 1.5 L/m2 day | [58] | |
CaCl2/cloth sand | 1 kg | 2.32 L/m2 day | [26] | |
CaCl2/sand | 1 kg | 1 L/m2 day | [59] | |
LiCl/sand | 90 mL/day, 115 mL/day | [24] | ||
CaCl2/saw wood/vermiculite | 40–140 mL/kg/day | [60] | ||
LiCl/active carbon felt | 40.8 kg | 14.7 L | [22] |
Summary of various silica gel and hygroscopic salts based desiccant materials for atmospheric water harvesting found in the literature.
Zeolites are the family of porous crystalline and hydrated aluminosilicates that are widely used as the adsorbents in many applications. These materials can extract water from air at low relative pressures due to their affinity with water [62]. As zeolite materials have a framework structure, a high temperature is required to regenerate and desorb the water vapors. Table 2 shows the summary of some potential zeolite materials with efficient adsorption capacities. Furukawa et al. studied the zeolite 13X and found that it can harvest water up to 0.40 g/g at low relative pressures [63]. The adsorption properties of Li-X zeolite and Na-X were investigated and found that these materials can be employed to extract water from air [64]. The results found that Li-X and Na-X can extract up to 0.244 g/g and 0.192 g/g respectively. The kind of ion in this type of zeolites not only influences the amount of adsorbed water but also the energy densities and heat of adsorption. Despite the high performance, the energy requirements for desorption purpose restricts the zeolite materials to be used in AWH systems [52].
Adsorbent | Material | Water harvesting capacity | Reference |
---|---|---|---|
Zeolite | Zeolite 13X | 0.40 g water/g zeolite | [63] |
Li-X-Zeolite | 0.244 g water/g zeolite | [64] | |
Na-X | 0.192 g water/g zeolite | [64] | |
AQSOA type zeolites | 0.1–0.3 kg water/kg zeolite | [65] |
Zeolite based desiccant materials for atmospheric water harvesting found in the literature.
MOFs have been researched for their water capture properties and they were found to be highly promising and energy efficient materials. Several members of the MOF family showed unprecedented water uptake property [63]. Specifically, zirconium MOFs made from Zr6O4(OH)4(-CO2)n secondary building units and carboxylate organic linkers showed very interesting properties in water adsorption [66]. MOF-841 was investigated and showed the maximum water uptake and maintained its structure over 80 adsorption–desorption cycles [63]. A similar trend was observed in other zirconium MOF named as MOF-801 which showed a water uptake at 10% relative humidity. Motivated by these results, MOF-801 based device was built and tested in Arizona, desert [49]. The device was consisted of two boxes, the inner box was open and holds the MOF material while, the outer box has a lid. The outer lid was open at night to allow the MOF-801 to in contact with ambient air and hold the water molecules in its pores and then the lid was closed in day and device was exposed to sunlight to regenerate the MOF material. This device was delivered 200–300 mL of water/kg of MOF/day at 20-40oC temperature and 5–40% relative humidity. This device showed remarkable results and proved as a first device in the history to extract water from the desert air. Table 3 shows the water harvesting capacities of potential MOFs. It can be seen that Co2Cl2BTDD material delivered 0.82 g of water/g of MOF under 5–30% relative humidity conditions [68]. It was found that the pore diameter of this material was above the critical diameter for water capillary action which enabled water uptake at the limit of reversibility. Figure 7 shows the framework structures of some potential MOFs used in AWH systems. The key in all MOFs is the framework structure which allow to trap water from low relative humidity conditions. The water harvesting through MOFs was moved to next level after the development of MOF-303 based device which showed extraordinary results at low relative humidity conditions and also exhibit adsorption and desorption cycles each on the scale of minutes [54]. This device was first tested in a laboratory and later in Mojave Desert at conditions of 10% relative humidity and 27°C and it delivered 0.7–1.0 L of water/kg of MOF/day [54]. It is clear from the discussion that MOFs can be considered as the potential and energy efficient materials for AWH. With these MOFs based AWH systems, not only clean water can be harvested in any climate but also to make this concept more mobile and dispensed [66].
Adsorbent | Material | Relative humidity (%) | Water harvesting capacity | Reference |
---|---|---|---|---|
Metal–Organic Framework | MOF-801 | 20 | 2.8 L | [27] |
MOF-303 | 0.175 L/kg | [67] | ||
MOF-841 | 5–35 | 44 wt% | [63] | |
Co2Cl2BTDD | 5–30 | 0.82 g/g | [68] | |
UiO-66 | 40 | 0.052 g/g | [69] | |
Banasorb-22 | 0.08 g/g | [70] | ||
Cr-soc-MOF-1 | 70 | 1.95 g/g | [71] | |
HSO3-UiO-66 | 0.038 g/g | [69] | ||
IRMOF-1 | 0.11 g/g | [70] |
Metal–organic framework based desiccant materials for atmospheric water harvesting found in the literature.
Illustration of MOFs structures used in AWH systems.
