Sample records for open surgical procedure

  1. Teaching Physician Guidelines for Surgical Procedures Minor Surgical Procedures

    E-print Network

    Goldman, Steven A.

    Teaching Physician Guidelines for Surgical Procedures Minor Surgical Procedures: § Procedures, the teaching physician must be present for the entire procedure § Teaching physician or resident may document the teaching physician's presence for the entire procedure High Risk and Complex Surgical Procedures

  2. Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease

    PubMed Central

    Zhou, Min; Huang, Dian; Liu, Chen; Liu, Zhao; Zhang, Min; Qiao, Tong; Liu, Chang-Jian

    2014-01-01

    Objective To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases. Design Case series study with retrospective analysis of prospectively collected nonrandomized data. Methods Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan–Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency. Results HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P<0.001, respectively), and the presence of diabetes and renal insufficiency were another two independent predictors of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively). Conclusion Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency. PMID:25284992

  3. [Surgical procedures for neuropathic pain].

    PubMed

    Goto, Shinichi; Taira, Takaomi

    2012-11-01

    Different surgical procedures are available for the treatment of many neuropathic pain syndromes. These surgical procedures can be divided into 2 main sections: non-destructive and destructive procedures. In recent years, the non-destructive neurostimulation method has undergone rapid development. Neurostimulation can be applied to a large part of the nervous system including the brain, spinal cord, and peripheral nerves. Spinal cord stimulation has become a dominant pain relief modality because of its minimal invasiveness and the development of a multi-contact stimulating electrode system powered by a multi-programmable and rechargeable stimulator. Currently, destructive surgical procedures have a limited range of indications for pain control. However, the advantages of destructive procedures over non-destructive ones include continuous pain reduction without implantation of a stimulation system. Each of the surgical procedures has great potential for providing patients with significant relief from neuropathic pain. PMID:23131742

  4. Surgical Procedures for Vestibular Dysfunction

    MedlinePLUS

    ... controlling vertigo remains in doubt. Oval or round window plugging Oval or round window plugging is a stabilizing procedure sometimes used for ... fistulas. Openings in the oval and/or round windows are patched with tissue taken from the external ...

  5. Open core control software for surgical robots

    PubMed Central

    Kozuka, Hiroaki; Kim, Hyung Wook; Takesue, Naoyuki; Vladimirov, B.; Sakaguchi, Masamichi; Tokuda, Junichi; Hata, Nobuhiko; Chinzei, Kiyoyuki; Fujimoto, Hideo

    2010-01-01

    Object In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days. A cutting-edge “intelligent surgical robot” will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are “home-made” in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. Materials and methods In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open Core Control software, several techniques for this purpose were introduced. Virtual fixture is well known technique as a “force guide” for supporting operators to perform precise manipulation by using a master–slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. Results The Open Core Control software was implemented on a surgical master–slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a “force guide” on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. Conclusion In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement “General Principles of Software

  6. Surgical Procedures. Second Edition. Teacher Edition.

    ERIC Educational Resources Information Center

    Baker, Beverly; And Others

    This teacher's guide contains 13 units of instruction for a course that will prepare students with the entry-level competencies needed by a surgical technologist. The course covers the following topics: introduction to surgical procedures; diagnostic procedures; general surgery; gastrointestinal surgery; obstetrics and gynecological surgery;…

  7. Evaluation of surgical procedures for trigeminal neuralgia.

    PubMed Central

    Ong, K. S.; Keng, S. B.

    2003-01-01

    Trigeminal neuralgia is a type of facial pain that is difficult to treat. The pain can be excruciating and debilitating. The wide range of treatments currently used for trigeminal neuralgia is ample evidence that there is no simple answer to how it should be managed. This review will evaluate the current surgical procedures used for the treatment of trigeminal neuralgia. A critical analysis of the evidence-based studies to date was done to evaluate and compare the efficacy of the different surgical procedures. Arguments for and against the use of surgery for trigeminal neuralgia are presented. In addition, the surgical procedures were compared with other treatments for trigeminal neuralgia. PMID:14959906

  8. Costs of surgical procedures in Indian hospitals

    PubMed Central

    Chatterjee, Susmita; Laxminarayan, Ramanan

    2013-01-01

    Objective Despite a growing volume of surgical procedures in low-income and middle-income countries, the costs of these procedures are not well understood. We estimated the costs of 12 surgical procedures commonly conducted in five different types of hospitals in India from the provider perspective, using a microcosting method. Design Cost and utilisation data were collected retrospectively from April 2010 to March 2011 to avoid seasonal variability. Setting For this study, we chose five hospitals of different types: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed district hospital, a 655-bed private teaching hospital and a 778-bed tertiary care teaching hospital based on their willingness to cooperate and data accessibility. The hospitals were from four states in India. The private, charitable and tertiary care hospitals serve urban populations, the district hospital serves a semiurban area and the private teaching hospital serves a rural population. Results Costs of conducting lower section caesarean section ranged from rupees 2469 to 41?087; hysterectomy rupees 4124 to 57?622 and appendectomy rupees 2421 to 3616 (US$1=rupees 52). We computed the costs of conducting lap and open cholecystectomy (rupees 27?732 and 44?142, respectively); hernia repair (rupees 13?204); external fixation (rupees 8406); intestinal obstruction (rupees 6406); amputation (rupees 5158); coronary artery bypass graft (rupees 177?141); craniotomy (rupees 75?982) and functional endoscopic sinus surgery (rupees 53?398). Conclusions Estimated costs are roughly comparable with rates of reimbursement provided by the Rashtriya Swasthya Bima Yojana (RSBY)—India's government-financed health insurance scheme that covers 32.4 million poor families. Results from this type of study can be used to set and revise the reimbursement rates. PMID:23794591

  9. Open surgical management of oesophageal diverticulum.

    PubMed

    Gust, Lucile; De Lesquen, Henri; Ouattara, Moussa; Thomas, Pascal Alexandre; D'Journo, Xavier Benoît

    2015-01-01

    Epiphrenic diverticula are defined as the herniation of the mucosa and submucosa through the muscular layers of the oesophageal wall in its lower third. An increased intraluminal pressure associated with an oesophageal motility disorder is usually present in the pathophysiology of the disease. Surgical treatment is indicated mostly in symptomatic patients. The current surgical treatment consists in: (i) removing the diverticulum; (ii) relieving the functional distal obstruction with an oesophageal myotomy including the lower oesophageal sphincter; and (iii) preventing an associated reflux by the addition of a non-obstructive partial fundoplication. Minimally invasive techniques have been reported, but traditional open procedures remain the treatment of choice of the disease. PMID:26108416

  10. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  11. Surgical Procedures in Predoctoral Periodontics Programs.

    ERIC Educational Resources Information Center

    Radentz, William H.; Caffesse, Raul G.

    1991-01-01

    A survey of 58 dental school periodontics departments revealed the frequency of predoctoral dental students performing surgery, the frequency of specific procedures, the degree of participation or performance of students, incidence of preclinical surgical laboratories in the curricula, and materials and anesthesia used. A wide range in…

  12. HAPTIC INTERACTION TO SIMULATE COMPLEX SURGICAL PROCEDURES

    E-print Network

    Salisbury, Kenneth

    for graphics and haptics developed at Stanford, including a proxy algorithm, collision detection methods, and stereo 3-D graphic rendering. In addition, we have developed support for multi-finger haptic gripperHAPTIC INTERACTION TO SIMULATE COMPLEX SURGICAL PROCEDURES Christopher Sewell, PhD Candidate

  13. Glove perforation during oral surgical procedures

    Microsoft Academic Search

    Ruth Lopes; Belmiro Cavalcanti; Egito Vasconcelos; Luiz Carlos Ferreira da Silva; Gabriela Granja Porto; B. Vasconcelos

    Objective: The aim of this study was to determine the incidence of glove perforation among undergraduates and residents performing maxillofacial surgery and identify procedures associated with the perforations. Study Design: For this purpose, 200 pairs of surgical gloves were used. For inspecting the perforations, the gloves were filled with water, at least 500 ml. Results: Sixteen gloves (8%) were perforated,

  14. Antibiotic prophylaxis in “clean” surgical procedures

    Microsoft Academic Search

    Colin Strachan

    1982-01-01

    The incidence of infection for clean surgical procedures should be less than 2%. The majority of infections are exogenous fromStaphylococcus aureus.These exogenous sources of bacteria include the ward, the theater environment, medical personnel, bed linen, and other infected patients. Endogenous infections may arise from the patient's own nose and skin; and although the majority of bacteria are staphylococcal, gram-negative intestinal

  15. Cardiac surgical procedures and glove reinforcements.

    PubMed

    Alrawi, Sadir J; Houshan, Iyad; Zanial, Suhaib A; Cunningham, Joseph N; Acinapura, Anthony J; Raju, Ramanathan

    2002-01-01

    The purpose of this prospective study is to determine the frequency and site of glove perforation during cardiac surgical procedures. Over a period of six months, gloves from 206 surgical team members were collected at the conclusion of surgery. All cases of known perforations were eliminated from the study. The percentage of glove perforation was 14%. The distribution of perforation across locations of the hand was significantly unequal (P = 0.001). We found that 73% of the punctures occurred in one of four contiguous locations on the glove: the radial side of the index finger (28%), the radial side of the thumb (21%), the palmar side of the index (14%), and the palmar side of the thumb (10%). Therefore, we recommend glove reinforcement on these locations that would provide better protection against transmission of infectious agents. Discomfort from restricted dexterity and impaired sense of touch with double gloving renders glove reinforcement a suitable alternative for universal precautions, especially in cardiac surgery while high level of perfection and dexterity were needed in lengthy, critical operations. PMID:11937466

  16. An approach to the ethical evaluation of innovative surgical procedures.

    PubMed

    Tan, Veronique K M; Chow, Pierce K H

    2011-01-01

    While there is an ethical obligation to improve clinical outcomes by developing better therapies, surgical innovation has largely progressed without the strict regulations required of novel pharmaceutical products. We explore the reasons why new surgical techniques are frequently introduced without the benefit of randomised controlled trials, and present an approach to the ethical evaluation of novel surgical procedures. PMID:21369629

  17. 20 CFR 220.60 - Diagnostic surgical procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...the evaluation of disability under the Board's disability program. In addition, the Board will not order procedures such as cardiac catheterization and surgical biopsy. However, if any of these procedures have been performed as part of a workup by the...

  18. 20 CFR 220.60 - Diagnostic surgical procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...the evaluation of disability under the Board's disability program. In addition, the Board will not order procedures such as cardiac catheterization and surgical biopsy. However, if any of these procedures have been performed as part of a workup by the...

  19. A novel surgical procedure: scaffold-pulmonary autograft transplantation.

    PubMed

    Xu, Xiu-Fang; Wang, Zhu-Heng; An, Guo-Ying; Guo, Hai-Ping; Wang, Sheng; Pei, Jin-Feng; Qin, En-Ming; Ren, Xue-Jun; Xu, Zhi-Wei; Gong, Da; Li, Wen-Bin

    2013-01-01

    Mitral valve-related operations are easy to perform and show good results, but to prevent severe thromboembolism or a high ratio of prosthetic valve destruction by tissue, lifetime anticoagulant therapy is essential after the operation. Thus, identifying a new type of surgical procedure and prosthetic valve to cure mitral valve diseases is necessary. Pulmonary valve autograft transplantation (Ross II) with the "top hat" transplantation technique was first reported by Ross DN to cure mitral disease. Because the "top hat" procedure has some shortcomings, we designed the scaffold-pulmonary autograft transplantation procedure and performed animal experiments to confirm the feasibility and effectiveness of the procedure. A total of 13 minipigs, weighing 20-25 kg, were employed as experimental animals to undergo scaffold-pulmonary autograft valve transplantation in our surgical animal lab. The surgical procedure was performed under hypothermic general anaesthesia and extracorporeal circulation (or cardiopulmonary bypass, CPB). Briefly, the chest cave was opened through the left intercostal, the pulmonary valve autograft was harvested during on-pump beating heart, and the pulmonary valve autograft was mounted in a self-made pulmonary valve scaffold and transferred to the mitral valve annulus without removing the mitral instruments. Finally, the outflow tract of the right ventricle was re-established with a pig pulmonary homograft. After finishing data collection, all animals were executed 1 hour after removal from the CPB. For the 13 minipigs that underwent the operation, the CPB time was 182.4 ± 23.4 min. Two of the thirteen cases died of bleeding during the operation and of a post-operative pulmonary embolism, and the remaining eleven survived for one hour. The pressure of the left atrium did not increase significantly (P = 1.00), and the ultrasonic cardiograph (UCG) showed good function of the new mitral valves, with mean ejection fraction (EF) values of 63.6%. The mitral valve orifice areas were 1.10 ± 0.13 cm(2) (pre-operation) and 1.01 ± 0.08 cm(2) (post-operation) (P = 0.013). The function and structure of the new mitral valves were normal. We preliminarily consider scaffold-pulmonary autograft valve transplantation to be a new alternative to cure mitral valve disease, but advanced chronic animal experiments will be needed to confirm the long-term results of the operation. The results showed it could be a new alternative to cure mitral valve disease. PMID:24040474

  20. Biomechanical function of surgical procedures for acromioclavicular joint dislocations

    Microsoft Academic Search

    Rajesh Jari; Ryan S. Costic; Mark W. Rodosky; Richard E. Debski

    2004-01-01

    PurposeSurgical procedures for treatment of acromioclavicular (AC) joint dislocation replace the coracoclavicular (CC) ligaments to minimize motion, allow scarring, and increase the subsequent stability of the joint. The purpose of this study was to evaluate the biomechanical function of the surgically repaired or reconstructed (CC Sling, Rockwood Screw [DePuy Orthopaedics, Warsaw, IN], and Coracoacromial [CA] Ligament Transfer Construct) AC joint

  1. [Surgical procedures involved in claims for alleged defects in praxis].

    PubMed

    Arimany-Manso, Josep; Benet-Travé, J; Bruguera-Cortada, M; Torné-Escasany, R; Klamburg-Pujol, J; Gómez-Durán, Esperanza L

    2014-03-01

    Medical professional liability and adverse events in health care are major concerns worldwide and the analysis of claims for alleged defects in praxis is a potential source of knowledge. High rates of adverse events and complaints have been reported in surgical procedures. This article analyzes the claims registered by the Council of Medical Colleges in Catalonia between 1986 and 2012, and explores surgical procedures claimed (ICD- 9-CM coding), as well as the final outcome of the claim. Among the 5,419 records identified on surgical procedures, the interventions of the musculoskeletal system and skin and integument showed the highest frequencies. Interventions related to "non-curative" medicine should be emphasized because of their higher rates of economical agreement or condemnation outcomes, which were significantly higher for mastopexia. The results underscore the importance of the surgical area in medical professional liability and the high risk of payouts among those procedures belonging to the so-called "non-curative" medicine. PMID:24913754

  2. Preventing Adhesions in Obstetric and Gynecologic Surgical Procedures

    PubMed Central

    González-Quintero, Víctor Hugo; Cruz-Pachano, Francisco E

    2009-01-01

    Adhesive disease represents a significant cause of morbidity for postoperative patients. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. The technology of adhesion prevention has significantly progressed. There are 3 methods approved by the US Food and Drug Administration for the prevention of postoperative adhesions, including Adept®, Interceed®, and Seprafilm®. The latter barrier is the most widely studied. This article reviews the current choices available for adhesion prevention barriers as well as surgical adjuncts that traditionally have been studied for that purpose. PMID:19399293

  3. How to control the risk of novel surgical procedures.

    PubMed

    Steiger, H J

    2001-01-01

    Novel surgical procedures impose particular problems in addition to the general issues of clinical research [1, 7]. Surgical procedures are usually highly technical and therefore difficult to judge by the institutional ethics committee. The ethics committee has therefore to rely on external experts and a relatively large responsibility remains with the surgeon in charge. There are no generally valid regulations regarding new surgical procedures. At our institution, informed consent by the patient, a detailed risk analysis, testing and training in the anatomy/animal lab are required, and in addition a formation/training visit if know-how is available elsewhere. In emergency situations, if during a procedure circumstances call for a new surgical procedure, all the above preconditions cannot be met. A suggested minimum requirement in such a situation is that the decision for a new procedure is achieved by agreement of two board certified specialists. A problem that has to be solved in the future is how to make the negative experiences with new surgical procedures generally available in order to prevent that the same mistakes are repeated in other institutions. PMID:11840716

  4. Effect of bariatric surgery on future general surgical procedures

    PubMed Central

    Kini, Subhash; Kannan, Umashankkar

    2011-01-01

    Bariatric surgery is now accepted as a safe and effective procedure for morbid obesity. The frequency of bariatric procedures is increasing with the adoption of the laparoscopic approach. The general surgeons will be facing many more of such patients presenting with common general surgical problems. Many of the general surgeons, faced with such situations, may not be aware of the changes in the gastrointestinal anatomy following bariatric procedures and management of these clinical situations will therefore present diagnostic and therapeutic challenges. We hereby present a review of management of few common general surgical problems in patients with a history of bariatric surgery. PMID:21523234

  5. Chronic pancreatitis: A surgical disease? Role of the Frey procedure

    PubMed Central

    Roch, Alexandra; Teyssedou, Jérome; Mutter, Didier; Marescaux, Jacques; Pessaux, Patrick

    2014-01-01

    Although medical treatment and endoscopic interventions are primarily offered to patients with chronic pancreatitis, approximately 40% to 75% will ultimately require surgery during the course of their disease. Although pancreaticoduodenectomy has been considered the standard surgical procedure because of its favorable results on pain control, its high postoperative complication and pancreatic exocrine or/and endocrine dysfunction rates have led to a growing enthusiasm for duodenal preserving pancreatic head resection. The aim of this review is to better understand the rationale underlying of the Frey procedure in chronic pancreatitis and to analyze its outcome. Because of its hybrid nature, combining both resection and drainage, the Frey procedure has been conceptualized based on the pathophysiology of chronic pancreatitis. The short and long-term outcome, especially pain relief and quality of life, are better after the Frey procedure than after any other surgical procedure performed for chronic pancreatitis. PMID:25068010

  6. Major surgical procedures in children with cerebral palsy.

    PubMed

    Theroux, Mary C; DiCindio, Sabina

    2014-03-01

    There are 3 surgical procedures that patients with cerebral palsy (CP) undergo that may be considered major procedures: femoral osteotomies combined with pelvic osteotomies, spine fusion, and intrathecal baclofen pump implant for the treatment of spasticity. Many complications are known to occur at a higher rate in this population, and some may be avoided with prior awareness of the preoperative pathophysiology of the patient with CP. PMID:24491650

  7. Suppression of Surgeons' Bacterial Hand Flora during Surgical Procedures with a New Antimicrobial Surgical Glove

    PubMed Central

    Kramer, Axel; Ouriel, Kenneth; Suchomel, Miranda; McLaws, Mary-Louise; Rottman, Martin; Leaper, David; Assadian, Afshin

    2014-01-01

    Abstract Background: Perforations of surgical gloves are common and increase with the duration of glove wear. Skin flora, re-grown after pre-operative disinfection of the hands, may contaminate a surgical site. An antimicrobial surgical glove with chlorhexidine on its inner surface has been developed. We hypothesized that by suppressing the re-growth of skin flora during the complete course of a surgical procedure, antimicrobial gloves may reduce the risk of surgical site contamination in the event of an intra-operative glove breach. Methods: We conducted a randomized, double-blind, single-center trial, to measure any differences in the bacterial skin populations of surgeons' hands during surgical procedures done with antimicrobial and non-antimicrobial surgical gloves [ISRCTN71391952]. In this study, 25 pairs of gloves were retrieved from 14 surgeons who donned them randomly on their dominant or non-dominant hand. The number of bacteria retrieved from glove fluid was measured and expressed as colony forming units (CFU)/mL. Results: The median cfu/mL of antimicrobial gloves was 0.00 (LQ: 0.00?CFU/mL; UQ: 0.00?cfu/mL), with a mean log10 cfu/mL=0.02 (range: 0.00–0.30). The median CFU/mL of non-antimicrobial gloves was 54.00 (LQ: 3.00?cfu/mL; UQ: 100.00?cfu/mL) with a mean log10 CFU/mL=1.32 (range: 0.00–2.39). After a mean operating time of 112?min, the difference in the log10 CFU/mL was 1.30 (p<0.001). Conclusions: A new antimicrobial surgical glove suppressed surgeons' hand flora during operative procedures. In the event of a glove breach, the use of such a glove may have the potential to prevent bacterial contamination of a sterile surgical site, thereby decreasing the risk of surgical site infection (SSI) and increasing patient safety. Further clinical studies are needed to confirm this concept. PMID:24116857

  8. [Urinary incontinence, should fertile women undergo surgical procedure?].