Other adsorbent materials for AWH that have been interested and investigated in the last decade are nano porous super gels and super hygroscopic gels [72, 73, 74]. The main factors of these type of materials include the effective capturing of water molecules, high efficiency storage, and fast water desorption abilities under different climatic conditions [28]. Figure 8 shows the nano-porous super hygroscopic hydrogel employed to harvest water from highly humid atmosphere zones [73]. This hydrogel was made up of Zn and O atoms in a unique ratio of 1:1.1. It was found that this synthesized hydrogel has a high-water uptake of over 420% of its own weight. A steep increase in water absorption at high relative humidity of over 80% was shown by the hydrogel which makes it suitable for extraction of water from the humid air. The hydrogel showed the excellent stability for more than 1000 absorption/desorption cycles. It was concluded from the calculations that the absorption cycles of 15 min and desorption of 5 min could give the maximum fresh water of over 14 L/kg of hydrogel/day. Similarly Figure 9 shows the illustration of super moisture-absorbent gel water harvesting process [72]. The super absorbent gel consists of poly-NIPAM framework which ultimately expands the internal area of the gel and serves as a pathway for water during desorption process. It was found that this super absorbent gel in saturated condition can directly release 50% of the absorbed water within 15–20 min once it is slightly heated to 40oC (denoted the “express mode”). After this phase, the water can be collected via condensation process (denoted the “normal mode”). The super moisture absorbent gel showed two water releasing modes and both can be powered by solar radiation. The super gel-based prototype was also investigated, and it was found that it can produced about 20 and 55 L of water in 60% and 90% relative humidity, respectively. These hydrogels-based systems can be considered as the low energy consumption and cost-effective.
Nano-porous super hygroscopic hydrogel-based AWH. (a) The hydrogel is made up of Zn:O ratio 1:1.1 (blue balls for zinc atoms, yellows balls for oxygen atoms). (b) SEM image of the hydrogel showing porous network. (c-d) The prototype developed for the absorption characteristics of the hydrogel by floating on the sea surface. (e) Schematic of the AWH system based on super hygroscopic hydrogel reproduced from [
Super moisture-absorbent gel-based AWH. (a) Illustration of the AWH process (moisture captured by the SMAG and releases water under room temperature). (b) Schematic showing the moisture absorption enabled by the SMAGs. (c) Schematic showing the express and normal modes for water harvesting reproduced from [
The supply of freshwater to a rapidly growing world population is a great societal challenge. In this regard, several technologies have been developed and currently in use worldwide, but the advancements of additional methods for freshwater generation is very crucial to effectively address the global water scarcity. For this purpose, this chapter highlights the importance of adsorption based AWH which utilizes the desiccant materials to capture water vapors from the atmosphere and condenses into liquid form. The important water vapor parameters in ambient air are discussed in this study. The fundamental principles of adsorption based AWH are reviewed, moreover, the progress and perspectives in this technology also explained from the viewpoints of newly developed desiccant materials and the modified AWH systems designs. The study explores the energy efficient desiccant materials which are already employed in AWH systems. From the literature, it was found that the recently developed MOFs are promising due to their flexible nature and tailorable architectures and can harvest water from the atmospheric air at low relative humidity conditions. Some newly developed hygroscopic gels are also showing great potential to utilized in AWH systems. It was found that the temporal and spatial restrictions for AWH and as well as the energy requirements can also be reduced if the appropriate adsorbents are selected. The adsorption based AWH systems ensures no bulky equipment, more environment-friendly and cost effective. Thus, this study presents a comprehensive knowledge on AWH through adsorbent materials.
This work is carried out in the Department of Agricultural Engineering, Bahauddin Zakariya University, Multan-Pakistan. The work is financially supported by the Director Research/ORIC grants of Bahauddin Zakariya University (Multan), awarded to Principal Investigator Dr. Muhammad Sultan.
The authors declare no conflict of interest.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. He has contributed in stochastic estimation of control area especially, in the Multiple Target Tracking and Interactive Multiple Model (IMM) research, Ball & Beam Control Problem, Robotics, Levitation Control. He has contributed in developing Algorithms for Fingerprint Matching, Computer Vision and Face Recognition. He has been supervising Pattern Recognition, Formal Languages and Distributed Processing projects for several years. He has reviewed many books on Management, Computer Science. Currently, he is an active and permanent reviewer for many international conferences and symposia and the program committee member for many international conferences.\nIn teaching he has taught the core computer science subjects like, Digital Design, Real Time Embedded System Programming, Operating Systems, Software Engineering, Data Structures, Databases, Compiler Construction. 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Networks of field sensors have emerging applications in environmental monitoring, in disaster monitoring, security, and agriculture. Batteries limit potential applications due to their low specific energy. A promising alternative is photovoltaics. Photovoltaics require large, bulky panels and are impacted by daily and seasonal variation in solar insolation that requires coupling to a backup power source. Polymer electrolyte membrane (PEM) fuel cells are a promising alternative, because they are clean, quiet, and operate at high efficiencies. However, challenges remain in achieving long lives due to catalyst degradation and hydrogen storage. In this chapter, we present a design framework for high-energy fuel cell power supplies applied to field sensor networks. The aim is to achieve long operational lives by controlling degradation and utilizing high-energy density fuels such as lithium hydride to produce hydrogen. Lithium hydride in combination with fuel-cell wastewater or ambient humidity can achieve fuel specific energy of 5000 Wh/kg. The results of the study show that the PEM hybrid system fueled using lithium hydride offers a three- to fivefold reduction in mass compared to state-of-the-art batteries.",book:{id:"6285",slug:"proton-exchange-membrane-fuel-cell",title:"Proton Exchange Membrane Fuel Cell",fullTitle:"Proton Exchange Membrane Fuel Cell"},signatures:"Jekan Thangavelautham",authors:[{id:"210571",title:"Prof.",name:"Jekan",middleName:null,surname:"Thangavelautham",slug:"jekan-thangavelautham",fullName:"Jekan Thangavelautham"}]},{id:"57938",doi:"10.5772/intechopen.71635",title:"Fundamentals of Electrochemistry with Application to Direct Alcohol Fuel Cell Modeling",slug:"fundamentals-of-electrochemistry-with-application-to-direct-alcohol-fuel-cell-modeling",totalDownloads:1358,totalCrossrefCites:1,totalDimensionsCites:6,abstract:"Fuel cell modeling is an inherently multiphysics problem. As a result, scientists and engineers trained in different areas are required to work together in this field to address the complex physicochemical phenomena involved in the design and optimization of fuel cell systems. This multidisciplinary approach forces researchers to become accustomed to new concepts. Electrochemical processes, for example, constitute the heart of a fuel cell. Accurate modeling of electrochemical reactions is therefore essential to successfully predict the performance of these devices. However, becoming familiar with the complex concepts of electrochemistry can be an arduous task for those who approach the study of fuel cells from fields other than chemical engineering. This process can extend over time and requires careful reading of many textbooks and papers, the most illuminating ones being hidden to the newcomer in a plethora of recent publications on the subject. The authors, who engaged in the study of fuel cells coming from the field of mechanical engineering, had to travel this road once and, with this contribution, would like to make the journey easier for those who come behind. As an illustrative example, the thermodynamic and electrochemical principles reviewed in this chapter are applied to a complex electrochemical system, the direct ethanol fuel cell (DEFC), reviewing recent work on this problem and suggesting future research directions.",book:{id:"6285",slug:"proton-exchange-membrane-fuel-cell",title:"Proton Exchange Membrane Fuel Cell",fullTitle:"Proton Exchange Membrane Fuel Cell"},signatures:"Juan Sánchez-Monreal, Marcos Vera and Pablo A. García-Salaberri",authors:[{id:"176049",title:"Dr.",name:"Marcos",middleName:null,surname:"Vera",slug:"marcos-vera",fullName:"Marcos Vera"},{id:"213212",title:"Dr.",name:"Juan",middleName:null,surname:"Sánchez-Monreal",slug:"juan-sanchez-monreal",fullName:"Juan Sánchez-Monreal"},{id:"213213",title:"Dr.",name:"Pablo A.",middleName:null,surname:"García-Salaberri",slug:"pablo-a.