    PubMed

    Panel, L; Mares, P; de Tayrac, R

    2009-02-01

    The goal of this study was to make a Medline research about pregnancies which occur after surgical procedures for stress urinary incontinence (SUI). Therefore, we do not know the recurrence rate of SUI after pregnancy and the influence of the way of delivery on the risk of recurrence. We do not know either if we should apply a surgical procedure on women who have not achieved their pregnancies. In 1998, a questionnaire based survey conducted in the USA showed a lower risk of recurrence after a caesarean section than after a vaginal delivery (p=0,03) when women had previously colposuspension or sling procedures. We found ten case reports and a French national survey (2006) about pregnancies after TOT or TVT procedure. No complication related to the tape was described during pregnancy. The recurrence rate along the pregnancy is about 15%, and the global recurrence rate (during pregnancy and after the childbirth) is about 20%. As a conclusion, pregnancy itself has an influence, and vaginal delivery seams to increase the risk of recurrence after the birth compare to the c-section. However this recurrence rate and these data do not appear enough to us to refuse a surgical treatment for women who have not completed their pregnancies and who suffer from UI without efficacy of physiotherapy. We do not have objective data to assess the best way of delivery. Further and large studies are needed although they are difficult to be carried through. PMID:19117785

  9. Anterior thoracic wall giant tumor--special surgical procedure.

    PubMed

    Grozavu, C; Fera, A; Ilia?, M; Marin, D; Pantile, D; Dabelea, C

    2012-01-01

    We describe the case of a 39 years old male known with an anterior thoracic traumatism in 1993 who observed ananterior thoracic wall tumor since 2000. After one and half year of empiric treatment the tumor starts growing very fast, reaching 30/40/35 cm by the date of his hospital admission (march 2003). Due to this accelerate growth and the size of the tumor the patient is proposed for a particular surgical procedure removing the tumor along with the anterior thoracic wall and the reconstruction using "spider web" technique, Thoratex reinforced mesh and muscle flaps. Thisprocedure had agood result, the patient returned to his anterior lifestyle few months after. The patient did not come for follow-up, although he was recommended to come every tree months. Four years after surgery (2007) the patient came back with local recurrence of the tumor. In 2007 the patient underwent another surgical intervention, removing the tumor recurrence. Chest wall tumors are complex surgical conditions requiring complex treatment. The empiric treatment and the fact that the patient did not come as planned for follow-up, prolonged his sufferance, leading to a second surgical intervention. PMID:22712358

  10. Selection of the surgical procedure for management of benign prostatic hyperplasia.

    PubMed

    Mebust, W K

    1994-01-01

    The standard method of surgically treating obstructing benign prostatic hyperplasia is transurethral resection of the prostate. It is the gold standard by which other therapeutic modalities, medical and surgical, should be measured. In those patients with larger prostate, open prostatectomy is the procedure of choice. Transurethral incision of the prostate has been under-utilized and would be useful in the majority of patients. The procedure is best used in patients who have glands under 30 grams and preferably around 20 grams in size. Therefore, in a given patient, the surgical procedure will be dependent upon the patient's general condition, the anatomy and size of his prostate, and the surgeon's skill and experience. Newer less invasive procedures are currently under evaluation and must be compared to transurethral prostatectomy, so that we can determine their possible role in the armamentarium of the urologist. Prospective randomized studies, comparing these new modalities to TUR-P, are needed, particularly with long-term outcome data. PMID:7528405

  11. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures

    Microsoft Academic Search

    Anthony P Furnary; Kathryn J Zerr; Gary L Grunkemeier; Albert Starr

    1999-01-01

    Background. Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection.Methods. In

  12. Cardiac surgical procedures for the coronary sequelae of Kawasaki disease

    PubMed Central

    Yuan, Shi-Min

    2012-01-01

    Objectives The aim of this article is to make an evaluation on the clinical features of patients with Kawasaki disease who require a cardiac surgical procedure including coronary artery bypass grafting, coronary arterial aneurysmorrhaphy or heart transplantation. Methods English literature of Kawasaki disease for cardiac surgery (1990–2011) was retrieved in the Pubmed database. The clinical features of the patient setting from the representative articles were collected and analyzed. Results Patients with Kawasaki disease were very young, with some requiring a cardiac surgical procedure at a very early age. The interval between the onset and the surgical operation was 9.5±9.4 years. The prevalence of myocardial infarction and re-infarction was high. Giant aneurysm, critical stenosis with calcification and thrombus formation of the coronary arteries often warrant coronary artery bypass, heart transplantation or coronary arterial aneurysm plication. The left internal mammary artery to the left anterior descending coronary artery was the most commonly used graft in coronary artery bypass. Graft patency rate was 82.4% at 21.4±32.3 (range 0.1–252) month follow-up. The early and late mortalities of this patient setting were 0.6 and 3.0%, respectively. Conclusions Patients with Kawasaki disease may develop coronary artery lesions prone to aneurysmal formation with calcification and thrombus and may require coronary artery bypass at a very early age. With the left internal mammary artery as the first choice of bypass graft, the long-term patency and patient survival was satisfactory. PMID:23226165

  13. Surgical procedure and long-term survival of hilar cholangiocarcinoma

    PubMed Central

    Wang, Yue; Yang, Helen; Shen, Chunjian; Luo, Ji

    2015-01-01

    Objective: The aim of this study was to identify the influencing factors related to outcome of patients with hilar cholangiocarcinoma. Methods: From January 1999 to January 2009, 204 cases of hilar cholangiocarcinoma undergoing surgery were analyzed retrospectively. Bismuth-Corlette classification showed type I in 18 patients, type II in 40, type IIIa in 65, type IIIb in 54, type IV in 27. Survival analysis was performed by the Kaplan-Meier method and the relationship between each of the clinicopathologic variables and survival was assessed by the log-rank test. Multivatiate results were confirmed using Cox regression. Results: Radical resection was accomplished in 161 of 204 patients (78.9%). Radical resection offered the best chance of long-term survival, with the 1-, 3-, and 5-year survival rate were 62.6%, 42.4%, 23.7%, respectively. Univariate analysis showed that lymph node metastasis, surgical margin, operative procedure and tumor differentiation were prognostic impacts. The difference was statistically significant (P < 0.05). Cox multivariate analysis showed that lymph node metastasis and surgical margin are two separate prognostic factors. Conclusion: Racical resection is the key to improve the long-term survival rate of hilar cholangiocarcinoma and a favorable outcome after resection is mainly determined by curative resection and the absence of lymph node metastasis. PMID:25785102

  14. Outpatient surgical procedures: which is the ideal teaching procedure for a resident surgeon?

    PubMed Central

    MILONE, M.; MUSELLA, M.; MAIETTA, P.; BIANCO, P.; TAFFURI, C.; SALVATORE, G.; MILONE, F.

    2013-01-01

    Summary Aim The aim of our study is to evaluate which surgical procedures can be considered the ideal teaching procedure for a resident surgeon. Materials and methods This is a retrospective study. A chart review was performed on all patients who underwent inguinal hernia repair, saphenectomy, excision of pilonidal sinus and hemorrhoidectomy at our institution, between September 2000 and July 2011, and have at least 1 year of follow-up. We evaluated operative time and complications comparing the results obtained by resident or attending surgeon. Results We obtained a higher operative time among the procedures performed by resident surgeons for all evaluated interventions. Whereas the occurrence of complications after hernia repair and excision and primary closure of pilonidal sinus were similar in case and control subjects (p = 0,1 and p = 0,1), the occurrence of complications after hemorrhoidectomy and saphenectomy was significantly higher in the case group (p = 0,08 and p = 0,1). Conclusion Hernia repair and excision and primary closure of pilonidal sinus have to be considered the ideal teaching procedure in a residency program, giving to the young surgeon the opportunity of reach several skills that he needs to master most difficult surgical procedures. Saphenectomy and hemorrhoidectomy should be considered safe only if performed by a senior resident surgeon. PMID:24342157

  15. Early Surgical Outcome of a New Modification for Senning Procedure.

    PubMed

    Ozkan, Suleyman; Kuserli, Yusuf

    2014-06-24

    Background?Senning operation has been modified many times in the search of excellence by different surgeons. We present here our experience with another modification of Senning procedure and evaluate its surgical outcome. Methods and Results?A total of 19 patients underwent Senning procedure between December 2009 and February 2012 in our hospital. Median age and weight of the patients were 30 months (3 months-17 years) and 9.6?kg (3.5-79 kg), respectively; 18 patients were with transposition of great arteries with atrial septal defect and 1 patient was operated Mustard with baffle stenosis. Interatrial patch was used in seven patients, and left atrial appendage was inverted as a patch in three patients. However, in 12 patients, Senning was performed without any patch. No leak or any gradient were not detected in immediate postoperative echocardiograms. Mean follow-up was 12.7?±?7 months. Echocardiographic studies showed that there is no any gradient in the pulmonary venous returns, in the systemic and pulmonic baffles, superior vena cava, inferior vena cava, valves, and outflow tracts. Conclusion?This technique is flexible, safe, fast, and has many advantages. Major expectations for long term to reduce reoperations are low potential to shrink, calcification, thrombus formation, and stenosis with growth potential. Finally, properly functioning chambers without stenosis may decrease the arrhythmia potential. PMID:24959933

  16. Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics

    PubMed Central

    Ioannou, Andreas L.; Kotsakis, Georgios A.; McHale, Michelle G.; Lareau, Donald E.; Hinrichs, James E.; Romanos, Georgios E.

    2015-01-01

    Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon's rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.

  17. Development of a patient-specific surgical simulator for pediatric laparoscopic procedures.

    PubMed

    Saber, Nikoo R; Menon, Vinay; St-Pierre, Jean C; Looi, Thomas; Drake, James M; Cyril, Xavier

    2014-01-01

    The purpose of this study is to develop and evaluate a pediatric patient-specific surgical simulator for the planning, practice, and validation of laparoscopic surgical procedures prior to intervention, initially focusing on the choledochal cyst resection and reconstruction scenario. The simulator is comprised of software elements including a deformable body physics engine, virtual surgical tools, and abdominal organs. Hardware components such as haptics-enabled hand controllers and a representative endoscopic tool have also been integrated. The prototype is able to perform a number of surgical tasks and further development work is under way to simulate the complete procedure with acceptable fidelity and accuracy. PMID:24732536

  18. Efficacy of double gloving technique in major and minor oral surgical procedures: A prospective study

    PubMed Central

    Padhye, Mukul N.; Girotra, Charu; Khosla, Aman R.; Gupta, Kavita V.

    2011-01-01

    Background: A prospective analysis was carried out over a 1-year period to assess gloves used during 100 major and 100 minor oral surgical procedures to test for efficacy of double gloving in oral surgical procedures. Purpose: The purpose of this study was to assess the efficacy of double gloving technique in preventing cross infection in both major and minor oral surgical procedures. Materials and Methods: Gloves used during 100 major and 100 minor oral surgical procedures were analyzed to check for glove perforations and skin punctures. 100 sterile gloves were tested as control. Statistical Analysis Used: Chi-square test was used to determine whether there was any difference between the expected and observed values in various categories. Results: A higher number of glove perforations was seen in minor oral surgical procedures compared with major surgeries, dominant hand compared with the nondominant, outer gloves compared with the inner, in procedures which took a longer duration of time to complete, in procedures involving wiring and in the index finger followed by the thumb and the palm. Conclusion: Double gloving technique using sterile gloves can be used as an effective means of infection control for all major and minor surgical procedures, especially high-risk procedures involving patients who maybe suffering from or carriers of blood-borne infections. PMID:23483758

  19. Open access carotid duplex scanning: throughput and resultant surgical workload.

    PubMed Central

    Maughn, N.; Forbes, M.; Summersgill, A.; Bourne, A.; Clarke, J. M.; Cheatle, T. R.

    2000-01-01

    It is now generally accepted that high-quality duplex scanning obviates the need for pre-operative angiography in the assessment of most cases of carotid disease. An information leaflet was circulated to all general practitioners and hospital doctors in early 1996. Indications, results of treatment and details of the open access service were described. This paper outlines the workload that followed, for both imaging and surgical departments. PMID:11103161

  20. Onion skin technique for open surgical replacement of aortic arch following primary endoprothesic thoracic aorta treatment.

    PubMed

    Totaro, Pasquale; Raviola, Eliana; Veronesi, Roberto; Mazzola, Alessandro

    2014-02-01

    Endovascular aortic replacement (EVAR) techniques have become the first choice option for many aortic diseases in patients in whom standard open surgery was contraindicated or with high surgical risk. A secondary open surgical treatment, following a primary EVAR procedure, could, however, be challenging depending on the type, the extension and the position of primary endoprosthesis. Here, we describe an original and easy technique capable of simplifying a secondary aortic arch replacement following EVAR treatment of the descending thoracic aorta. The basic concept of such techniques is similar to that of the conventional 'elephant trunk' technique and is based on an inverted straight tube graft inserted into the endoprosthesis and anastomized using a multi-layer double suture with external strip felt of Dacron. PMID:23868952

  1. [Revision after surgical procedures in the middle ear and mastoid].

    PubMed

    Zelený, M; Navrátilová, A

    1989-03-01

    In a group of 46 revised operations the most frequent cause of revision was persisting secretion--in 41 patients. After elimination of general causes and after failure of conservative treatment, during revision the following local causes were revealed: relapse of cholesteatoma in 44%, inflammation of the residual or repneumatized spaces in 41%, ostitis of the long process of the incus in 10% and inflammation in the divided trepanation cavities in 5%. By the first revision the authors achieved a dry trepanation cavity in 58.5% of the operated patients. By the second and third revision they increased the number of dry trepanation cavities to 83% and in the remaining ones there was only an occasional secretion. The revision involved usually a more radical procedure. In some of the patients operated by the "closed" technique the authors changed to the "open" technique. A radical approach to the auditory ossicles and the ear drum, if they were preserved during the primary operation, led to a deterioration of hearing in 22 of 41 operated patients, i. e. in 53.66%. This is the cost of obtaining a dry trepanation cavity. PMID:2731259

  2. Catheter for Cleaning Surgical Optics During Surgical Procedures: A Possible Solution for Residue Buildup and Fogging in Video Surgery.

    PubMed

    de Abreu, Igor Renato Louro Bruno; Abrăo, Fernando Conrado; Silva, Alessandra Rodrigues; Corręa, Larissa Teresa Cirera; Younes, Riad Nain

    2015-05-01

    Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of "fog" or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics. PMID:26054990

  3. Open lung biopsy as an outpatient procedure

    Microsoft Academic Search

    Christopher J Blewett; W. Frederick Bennett; John D Miller; John D Urschel

    2001-01-01

    Background. Lung biopsies are frequently needed to diagnose diffuse interstitial lung diseases. Both limited thoracotomy (open lung biopsy) and thoracoscopy can be used for lung biopsies, but both procedures have traditionally required hospital admission. We report a series of patients that underwent outpatient open lung biopsy to show the safety and effectiveness of this practice.Methods. We reviewed records of ambulatory,

  4. Automated Tissue Retraction for Robot-Assisted Surgical Procedures Sachin Patil Ron Alterovitz

    E-print Network

    North Carolina at Chapel Hill, University of

    Automated Tissue Retraction for Robot-Assisted Surgical Procedures Sachin Patil Ron Alterovitz surgical task of tissue retraction, which involves grasping and lifting a thin layer of tissue to expose location for automated retraction of tissue flaps using a generic 6-DOF gripper. We use a nonlinear FEM

  5. A Workcell for the Development of Robot-Assisted Surgical Procedures

    Microsoft Academic Search

    Claudio Casadei; Sandra Martelli; Paolo Fiorini

    2000-01-01

    This paper describes a robotic workstation for the development of new robot-assisted surgical procedures. This work is motivated by the difficulties and cost associated to the development of surgical robots, often requiring large investments and several re-designs which limit wider use of this technology. The approach presented here consists of using a general purpose robotic workcell to develop the hardware

  6. Design and development of a tissue retractor for use in minimally invasive surgical procedures

    E-print Network

    Begg, Nikolai David Michael

    2009-01-01

    Laparoscopic surgery is a widespread and rapidly growing surgical technique. One of the challenges facing surgeons performing laparoscopic procedures is the retraction of anatomical structures that restrict vision and ...

  7. GiPSi: An Open Source\\/Open Architecture Software Development Framework for Surgical Simulation

    Microsoft Academic Search

    Tolga Gokce Goktekin; Murat Cenk Cavusoglu; Frank Tendick; Shankar Sastry

    2004-01-01

    In this paper we propose an open source\\/open architecture framework for developing organ level surgical simulations. Our goal is to facilitate shared development of reusable models, to accommodate heterogeneous models of computation, and to provide a framework for interfacing multiple heterogeneous models. The framework provides an intuitive API for interfacing dynamic models defined over spatial do- mains. It is specifically

  8. Retrospective analysis of minimal-incision, endoscopic, and open procedures for heel spur syndrome.

    PubMed

    Brekke, M K; Green, D R

    1998-02-01

    Forty-four patients with recalcitrant heel spur syndrome who underwent surgical correction (54 procedures) were studied retrospectively. The results of minimal-incision, endoscopic, and open plantar fasciotomy procedures were compared. This study focuses on patient satisfaction, pain reduction, convalescence, and postoperative problems. Although all procedure groups reported high degrees of patient satisfaction and reduction of pain, some notable differences among the three groups were observed. PMID:9503769

  9. Surgical management of hepatocellular carcinoma after Fontan procedure

    PubMed Central

    Kwon, Steve; Scovel, Lauren; Yeh, Matthew; Dorsey, David; Dembo, Gregory; Krieger, Eric V.; Bakthavatsalam, Ramassmy; Park, James O.; Riggle, Kevin M.; Riehle, Kimberly J.

    2015-01-01

    The Fontan operation has successfully prolonged the lives of patients born with single-ventricle physiology. A long-term consequence of post-Fontan elevation in systemic venous pressure and low cardiac output is chronic liver inflammation and cirrhosis, which lead to an increased risk of hepatocellular carcinoma (HCC). Surgical management of patients with post-Fontan physiology and HCC is challenging, as the requirement for adequate preload in order to sustain cardiac output conflicts with the low central venous pressure (CVP) that minimizes blood loss during hepatectomy. Consequently, liver resection is rarely performed, and most reports describe nonsurgical treatments for locoregional control of the tumors in these patients. Here, we present a multidisciplinary approach to a successful surgical resection of a HCC in a patient with Fontan physiology.