-garcia-salaberri",fullName:"Pablo A. García-Salaberri"}]},{id:"59885",doi:"10.5772/intechopen.74780",title:"Transformation of Conventional Houses to Smart Homes by Adopting Demand Response Program in Smart Grid",slug:"transformation-of-conventional-houses-to-smart-homes-by-adopting-demand-response-program-in-smart-gr",totalDownloads:1039,totalCrossrefCites:1,totalDimensionsCites:6,abstract:"In an ever-growing state of electricity demand due to population growth as well as modernization of societies, it has compelled us to look for many options to cope with the situations. However, for a balanced electrical power demand and supply, it is necessary to respond requirement at any time without any interruption with the strategy of demand response programs (DRP) to the users. In order to promote smart usage of electrical power, smart grid networks are gradually transforming conventional grids in many places. As a part of smart grid, conventional houses may be transformed to smart house by simply implementing some intelligent controller with interfaces like smart plugs to the conventional electrical appliances. This chapter elaborates a new strategy of home energy management system (HEMS) in a smart grid environment to transform any ordinary premises to smart house to be energy efficient by simply rescheduling operation time.",book:{id:"6698",slug:"smart-microgrids",title:"Smart Microgrids",fullTitle:"Smart Microgrids"},signatures:"Mohammad Shakeri and Nowshad Amin",authors:[{id:"192623",title:"Dr.",name:"Nowshad",middleName:null,surname:"Amin",slug:"nowshad-amin",fullName:"Nowshad Amin"},{id:"237347",title:"Dr.",name:"Mohammad",middleName:null,surname:"Shakeri",slug:"mohammad-shakeri",fullName:"Mohammad Shakeri"}]},{id:"57505",doi:"10.5772/intechopen.71470",title:"Robotic Technologies for Proton Exchange Membrane Fuel Cell Assembly",slug:"robotic-technologies-for-proton-exchange-membrane-fuel-cell-assembly",totalDownloads:1367,totalCrossrefCites:2,totalDimensionsCites:3,abstract:"Proton exchange membrane fuel cell (PEMFC) stacks and their components are currently being manufactured using laboratory fabrication methods. While in recent years these methods have been scaled up in size, they do not incorporate high-volume manufacturing methods. In this context, manufacturing R&D is necessary to prepare advanced manufacturing and assembly technologies that are required for low-cost, high-volume fuel cell power plant production. U.S. Department of Energy (DOE) has identified high-priority manufacturing R&D needs for PEMFCs. Along with efforts to develop technologies for high-speed manufacturing of fuel cell components, DOE identified the need for demonstrating automated assembly processes for fuel cell stacks. The scope of this chapter is to review current manufacturing R&D efforts in the area of automated processes for assembling PEMFC stacks, to present the current state of development, successful demonstrations, related technological challenges and the technical solutions used to overcome them. An emphasis of this review is on the design of tools used for robotic grasping, handling and inserting fuel cell components in the stack and on the use of design for manufacture and assembly (DFMA) strategies that enable the automated assembly process.",book:{id:"6285",slug:"proton-exchange-membrane-fuel-cell",title:"Proton Exchange Membrane Fuel Cell",fullTitle:"Proton Exchange Membrane Fuel Cell"},signatures:"Vladimir Gurau, Devin Fowler and Daniel Cox",authors:[{id:"219399",title:"Dr.",name:"Vladimir",middleName:null,surname:"Gurau",slug:"vladimir-gurau",fullName:"Vladimir Gurau"},{id:"220252",title:"MSc.",name:"Devin",middleName:null,surname:"Fowler",slug:"devin-fowler",fullName:"Devin Fowler"},{id:"222195",title:"Prof.",name:"Daniel",middleName:null,surname:"Cox",slug:"daniel-cox",fullName:"Daniel Cox"}]}],mostDownloadedChaptersLast30Days:[{id:"57392",title:"Advanced Supporting Materials for Polymer Electrolyte Membrane Fuel Cells",slug:"advanced-supporting-materials-for-polymer-electrolyte-membrane-fuel-cells",totalDownloads:1654,totalCrossrefCites:0,totalDimensionsCites:2,abstract:"Among the various kinds of fuel cell, polymer electrolyte membrane fuel cell (PEMFC) is the most prominent energy conversion device for portable applications. The catalyst-supporting materials provide active triple phase boundary for electrochemical reactions where the reactant molecules can easily interact with the catalyst surface. Catalysts play a vital role for improving the overall efficiency of the fuel cells through the advancement in the catalyst and their supporting materials for cathodic oxygen reduction reaction (ORR) in PEMFCs. The supporting materials mainly contribute to increase the electrocatalytic activity of the catalysts by providing more active surface area and extended life-time. The major roles of supporting materials are (i) they act as electron source with improved conductivity; (ii) they hold the metal nanoparticles; (iii) they possess higher surface area and (iv) they should have better stability under operating conditions. In this chapter, the various supporting materials were reviewed carefully based on their nature and performance toward the electrochemical reduction of oxygen for PEMFCs. They are classified into three major categories as (i) carbon supports; (ii) carbon-free supports, and (iii) polymer nanocomposites. In summary, the overall view on support materials and their role on electrocatalysis for fuel cell reactions is provided.",book:{id:"6285",slug:"proton-exchange-membrane-fuel-cell",title:"Proton Exchange Membrane Fuel Cell",fullTitle:"Proton Exchange Membrane Fuel Cell"},signatures:"Narayanamoorthy Bhuvanendran",authors:[{id:"210500",title:"Dr.",name:"Narayanamoorthy",middleName:null,surname:"Bhuvanendran",slug:"narayanamoorthy-bhuvanendran",fullName:"Narayanamoorthy Bhuvanendran"}]},{id:"66339",title:"Cathode for Thin-Film Lithium-Ion Batteries",slug:"cathode-for-thin-film-lithium-ion-batteries",totalDownloads:806,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Thin-film lithium-ion batteries (LIBs) have attracted considerable attention for energy storage device application owing to their high specific energy compared to conventional LIBs. However, the significant breakthroughs of electrochemical performance for electrode materials, electrolyte, and