  10. MDCT in the diagnosis of small-bowel obstruction by a retained surgical swab.

    PubMed

    Bindapersad, M; Govender, N; Andronikou, S

    2012-02-01

    We describe a case report of gossypiboma (retained surgical swab), a rare occurrence secondary to a previous open surgical procedure. The incidence has been estimated at between 1 in 100 to 5 000 surgical procedures. PMID:22353318

  11. Method for separating patient and procedural factors while analyzing interdepartmental differences in rates of surgical infections: The Israeli study of surgical infection in abdominal operations

    Microsoft Academic Search

    E. Simchen; D. Zucker; Igra Y. Siegman; N. Galai

    1996-01-01

    The objective of this study was to develop a method for analyzing differences in the performance of hospitals with respect to outcome by separating patient factors from procedural factors. The setting included a prospective follow-up of a sample of 5571 patients undergoing all types of surgical procedures in general surgery departments of 11 hospitals (20 surgical departments) across Israel. Of

  12. Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure

    Microsoft Academic Search

    Attila Pavlik; Dezső Csépai; Péter Hidas

    2001-01-01

    We present our technique for surgically treating Tossy III acromioclavicular joint dislocation, discuss the indications for various procedures, and evaluate our postoperative results. We operated on 17 patients suffering from chronic acromioclavicular instability after such dislocation using a modified Weaver-Dunn procedure, in which there is no lateral clavicular end resection, the coracoacromial ligament graft is sutured to the inferior part

  13. “Reality Surgery” — A Research Ethics Perspective on the Live Broadcast of Surgical Procedures

    PubMed Central

    Williams, Judson B.; Mathews, Robin; D'Amico, Thomas A.

    2013-01-01

    In recent years, the live broadcasting of medical and surgical procedures has gained worldwide popularity. While the practice has appropriately been met with concerns for patient safety and privacy, many physicians tout the merits of real time viewing as a form of investigation, accelerating the process leading to adoption or abolition of newer techniques or technologies. This view introduces a new series of ethical considerations that need to be addressed. As such, this article considers, from a research ethics perspective, the use of live surgical procedure broadcast for investigative purposes. PMID:21292217

  14. Geographic variation in rates of selected surgical procedures within Los Angeles County.

    PubMed Central

    Carlisle, D M; Valdez, R B; Shapiro, M F; Brook, R H

    1995-01-01

    OBJECTIVE. We explore the contribution of income and ethnicity to geographic variation in utilization of surgical procedures. DATA SOURCES/STUDY SETTING. We assessed the use of eight procedures from 1986 through 1988 among residents of Los Angeles County using data from the California Discharge Dataset, the 1980 census, and other secondary sources. Procedures chosen for evaluation were coronary artery bypass grafting (CABG), coronary artery angioplasty, permanent pacemaker insertion, mastectomy, simple hysterectomy, transurethral prostate resection (TURP), carotid endarterectomy, and appendectomy. STUDY DESIGN. The amount of inter-zip code variation for each procedure was first measured using various estimates including the analysis of variance coefficient of variation (CVA). Population-weighted multivariate regression analysis was used to model variation in age- and gender-adjusted rates of procedure use among 236 residential zip codes. PRINCIPAL FINDINGS. Highest-variation procedures were coronary artery angioplasty (CVA = .392) and carotid endarterectomy (CVA = .374). The procedures with the lowest degree of variation were cardiac pacemaker implantation (CVA = .194) and hysterectomy (CVA = .195). Variation was significantly related to income (carotid endarterectomy) and either African American or Latino zip code ethnicity for all procedures except pacemaker implantation. For all procedures except appendectomy, the direction of the effect was toward fewer procedures with lower income. However, the effect of African American or Latino population ethnicity varied. CONCLUSIONS. In this large urban area both population ethnicity and socioeconomic status are significantly associated with the geographic utilization of selected surgical procedures. PMID:7721583

  15. Outcomes for incisional hernia repair in patients undergoing concomitant surgical procedures.

    PubMed

    Altom, Laura K; Graham, Laura A; Gray, Stephen H; Snyder, Christopher W; Vick, Catherine C; Hawn, Mary T

    2012-02-01

    The safety and efficacy of performing concomitant surgical procedures with an incisional hernia repair (IHR) is not well understood. There are conflicting reports on the outcomes for permanent mesh implantation in the setting of clean-contaminated procedures. The purpose of this study was to review the effect of concomitant surgical procedures on IHR outcomes. This is a retrospective multisite cohort of patients undergoing elective IHR at 16 Veterans Affairs hospitals from 1998 to 2002. Concomitant procedure status, hernia characteristics, and operative details were determined using physician-abstracted operative notes. Hernia outcomes of recurrence and mesh explantation were determined from the medical chart. ?(2) tests, Kaplan-Meier curves, and Cox regression were used to evaluate the effects of concomitant status on hernia outcomes. Of the 1495 elective IHRs, 75 (4.8%) were same site and 56 (3.8%) different site concomitant procedures. At median follow-up of 69.3 months (range 19.1-98.3), 33.6 per cent of patients had a recurrence, mesh explantation, or both. Permanent mesh placement was less likely among concomitant procedures as compared with nonconcomitant procedures (P < 0.0001). Adjusted Cox proportional hazards models of hernia outcomes resulted in an increased hazard for recurrence among same site clean procedures (Hazard Ratio (HR) = 1.8, P = 0.03) and an increased hazard for mesh explantation among same site clean-contaminated procedures (HR = 8.4, P = 0.002). Concomitant same site procedures are significantly associated with adverse hernia outcomes as compared with isolated IHR or IHR with other site concomitant procedures. The high failure rate of hernia repairs among same site concomitant procedures should be taken into account during the surgical decision-making process. PMID:22369837

  16. Abortion - surgical

    MedlinePLUS

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion uses a vacuum to remove the fetus and related pregnancy material from the uterus. The procedure is ...

  17. The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation.

    PubMed Central

    Bhatia, D S; Bowen, J C; Money, S R; Van Meter, C H; McFadden, P M; Kot, J B; Pridjian, A K; Ventura, H O; Mehra, M R; Smart, F W; Ochsner, J L

    1997-01-01

    OBJECTIVE: The authors present their experience with patients having undergone orthotopic heart transplantation (OHT) in whom surgical conditions subsequently developed that required operative intervention. The incidence, morbidity, and mortality of these procedures are reported. SUMMARY BACKGROUND DATA: Several studies have evaluated the management options of biliary tract disease after OHT. Multiple reports of patients having undergone OHT who subsequently underwent peripheral vascular reconstructions, plastic reconstructive, and thoracic procedures also have been published. METHODS: A chart review of 349 patients who underwent OHT between 1985 and 1996 was conducted to identify surgical procedures that were required in the post-transplant period. Their outcomes are reported. RESULTS: Of 349 patients who underwent OHT, conditions requiring 94 surgical procedures developed in 54 patients (15%). Biliary tract disease developed in 17 patients (5%) who required cholecystectomy, 2 of the 5 patients with acute cholecystitis died. Eight patients (2%) underwent orthopedic procedures with no operative mortality. Flap advancements for sternal wound infections were performed in five patients and four deaths occurred. Seventeen thoracic procedures were performed in 11 patients with an overall mortality of 45%. Twenty-one vascular procedures were performed on 17 patients with 1 delayed death due to a malignancy. Seven patients underwent procedures of the colon and rectum with no mortality. Seven patients underwent repair of inguinal or incisional hernias with no mortality. Various infections occurred with one resultant death after operative intervention. Six procedures were performed for diseases of the small intestine with no resultant mortalities. CONCLUSIONS: Patients having undergone OHT and chronic immunosuppression are at increased risk of having complications develop from infection. Acute cholecystitis and sternal wound infection caused an inordinate risk of complications and death. Malignancies developed in four patients who required surgical intervention. A heightened awareness of coexisting peripheral vascular disease in patients transplanted for ischemic cardiomyopathy should exist. Close screening before surgery and surveillance after surgery to identify risk factors for infection and vascular disease and to screen for malignancies are essential. PMID:9230809

  18. Surgical site infections in standard neurosurgery procedures- a study of incidence, impact and potential risk factors.

    PubMed

    Abu Hamdeh, Sami; Lytsy, Birgitta; Ronne-Engström, Elisabeth

    2014-04-01

    OBJECTIVES. Surgical site infections (SSIs) may be devastating for the patient and they carry high economic costs. Studies of SSI after neurosurgery report an incidence of 1-11%. However, patient material, follow-up time and definition of SSI have varied. In the present study we prospectively recorded the prevalence of SSI 3 months after standard intracranial neurosurgical procedures. The incidence, impact and risk factors of SSI were analysed. METHODS. We included patients admitted during 2010 to our unit for postoperative care after standard neurosurgical procedures. SSI was defined as evident with positive cultures from surgical samples or CSF, and/or purulent discharge during reoperation. Follow-up was done after 3 and 12 months and statistics was obtained after 3 months. The predictive values on the outcome of demographic and clinical factors describing the surgical procedure were evaluated using linear regression. RESULTS. A total of 448 patients were included in the study and underwent a total of 466 procedures. Within 3 and 12 months, 33 and 88 patients, respectively, had died. Of the surviving patients, 20 (4.3% of procedures) developed infections within 3 months and another 3 (4.9% of procedures) within 12 months. Risk factors for SSI were meningioma, longer operation time, craniotomy, dural substitute, and staples in wound closure. Patients with SSI had significantly longer hospital stay. Multivariate analysis showed that factors found significant in univariate analysis frequently occur together. DISCUSSION. We studied the prevalence of SSI after 3 and 12 months in a prospective 1-year material with standard neurosurgical procedures and found it to be 4.3% and 4.9%, respectively. The analysis of the results showed that a combination of parameters indicating a longer and more complicated procedure predicted the development of SSI. Our conclusion is that the prevention of SSI has to be done at many levels, especially with patients undergoing long surgical procedures. PMID:24588653

  19. Raven-II: an open platform for surgical robotics research.

    PubMed

    Hannaford, Blake; Rosen, Jacob; Friedman, Diana W; King, Hawkeye; Roan, Phillip; Cheng, Lei; Glozman, Daniel; Ma, Ji; Kosari, Sina Nia; White, Lee

    2013-04-01

    The Raven-II is a platform for collaborative research on advances in surgical robotics. Seven universities have begun research using this platform. The Raven-II system has two 3-DOF spherical positioning mechanisms capable of attaching interchangeable four DOF instruments. The Raven-II software is based on open standards such as Linux and ROS to maximally facilitate software development. The mechanism is robust enough for repeated experiments and animal surgery experiments, but is not engineered to sufficient safety standards for human use. Mechanisms in place for interaction among the user community and dissemination of results include an electronic forum, an online software SVN repository, and meetings and workshops at major robotics conferences. PMID:23204264

  20. Remifentanil-based anesthesia versus a propofol technique for otologic surgical procedures.

    PubMed

    Jellish, W S; Leonetti, J P; Avramov, A; Fluder, E; Murdoch, J

    2000-02-01

    Otologic procedures require a still surgical field and are associated with a 50% incidence of emetic symptoms. Propofol reduces nausea and vomiting but not intraoperative movement. This study compares a remifentanil/propofol anesthetic to a propofol/fentanyl combination to determine which provides the best perioperative conditions for otologic microsurgery. Eighty healthy patients were randomly assigned to receive one of the anesthetic combinations. Demographic data, hemodynamic variables, movement, and bispectral index monitoring values in addition to anesthetic emergence, nausea, vomiting, pain, and other recovery variables were compared between groups with appropriate statistical methods. Both groups were similar. Times to eye opening (7.7 +/- 0.7 vs 12.4 +/- 1.2 minutes) and extubation (9.8 +/- 0.9 vs 12.4 +/- 1.0 minutes) were shorter with remifentanil. This group also had lower hemodynamic variables and movement (23% vs 65%) under anesthesia. Postoperative pain was mild in both groups, but remifentanil patients had more than the propofol group. All other postoperative parameters were similar. Remifentanil-based anesthesia produces better hemodynamic stability, less movement, and faster emergence after otologic surgery, with propofol's antiemetic effect, for the same cost. PMID:10652394

  1. The modified Broström-Gould procedure--early results using a newly described surgical technique.

    PubMed

    Molloy, Andy P; Ajis, Adam; Kazi, Hussain

    2014-09-01

    Ankle lateral ligament injuries are one of the most common sporting injuries, with the majority being successfully treated conservatively. However, reconstruction is required if this fails. We present the clinical results of a newly described surgical technique of triple-breasting the lateral ligament complex using suture anchors. Sixteen patients (18 ankles) were treated with this new technique. The mean duration of symptoms was 77 months. The mean follow-up was 25 months. All patients underwent an arthroscopy followed by lateral ligament reconstruction by this new technique. Additional pathology included osteoarthritis (2), ankle impingement due to anterior cheilus (2), osteochondral defects (3) and non-union of fracture of anterior process of calcaneus. Additional procedures above diagnostic arthroscopy, soft tissue debridement and modified Broström-Gould repair included debridement and microfracture (3), open excision of anterior calcaneal process (1) and arthroscopic anterior ankle cheilectomy (2). At final follow-up, all ankles were subjectively and objectively stable. Mean AOFAS score improved from 53 to 88. This was statistically significant (p<0.05). Eight patients had resumed normal pre-injury level of activities (including sports), 8 had some reduction in normal level of activity. The early results of our modification show it to be safe, successful and comparable with previously published series with all patients having objectively and subjectively stable ankles at final follow-up. PMID:25103713

  2. Pathologic comparison of video-assisted thoracic surgical lung biopsy with traditional open lung biopsy

    Microsoft Academic Search

    Mitsutaka Kadokura; Thomas V. Colby; Jeffrey L. Myers; Mark S. Allen; Claude Deschamps; Victor F. Trastek; Peter C. Pairolero

    1995-01-01

    Video-assisted thoracic surgical lung biopsy is an alternative to traditional open lung biopsy for diagnosis in patients with pleuropulmonary diseases. Between January 7, 1991, and August 3, 1993, 71 consecutive patients had video-assisted thoracic surgical lung biopsy and 42 patients had traditional open lung biopsy. A specific histologic diagnosis that correlated with the clinical findings was sought in each case

  3. Superior vena cava syndrome of malignant origin. Which surgical procedure for which diagnosis?

    Microsoft Academic Search

    Henri Porte; David Metois; Laetitia Finzi; Gilles Lebuffe; Anne Guidat; Massimo Conti; Alain Wurtz

    2000-01-01

    Objective: Since some malignancies causing superior vena cava syndrome (SVCS) are only sensitive to a specific treatment regimen, it is crucial to diagnose the underlying pathology in such cases. The aim of the present study was to review the surgical procedures used to establish the aetiology of SVCS of a malignant origin. Methods: This retrospective study was based on a

  4. Validation study of a computer-based open surgical trainer: SimPraxis® simulation platform

    PubMed Central

    Tran, Linh N; Gupta, Priyanka; Poniatowski, Lauren H; Alanee, Shaheen; Dall’Era, Marc A; Sweet, Robert M

    2013-01-01

    Background Technological advances have dramatically changed medical education, particularly in the era of work-hour restrictions, which increasingly highlights a need for novel methods to teach surgical skills. The purpose of this study was to evaluate the validity of a novel, computer-based, interactive, cognitive simulator for training surgeons to perform pelvic lymph node dissection (PLND). Methods Eight prostate cancer experts evaluated the content of the simulator. Contextual aspects of the simulator were rated on a five-point Likert scale. The experts and nine first-year residents completed a simulated PLND. Time and deviations were logged, and the results were compared between experts and novices using the Mann–Whitney test. Results Before training, 88% of the experts felt that a validated simulator would be useful for PLND training. After testing, 100% of the experts felt that it would be more useful than standard video training. Eighty-eight percent stated that they would like to see the simulator in the curriculum of residency programs and 56% thought it would be useful for accreditation purposes. The experts felt that the simulator aided in overall understanding, training indications, concepts and steps of the procedure, training how to use an assistant, and enhanced the knowledge of anatomy. Median performance times taken by experts and interns to complete a PLND procedure on the simulator were 12.62 and 23.97 minutes, respectively. Median deviation from the incorporated procedure pathway for experts was 24.5 and was 89 for novices. Conclusion We describe an interactive, computer-based simulator designed to assist in mastery of the cognitive steps of an open surgical procedure. This platform is intuitive and flexible, and could be applied to any stepwise medical procedure. Overall, experts outperformed novices in their performance on the trainer. Experts agreed that the content was acceptable, accurate, and representative. PMID:23745097

  5. [Thin perforator flaps elevated in the plane of the superficial fascia: Principle and surgical procedure].

    PubMed

    Qassemyar, Q; Delobaux, A

    2015-06-01

    Perforator flaps have an ever growing place in reconstructive surgery and classical surgical procedures describe sub or supra-fascial plane elevation. In some indications, defatting of perforator flaps may be necessary and different methods have been described, primary or secondary, but may expose to partial loss of the flap or to another operation. Recently, a new method of perforator flap elevation in the plane of the superficial fascia has been described. This method permits to obtain a thin and reliable flap in the same procedure without the need of debulking and while decreasing donor site morbidity. We present the principle and the surgical procedure of this new method. Advantages and drawbacks are discussed with the help of clinical cases. PMID:25201098

  6. Treatment of Wolff-Parkinson-White Syndrome With a Thoracoscopic Surgical Procedure.

    PubMed

    Tanoue, Motoko; Sakamoto, Shun-Ichiro; Miyauchi, Yasushi; Usuda, Jitsuo; Nitta, Takashi

    2015-07-01

    Thoracoscopic surgery for the treatment of Wolff-Parkinson-White syndrome is rare. We report a case of thoracoscopic surgical ablation of the epicardial pathway in a 13-year-old female patient. Intraoperative electroanatomic mapping was performed to identify the exact location of accessory electrical conduction in the right atrioventricular groove. Stamping ablation using a bipolar radiofrequency pen device achieved irreversible disappearance of the delta wave. Eight months after the surgical procedure, there has been no recurrence of arrhythmia in this patient. PMID:26140800

  7. Pesamosca osteoplasty: surgical procedure for the spatial correction of cubitus varus or valgus post malunited supracondylar fractures of the humerus

    PubMed Central

    Burnei, G; Gavriliu, ?; Nepaliuc, I; Vlad, C; Dr?goescu, M; Georgescu, I; Ghita, RA; Muntean, L; Pârvan, AA; Dughil?, C; ?iripa, I; Hamei, ?; Klinaku, I

    2014-01-01

    Introduction. Supracondylar fractures of the humerus represent a current concern in the child’s and adolescent’s osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in “Prof. Dr. Alexandru Pesamosca” Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation. Material and method. The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications – 28 out of 96 (29.1%) – were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure. Results. The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow’s mobility was completely recovered, the thoracic member’s axis was appropriate and the metaphyseal diaphyseal osteotomy site healed completely in 3 months’ time. Conclusions. Compared to other surgical techniques, the Pesamosca technique offers to the surgeon the possibility of correcting the varus or the valgus deformity as well as the malrotation in a simple, secure and efficient manner. PMID:25713629

  8. Concomitant surgical procedures for coronary artery disease and intraperitoneal double cancers: Report of a case

    Microsoft Academic Search

    Masahiko Taniguchi; Wataru Kamiike; Toshiki Takahashi; Kazuhiro Iwase; Namiko Ishikawa; Toyokazu Aono; Norihide Fukushima; Keishi Kadoba; Kazuhiro Taniguchi; Hikaru Matsuda

    1997-01-01

    Concomitant surgical procedures for coronary artery disease and double cancers are reported. A 61-year-old man with severe\\u000a triple-vessel coronary disease was found to have early gastric cancer and advanced rectal cancer. We successfully performed\\u000a a concomitant coronary artery bypass graft using an extracorporeal ultrafiltration membrane and curative surgery for both\\u000a cancers. Concomitant surgery thus appears to be a benefical and

  9. Open evacuation of pus: a satisfactory surgical approach to the problem of brain abscess?

    Microsoft Academic Search

    R S Maurice-Williams

    1983-01-01

    The operative management of intracerebral abscesses remains controversial, with both primary radical excision and repeated aspiration having their advocates. This paper describes a surgical technique which combines the advantages while avoiding the disadvantages of the two surgical approaches. At open operation the abscess is widely incised, all pus removed from within the capsule and any daughter loculi under direct vision

  10. Surgical Technique for Spinal Cord Delivery of Therapies: Demonstration of Procedure in Gottingen Minipigs

    PubMed Central

    Federici, Thais; Hurtig, Carl V.; Burks, Kentrell L.; Riley, Jonathan P.; Krishna, Vibhor; Miller, Brandon A.; Sribnick, Eric A.; Miller, Joseph H.; Grin, Natalia; Lamanna, Jason J.; Boulis, Nicholas M.

    2012-01-01

    This is a compact visual description of a combination of surgical technique and device for the delivery of (gene and cell) therapies into the spinal cord. While the technique is demonstrated in the animal, the procedure is FDA-approved and currently being used for stem cell transplantation into the spinal cords of patients with ALS. While the FDA has recognized proof-of-principle data on therapeutic efficacy in highly characterized rodent models, the use of large animals is considered critical for validating the combination of a surgical procedure, a device, and the safety of a final therapy for human use. The size, anatomy, and general vulnerability of the spine and spinal cord of the swine are recognized to better model the human. Moreover, the surgical process of exposing and manipulating the spinal cord as well as closing the wound in the pig is virtually indistinguishable from the human. We believe that the healthy pig model represents a critical first step in the study of procedural safety. PMID:23242422

  11. The surgical results of the pubovaginal sling procedure using Intravaginal Slingplasty (IVS) for stress urinary incontinence

    Microsoft Academic Search

    Erem Kaan Basok; Asif Yildirim; Necmettin Atsu; Cenk Gurbuz; Resit Tokuc

    2006-01-01

    Objective: We investigated the surgical results and complications of the Intravaginal Slingplasty (IVS) procedure in women\\u000a with stress urinary incontinence. Patients and methods: A total of 72 women with urethral hypermobility underwent the pubovaginal\\u000a sling procedure using IVS with a mean age of 50.35±9.07 years. Average Body Mass Index, mean parity and daily mean pad usage\\u000a was 29.2±3.5, 3.7±1.74 and 2.9±1.76,

  12. [Characteristics of anesthesia in patients with osteogenesis imperfecta undergoing orthopedic surgical procedures].

    PubMed

    Tripkovi?, Branko; Anti?evi?, Darko; Buljan, Melita; Jakovina-Blažekovi?, Sanja; Oreškovi?, Zrinka; Kubat, Ozren

    2014-01-01

    The aim is to show our experience in anesthesia of patients with osteogenesis imperfecta (OI) who have undergone orthopedic surgical procedures. This is a retrospective analysis of OI patients treated at our Department from 1980 to 2012. We analyzed demographics, comorbidities, preoperative characteristics, anesthesia types, anesthetics and intraoperative and postoperative complications. In the given period, 26 OI patients were treated, using 103 surgeries, and 103 anesthesia procedures. Most procedures, a total of 68, were used in children aged 0-10 years. According to the diagnosis, OI type III was mostly encountered. The rating of the American Society of Anesthesiologist (ASA) physical status was II in most cases, a total of 99. General anesthesia was used in 89 cases, and regional anesthesia in 14. Fourteen intraoperative complications were seen, mostly difficult intubation, and six postoperative cardiovascular instability cases. With careful preparation, and knowledge of pitfalls, anesthesia in these patients should be a safe procedure. PMID:25632774

  13. Open surgical excision of subglottic hemangioma in children

    Microsoft Academic Search

    Brian J. Wiatrak; James S. Reilly; Allan B. Seid; Seth M. Pransky; Jasper V. Castillo

    1996-01-01

    Subglottic hemangioma is an unusual entity which may involute spontaneously without aggressive surgical intervention; although tracheotomy is sometimes necessary. The actual time course for involution is not clear by reviewing the literature [1,14]. Numerous treatment modalities are described for the treatment of this condition, including tracheotomy, CO2 laser ablation and intralesional steroid injection with or without endotracheal intubation. Surgical resection

  14. Prophylactic atrial arrhythmia surgical procedures with congenital heart operations: review and recommendations.

    PubMed

    Mavroudis, Constantine; Stulak, John M; Ad, Niv; Siegel, Allison; Giamberti, Alessandro; Harris, Louise; Backer, Carl L; Tsao, Sabrina; Dearani, Joseph A; Weerasena, Nihal; Deal, Barbara J

    2015-01-01

    Specific congenital heart anomalies significantly increase the risk for late atrial arrhythmias, raising the question whether prophylactic arrhythmia operations should be incorporated into reparative open heart procedures. Currently no consensus exists regarding standard prophylactic arrhythmia procedures. Questions remain concerning the arrhythmia-specific lesions to perform, energy sources to use, need for atrial appendectomy, and choosing a right, left, or biatrial Maze procedure. These considerations are important because prophylactic arrhythmia procedures are performed without knowing if the patient will actually experience an arrhythmia. This review identifies congenital defects with a risk for the development of atrial arrhythmias and proposes standardizing lesion sets for prophylactic arrhythmia operations. PMID:25442995

  15. Complications of laparoscopic versus open bariatric surgical interventions in obesity management.

    PubMed

    Yin, Jian; Hou, Xuhui

    2014-11-01

    With the epidemic of obesity fast spreading its grasp throughout the world, the medical professionals of diverse facilities need to be called on for better management to prevent its further progression. In particular, the gastroenterologists have a major role to play in all aspects of obese patient care. They should be able to recognize and treat obesity and associated disorders through the understanding and assessment of the various benefits and risks linked with a particular type of obesity treatment option. While treating these problems, a better understanding of the physiologic and anatomic alterations that might be associated with the treatment procedure and the weight loss-linked problems in association with the method of surgical intervention need to be weighed. Morbid obesity has been efficaciously treated by bariatric surgery promoting weight loss considerably and reducing the obesity-associated risks such as certain cancers, diabetes, cardiovascular disease, and all-cause mortality. Bariatric surgery has been performed traditionally through open method or, the more recent and popular form, laparoscopically that involves only a small incision in the abdomen. The laparoscopic bariatric surgery has become the surgical method of choice since its introduction in 1993 and has immediately crossed open surgery in terms of popularity. Drastic numbers came out when the two methods were compared for their applicability during a 3-year period in the United States. Only 6,000 reported open gastric bypass surgeries were recorded, but the number soared to nearly 16,000 for laparoscopic gastric bypass surgeries. The laparoscopic method has been found to be associated with much reduced complications and hospital stay along with lower cases of mortality as suggested by small randomized controlled trials and observational studies. However, these facts need to be reassessed through large-sized controlled trials and population-based studies. In addition, the previously ignored complications associated with laparoscopic methods should be studied in detail. Since the cases of obesity have been ever increasing and bariatric surgery is also gaining in popularity, it is important that the safest procedure should be identified. The main objective of this review was to compare the benefits and risks associated with open versus laparoscopic mode of bariatric surgery with a greater focus on the laparoscopic method. Although there are few reviews that have compared the two methods, none have focused on the complications of the two approaches. All these aspects have been dealt in detail here. PMID:24906233

  16. Urethral complications after tension-free vaginal tape procedures: A surgical management case series

    PubMed Central

    Sergouniotis, Fotios; Jarlshammar, Björn; Larsson, Per-Göran

    2015-01-01

    AIM: To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures. METHODS: This study encompasses a retrospective review of nine patients presented with urethral complications after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset (< 12 mo) or late onset (> 12 mo) according to when they were first reported. RESULTS: Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence (7/9 patients), urinary retention/voiding dysfunction (4/9 patients), urethritis (4/9 patients), relapse of stress-incontinence (3/9 patients), recurrent urinary tract infections (5/9 patients), and hematuria (1/9 patient). In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures. CONCLUSION: Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.

  17. Development of an outcome/variance tracking tool for sedation and non-surgical procedures.

    PubMed

    Gruber, M; Molke, K L; Siegel, E; DeJesus, Y; Roquemore, J; Shannon, V; Porche, V H; Luther, K M

    2001-01-01

    A large academic cancer center devised a performance improvement plan for special procedures and sedation. A group of interdisciplinary professionals convened to address data collection, complications, and outcomes for non-surgical procedures and sedation. Administrative, medical, and nursing representatives from all areas in which these procedures are performed gathered to assess existing data and data collection methods and to develop an improvement plan. Gastroenterology, pulmonary, diagnostic imaging, intensive care, gynecology, genitourinary, hematology, and anesthesiology specialties were represented. The group was facilitated by staff from the institution's Office of Performance Improvement and co-chaired by an anesthesiologist and a pulmonary specialist. A representative from the Practice Outcomes Department was also an active participant. This article describes group process, design efforts, pilot testing, and analyses for this project. Pilot data are presented as well as a discussion of staff involvement. PMID:11837212

  18. Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer

    PubMed Central

    He, Xiao-Dong; Li, Jing-Jing; Liu, Wei; Qu, Qiang; Hong, Tao; Xu, Xie-Qun; Li, Bing-Lu; Wang, Ying; Zhao, Hai-Tao

    2015-01-01

    AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis (TNM) staging system. METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system (AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy (or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm non-neoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient’s circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. Kaplan-Meier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was considered statistically significant. RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage?I, 25 cases of stage II, 21 cases of stage IIIA, 21 cases of stage IIIB, 24 cases of stage IVA, 43 cases of stage IVB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and?I?disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy (P = 0.826). The prognosis of stage II patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage III patients, radical cholecystectomy was significantly superior to other surgical options (P < 0.05). For stage IVA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage IVB, patients who underwent palliative resection significantly outlived those with non-surgical treatment (P < 0.01) CONCLUSION: For stages 0 and?I?patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages II and III patients. PMID:25914471

  19. GiPSi: A Framework for Open Source\\/Open Architecture Software Development for Organ-Level Surgical Simulation

    Microsoft Academic Search

    Murat Cenk Cavusoglu; Tolga Goktekin; Frank Tendick

    2006-01-01

    This paper presents the architecture details of an evolving open source\\/open architecture software framework for developing organ level surgical simulations. Our goal is to facilitate shared development of reusable models, to accommo- date heterogeneous models of computation, and to provide a framework for interfacing multiple heterogeneous models. The framework provides an API for interfacing dynamic models defined over spatial domains.

  20. A review of the tragal pointer: anatomy and its importance as a landmark in surgical procedures.

    PubMed

    Muhleman, M A; Wartmann, C T; Hage, R; Matusz, P; Shoja, M M; Tubbs, R S; Loukas, M

    2012-05-01

    The tragal pointer has long been used as a surgical landmark for the identification of the facial nerve trunk and the maxillary artery in such procedures as parotidectomy, internal fixation of subcondylar and condylar fractures, mandibular osteotomy, temporomandibular joint arthroplasty, and percutaneous blocks of branches of the trigeminal nerve and pterygopalatine ganglion. Aside from its use as an external landmark, it has also been implicated as a contributor to crease formation in the presence of peripheral arterial disease. This article will review the available literature on the tragal pointer's use as an external landmark. PMID:22648581

  1. Patient safety in dermatologic surgery: Part I. Safety related to surgical procedures.

    PubMed

    Hansen, Timothy J; Lolis, Margarita; Goldberg, David J; MacFarlane, Deborah F

    2015-07-01

    Surgical procedures involve unique elements related to patient safety. One must be aware of potential complications and safety issues within the practice of dermatologic surgery. Developing a high level of competence in skin surgery will address some safety issues, while implementing protocols and redundancies provides systems-based correction for other safety issues. We provide an in-depth review of patient safety in dermatologic surgery. In particular, we highlight the most common safety issues and methods for reducing error. PMID:26089045

  2. Is There a Need for New Surgical Procedures for Glaucoma? Yes!

    PubMed Central

    Spaeth, George L; Cvintal, Victor; Figueiredo, Ana

    2015-01-01

    The only method to slow or stop progressive damage caused by glaucoma, the leading cause of irreversible blindness, definitively shown to be effective, is lowering intraocular pressure, though there is also evidence that stabilizing the pressure may be beneficial. Performing surgery on the eye has proven effective in some cases, using various techniques, though with variable frequencies of success (stabilization of the disease) and various frequencies and severities of complications. Surgery offers the great advantage of longer duration of action than medicinal treatments presently available, and, also, of lessening the need of the patient to be faithful using suggested medications. There is a need to develop surgical procedures which will be effective in 1) lowering or stabilizing intraocular pressure in a way most likely to prevent glaucomatous deterioration, 2) causing the fewest and least severe problems, and 3) being the most economical. Recent efforts in this regard are promising, but not yet proven superior to well-performed trabeculectomy, itself an evolving procedure.

  3. Pressure Ulcer Prevalence and Risk Factors among Prolonged Surgical Procedures in the OR

    PubMed Central

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2015-01-01

    Pressure ulcer formation related to positioning in the OR increases length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admit patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (?2 = 7.897, P = .048), OR bed surface (ie, foam table pad) (?2 15.848, P = .000), skin assessment in the postanesthesia care unit (?2 = 41.652, P = .000), and male gender (?2 = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that use of foam pad (B = 2.691, P = .024) and a lower day-one Braden score (B = .244, P = .003) were predictive of pressure ulcers. PMID:22118201

  4. Anaesthesia for ophthalmologic surgical procedures in a patient with advanced amyotrophic lateral sclerosis: a case report

    PubMed Central

    Kowalik, Maciej M; Smiatacz, Tomasz; Pajuro, Robert; Skowro?ski, Roman; Trocha, Hanna; Nyka, Walenty; Raczy?ska, Krystyna; Wujtewicz, Maria

    2008-01-01

    Introduction Anaesthesia procedures for surgical interventions in patients with amyotrophic lateral sclerosis (ALS) are not commonly found in clinical practice, and often have special considerations that must be taken into account in treatment planning. As a result, these procedures are rarely subject to publication, rendering it difficult for the anaesthesiologists to find useful and reliable information on this topic. ALS also presents a contraindication to the use of nondepolarising neuromuscular blocking drugs during general anaesthesia. Case presentation In the case presented here, a 52-year old, White man, the progression of the disease to tetraparesis and respiratory failure, in addition to having the patient on chronic mechanical ventilation support, provided additional challenges to the handling team. The maturation of cataracts severely impaired communication with the patient, and surgical treatment of the cataract presented the only means to save communication. Such interventions are generally performed under local anaesthesia with the advice of the attending anaesthesiologist. However, in this case the patients' announcements during the operation would be unreadable to the advising anaesthesiologist. Here, the authors share experiences from a successfully applied combination of topical and general anaesthesia for two cataract operations and a vitrectomy. This was tolerated well by the patient, and without any side-effects. Conclusion The applied treatment resulted in a substantial improvement of the vision and allowed communication to be maintained with the patient. PMID:19021894

  5. Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension

    PubMed Central

    Yang, Lin; Yuan, Li-Juan; Dong, Rui; Yin, Ji-Kai; Wang, Qing; Li, Tao; Li, Jiang-Bin; Du, Xi-Lin; Lu, Jian-Guo

    2013-01-01

    AIM: To determine the clinical value of a splenorenal shunt plus pericardial devascularization (PCVD) in portal hypertension (PHT) patients with variceal bleeding. METHODS: From January 2008 to November 2012, 290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding: 207 patients received a routine PCVD procedure (PCVD group), and 83 patients received a PCVD plus a splenorenal shunt procedure (combined group). Changes in hemodynamic parameters, rebleeding, encephalopathy, portal vein thrombosis, and mortality were analyzed. RESULTS: The free portal pressure decreased to 21.43 ± 4.35 mmHg in the combined group compared with 24.61 ± 5.42 mmHg in the PCVD group (P < 0.05). The changes in hemodynamic parameters were more significant in the combined group (P < 0.05). The long-term rebleeding rate was 7.22% in the combined group, which was lower than that in the PCVD group (14.93%), (P < 0.05). CONCLUSION: Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT. It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered. PMID:24409071

  6. Long-Term Surgical Results of Pubovaginal Sling Procedure Using Polypropylene Mesh in the Treatment of Stress Urinary Incontinence

    Microsoft Academic Search

    Hann-Chorng Kuo

    2005-01-01

    Introduction: Surgery for stress urinary incontinence (SUI) in women might cure incontinence symptom butdevelop new problems. This study assessed the long-term outcome of pubovaginal sling procedure using polypropylene mesh in patients with SUI. Materials and Methods: A total of 108 patients with various types of SUI received pubovaginal sling procedure using polypropylene mesh. A surgical technique that did not create

  7. Renal autotransplantation in open surgical repair of suprarenal abdominal aortic aneurysm

    PubMed Central

    Min, Eun-Ki; Kim, Young Hoon; Han, Duck Jong; Han, Youngjin; Kwon, Hyunwook; Choi, Byung Hyun; Park, Hojong; Choi, Ji Yoon; Kwon, Tae-Won

    2015-01-01

    Although the standard treatment of abdominal aortic aneurysm has shifted from open surgery to endovascular repair, open surgery has remained the standard of care for complex aneurysms involving the visceral arteries and in patients unsuitable for endovascular aneurysm repair. Postoperative renal insufficiency may occur after open surgical repair of suprarenal abdominal aortic aneurysm. Methods of minimizing renal ischemic injury include aortic cross-clamping and renal reconstruction techniques. This report describes the use of renal autotransplantation for renal reconstruction during open surgical repair of a suprarenal abdominal aortic aneurysm. This technique was successful, suggesting its feasibility for open suprarenal abdominal aortic aneurysm repair, minimizing renal ischemic injury and optimizing postoperative renal function. PMID:26131445

  8. Coblation: a new technology and technique for skin resurfacing and other aesthetic surgical procedures.

    PubMed

    Mancini, P F

    2001-01-01

    After years performing CO2 laser skin resurfacing, I started testing a new technology based on the modification of a bipolar electrosurgical unit in 1998. This technology called Coblation works by a radiofrequency mechanism and from the beginning it showed many advantages over lasers. My histologic and clinical preliminary results have already been published, but now, with a larger group and a 2-year follow-up, I can state that this new device is very effective and safe for skin resurfacing. The device works at low temperatures, avoiding the great thermal injury of a CO2 laser, but is able to cause some damage in the superficial dermis. The working temperature is high enough to cause shrinkage of collagen and the dermal damage promotes the deposition of new collagen during the postoperative months. During surgery, Coblation can act as an electrosurgical unit and can coagulate the small vessels, achieving a bloodless surgical field. The clinical results show good, long-term results with a short and comfortable recovery period and minimal complications. I combined this resurfacing with face lifts without any special problems. The new cutting-coagulating terminals allow this new technology to be used in other surgical procedures, like transconjunctival blepharoplasties. The Coblation transconjunctival blepharoplasty, combined with Coblation resurfacing, seems to be very effective, with fast healing, due to the low temperatures used during the procedure, and a good aesthetic result. The device is small, light, and it is safer than a laser since it doesn't need any safety measures, such as goggles. After two years and more than 80 patients, I can state that Coblation is a very good alternative to laser skin resurfacing and that it will be used for many other aesthetic surgery procedures in the future. PMID:11692253