electrode/electrolyte interface are still highly desirable. This chapter firstly gives an overview of cathode materials including lithium-containing cathode (e.g., LiCoO2, LiMn2O4, LiFePO4, LiNi1−x−yMnxCoyO2, LiNi0.5Mn1.5O4) and lithium-free cathode (e.g., vanadium oxides) for LIBs in terms of specific capacity, energy density, working voltage, cycling life, and safety. In the meanwhile, the existing drawbacks and limitations of various battery chemistries are also analyzed. Furthermore, some modification strategies for these cathode materials have also been discussed for improving electrochemical performance. Finally, the thin-film Li-ion battery applications of these cathode materials are summed up toward next-generation flexible and high-energy devices.",book:{id:"6837",slug:"lithium-ion-batteries-thin-film-for-energy-materials-and-devices",title:"Lithium-ion Batteries",fullTitle:"Lithium-ion Batteries - Thin Film for Energy Materials and Devices"},signatures:"Yuan-Li Ding",authors:[{id:"269473",title:"Prof.",name:"Yuanli",middleName:null,surname:"Ding",slug:"yuanli-ding",fullName:"Yuanli Ding"}]},{id:"57548",title:"Introductory Chapter: An Overview of PEM Fuel Cell Technology",slug:"introductory-chapter-an-overview-of-pem-fuel-cell-technology",totalDownloads:1855,totalCrossrefCites:0,totalDimensionsCites:0,abstract:null,book:{id:"6285",slug:"proton-exchange-membrane-fuel-cell",title:"Proton Exchange Membrane Fuel Cell",fullTitle:"Proton Exchange Membrane Fuel Cell"},signatures:"Tolga Taner",authors:[{id:"197240",title:"Associate Prof.",name:"Tolga",middleName:null,surname:"Taner",slug:"tolga-taner",fullName:"Tolga Taner"}]},{id:"60763",title:"Assessment of Reliability of Composite Power System Including Smart Grids",slug:"assessment-of-reliability-of-composite-power-system-including-smart-grids",totalDownloads:1380,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"The large service interruptions of power supply in the transmission system have significant impact on modern society. The aim of the power system engineers is to prevent and mitigate such events with optimal decisions in design, planning, operation and maintenance. Due to the rapid growth in the power demand and competitive power market scenario, the transmission and distribution systems are frequently being operated under heavily loaded conditions. This tends to make failure of components more frequent in the power system necessitating large downtime to repair or replace the equipment. A majority of the service interruptions are happening due to lack of proper planning and operation of power system. Therefore, complete reliability assessment in generation, transmission and distribution systems is needed at the planning stage. The reliability assessment in smart grids is very much beneficial to the power operator and reduces the risk of grid failure due to failure of major components in power systems. This chapter is confined to composite power system reliability assessment. The composite power system combines both the generation and transmission systems’ adequacy. The generation system in the composite power system includes both conventional and renewable sources. The composite power system reliability assessment is quite difficult due to the large number of equipment, interconnected network topology and uncertainties in generation capacity. The reliability assessment concentrates mainly on the use of probabilistic states of components in generation and transmission systems to evaluate the overall reliability. This analysis will result in a cost-effective system configuration to provide continuous power supply to the consumers at reasonable cost. The reliability level of the system is measured by the defined indices. One of these indices is the probability of average power availability at load bus. This reliability assessment mainly focuses on development of methods to evaluate the probability of average power availability at load buses for a specified system configuration. This chapter discusses the two main techniques called node elimination method and modified minimal cut set method.",book:{id:"6698",slug:"smart-microgrids",title:"Smart Microgrids",fullTitle:"Smart Microgrids"},signatures:"Thotakura Bharath Kumar, M. Ramamoorty and O. Chandra Sekhar",authors:[{id:"236816",title:"Dr.",name:"Bharath Kumar",middleName:null,surname:"T",slug:"bharath-kumar-t",fullName:"Bharath Kumar T"},{id:"237692",title:"Dr.",name:"Ramamoorty",middleName:null,surname:"M",slug:"ramamoorty-m",fullName:"Ramamoorty M"},{id:"244043",title:"Dr.",name:"Chandra Sekhar",middleName:null,surname:"O",slug:"chandra-sekhar-o",fullName:"Chandra Sekhar O"}]},{id:"58665",title:"Degradation in PEM Fuel Cells and Mitigation Strategies Using System Design and Control",slug:"degradation-in-pem-fuel-cells-and-mitigation-strategies-using-system-design-and-control",totalDownloads:1604,totalCrossrefCites:3,totalDimensionsCites:7,abstract:"The rapid miniaturization of electronics, sensors, and actuators has reduced the cost of field sensor networks and enabled more functionality in ever smaller packages. Networks of field sensors have emerging applications in environmental monitoring, in disaster monitoring, security, and agriculture. Batteries limit potential applications due to their low specific energy. A promising alternative is photovoltaics. Photovoltaics require large, bulky panels and are impacted by daily and seasonal variation in solar insolation that requires coupling to a backup power source. Polymer electrolyte membrane (PEM) fuel cells are a promising alternative, because they are clean, quiet, and operate at high efficiencies. However, challenges remain in achieving long lives due to catalyst degradation and hydrogen storage. In this chapter, we present a design framework for high-energy fuel cell power supplies applied to field sensor networks. The aim is to achieve long operational lives by controlling degradation and utilizing high-energy density fuels such as lithium hydride to produce hydrogen. Lithium hydride in combination with fuel-cell wastewater or ambient humidity can achieve fuel specific energy of 5000 Wh/kg. The results of the study show that the PEM hybrid system fueled using lithium hydride offers a three- to fivefold reduction in mass compared to state-of-the-art batteries.",book:{id:"6285",slug:"proton-exchange-membrane-fuel-cell",title:"Proton Exchange Membrane Fuel Cell",fullTitle:"Proton Exchange Membrane Fuel Cell"},signatures:"Jekan Thangavelautham",authors:[{id:"210571",title:"Prof.",name:"Jekan",middleName:null,surname:"Thangavelautham",slug:"jekan-thangavelautham",fullName:"Jekan Thangavelautham"}]}],onlineFirstChaptersFilter:{topicId:"765",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:89,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:103,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:31,numberOfPublishedChapters:314,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:141,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!0},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:112,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:16,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:4,numberOfOpenTopics:1,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!0},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:14,numberOfOpenTopics:5,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"11",title:"Biochemistry",doi:"10.5772/intechopen.72877",issn:"2632-0983",scope:"Biochemistry, the study of chemical transformations occurring within living organisms, impacts all areas of life sciences, from molecular crystallography and genetics to ecology, medicine, and population biology. Biochemistry examines macromolecules - proteins, nucleic acids, carbohydrates, and lipids – and their building blocks, structures, functions, and interactions. Much of biochemistry is devoted to enzymes, proteins that catalyze chemical reactions, enzyme structures, mechanisms of action and their roles within cells. Biochemistry also studies small signaling molecules, coenzymes, inhibitors, vitamins, and hormones, which play roles in life processes. Biochemical experimentation, besides coopting classical chemistry methods, e.g., chromatography, adopted new techniques, e.g., X-ray diffraction, electron microscopy, NMR, radioisotopes, and developed sophisticated microbial genetic tools, e.g., auxotroph mutants and their revertants, fermentation, etc. More recently, biochemistry embraced the ‘big data’ omics systems. Initial biochemical studies have been exclusively analytic: dissecting, purifying, and examining individual components of a biological system; in the apt words of Efraim Racker (1913 –1991), “Don’t waste clean thinking on dirty enzymes.” Today, however, biochemistry is becoming more agglomerative and comprehensive, setting out to integrate and describe entirely particular biological systems. The ‘big data’ metabolomics can define the complement of small molecules, e.g., in a soil or biofilm sample; proteomics can distinguish all the comprising proteins, e.g., serum; metagenomics can identify all the genes in a complex environment, e.g., the bovine rumen. This Biochemistry Series will address the current research on biomolecules and the emerging trends with great promise.",coverUrl:"https://cdn.intechopen.com/series/covers/11.jpg",latestPublicationDate:"June 24th, 2022",hasOnlineFirst:!0,numberOfPublishedBooks:31,editor:{id:"31610",title:"Dr.",name:"Miroslav",middleName:null,surname:"Blumenberg",slug:"miroslav-blumenberg",fullName:"Miroslav Blumenberg",profilePictureURL:"https://mts.intechopen.com/storage/users/31610/images/system/31610.jpg",biography:"Miroslav Blumenberg, Ph.D., was born in Subotica and received his BSc in Belgrade, Yugoslavia. He completed his Ph.D. at MIT in Organic Chemistry; he followed up his Ph.D. with two postdoctoral study periods at Stanford University. Since 1983, he has been a faculty member of the RO Perelman Department of Dermatology, NYU School of Medicine, where he is codirector of a training grant in cutaneous biology. Dr. Blumenberg’s research is focused on the epidermis, expression of keratin genes, transcription profiling, keratinocyte differentiation, inflammatory diseases and cancers, and most recently the effects of the microbiome on the skin. He has published more than 100 peer-reviewed research articles and graduated numerous Ph.D. and postdoctoral students.",institutionString:null,institution:{name:"New York University Langone Medical Center",institutionURL:null,country:{name:"United States of America"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:4,paginationItems:[{id:"14",title:"Cell and Molecular Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/14.jpg",isOpenForSubmission:!0,annualVolume:11410,editor:{id:"165627",title:"Dr.",name:"Rosa María",middleName:null,surname:"Martínez-Espinosa",slug:"rosa-maria-martinez-espinosa",fullName:"Rosa María Martínez-Espinosa",profilePictureURL:"https://mts.intechopen.com/storage/users/165627/images/system/165627.jpeg",biography:"Dr. Rosa María Martínez-Espinosa has been a Spanish Full Professor since 2020 (Biochemistry and Molecular Biology) and is currently Vice-President of International Relations and Cooperation development and leader of the research group 'Applied Biochemistry” (University of Alicante, Spain). Other positions she has held at the university include Vice-Dean of Master Programs, Vice-Dean of the Degree in Biology and Vice-Dean for Mobility and Enterprise and Engagement at the Faculty of Science (University of Alicante). She received her Bachelor in Biology in 1998 (University of Alicante) and her PhD in 2003 (Biochemistry, University of Alicante). She undertook post-doctoral research at the University of East Anglia (Norwich, U.K. 2004-2005; 2007-2008).