  9. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    PubMed Central

    Lühmann, Dagmar; Burkhardt-Hammer, Tatjana; Borowski, Cathleen; Raspe, Heiner

    2005-01-01

    Introduction In up to 30% of patients undergoing lumbar disc surgery for herniated or protruded discs outcomes are judged unfavourable. Over the last decades this problem has stimulated the development of a number of minimally-invasive operative procedures. The aim is to relieve pressure from compromised nerve roots by mechanically removing, dissolving or evaporating disc material while leaving bony structures and surrounding tissues as intact as possible. In Germany, there is hardly any utilisation data for these new procedures – data files from the statutory health insurances demonstrate that about 5% of all lumbar disc surgeries are performed using minimally-invasive techniques. Their real proportion is thought to be much higher because many procedures are offered by private hospitals and surgeries and are paid by private health insurers or patients themselves. So far no comprehensive assessment comparing efficacy, safety, effectiveness and cost-effectiveness of minimally-invasive lumbar disc surgery to standard procedures (microdiscectomy, open discectomy) which could serve as a basis for coverage decisions, has been published in Germany. Objective Against this background the aim of the following assessment is: Based on published scientific literature assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery compared to standard procedures. To identify and critically appraise studies comparing costs and cost-effectiveness of minimally-invasive procedures to that of standard procedures. If necessary identify research and evaluation needs and point out regulative needs within the German health care system. The assessment focusses on procedures that are used in elective lumbar disc surgery as alternative treatment options to microdiscectomy or open discectomy. Chemonucleolysis, percutaneous manual discectomy, automated percutaneous lumbar discectomy, laserdiscectomy and endoscopic procedures accessing the disc by a posterolateral or posterior approach are included. Methods In order to assess safety, efficacy and effectiveness of minimally-invasive procedures as well as their economic implications systematic reviews of the literature are performed. A comprehensive search strategy is composed to search 23 electronic databases, among them MEDLINE, EMBASE and the Cochrane Library. Methodological quality of systematic reviews, HTA reports and primary research is assessed using checklists of the German Scientific Working Group for Health Technology Assessment. Quality and transparency of cost analyses are documented using the quality and transparency catalogues of the working group. Study results are summarised in a qualitative manner. Due to the limited number and the low methodological quality of the studies it is not possible to conduct metaanalyses. In addition to the results of controlled trials results of recent case series are introduced and discussed. Results The evidence-base to assess safety, efficacy and effectiveness of minimally-invasive lumbar disc surgery procedures is rather limited: Percutaneous manual discectomy: Six case series (four after 1998) Automated percutaneous lumbar discectomy: Two RCT (one discontinued), twelve case series (one after 1998) Chemonucleolysis: Five RCT, five non-randomised controlled trials, eleven case series Percutaneous laserdiscectomy: One non-randomised controlled trial, 13 case series (eight after 1998) Endoscopic procedures: Three RCT, 21 case series (17 after 1998) There are two economic analyses each retrieved for chemonucleolysis and automated percutaneous discectomy as well as one cost-minimisation analysis comparing costs of an endoscopic procedure to costs for open discectomy. Among all minimally-invasive procedures chemonucleolysis is the only of which efficacy may be judged on the basis of results from high quality randomised controlled trials (RCT). Study results suggest that the procedure maybe (cost)effectively used as an intermediate therapeutical option between conservative and operative management of small lumbar disc herniations

  10. Indications to open surgical repair of the thoracic aorta in the "endovascular" era.

    PubMed

    Gaudric, J; Jouhannet, C; Dennery, M; Kagan, N; Chiche, L; Koskas, F

    2015-10-01

    Endovascular techniques have deeply modified the indications to open surgical repair in nearly all the vascular tree and especially in areas where the invasiveness of open surgery is real like the thoracic aorta. However their anatomical and technological limits on one hand and uncertainty on their long term results on the other hand still leave a large place for open surgery. Also, immediate as well as late results of open surgery have continued their progress during the endovascular era, rendering it competitive in trained centers for fit selected patients. PMID:25896513

  11. Clinical Application of Diode Laser (980?nm) in Maxillofacial Surgical Procedures.

    PubMed

    Aldelaimi, Tahrir N; Khalil, Afrah A

    2015-06-01

    For many procedures, lasers are now becoming the treatment of choice by both clinicians and patients, and in some cases, the standard of care. This clinical study was carried out at Department of Maxillofacial Surgery, Ramadi Teaching Hospital, Rashid Private Hospital and Razi Private Hospital, Anbar Health Directorate, Anbar Province, Iraq. A total of 32 patients including 22 (?70%) male and 10 (?30%) female with age range from 5 months to 34 years old. Chirolas 20W diode laser emitting at 980 nm was used. Our preliminary clinical findings include sufficient hemostasis, coagulation properties, precise incision margin, lack of swelling, bleeding, pain, scar tissue formation and overall satisfaction were observed in the clinical application. The clinical application of the diode (980 nm) laser in maxillofacial surgery proved to be of beneficial effect for daily practice and considered practical, effective, easy to used, offers a safe, acceptable, and impressive alternative for conventional surgical techniques. PMID:26080161

  12. Non-photorealistic rendering of virtual implant models for computer-assisted fluoroscopy-based surgical procedures

    NASA Astrophysics Data System (ADS)

    Zheng, Guoyan

    2007-03-01

    Surgical navigation systems visualize the positions and orientations of surgical instruments and implants as graphical overlays onto a medical image of the operated anatomy on a computer monitor. The orthopaedic surgical navigation systems could be categorized according to the image modalities that are used for the visualization of surgical action. In the so-called CT-based systems or 'surgeon-defined anatomy' based systems, where a 3D volume or surface representation of the operated anatomy could be constructed from the preoperatively acquired tomographic data or through intraoperatively digitized anatomy landmarks, a photorealistic rendering of the surgical action has been identified to greatly improve usability of these navigation systems. However, this may not hold true when the virtual representation of surgical instruments and implants is superimposed onto 2D projection images in a fluoroscopy-based navigation system due to the so-called image occlusion problem. Image occlusion occurs when the field of view of the fluoroscopic image is occupied by the virtual representation of surgical implants or instruments. In these situations, the surgeon may miss part of the image details, even if transparency and/or wire-frame rendering is used. In this paper, we propose to use non-photorealistic rendering to overcome this difficulty. Laboratory testing results on foamed plastic bones during various computer-assisted fluoroscopybased surgical procedures including total hip arthroplasty and long bone fracture reduction and osteosynthesis are shown.

  13. Epilepsy surgery: recent advances in brain mapping, neuroimaging and surgical procedures.

    PubMed

    Dorfer, C; Widjaja, E; Ochi, A; Carter Snead Iii, O; Rutka, J T

    2015-06-01

    The general principle of epilepsy surgery is to achieve seizure freedom without causing any neurological deficit that would outweigh the clinical benefit. To achieve this, the epileptogenic zone, which is the part of the brain responsible for seizure generation, as well as the anatomic location of the eloquent cortex must be precisely identified in order to spare those functions during excision of the epileptogenic tissue. Major technical advances over the last decade have continuously contributed to increase our ability to map the brain and identify these critical areas. These technologies and innovations that can be routinely used today include non-invasive studies such as magnetoencephalography (MEG), functional MRI (fMRI), simultaneous EEG-fMRI, and nuclear medicine based methods like PET and SPECT as well as invasive studies through chronically implanted electrodes. Electrodes can be either placed subdurally via burr holes and craniotomies or within the brain parenchima via frame-based and frameless stereotactic methods. Apart from a continuous change in these insertion techniques, the most valuable advances here include recordings on high frequency bandwidth (100-600 Hz EEG) that are capable to delineate high-frequency oscillations (HFOs). These HFOs have been recognized as a biomarker for epileptogenic tissue. All of these technical advances have made epilepsy surgery a truly multidisciplinary field and surgeons have to be able to understand and interpret all of the gathered data. Moreover, this development has influenced surgical approaches and techniques and epilepsy surgery today includes a wide variety of procedures. These can be subdivided into resective, disconnective and neuromodulation procedures and vary from a small, targeted lesionectomy to disconnection/resection of one entire hemisphere. This review will give an overview of the available surgical techniques today and will focus on how the technical advances enable us to map the brain and delineate the critical areas. PMID:25649065

  14. Multi-procedure management in an eyeglasses-related open globe injury

    PubMed Central

    Skopi?ski, Piotr; Langwi?ska-Wo?ko, Ewa; Korwin, Magdalena; Ko?odziejczyk, Wojciech; Ambroziak, Anna Maria

    2014-01-01

    We present a case of successful multi-procedure management of a patient with an open globe injury. A 47-year-old man sustained an injury to his left eye caused by glass fragments of his own spectacles shattered while he was protecting an unknown woman from physical assault at a bus stop. Over a span of 65 months the patient underwent multiple procedures including primary wound repair, penetrating keratoplasty combined with extracapsular cataract extraction, neodymium: YAG laser capsulotomy, and laser-assisted subepithelial keratectomy (LASEK), and had a successfully treated episode of corneal graft rejection. This sequence of treatment substantially improved his left eye vision from hand movements at the time of admission to 0.9–0.5 × 90 at the last follow-up nearly 10 years after the trauma. Proper initial surgical management of an open globe injury can create the possibility for virtually complete vision restoration. PMID:24729818

  15. A standard operating procedure for the surgical implantation of transmitters in juvenile salmonids

    USGS Publications Warehouse

    Liedtke, T.L.; Beeman, J.W.; Gee, L.P.

    2012-01-01

    Biotelemetry is a useful tool to monitor the movements of animals and is widely applied in fisheries research. Radio or acoustic technology can be used, depending on the study design and the environmental conditions in the study area. A broad definition of telemetry also includes the use of Passive Integrated Transponder (PIT) tags, either separately or with a radio or acoustic transmitter. To use telemetry, fish must be equipped with a transmitter. Although there are several attachment procedures available, surgical implantation of transmitters in the abdominal cavity is recognized as the best technique for long-term telemetry studies in general (Stasko and Pincock, 1977; Winter, 1996; Jepsen, 2003), and specifically for juvenile salmonids, Oncorhynchus spp. (Adams and others, 1998a, 1998b; Martinelli and others, 1998; Hall and others, 2009). Studies that use telemetry assume that the processes by which the animals are captured, handled, and tagged, as well as the act of carrying the transmitter, will have minimal effect on their behavior and performance. This assumption, commonly stated as a lack of transmitter effects, must be valid if telemetry studies are to describe accurately the movements and behavior of an entire population of interest, rather than the subset of that population that carries transmitters. This document describes a standard operating procedure (SOP) for surgical implantation of radio or acoustic transmitters in juvenile salmonids. The procedures were developed from a broad base of published information, laboratory experiments, and practical experience in tagging thousands of fish for numerous studies of juvenile salmon movements near Columbia River and Snake River hydroelectric dams. Staff from the Western Fisheries Research Center's Columbia River Research Laboratory (CRRL) frequently have used telemetry studies to evaluate new structures or operations at hydroelectric dams in the Columbia River Basin, and these evaluations typically require large numbers of tagged fish. For example, a study conducted at the dams on the Columbia River and funded by the U.S. Army Corps of Engineers required tagging and monitoring of 40,000 juvenile salmon during a 3-month migration period (Counihan and others, 2006a, 2006b; Perry and others, 2006). To meet the demands of such a large study, the authors and CRRL staff refined the SOP to increase efficiency in the tagging process while maintaining high standards of fish care. The SOP has been used in laboratory and field settings for more than 15 years, and consistently has produced low mortality rates (<1 percent) and transmitter loss rates (<0.01 percent) in the 24-36 hours after tagging. In addition to describing the detailed surgical procedures required for transmitter implantation, this document provides guidance on fish collection, handling and holding, and the release of tagged fish. Although often overlooked, or at least underemphasized, these processes can have a large impact on the outcome of the tagging procedure. Stress associated with the individual steps in handling and tagging can be cumulative and lethal (Maule and others, 1988; Wedemeyer and others, 1990; Portz and others, 2006), so the goal is to provide the best possible fish care at every step in order to manage the overall effect on study fish.

  16. Autologous fibrin sealant (Vivostat®) in the neurosurgical practice: Part I: Intracranial surgical procedure

    PubMed Central

    Graziano, Francesca; Certo, Francesco; Basile, Luigi; Maugeri, Rosario; Grasso, Giovanni; Meccio, Flavia; Ganau, Mario; Iacopino, Domenico G.

    2015-01-01

    Background: Hemorrhages, cerebrospinal fluid (CSF) fistula and infections are the most challenging postoperative complications in Neurosurgery. In this study, we report our preliminary results using a fully autologous fibrin sealant agent, the Vivostat® system, in achieving hemostasis and CSF leakage repair during cranio-cerebral procedures. Methods: From January 2012 to March 2014, 77 patients were studied prospectively and data were collected and analyzed. Autologous fibrin sealant, taken from patient's blood, was prepared with the Vivostat® system and applied on the resection bed or above the dura mater to achieve hemostasis and dural sealing. The surgical technique, time to bleeding control and associated complications were recorded. Results: A total of 79 neurosurgical procedures have been performed on 77 patients. In the majority of cases (98%) the same autologous fibrin glue provided rapid hemostasis and dural sealing. No patient developed allergic reactions or systemic complications in association with its application. There were no cases of cerebral hematoma, swelling, infection, or epileptic seizures after surgery whether in the immediate or in late period follow-up. Conclusions: In this preliminary study, the easy and direct application of autologous fibrin sealant agent helped in controlling cerebral bleeding and in providing prompt and efficient dural sealing with resolution of CSF leaks. Although the use of autologous fibrin glue seems to be safe, easy, and effective, further investigations are strongly recommended to quantify real advantages and potential limitations. PMID:25984391

  17. In Vivo Evaluation of Different Surgical Procedures for Autologous Chondrocyte Implantation

    PubMed Central

    Maréchal, Marina; Van Hauwermeiren, Hadewych; Neys, Johan; Vanderlinden, Gert

    2013-01-01

    Objective: Autologous chondrocyte implantation (ACI) involves the application of a chondrocyte suspension into a membrane-sealed cartilage defect. Recently, “cell-seeded collagen matrix-supported” ACI has been developed wherein chondrocytes are seeded on a biomembrane. This study aimed at preclinically comparing 4 variant ACI techniques in a refined goat model: 2 traditional procedures, whereby the defect is sealed by a periosteal flap or collagen membrane, and 2 cell-seeding methods, with the collagen membrane either sutured or glued into the defect. Design: The efficacy of the surgical techniques was evaluated in an acute critical size chondral defect in the medial condyle of 32 skeletally mature goats, randomly assigned to 1 of the 4 aforementioned treatment groups. After 10 weeks in vivo, the quality of the repair was graded histologically by 2 independent, blinded readers using the “modified O’Driscoll” score. Results: The cell-seeding procedure whereby the membrane is sutured into the defect has a similar structural repair capacity than traditional ACI techniques. However, when the cell-seeded membrane was glued into the defect, the outcome appeared inferior. Conclusion: These findings indicate that optimizing the goat model and the postoperative recovery does allow preclinical evaluation of ACI-based cartilage implants in a load-bearing setting. This preclinical observation provides support to the clinical utilization of the sutured membrane-seeded (ACI-CS) technique, provided sutures, but not fibrin sealants, are used to fix the cell-seeded membrane in the defect bed.

  18. The interaction between cost-management and learning for major surgical procedures - lessons from asymmetric information.

    PubMed

    Ernst, Christian M

    2003-03-01

    The theory of the learning curve states that learning effects are of particular importance in industries, where human skills play an important role. Consequently, one would expect to find large learning effects for surgical procedures because the physician's experience is quite important for this type of work. For hospitals, there exists indeed a well-documented effect that shows a positive relationship between the number of a certain type of surgery being performed and its resulting quality (volume-outcome relationship). Empirical analyses of the impact of learning on the average cost of a procedure, however, have noted a conspicuous absence of learning effects. Using a mechanism design approach, the paper analyzes a model of quality and cost-management for a hospital, where learning effects are included into the cost function and asymmetric information exists between management and physician. It seeks to answer the question, whether recommendations from a symmetric information scenario with respect to learning carry over to a health care setting, where informational problems tend to be pronounced and severe. If surgery volume interacts with physicians' informational rents, an optimal management reaction to the presence of learning may result in a policy, which is the exact opposite of the one under symmetric information. PMID:12605465

  19. Impact of endovascular repair on open aortic aneurysm surgical training

    Microsoft Academic Search

    Frank R. Arko; W. Anthony Lee; Bradley B. Hill; Cornelius Olcott IV; E. John Harris; Ronald L. Dalman; Thomas J. Fogarty; Christopher K. Zarins

    2001-01-01

    Purpose: The purpose of this study was to determine the impact of an endovascular stent-graft program on vascular training in open aortic aneurysm surgery. Methods: The institutional and vascular surgery fellow experience in aortic aneurysm repair during a 6-year period was reviewed. The 3-year period before introduction of endovascular repair was compared with the 3-year period after introduction of endovascular

  20. Comparative analysis of Laparoscopic versus open surgical radiofrequency ablation for malignant liver tumors

    PubMed Central

    Yun, Duhwan; Kim, Seokhwan; Song, Insang

    2014-01-01

    Backgrounds/Aims This study aims to evaluate the comparative effectiveness of two surgical approaches on the treatment outcomes of radiofrequency ablation (RFA) for malignant liver tumors. Methods Fifty-seven patients with malignant liver tumors, hepatocellular carcinoma, cholangiocarcinoma and liver metastases, who were candidates for RFA, underwent laparoscopic or open surgical treatments. Results The patients' characteristics were comparable in the two groups that received open (n=33, 57.9%) and laparoscopic (n=24, 42.1%) surgical treatments. There were no statistically significant differences between the two groups in terms of recurrence rate (p=0.337) and overall survival (p=0.423). However, patients in the laparoscopic RFA group had significantly shorter hospital stay (14.1 vs. 5.9 days, p<0.05) and experienced fewer complications (Grade I: 62.5% vs. 26.3%, p=0.102). Conclusions Laparoscopic RFA can be performed for malignant liver tumors with lower morbidity rates, less invasiveness and lower expense compared to open surgical approach.

  1. Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification

    PubMed Central

    Radosa, M. P.; Meyberg-Solomayer, G.; Radosa, J.; Vorwergk, J.; Oettler, K.; Mothes, A.; Baum, S.; Juhasz-Boess, I.; Petri, E.; Solomayer, E. F.; Runnebaum, I. B.

    2014-01-01

    Introduction: The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system. Material and Methods: Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups were evaluated. Covariates recorded were the technical complexity of the operation, type of study cohort, study size, data acquisition as well as study centre. Target variables recorded were the surgical morbidity rate, subdivided into mild (Clavien-Dindo grade I–II) and severe complications (Clavien-Dindo grade III–V). In addition, a binary logistic regression analysis for the mentioned covariates and the occurrence of surgical complication was carried out. Results: 946 complications were recorded (overall complication rate: 13?%). These included 664 mild complications (8.9?%) and 305 severe complications (4.1?%). A correlation was found between the covariates technical complexity (relative risk [rR] 1.37; p?surgical complications. Conclusion: By means of a standardised registration of complications using the Clavien-Dindo classification it appears to be possible to limit the methodologically caused underestimation of surgical morbidity in the retrospective evaluation of gynaecological-endoscopic therapeutic procedures. Factors decisively influencing the surgical morbidity of gynaecological-laparoscopic therapeutic procedures are the respective operative experience of the treating facility as well as the technical complexity of the intervention. PMID:25221343

  2. Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures.