\nHer multidisciplinary research focuses on investigating archaea and their potential applications in biotechnology. She has an H-index of 21. She has authored one patent and has published more than 70 indexed papers and around 60 book chapters.\nShe has contributed to more than 150 national and international meetings during the last 15 years. Her research interests include archaea metabolism, enzymes purification and characterization, gene regulation, carotenoids and bioplastics production, antioxidant\ncompounds, waste water treatments, and brines bioremediation.\nRosa María’s other roles include editorial board member for several journals related\nto biochemistry, reviewer for more than 60 journals (biochemistry, molecular biology, biotechnology, chemistry and microbiology) and president of several organizing committees in international meetings related to the N-cycle or respiratory processes.",institutionString:null,institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,annualVolume:11411,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. Dr. Beydemir is also Rector of Bilecik Şeyh Edebali University, Turkey.",institutionString:null,institution:{name:"Anadolu University",institutionURL:null,country:{name:"Turkey"}}},editorTwo:{id:"13652",title:"Prof.",name:"Deniz",middleName:null,surname:"Ekinci",slug:"deniz-ekinci",fullName:"Deniz Ekinci",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYLT1QAO/Profile_Picture_1634557223079",biography:"Dr. Deniz Ekinci obtained a BSc in Chemistry in 2004, MSc in Biochemistry in 2006, and PhD in Biochemistry in 2009 from Atatürk University, Turkey. He studied at Stetson University, USA, in 2007-2008 and at the Max Planck Institute of Molecular Cell Biology and Genetics, Germany, in 2009-2010. Dr. Ekinci currently works as a Full Professor of Biochemistry in the Faculty of Agriculture and is the Head of the Enzyme and Microbial Biotechnology Division, Ondokuz Mayıs University, Turkey. He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. Dr. Ekinci serves as the Editor in Chief of four international books and is involved in the Editorial Board of several international journals.",institutionString:null,institution:{name:"Ondokuz Mayıs University",institutionURL:null,country:{name:"Turkey"}}},editorThree:null},{id:"17",title:"Metabolism",coverUrl:"https://cdn.intechopen.com/series_topics/covers/17.jpg",isOpenForSubmission:!0,annualVolume:11413,editor:{id:"138626",title:"Dr.",name:"Yannis",middleName:null,surname:"Karamanos",slug:"yannis-karamanos",fullName:"Yannis Karamanos",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002g6Jv2QAE/Profile_Picture_1629356660984",biography:"Yannis Karamanos, born in Greece in 1953, completed his pre-graduate studies at the Université Pierre et Marie Curie, Paris, then his Masters and Doctoral degree at the Université de Lille (1983). He was associate professor at the University of Limoges (1987) before becoming full professor of biochemistry at the Université d’Artois (1996). He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,annualVolume:11414,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:13,paginationItems:[{id:"82285",title:"Parvovirus Vectors: The Future of Gene Therapy",doi:"10.5772/intechopen.105085",signatures:"Megha Gupta",slug:"parvovirus-vectors-the-future-of-gene-therapy",totalDownloads:3,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"81793",title:"Canine parvovirus-2: An Emerging Threat to Young Pets",doi:"10.5772/intechopen.104846",signatures:"Mithilesh Singh, Rajendran Manikandan, Ujjwal Kumar De, Vishal Chander, Babul Rudra Paul, Saravanan Ramakrishnan and Darshini Maramreddy",slug:"canine-parvovirus-2-an-emerging-threat-to-young-pets",totalDownloads:15,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"81271",title:"The Diversity of Parvovirus Telomeres",doi:"10.5772/intechopen.102684",signatures:"Marianne Laugel, Emilie Lecomte, Eduard Ayuso, Oumeya Adjali, Mathieu Mével and Magalie Penaud-Budloo",slug:"the-diversity-of-parvovirus-telomeres",totalDownloads:38,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Recent Advances in Canine Medicine",coverURL:"https://cdn.intechopen.com/books/images_new/11580.jpg",subseries:{id:"19",title:"Animal Science"}}},{id:"79209",title:"Virtual Physiology: A Tool for the 21st Century",doi:"10.5772/intechopen.99671",signatures:"Carmen Nóbrega, Maria Aires Pereira, Catarina Coelho, Isabel Brás, Ana Cristina Mega, Carla Santos, Fernando Esteves, Rita Cruz, Ana I. 