    PubMed

    Barouk, L S

    2000-09-01

    At first, scarf osteotomy can be technically demanding. The aim of the author has been to develop an efficient technique, make it easier and more accurate, and to achieve immediate reproducibility of results. Neither the skin incision nor the length of the osteotomy result in postoperative edema, whereas the strong fixation enables very early functional recovery. Complications are rare and avoidable. The sum of the scarf's advantages results in a reliable surgical procedure. The scarf osteotomy is extremely versatile, because it allows a wide range of fragment displacement. This is why the scarf is not a single osteotomy but several. This means its indications are broad, from mild to the most advanced deformities, including arthritic, juvenile, iatrogenic, and even rheumatoid hallux valgus. The contraindications of scarf osteotomy are a very large hallux valgus deformity with a very thin first metatarsal; extremely deformed MPT joint, and hallux valgus combined with a severe pes planus and hypermobility of the first metatarsal (the Lapidus procedure is preferable at this stage). Finally, we should remember the two following points: 1. Whatever the indication, the scarf first metatarsal osteotomy is only one of the four steps necessary for correcting hallux valgus deformity: a) MTP lateral release, b) Scarf osteotomy, c) medial capsulorraphy, and d) great toe proximal osteotomy. 2. The scarf is just one element of the different procedures, including the Weil lesser ray osteotomy, which allow precise forefoot management according to each static disorder. These techniques have very significantly extended the indications for most static disorders where corrective surgery preserves the joints and their mobility. PMID:11232396

  3. Minor surgical procedures and musculoskeletal injections by primary care physicians - an Israeli experience

    PubMed Central

    2014-01-01

    Abstarct Background Since minor surgical and musculoskeletal problems are commonly seen in primary care, primary care physicians are expected to possess the skills required to perform minor surgical procedures (MSP) and musculoskeletal injections (MSI). Objective To evaluate the performance of MSP and MSI by primary care physicians in the Southern District (Negev) of Clalit Health Services (CHS) health maintenance organization (HMO) in Israel. Methods A structured self-report questionnaire was sent to all 277 primary care physicians, other than pediatricians, working in the Southern District (Negev) of CHS HMO. Results One hundred fifty one of the 277 questionnaires (54%) were completed and returned. Sixty five percent of the primary care physicians perform any MSP and 46% perform any MSI. The main barriers reported for performing MSP and MSI were lack of time (74% and 66%, respectively) and training (41% and 60%, respectively). Forty percent of the physicians cited remuneration as a potential motivating factor. A logistic regression model showed that male physicians and physicians who work full or part-time in rural areas, are more likely to perform MSP (Odds ratio 2.12 and 2.24, respectively). Male physicians, especially board-certified family physicians, are more likely to perform MSI (Odds ratio 2.86 and 7.0 respectively). Conclusion MSP and MSI are practiced by only some primary care physicians. HMOs and individuals responsible for designing training curricula in family medicine and primary care can encourage primary care physicians to perform MSP and MSI by providing courses, specific compensation, and dedicated time. This can strengthen the bond between primary care physicians and patients, reduce waiting time for patients, and save money for HMO’s. PMID:24666479

  4. Factors Surgical Team Members Perceive Influence Choices of Wearing or Not Wearing Personal Protective Equipment during Operative/Invasive Procedures

    ERIC Educational Resources Information Center

    Cuming, Richard G.

    2009-01-01

    Exposure to certain bloodborne pathogens can prematurely end a person's life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail…

  5. A Critical Analysis of Penile Enhancement Procedures for Patients with Normal Penile Size: Surgical Techniques, Success, and Complications

    Microsoft Academic Search

    Yoram Vardi; Yaron Harshai; Tamir Gil; Ilan Gruenwald

    2008-01-01

    Context: Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmor- phism). Objectives: The aim of this review is to describe the various reported techniques and to provide the available scientific data on the success and complication rates of penile enhancement procedures. Evidence acquisition: We performed an extensive

  6. Trends in hospital admissions and surgical procedures for acquired toe deformities in the West Midlands, England 1988–1997

    Microsoft Academic Search

    K. M. Dunn; D. J. McBride; S. A. Bridgman

    1999-01-01

    Background: Acquired toe deformities are relatively common, but there is a relative paucity of epidemiological information. The objective of this study was to describe the epidemiology of hospital admissions for acquired toe deformities. Method: Analysis of National Health Service hospital admissions in the West Midlands (UK) between 1988 and 1997, with a diagnosis of acquired toe deformities. Results: Surgical procedure

  7. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.

    PubMed

    Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

    2007-06-01

    Background? Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives? Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy? A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria? Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2?years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40?years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis? Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results? Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P?>?0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions? Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. PMID:21631787

  8. 19 CFR 132.12 - Procedure on opening of potentially filled quotas.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 false Procedure on opening of potentially filled quotas. 132...of Quotas § 132.12 Procedure on opening of potentially filled quotas. (a) Preliminary review before opening. When it is anticipated that a...

  9. OPERATIONS ON THE PERICARDIUM—A Review of Current Surgical Procedures

    PubMed Central

    Brewer, Lyman A.

    1956-01-01

    Improved management of pericardial disease has resulted from a better understanding of the pathological physiology and refined surgical technique. In acute cardiac tamponade from trauma, our experience has shown that simple pericardial aspiration, because it relieves the tamponade, renders open operation unnecessary unless the hemorrhage is unusually severe. However, in chronic tamponade, from prolonged pericardial bleeding or effusion, the “pericardio-pleural window” operation described in this article will safely decompress the pericardium without secondary infection and the necessity of reoperation. With chronic constrictive pericarditis, on the other hand, catheterization studies reveal that left heart constriction is more important than that of the right heart or vena cavae. So it is important to pay more attention to decortication of the left heart than was formerly believed. Excision of pericardial tumors, most often cystic, is indicated because they are indistinguishable from malignant growths, although they in themselves are not of serious import. Fatty and fibrous pericardium have proved to be suitable viable material for various plastic operations on the heart, lung and esophagus. Finally, experience with poudrage to revascularize the myocardium is proving that this is a very satisfactory technique which can be performed with minimal risk. PMID:13374559

  10. Galen: a third generation terminology tool to support a multipurpose national coding system for surgical procedures.

    PubMed

    Trombert-Paviot, B; Rodrigues, J M; Rogers, J E; Baud, R; van der Haring, E; Rassinoux, A M; Abrial, V; Clavel, L; Idir, H

    1999-01-01

    GALEN has developed a new generation of terminology tools based on a language independent concept reference model using a compositional formalism allowing computer processing and multiple reuses. During the 4th framework program project Galen-In-Use we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures (CCAM) in France. On one hand we contributed to a language independent knowledge repository for multicultural Europe. On the other hand we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW to process French professional medical language rubrics produced by the national colleges of surgeons into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation on one hand we generate controlled French natural language to support the finalization of the linguistic labels in relation with the meanings of the conceptual system structure. On the other hand the classification manager of third generation proves to be very powerful to retrieve the initial professional rubrics with different categories of concepts within a semantic network. PMID:10725030

  11. Management of Extreme Ametropia after Penetrating Keratoplasty: A Series of Surgical Procedures for High Myopia and Astigmatism

    PubMed Central

    Valdez-Garcia, Jorge E.; Cueto-Gómez, Juan J.; Lozano-Ramírez, Juan F.; Tamez-Peńa, Alejandro E.

    2014-01-01

    A series of surgical interventions – relaxing corneal incisions, intraocular lens, and intrastromal rings – were used to correct a case of extreme ametropia in a thin cornea after a penetrating keratoplasty in an 18-year-old patient who presented with a ?10.25 ?8.50 × 120 preoperative refraction and 20/200 best-corrected visual acuity (BCVA). After a series of surgical procedures, the patient's BCVA in his left eye improved to 20/30 with +0.50 ?1.00 × 170, the slit lamp examination showed no significant findings, and the patient's visual complaints disappeared. At the 1-year follow-up, the BCVA was 20/25, without visual complaints. The process of individualizing the surgical procedure in the present case was employed in an outcome-based approach, that is, the next surgical procedure was defined after the surgery and postoperative evaluation. The patient did not present complications during the follow-up period of 2.5 years. PMID:25232339

  12. Recurrent lumbar disc herniation: A prospective comparative study of three surgical management procedures

    PubMed Central

    El Shazly, Ayman A.; El Wardany, Mohammed A.; Morsi, Ahmad M.

    2013-01-01

    Context: The optimal surgical treatment of recurrent lumbar disc herniation is controversial. Aim: To compare prospectively the clinical outcomes of surgical treatment of recurrent lumbar disc herniation by three different methods; discectomy alone, discectomy with transforaminal lumbar interbody fusion (TLIF), and diecectomy with posterolateral fusion (PLF), regardless of the postoperative radiological findings. Study Design: This is a prospective, randomized, comparative study. Materials and Methods: This is a prospective, randomized, comparative study on 45 patients with first time recurrent lumbar disc herniation. Patients were evaluated clinically by using the criteria of the Japanese Orthopedic Association's evaluation system for low back pain syndrome (JOA score). The patients were classified into three groups: Group A; patients who had revision discectomy alone, group B; patients who had revision discectomy with TLIF, and group C; patients who had revision discectomy with PLF. The mean follow-up period was 37 (±7.85 STD) months. Results: The mean overall recovery rate was 87.2% (±19.26 STD) and the satisfactory rate was 88.9%. Comparison between the three groups showed no significant difference with regard to the mean total postoperative JOA score, recovery rate, and satisfactory rate. However, the postoperative low back pain was significantly higher in group A than that of group B and C. Two patients in group A required further revision surgery. The incidences of dural tear and postoperative neurological deficit were higher in group A. The intraoperative blood loss and length of operation were significantly less in group A. The total cost of the procedure was significantly different between the three groups, being least in group A and highest in group B. There was no significant difference between the three groups with regard to the length of postoperative hospital stay. Conclusion: Revision discectomy is effective in patients with recurrent lumbar disc herniation. Fusion with revision discectomy improves the postoperative low back pain, decreases the intraoperative risk of dural tear or neural damage and decreases the postoperative incidence of mechanical instability or re-recurrence. TLIF and PLF have comparable results when used with revision discectomy, but PLF has significantly less total cost than TLIF. PMID:24403956

  13. A comparison of surgical impression, histological findings and microbiological results at open appendicectomy.

    PubMed

    Colleran, G; Heneghan, H; Sweeney, K J; Kerin, M J

    2007-10-01

    There is no accurate predictor of complications following open appendicectomy. Surgical impression, histological findings and peritoneal culture swabs have been used. The value of peritoneal culture swab was assessed in this study. All patients undergoing open appendicectomy between January 2003 and December 2005 were included in the study. During the 24-month period, 952 patients underwent open appendicectomy. Peritoneal culture swabs were taken from 309 patients (32%). There was a significant difference in the mean postoperative length of stay +/- SEM between those with a positive culture (7 days +/- 0.6), those with a sterile culture result (3.7 days +/- 0.2) and those on whom a culture swab was not taken (4.9 days +/- 0.3); p<0.0001, ANOVA. Surgeons were more likely to overcall the severity of the appendix pathology (p < 0.0001 surgical vs. histological findings; Fisher's exact test), however, there was no significant difference in the power of surgical or histological assessment of the appendicitis at predicting a positive peritoneal culture result. Complex appendicitis was more likely to be associated with a positive peritoneal culture (P < 0.0001; Fisher's exact test). No antibiotic regime was changed on the basis of a positive culture swab. Fifteen patients were readmitted within 6 months of appendicectomy, predictors of readmission included histologically confirmed complex appendicitis and a positive peritoneal culture swab. Peritoneal culture swabs do not improve immediate postoperative therapy based on surgical impression and rapid histological reporting, however, the routine use of peritoneal culture swabs may be of value in identifying patients requiring outpatient follow-up. PMID:18196884

  14. GALEN: a third generation terminology tool to support a multipurpose national coding system for surgical procedures.

    PubMed

    Trombert-Paviot, B; Rodrigues, J M; Rogers, J E; Baud, R; van der Haring, E; Rassinoux, A M; Abrial, V; Clavel, L; Idir, H

    2000-09-01

    Generalised architecture for languages, encyclopedia and nomenclatures in medicine (GALEN) has developed a new generation of terminology tools based on a language independent model describing the semantics and allowing computer processing and multiple reuses as well as natural language understanding systems applications to facilitate the sharing and maintaining of consistent medical knowledge. During the European Union 4 Th. framework program project GALEN-IN-USE and later on within two contracts with the national health authorities we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures named CCAM in a minority language country, France. On one hand, we contributed to a language independent knowledge repository and multilingual semantic dictionaries for multicultural Europe. On the other hand, we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW (for classification workbench) to process French professional medical language rubrics produced by the national colleges of surgeons domain experts into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation, on one hand, we generate with the LNAT natural language generator controlled French natural language to support the finalization of the linguistic labels (first generation) in relation with the meanings of the conceptual system structure. On the other hand, the Claw classification manager proves to be very powerful to retrieve the initial domain experts rubrics list with different categories of concepts (second generation) within a semantic structured representation (third generation) bridge to the electronic patient record detailed terminology. PMID:10978911

  15. A MATERIAL COST-MINIMIZATION ANALYSIS FOR HERNIA REPAIRS AND MINOR PROCEDURES DURING A SURGICAL MISSION IN THE DOMINICAN REPUBLIC

    PubMed Central

    Cavallo, Jaime A.; Ousley, Jenny; Barrett, Christopher D.; Baalman, Sara; Ward, Kyle; Borchardt, Malgorzata; Thomas, J. Ross; Perotti, Gary; Frisella, Margaret M.; Matthews, Brent D.

    2013-01-01

    INTRODUCTION Expenditures on material supplies and medications constitute the greatest per capita costs for surgical missions. We hypothesized that supply acquisition at nonprofit organization (NPO) costs would lead to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for hernia repairs and minor procedures during a surgical mission in the Dominican Republic (DR). METHODS Items acquired for a surgical mission were uniquely QR-coded for accurate consumption accounting. Both NPO and US academic institution unit costs were associated with each item in an electronic inventory system. Medication doses were recorded and QR-codes for consumed items were scanned into a record for each sampled procedure. Mean material costs and cost savings ± SDs were calculated in US dollars for each procedure type. Cost-minimization analyses between the NPO and the US academic institution platforms for each procedure type ensued using a two-tailed Wilcoxon matched-pairs test with ?=0.05. Item utilization analyses generated lists of most frequently used materials by procedure type. RESULTS The mean cost savings of supply acquisition at NPO costs for each procedure type were as follows: $482.86 ± $683.79 for unilateral inguinal hernia repair (IHR, n=13); $332.46 ± $184.09 for bilateral inguinal hernia repair (BIHR, n=3); $127.26 ± $13.18 for hydrocelectomy (HC, n=9); $232.92 ± $56.49 for femoral hernia repair (FHR, n=3); $120.90 ± $30.51 for umbilical hernia repair (UHR, n=8); $36.59 ± $17.76 for minor procedures (MP, n=26); and $120.66 ± $14.61 for pediatric inguinal hernia repair (PIHR, n=7). CONCLUSION Supply acquisition at NPO costs leads to significant cost-savings compared to supply acquisition at US academic institution costs from the provider perspective for IHR, HC, UHR, MP, and PIHR during a surgical mission to DR. Item utilization analysis can generate minimum-necessary material lists for each procedure type to reproduce cost-savings for subsequent missions. PMID:24162140

  16. Gauze Packing of Open Surgical Wounds: Empirical or Evidence-Based Practice?

    PubMed Central

    Dinah, F; Adhikari, A

    2006-01-01

    INTRODUCTION Most surgical wounds are closed primarily, but some are allowed to heal by secondary intention. This usually involves repeated packing and dressing of the raw wound surfaces. Although the long-term care of such wounds has devolved to the care of nurses in the community or out-patient setting, the initial wound dressing or cavity packing is done by the surgeon in the operating theatre. Many surgeons are unaware of the growth of the discipline of wound care, and still use traditional soaked gauze for dressing and packing open surgical wounds and cavities. RESULTS This review summarises the some of the modern alternatives available and the evidence – or the lack of it – for their use in both the acute and chronic setting. PMID:16460637

  17. Outcomes of 807 Thompson hip hemiarthroplasty procedures and the effect of surgical approach on dislocation rates.

    PubMed

    Abram, S G F; Murray, J B

    2015-06-01

    The majority of displaced intracapsular fractures in our unit are managed with a Thompson hip hemiarthroplasty. Recent UK guidance from the National Institute for Health and Care Excellence has, however, advised against the continued used of the Thompson implant in patients with hip fracture. The aim of this study was to review the outcomes and complications after Thompson hip hemiarthroplasty, including the impact of modern surgical approaches and cementing, whilst controlling for confounding factors. We reviewed the outcomes following Thompson hip hemiarthroplasty from a series of 807 cases performed between April 2008 and November 2013. Of these, 721 (89.3%) were cemented and 86 (10.7%) uncemented. A total of 575 (71.3%) procedures were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%). Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (seven of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% confidence interval (CI) 2.8-26.3), p<0.001). Patients were discharged home in 459 cases (56.9%), to a care home or other hospital in 273 cases (33.8%). Of the total number of patients, 75 died during their admission (9.3%), and 51.8% (338 of 653) returned home within 30 days. The 30-day mortality was 7.1% (57 cases) and the 1-year mortality was 16.6% (116 of 699). We recommend against the continued use of the posterior approach in hip hemiarthroplasty, as enhanced soft tissue repair did not reduce the dislocation rates to an acceptable level in this series utilising the Thompson implant. Our findings, however, demonstrate satisfactory results for patients treated with the Thompson hip hemiarthroplasty performed through an anterolateral approach. We suggest that the continued use of this implant in a carefully selected patient cohort is justifiable. PMID:25704140

  18. Magnesium Lowers the Incidence of Postoperative Junctional Ectopic Tachycardia in Congenital Heart Surgical Patients: Is There a Relationship to Surgical Procedure Complexity?

    PubMed

    He, Dingchao; Sznycer-Taub, Nathaniel; Cheng, Yao; McCarter, Robert; Jonas, Richard A; Hanumanthaiah, Sridhar; Moak, Jeffrey P

    2015-08-01

    Magnesium sulfate was given to pediatric cardiac surgical patients during cardiopulmonary bypass period in an attempt to reduce the occurrence of postoperative junctional ectopic tachycardia (PO JET). We reviewed our data to evaluate the effect of magnesium on the occurrence of JET and assess a possible relationship between PO JET and procedure complexity. A total of 1088 congenital heart surgeries (CHS), performed from 2005 to 2010, were reviewed. A total of 750 cases did not receive magnesium, and 338 cases received magnesium (25 mg/kg). All procedures were classified according to Aristotle score from 1 to 4. Overall, there was a statistically significant decrease in PO JET occurrence between the two groups regardless of the Aristotle score, 15.3 % (115/750) in non-magnesium group versus 7.1 % (24/338) in magnesium group, P < 0.001. In the absence of magnesium, the risk of JET increased with increasing Aristotle score, P = 0.01. Following magnesium administration and controlling for body weight, surgical and aortic cross-clamp times in the analyses, reduction in adjusted risk of JET was significantly greater with increasing Aristotle level of complexity (JET in non-magnesium vs. magnesium group, Aristotle level 1: 9.8 vs. 14.3 %, level 4: 11.5 vs. 3.2 %; odds ratio 0.54, 95 % CI 0.31-0.94, P = 0.028). Our data confirmed that intra-operative usage of magnesium reduced the occurrence of PO JET in a larger number and more diverse group of CHS patients than has previously been reported. Further, our data suggest that magnesium's effect on PO JET occurrence seemed more effective in CHS with higher levels of Aristotle complexity. PMID:25762470

  19. [Spectrum of surgical procedures performed in German rescue centers and the field hospital in Afghanistan in 2008].