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Oliveira, João Mesquita and Helena Vala",slug:"virtual-physiology-a-tool-for-the-21st-century",totalDownloads:150,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Updates on Veterinary Anatomy and Physiology",coverURL:"https://cdn.intechopen.com/books/images_new/10665.jpg",subseries:{id:"19",title:"Animal Science"}}}]},overviewPagePublishedBooks:{paginationCount:11,paginationItems:[{type:"book",id:"7233",title:"New Insights into Theriogenology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7233.jpg",slug:"new-insights-into-theriogenology",publishedDate:"December 5th 2018",editedByType:"Edited by",bookSignature:"Rita Payan-Carreira",hash:"74f4147e3fb214dd050e5edd3aaf53bc",volumeInSeries:1,fullTitle:"New Insights into Theriogenology",editors:[{id:"38652",title:"Prof.",name:"Rita",middleName:null,surname:"Payan-Carreira",slug:"rita-payan-carreira",fullName:"Rita Payan-Carreira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRiFPQA0/Profile_Picture_1614601496313",biography:"Rita Payan Carreira earned her Veterinary Degree from the Faculty of Veterinary Medicine in Lisbon, Portugal, in 1985. She obtained her Ph.D. in Veterinary Sciences from the University of Trás-os-Montes e Alto Douro, Portugal. After almost 32 years of teaching at the University of Trás-os-Montes and Alto Douro, she recently moved to the University of Évora, Department of Veterinary Medicine, where she teaches in the field of Animal Reproduction and Clinics. Her primary research areas include the molecular markers of the endometrial cycle and the embryo–maternal interaction, including oxidative stress and the reproductive physiology and disorders of sexual development, besides the molecular determinants of male and female fertility. She often supervises students preparing their master's or doctoral theses. She is also a frequent referee for various journals.",institutionString:null,institution:{name:"University of Évora",institutionURL:null,country:{name:"Portugal"}}}]},{type:"book",id:"7144",title:"Veterinary Anatomy and Physiology",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/7144.jpg",slug:"veterinary-anatomy-and-physiology",publishedDate:"March 13th 2019",editedByType:"Edited by",bookSignature:"Catrin Sian Rutland and Valentina Kubale",hash:"75cdacb570e0e6d15a5f6e69640d87c9",volumeInSeries:2,fullTitle:"Veterinary Anatomy and Physiology",editors:[{id:"202192",title:"Dr.",name:"Catrin",middleName:null,surname:"Rutland",slug:"catrin-rutland",fullName:"Catrin Rutland",profilePictureURL:"https://mts.intechopen.com/storage/users/202192/images/system/202192.png",biography:"Catrin Rutland is an Associate Professor of Anatomy and Developmental Genetics at the University of Nottingham, UK. She obtained a BSc from the University of Derby, England, a master’s degree from Technische Universität München, Germany, and a Ph.D. from the University of Nottingham. She undertook a post-doctoral research fellowship in the School of Medicine before accepting tenure in Veterinary Medicine and Science. Dr. Rutland also obtained an MMedSci (Medical Education) and a Postgraduate Certificate in Higher Education (PGCHE). She is the author of more than sixty peer-reviewed journal articles, twelve books/book chapters, and more than 100 research abstracts in cardiovascular biology and oncology. She is a board member of the European Association of Veterinary Anatomists, Fellow of the Anatomical Society, and Senior Fellow of the Higher Education Academy. 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He has taught at Thompson Rivers University, Canada; University of Paris-Est, France; Osnabruck University of Applied Science, Germany; and Shanghai Institute of Technology and Tianjin University of Technology, China. He has published research in Research Policy, Applied Economics, Review of Economic Philosophy, Strategic Change, International Journal of Logistics, Sustainability, Journal of Environmental Management, Journal of Global Information Management, Journal of Cleaner Production, M@N@GEMENT, and more. He is a member of CEDIMES Institut (France), Academy of International Business (AIB), Strategic Management Society (SMS), Academy of Management (AOM), Administrative Science Association of Canada (ASAC), and Canadian council of small business and entrepreneurship (CCSBE). He is currently the director of the Research Group on Contemporary Asia (GERAC) at Laval University. 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Thus proteomics, an area of research that detects all protein forms expressed in an organism, including splice isoforms and post-translational modifications, is more suitable than genomics for a comprehensive understanding of the biochemical processes that govern life. The most common proteomics applications are currently in the clinical field for the identification, in a variety of biological matrices, of biomarkers for diagnosis and therapeutic intervention of disorders. From the comparison of proteomic profiles of control and disease or different physiological states, which may emerge, changes in protein expression can provide new insights into the roles played by some proteins in human pathologies. Understanding how proteins function and interact with each other is another goal of proteomics that makes this approach even more intriguing. Specialized technology and expertise are required to assess the proteome of any biological sample. Currently, proteomics relies mainly on mass spectrometry (MS) combined with electrophoretic (1 or 2-DE-MS) and/or chromatographic techniques (LC-MS/MS). MS is an excellent tool that has gained popularity in proteomics because of its ability to gather a complex body of information such as cataloging protein expression, identifying protein modification sites, and defining protein interactions. The Proteomics topic aims to attract contributions on all aspects of MS-based proteomics that, by pushing the boundaries of MS capabilities, may address biological problems that have not been resolved yet.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",hasOnlineFirst:!0,hasPublishedBooks:!0,annualVolume:11414,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. 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