    PubMed

    Güsgen, C; Achatz, G; Palm, H-G; Kollig, E; Engelhardt, M; Willy, C; Lieber, A

    2010-02-01

    From the military perspective detailed knowledge about the spectrum of operations undertaken abroad is of particular interest to provide indications of the skills that will be required by the surgeons. Therefore, all surgical reports produced in 2008 in the operation theatres of Mazar-e-Sharif, Feyzabad and Kunduz were reviewed. The overview shows that a total of 799 operations were performed equivalent to 0.4-1.6 operations/day. Most of the patients who underwent surgery were local civilians and most of these operations involved osteosynthesis, débridement and soft tissue procedures. Of the surgical procedures 11% involved patients who were German service personnel of which 85% were urgent or emergency procedures and 25% of these involved treatment of combat injuries. When civilian patients with life-threatening injuries or diseases are referred to the medical facilities there is little opportunity to make decisions with regard to acceptance. Often it may be necessary for surgeons to perform procedures which are outside their field of specialization. In order to ensure a favorable outcome in acute situations surgeons mainly required skills in emergency surgery of the body cavities (visceral and thoracic surgery). PMID:20094698

  20. [A new concept in surgery of the digestive tract: surgical procedure assisted by computer, from virtual reality to telemanipulation].

    PubMed

    Marescaux, J; Clément, J M; Vix, M; Russier, Y; Tassetti, V; Mutter, D; Cotin, S; Ayache, N

    1998-02-01

    Surgical simulation increasingly appears to be an essential aspect of tomorrow's surgery. The development of a hepatic surgery simulator is an advanced concept calling for a new writing system which will transform the medical world: virtual reality. Virtual reality extends the perception of our five senses by representing more than the real state of things by the means of computer sciences and robotics. It consists of three concepts: immersion, navigation and interaction. Three reasons have led us to develop this simulator: the first is to provide the surgeon with a comprehensive visualisation of the organ. The second reasons is to allow for planning and surgical simulation that could be compared with the detailed flight-plan for a commercial jet pilot. The third lies in the fact that virtual reality is an integrated part of the concept of computer assisted surgical procedure. The project consists of a sophisticated simulator which must include five requirements: a) visual fidelity, b) interactivity, c) physical properties, d) physiological properties, e) sensory input and output. In this report we describe how to obtain a realistic 3D model of the liver from bi-dimensional 2D medical images for anatomical and surgical training. The introduction of a tumor and the consequent planning and virtual resection is also described, as are force feedback and real-time interaction. PMID:9752550

  1. Long-term results of surgical techniques and procedures in men with benign prostatic hyperplasia.

    PubMed

    Metcalfe, Charles; Poon, Kenneth S

    2011-08-01

    Benign prostatic hyperplasia (BPH) is one of the most common conditions associated with the aging male. Surgical management of lower urinary tract symptoms attributed to BPH has progressed over time as urologic surgeons search for more innovative and less invasive forms of treatment. Transurethral resection of the prostate (TURP) has long been the "gold standard" to which all other forms of treatment are compared. There are several different methods of surgical treatment of BPH, including whole gland enucleation/intact removal, vaporization, and induction of necrosis with delayed reabsorption as well as hybrid techniques. As with any form of surgical intervention, long-term results define success. Long-term follow-up consists of examining overall efficacy with attention to associated adverse events. TURP has the luxury of the longest follow-up, while less invasive forms of treatment starting to acquire long-term data. There are several surgical options for BPH; newer methods do show promise, while the "gold standard" continues to demonstrate excellent surgical results. PMID:21484456

  2. Management of multiple and isolated gingival recession sites with periodontal plastic surgical procedures--a case report.

    PubMed

    Amberkar, Snehal C; Deshmukh, Vijay; Acharya, Aneesha; Jhaveri, Hiral M

    2010-10-01

    Multiple recession defects in the dentition of an individual are routinely encountered in clinical practice and as such present a challenge for management. Periodontal plastic surgical procedures aim to restore both gingival esthetics as well as function in these defects. This case report highlights four periodontal plastic surgical techniques (the coronally advanced flap for single and multiple recession defects, double papillae with subepithelial connective tissue graft, and envelope technique with subepithelial connective tissue graft) that have been employed for root coverage in isolated Miller Class I recession defects in a 35-year-old individual. Three of the techniques resulted in 100% root coverage in all treated sites, while the site treated with subepithelial connective graft by envelope technique resulted in 83.3% root coverage. Treatment also helped to resolve hypersensitivity and achieved satisfaction of the patient's esthetic concerns. PMID:20806098

  3. GiPSi:a framework for open source/open architecture software development for organ-level surgical simulation.

    PubMed

    Cavu?o?lu, M Cenk; Göktekin, Tolga G; Tendick, Frank

    2006-04-01

    This paper presents the architectural details of an evolving open source/open architecture software framework for developing organ-level surgical simulations. Our goal is to facilitate shared development of reusable models, to accommodate heterogeneous models of computation, and to provide a framework for interfacing multiple heterogeneous models. The framework provides an application programming interface for interfacing dynamic models defined over spatial domains. It is specifically designed to be independent of the specifics of the modeling methods used, and therefore facilitates seamless integration of heterogeneous models and processes. Furthermore, each model has separate geometries for visualization, simulation, and interfacing, allowing the model developer to choose the most natural geometric representation for each case. Input/output interfaces for visualization and haptics for real-time interactive applications have also been provided. PMID:16617620

  4. Effort Thrombosis: Effective Treatment with Vascular Stent After Unrelieved Venous Stenosis Following a Surgical Release Procedure

    Microsoft Academic Search

    Gary S. Cohen; Larry Braunstein; David S. Ball; Frank Domeracki

    1996-01-01

    Acute symptomatic effort thrombosis in a 33-year-old male necessitated an aggressive approach consisting of thrombolysis, angioplasty, and surgical thoracic outlet release. The patient required postoperative placement of a Wallstent and was placed on anticoagulation. He has remained symptom free for the past 10 months, both clinically and sonographically.

  5. Effort Thrombosis: Effective treatment with vascular stent after unrelieved venous stenosis following a surgical release procedure

    Microsoft Academic Search

    Gary S. Cohen; Larry Braunstein; David S. Ball; Frank Domeracki

    1996-01-01

    Acute symptomatic effort thrombosis in a 33-year-old male necessitated an aggressive approach consisting of thrombolysis,\\u000a angioplasty, and surgical thoracic outlet release. The patient required postoperative placement of a Wallstent and was placed\\u000a on anticoagulation. He has remained symptom free for the past 10 months, both clinically and sonographically.

  6. Expert's evaluation of innovative surgical instrument and operative procedure using haptic interface in vir-

    E-print Network

    Boyer, Edmond

    work through visualization of three-dimensional images of anatomy and pathology. In addition, virtual-evaluation. In this paper, they intend to evaluate the usage of the product in a virtual environment using a 3D haptic feed of the innovative surgical instrument developed. We used virtual reality environment and the manufactured prototype

  7. Measuring pain in children with cognitive impairment: pain response to surgical procedures

    Microsoft Academic Search

    Chantal Terstegen; Hans M. Koot; Josien B. de Boer; Dick Tibboel

    2003-01-01

    This study investigated post-surgical pain in children with profound cognitive impairment (PCI), searching for a core set of cues these children use to express their pain. Fifty-two children were observed while they were admitted to the Sophia Children's Hospital for surgery, twice before and five times after surgery. All observations were scored with the item pool consisting of 134 possible

  8. Application of the procedural consolidation concept to surgical treatment of children with epidermolysis bullosa: a retrospective analysis

    PubMed Central

    Karaman Ili?, Maja; Kern, Josipa; Babi?, Irena; Šimi?, Diana; Kljenak, Antun; Majeri? Kogler, Višnja

    2011-01-01

    Aim To assess the efficacy of the procedural consolidation concept (PCC) at reducing the number of sessions of general anesthesia necessary for treating children with epidermolysis bullosa (EB). Methods We examined the records of children treated at Children's Hospital of Zagreb between April 1999 and December 2007. Children treated before the introduction of PCC in January 2005 (n?=?39) and after (n?=?48) were analyzed in order to determine the effect of PCC on the occurrence of complications, days of hospitalization, and number of hospitalizations. Results During the study period, 53 patients underwent 220 sessions of general anesthesia for a total of 743 surgical interventions per session. Before the introduction of PCC (n?=?39 patients, 83 sessions), the median number of interventions per session was 2 (range 1-5), and after the introduction of PCC (n?=?48 patients, 137 sessions) it was 4 (range 3-7, P?surgical procedure decreased from 1 (range 0-10) to 0.6 (range 0-2.5) (P?procedure was 3 times lower after the introduction of PCC (median 0.3, range 0.2-3) than before (median 1, range 0.75-1.7) (P?surgical treatment of children with EB. PMID:21853547

  9. Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection

    PubMed Central

    Lorenzon, Laura; La Torre, Marco; Ziparo, Vincenzo; Montebelli, Francesco; Mercantini, Paolo; Balducci, Genoveffa; Ferri, Mario

    2014-01-01

    AIM: To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection. METHODS: Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor’s location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals’ rates and incidence of incisional hernias) and (4) costs. RESULTS: Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias. CONCLUSION: Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors’ location and the post-operative hernias. PMID:24707154

  10. Medical tongue piercing – development and evaluation of a surgical protocol and the perception of procedural discomfort of the participants

    PubMed Central

    2014-01-01

    Background A system providing disabled persons with control of various assistive devices with the tongue has been developed at Aalborg University in Denmark. The system requires an activation unit attached to the tongue with a small piercing. The aim of this study was to establish and evaluate a safe and tolerable procedure for medical tongue piercing and to evaluate the expected and perceived procedural discomfort. Methods Four tetraplegic subjects volunteered for the study. A surgical protocol for a safe insertion of a tongue barbell piercing was presented using sterilized instruments and piercing parts. Moreover, post-procedural observations of participant complications such as bleeding, edema, and infection were recorded. Finally, procedural discomforts were monitored by VAS scores of pain, changes in taste and speech as well as problems related to hitting the teeth. Results The piercings were all successfully inserted in less than 5 min and the pain level was moderate compared with oral injections. No bleeding, infection, embedding of the piercing, or tooth/gingival injuries were encountered; a moderate edema was found in one case without affecting the speech. In two cases the piercing rod later had to be replaced by a shorter rod, because participants complained that the rod hit their teeth. The replacements prevented further problems. Moreover, loosening of balls was encountered, which could be prevented with the addition of dental glue. No cases of swallowing or aspiration of the piercing parts were recorded. Conclusions The procedure proved simple, fast, and safe for insertion of tongue piercings for tetraplegic subjects in a clinical setting. The procedure represented several precautions in order to avoid risks in these susceptible participants with possible co-morbidity. No serious complications were encountered, and the procedure was found tolerable to the participants. The procedure may be used in future studies with tongue piercings being a prerequisite for similar systems, and this may include insertion in an out-patient setting. PMID:24684776

  11. Review of surgical ventricular restoration: A procedure to treat cardiac failure

    Microsoft Academic Search

    Anupam A. Sule; Ajey A. Sule; Downey H. Fred; Sanjeev S. Thakur

    2010-01-01

    Severe heart failure refractory to medical treatment necessitates the use of other modalities of treatment. Surgical ventricular\\u000a restoration (SVR) surgery can provide relief until donour hearts are available or when transplantation is contraindicated.\\u000a In this review we look at the physiological basis for improvement in cardiac function and cardiac and haemodynamic changes\\u000a that occur after SVR. We also compile the

  12. Outcomes of implants placed with three different flapless surgical procedures: a systematic review.

    PubMed

    Voulgarakis, A; Strub, J R; Att, W

    2014-04-01

    The aim of this systematic review was to evaluate the outcomes of flapless surgery for implants placed using either free-hand or guided (with or without 3D navigation) surgical methods. Literature searches were conducted to collect information on survival rate, marginal bone loss, and complications of implants placed with such surgeries. Twenty-three clinical studies with a minimum of 1 year follow-up time were finally selected and reviewed. Free-hand flapless surgery demonstrated survival rates between 98.3% and 100% and mean marginal bone loss between 0.09 and 1.40 mm at 1-4 years after implant insertion. Flapless guided surgery without 3D navigation showed survival rates between 91% and 100% and mean marginal bone loss of 0.89 mm after an observation period of 2-10 years. The survival rates and mean marginal bone loss for implants placed with 3D guided flapless surgery were 89-100% and 0.55-2.6mm, respectively, at 1-5 years after implant insertion. In 17 studies, surgical and technical complications such as bone perforation, fracture of the surgical guide, and fracture of the provisional prosthesis were reported. However, none of the identified methods has demonstrated advantages over the others. Further studies are needed to confirm the predictability and effectiveness of 3D navigation techniques. PMID:24290308

  13. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

    PubMed Central

    Shukry, Mohanad; Miller, Jeffrey A

    2010-01-01

    Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC), airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 ?g kg?1, and infusion dose ranged from 0.2 to 10 ?g kg?1 h?1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies. PMID:20421911

  14. Vagal nerve stimulation for refractory epilepsy: the surgical procedure and complications in 100 implantations by a single medical center.

    PubMed

    Horowitz, Gilad; Amit, Moran; Fried, Itzhak; Neufeld, Miri Y; Sharf, Liad; Kramer, Uri; Fliss, Dan M

    2013-01-01

    In 1997, the US Food and Drug Administration approved the use of intermittent stimulation of the left vagal nerve as adjunctive therapy for seizure control. Vagal nerve stimulation (VNS) has since been considered a safe and effective treatment for medically intractable seizures. The objective of this study is to present our experience with the surgical procedure and outcomes after VNS insertion in the first 100 consecutive patients treated at the Tel-Aviv "Sourasky" Medical Center (TASMC). All patients who underwent VNS device implantation by the authors at TASMC between 2005 and 2011 were studied. The collected data included age at onset of epilepsy, seizure type, duration of epilepsy, age at VNS device implantation, seizure reduction, surgical complications, and adverse effects of VNS over time. Fifty-three males and 47 females, age 21.2 ± 11.1 years, underwent VNS implantation. Indications for surgery were medically refractory epilepsy. The most common seizure type was focal (55 patients, 55 %). Seizure duration until implantation was 14.4 ± 9 years. Mean follow-up time after device insertion was 24.5 ± 22 months. Complications were encountered in 12 patients. The most common complication was local infection (6 patients, 6 %). Six devices were removed-four due to infection and two due to loss of clinical effect. Currently, 63 patients remain in active long-term follow-up; of these, 35 patients have >50 % reduction in frequency of attacks.VNS is a well-tolerated and effective therapeutic alternative in the management of medically refractory epilepsy. The surgical procedure is safe and has a low complication rate. PMID:22836871

  15. Unloading Procedures OPENING DOOR: Make sure that gauge is at 0 PSIG before opening door. Wearing

    E-print Network

    Cui, Yan

    lab coat, heat-resistant gloves and preferably safety glasses, stand at arms length and slowly open autoclaved materials. Loading Procedures Personal Protective Equipment (PPE): Wear lab coat, gloves: Sharps are to be put into a puncture-resistant disposable container, not an autoclave bag. Never overfill

  16. Open surgical repair for chronic type B aortic dissection: a systematic review

    PubMed Central

    Tian, David H.; De Silva, Ramesh P.; Wang, Tom

    2014-01-01

    Background The treatment of chronic type B aortic dissection (CBAD) remains complicated. Thoracic endovascular aortic repair (TEVAR) has supplanted open surgical repair (OSR) as the preferred surgical treatment for CBAD. Despite TEVAR’s superior short-term results, much less is understood about its long-term outcomes. As much of the understanding of OSR originates from historical report, contemporary series, with modern surgical techniques and technologies, may present an alternative to TEVAR. The present systematic review will assess the short- and long-term outcomes of historic and contemporary series of OSR for CBAD. Methods Electronic searches were performed using six databases from their inception to March 2014. Relevant studies with OSRs for chronic type B dissection were identified. Data were extracted by two independent reviewers and analyzed according to predefined clinical endpoints. Studies were sub-classified into the pre-endovascular (historic series) and endovascular era (contemporary series) depending on whether the majority of cases were performed after 1999. Results Nineteen studies were identified for inclusion for quantitative analysis. Pooled short-term mortality was 11.1% overall, and 7.5% in the nine contemporary studies. Stroke, spinal cord ischemia, renal dysfunction, and reoperation for bleeding were 5.9%, 4.9%, 8.1%, and 8.1%, respectively, for the contemporary series. Absolute late reintervention was identified in 13.3% of patients overall, and in 11.3% of patients in the contemporary series. Aggregated survival at 1-, 3-, 5-, and 10-years of all patients were 82.1%, 74.1%, 66.3%, and 50.8%, respectively. Conclusions OSR for chronic type B dissection in the contemporary era offers acceptable results. Management approaches should be considered carefully, taking into account both short-term and long-term complications. More research is required to clarify specific indications for OSR and TEVAR in chronic type B dissections. PMID:25133097

  17. Surgical treatment for pilon fracture of the ankle-open reduction and internal fixation.

    PubMed

    Chen, Y W; Huang, P J; Hsu, C Y; Kuo, C H; Cheng, Y M; Lin, S Y; Chen, L H; Chiang, H C

    1998-01-01

    From 1991 to 1994, 39 ankles of 38 patients underwent surgical open reduction and internal fixation for pilon fractures. These patients included 29 males and 9 females with an average age of 38.6 y/o (range 28 y/o-58 y/o). The follow up and evaluation period averaged 31.7 months (range 22Ms-44Ms), during which time a standing x-ray for arthrosis grading and functional scale was used for clinical evaluation. Complications included 1 case of infection, 1 case of loss reduction, 2 cases of partial skin necrosis and 2 cases of delayed union. Post-traumatic arthritis occurred in 23 ankles (59%) but only 4 ankles of grade 4 arthrosis resulted in poor functional scale and the overall satisfactory rate was 82%. It was found that anatomic reduction, rigid fixation and early motion exercise are important to successful treatment of ankle fractures. Regarding pilon fracture, specifically the severity of fracture pattern and delay of reduction are important problems to overcome to ensure successful results. Therefore, adequate surgical approach for entire view of ankle joint, reduction and fixation of fibula, sufficient bone graft for articular support, intraoperative x-ray check and postoperative immobilization are essential for the achievement of better clinical results. PMID:9519687

  18. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

    Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”. PMID:24741501

  19. Opening Procedures Handbook. A Guide for Boards of Trustees and Leaders of New Charter Schools

    ERIC Educational Resources Information Center

    Massachusetts Department of Education, 2006

    2006-01-01

    The Charter School Office has created the Opening Procedures Handbook as a tool to assist charter school founding groups prepare for the exciting, yet challenging, task of opening a Massachusetts public charter school. The Handbook summarizes the opening procedures process, identifies the action items that must be completed prior to the school's…

  20. Evolution from open surgical to endovascular treatment of ureteral-iliac artery fistula

    PubMed Central

    Malgor, Rafael D.; Oderich, Gustavo S.; Andrews, James C.; McKusick, Michael; Kalra, Manju; Misra, Sanjay; Gloviczki, Peter; Bower, Thomas C.

    2015-01-01

    Purpose To review the indications and results of open surgical and endovascular treatment for ureteral-iliac artery fistula (UIAF). Methods We reviewed the clinical data of 20 consecutive patients treated for 21 UIAFs between 1996 and 2010. Since 2004, iliac artery stent grafts were the primary treatment except for complex fistulas with enteric contamination or abscess. Endpoints were early morbidity and mortality, patient survival, vessel or graft patency, freedom from vascular or stent graft/graft infection, and freedom from recurrent bleeding. Results There were 20 patients, 15 females, and five males, with mean age of 63 ± 13 years. Predisposing factors for UIAF were prior tumor resection in 18 patients, radiation in 15, ureteral stents in 15, ileal conduits in four, and ileofemoral grafts in three. All patients presented with hematuria, which was massive in 10. Treatment included iliac stent grafts in 11 patients/12 fistulas (55%), with internal iliac artery (IAA) exclusion in nine, femoral crossover graft with IAA exclusion in five, direct arterial repair in three, and ureteral exclusion with percutaneous nephrostomy and no arterial repair in one. There were no early deaths. Five of eight patients treated by open surgical repair developed complications, which included enterocutaneous fistula in three and superficial wound infection in two. Four patients (36%) treated by iliac stent grafts had complications, including pneumonia, non-ST segment elevation myocardial infarction, buttock claudication, and early stent occlusion in one each. After a median follow-up of 26 months, no one had recurrent massive hematuria, but minor bleeding was reported in three. Patient survival at 5 years was 42% compared with 93% for the general population (P < .001). Freedom from any recurrent bleeding at 3 years was 76%. In the stent graft group, primary and secondary patency rates and freedom from stent graft infection at 3 years were 81%, 92%, and 100%. Conclusions UIAF is a rare complication associated with prior tumor resection, radiation, and indwelling ureteral stents. In select patients without enteric communication or abscess, iliac artery stent grafts are safe and effective treatment, and carry a low risk of recurrent massive hematuria or stent graft infection on early follow-up. Direct surgical repair carries a high risk of enterocutaneous fistula. PMID:22326578

  1. Short-term survival and effects of transmitter implantation into western grebes using a modified surgical procedure

    USGS Publications Warehouse

    Gaydos, Joseph K.; Massey, J. Gregory; Mulcahy, Daniel M.; Gaskins, Lori A.; Nysewander, David; Evenson, Joseph; Siegel, Paul B.; Ziccardi, Michael H.

    2011-01-01

    Two pilot trials and one study in a closely related grebe species suggest that Western grebes (Aechmophorus occidentalis) will not tolerate intracoelomic transmitter implantation with percutaneous antennae and often die within days of surgery. Wild Western grebes (n = 21) were captured to evaluate a modified surgical technique. Seven birds were surgically implanted with intracoelomic transmitters with percutaneous antennae by using the modified technique (transmitter group), 7 received the same surgery without transmitter implantation (celiotomy group), and 7 served as controls (only undergoing anesthesia). Modifications included laterally offsetting the body wall incision from the skin incision, application of absorbable cyanoacrylate tissue glue to the subcutaneous space between the body wall and skin incisions, application of a waterproof sealant to the skin incision after suture closure, and application of a piece of porcine small intestine submucosa to the antenna egress. Survival did not differ among the 3 groups with 7 of 7 control, 6 of 7 celiotomy, and 6 of 7 transmitter birds surviving the 9-day study. Experimental birds were euthanized at the end of the study, and postmortem findings indicated normal healing. Significant differences in plasma chemistry or immune function were not detected among the 3 groups, and only minor differences were detected in red blood cell indices and plasma proteins. After surgery, the birds in the transmitter group spent more time preening tail feathers than those in the control and celiotomy groups. These results demonstrate that, in a captive situation, celiotomy and intracoelomic transmitter implantation caused minimal detectable homeostatic disturbance in this species and that Western grebes can survive implantation of intracoelomic transmitters with percutaneous antennae. It remains to be determined what potential this modified surgical procedure has to improve postoperative survival of Western grebes that are intracelomically implanted with transmitters with percutaneous antennae and released into the wild.

  2. Postoperative wound dealing and superficial surgical site infection in open radical prostatectomy.

    PubMed

    Yamamichi, Fukashi; Shigemura, Katsumi; Yamashita, Mauso; Tanaka, Kazushi; Arakawa, Soishi; Fujisawa, Masato

    2014-09-01

    The number of open radical prostatectomy (RP) surgeries has been decreasing owing to the spread of laparoscopic and robotic surgery, which has implications for postoperative wound healing. The purpose of this study was to investigate and document the current status of postoperative wound healing and superficial surgical site infection (SSI) in open RPs. One hundred and seventy-five antegrade RPs with the same or similar kinds of prophylactic antibiotic administration were divided into two groups: (i) 'no intervention' (wound covering group) and (ii) 'washing', using a washing solution from the second postoperative day to the day of skin staple removal (wound washing group). We compared these groups for the occurrence of superficial SSI. The wound covering group had three (3·03%) cases of superficial SSI, with one case caused by methicillin sensitive Staphylococcus aureus (MSSA). The wound washing group had nine (11·8%) cases of superficial SSI, with three cases caused by MSSA, two cases caused by methicillin resistant Staphylococcus aureus (MRSA) and one by Pseudomonas aeruginosa. The wound covering group showed a significantly lower ratio of superficial SSI (P?=?0·0472). In conclusion, the postoperative wound status data in this study suggests that no wound intervention after RP resulted in a comparatively lower ratio of superficial SSI than in the wound washing group. PMID:25186077

  3. Stryphnodendron adstringens extract associated with the hooves trimming surgical procedure for the treatment of bovine digital dermatitis.

    PubMed

    Silva, Luiz A F; de Moura, Maria I; Dambros, Carlos E; Freitas, Sabrina L R; Souza, Luiz A; Abreu, Morgana P

    2013-06-01

    Hoof care, lesion curettage, and application of 5 % Stryphnodendron adstringens bark extract (S. adstringens (Mart.) Coville) or 3 % copper sulfate on surgical wounds of cattle were carried out in this research. A total of 180 cattle with digital dermatitis were used. They were distributed into six groups of 30 animals each (GI, GII, GIII, GIV, GV, and GVI). In GI and GII, only the sick digit was trimmed; in GIII and GIV, both sick and healthy digits of the lesioned limb were trimmed; and in GV and GVI, all digits were trimmed. During the postoperative period, 5 % S. adstringens extract was applied in GI, GIII, and GV, and 3 % copper sulfate solution was applied in GII, GIV, and GVI. After 60 days of evaluation, the data were analyzed using the Chi-squared test (p? ? ?0.05). Both therapeutic protocols utilizing surgical curettage of the lesions were efficient for treating digital dermatitis. However, when the procedure is followed by the trimming of sick and healthy digits, the healing is optimized and a greater number of animals are rehabilitated. PMID:23443825

  4. Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

    PubMed

    Ohba, Seigo; Yoshimura, Hitoshi; Ishimaru, Kyoko; Awara, Kousuke; Sano, Kazuo

    2014-05-01

    The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery. PMID:24811701

  5. Use of high-magnification loupes or surgical operating microscope when performing prophylaxes, scaling or root planing procedures.

    PubMed

    Mamoun, John

    2013-01-01

    The use of high-level magnification (6-8x loupes magnification, or higher degrees of magnification provided by the surgical operating microscope), combined with head-mounted, coaxial lighting, may improve the ability of a dentist or dental hygienist to perform prophylaxis or scaling and root planing procedures, compared to the performance of these tasks using unaided vision or entry-level (2.5x) magnification, combined with overhead operatory lighting. A magnified view of the supragingival contours of a tooth surface facilitates visualizing the dimensions and curvature of the unseen sub-gingival tooth surfaces, which facilitates detection and removal of calculus that is located on these subgingival surfaces. Improved calculus removal ability may lead to better periodontal disease outcomes. PMID:24245463

  6. Patch bulging after plaque incision and grafting procedure for Peyronie's disease. Surgical repair with a collagen fleece.

    PubMed

    Fabiani, Andrea; Fioretti, Fabrizio; Filosa, Alessandra; Servi, Lucilla; Mammana, Gabriele

    2015-06-01

    The incision/excision and grafting techniques (PIG) for surgical therapy of Peyronie's disease (PD) have gained popularity in recent years. Several different graft materials have been used but the ideal graft has yet to be established. The use of grafting materials could cause complications. In the daily clinical practice it will always be more frequent to manage complications arising from their use. We present herein the case of a patch bulging repaired with a ready-to-use collagen fleece (Tachosil®, Takeda, Linz, Austria, Europe) in a 61 years old man subjected to intervention of geometric corporoplasty with Paulo Egydio technique using an acellular collagen material (Xenform® patch, Boston Scientific, Natick, MA, USA) as graft. We also discuss the possible implications of PIG procedure. PMID:26150042

  7. Comparison of surgical, functional, and oncological outcomes of open and robot-assisted partial nephrectomy

    PubMed Central

    Boylu, Ugur; Basatac, Cem; Yildirim, Umit; Onol, Fikret F.; Gumus, Eyup

    2015-01-01

    BACKGROUND: We aimed to compare the surgical, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) with open partial nephrectomy (OPN) in the management of small renal masses. MATERIALS AND METHODS: Between 2009 and 2013, a total of 46 RAPN patients and 20 OPN patients was included in this study. Patients’ demographics, mean operative time, estimated blood loss (EBL), warm ischemia time (WIT), length of hospital stay, pre- and post-operative renal functions, complications and oncological outcomes were recorded, prospectively. RESULTS: Mean tumor size was 4.04 cm in OPN group and 3.56 cm in RAPN group (P = 0.27). Mean R.E.N.A.L nephrometry score was 6.35 in OPN group and 5.35 in RAPN group (P = 0.02). The mean operative time was 152 min in OPN group and 225 min in RAPN group (P = 0.006). The mean EBL in OPN and RAPN groups were 417 ml and 268 ml, respectively (P = 0.001). WIT in OPN group was significantly shorter than RAPN group (18.02 min vs. 23.33 min, P = 0.003). The mean drain removal time and the length of hospital stay were longer in OPN group. There were no significant differences in terms of renal functional outcomes and postoperative complications between groups. CONCLUSION: Minimally invasive surgical management of renal masses with RAPN offers better outcomes in terms of EBL and length of stay. However, the mean operative time and WIT were significantly shorter in OPN group. RAPN is a safe and effective minimally invasive alternative to OPN in terms of oncological and functional outcomes. PMID:25598603

  8. Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: Comparison of retroperitoneoscopic and open nephroureterectomy

    PubMed Central

    Taweemonkongsap, Tawatchai; Nualyong, Chaiyong; Amornvesukit, Teerapon; Leewansangtong, Sunai; Srinualnad, Sittiporn; Chaiyaprasithi, Bansithi; Sujijantararat, Phichaya; Tantiwong, Anupan; Soontrapa, Suchai

    2008-01-01

    Objectives To determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC). Patients and methods From April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression. Results The mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3–72) for RNU and 27.9 months (range 3–63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227). Conclusion Retroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC. PMID:18194580

  9. Innovative procedure for computer-assisted genioplasty: three-dimensional cephalometry, rapid-prototyping model and surgical splint.

    PubMed

    Olszewski, R; Tranduy, K; Reychler, H

    2010-07-01

    The authors present a new procedure of computer-assisted genioplasty. They determined the anterior, posterior and inferior limits of the chin in relation to the skull and face with the newly developed and validated three-dimensional cephalometric planar analysis (ACRO 3D). Virtual planning of the osteotomy lines was carried out with Mimics (Materialize) software. The authors built a three-dimensional rapid-prototyping multi-position model of the chin area from a medical low-dose CT scan. The transfer of virtual information to the operating room consisted of two elements. First, the titanium plates on the 3D RP model were pre-bent. Second, a surgical guide for the transfer of the osteotomy lines and the positions of the screws to the operating room was manufactured. The authors present the first case of the use of this model on a patient. The postoperative results are promising, and the technique is fast and easy-to-use. More patients are needed for a definitive clinical validation of this procedure. PMID:20417056

  10. A Fluidic Cell Embedded Electromagnetic Wave Sensor for Online Indication of Neurological Impairment during Surgical Procedures

    NASA Astrophysics Data System (ADS)

    Blakey, R. T.; Mason, A.; Al-Shamma'a, A. I.

    2013-06-01

    Lactate is known to be an indicator of neurological impairment during aortic aneurysm surgery. It is suggested that cerebrospinal fluid removed during such surgery could provide useful information in this regard. Medical professionals find the prospect of online detection of such analytes exciting, as current practice is time consuming and leads to multiple invasive procedures. Advancing from the current laboratory based analysis techniques to online methods could provide the basis for improved treatment regimes, better quality of care, and enhanced resource efficiency within hospitals. Accordingly, this article considers the use of a low power fluidic system with embedded electromagnetic wave sensor to detect varying lactate concentrations. Results are promising over the physiological range of 0 - 20 mmol/L with a calibration curve demonstrating an R2 value > 0.98.

  11. Occupational Radiation Exposure from C Arm Fluoroscopy During Common Orthopaedic Surgical Procedures and its Prevention

    PubMed Central

    Samuel, Sumant; Saran, Atul K; Mahajan, M K; Mam, M K

    2015-01-01

    Background: Image intensifiers have become popular due to the concept of minimally invasive surgeries leading to decreasing invasiveness, decreased operative time, and less morbidity. The drawback, however, is an increased risk of radiation exposure to surgeon, patient and theatre staff. These exposures have been of concern due to their potential ability to produce biological effects. The present study was embarked upon to analyse the amount of radiation received by orthopedic surgeons in India using standard precautionary measures and also to bring awareness about the use of image intensifier safety in everyday practice. Materials and Methods: Twelve right-handed male orthopedic surgeons (4 senior consultants, 5 junior consultants and 3 residents) were included in a three month prospective study for radiation exposure measurement with adequate protection measures in all procedures requiring C Arm fluoroscopy. Each surgeon was provided with 5 Thermo Luminescent Dosimeter (TLD) badges which were tagged at the level of neck, chest, gonads and both wrists. Operative time and exposure time of each procedure was recorded. Exposure dose of each badge at the end of the study was obtained and the results were analysed. Results: Mean radiation exposure to all the parts were well within permissible limits. There was a significantly positive correlation between the exposure time and the exposure dose for the left wrist (r=0.735, p<0.01) and right wrist (r=0.58, p<0.05). The dominant hand had the maximum exposure overall. Conclusion: Orthopaedic surgeons are not classified radiation workers. The mean exposure doses to all parts of the body were well within permissible limits. Nothing conclusive, however, can be said about the stochastic effects (chance effects like cancers). Any amount of radiation taken is bound to pose an additional occupational hazard. It is thus desirable that radiation safety precautions should be taken and exposures regularly monitored with at least one dosimeter for monitoring the whole-body dose. PMID:25954671

  12. Role of ancillary procedures in surgical management of carpal tunnel syndrome: epineurotomy, internal neurolysis, tenosynovectomy, and tendon transfers.

    PubMed

    Ting, Jess; Weiland, Andrew J

    2002-05-01

    The role of ancillary procedures in the treatment of carpal tunnel syndrome is controversial, especially with regard to internal neurolysis and epineurotomy. At present, there are little to no data to support their routine use in the treatment of primary carpal tunnel syndrome. Similarly, the use of tenosynovectomy in carpal tunnel surgery should be limited to those patients with clear underlying rheumatologic or inflammatory risk factors, or with gross synovitis incidentally noted at surgery. The Camitz transfer is uniquely suited to treating the thenar wasting seen in advanced carpal tunnel syndrome. It can be performed concurrently with open carpal tunnel release with minimal additional dissection and morbidity. PMID:12371034

  13. Incisional Surgical Site Infection after Elective Open Surgery for Colorectal Cancer

    PubMed Central

    Kusumi, Takaya; Hosokawa, Masao; Sumikawa, Sosuke; Furukawa, Hiroshi

    2014-01-01

    Background. The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer. Methods. We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development. Results. A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4). Conclusions. The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI. PMID:24800067

  14. A pilot study to determine medical laser generated air contaminant emission rates for a simulated surgical procedure.

    PubMed

    Lippert, Julia F; Lacey, Steven E; Lopez, Ramon; Franke, John; Conroy, Lorraine; Breskey, John; Esmen, Nurtan; Liu, Li

    2014-01-01

    The U.S. Occupational Safety and Health Administration (OSHA) estimates that half a million health-care workers are exposed to laser surgical smoke each year. The purpose of this study was to establish a methodology to (1) estimate emission rates of laser-generated air contaminants (LGACs) using an emission chamber, and to (2) perform a screening study to differentiate the effects of three laser operational parameters. An emission chamber was designed, fabricated, and assessed for performance to estimate the emission rates of gases and particles associated with LGACs during a simulated surgical procedure. Two medical lasers (Holmium Yttrium Aluminum Garnet [Ho:YAG] and carbon dioxide [CO2]) were set to a range of plausible medical laser operational parameters in a simulated surgery to pyrolyze porcine skin generating plume in the emission chamber. Power, pulse repetition frequency (PRF), and beam diameter were evaluated to determine the effect of each operational parameter on emission rate using a fractional factorial design. The plume was sampled for particulate matter and seven gas phase combustion byproduct contaminants (benzene, ethylbenzene, toluene, formaldehyde, hydrogen cyanide, carbon dioxide, and carbon monoxide): the gas phase emission results are presented here. Most of the measured concentrations of gas phase contaminants were below their limit of detection (LOD), but detectable measurements enabled us to determine laser operation parameter influence on CO2 emissions. Confined to the experimental conditions of this screening study, results indicated that beam diameter was statistically significantly influential and power was marginally statistically significant to emission rates of CO2 when using the Ho:YAG laser but not with the carbon dioxide laser; PRF was not influential vis-a-vis emission rates of these gas phase contaminants. PMID:24498966

  15. Surgical management of Gerhardt syndrome.

    PubMed

    Chiril?, M; Mure?an, R; Cosgarea, M; Tomescu, E

    2010-01-01

    Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies. PMID:20726297

  16. The preferable use of port access surgical technique for right and left atrial procedures.

    PubMed

    Gersak, B; Sostaric, M; Kalisnik, J M; Blumauer, R

    2005-01-01

    We analyzed the results of mitral valve operations, either alone or in any combination with the tricuspid valve surgeries in the period from January 2001 till June 2004. The period was divided into two parts, classical sternotomy part (C) (110 patients) and minimally invasive port access part (PA) (105 patients), later being used from December 2002 till now. Also, what we were interested in was the total hospital cost of both types of the procedures and if there are any advantages of port access over the classical sternotomy. The mean age was 61.2 +/- 10.2 and 60.3 +/- 12.4 (C versus PA) and mean additive Euroscore was 6.5 versus 4.8 (C versus PA). There were statistically significant differences (P < .0001) in cardiopulmonary bypass time (CPB) and aortic cross-clamp time (AXT) between both groups: CPB C versus PA: 98.3 +/- 33.5 minutes versus 149.2 +/- 44.2 minutes (mean +/- sd), AXT C versus PA: 62.9 +/- 20.6 minutes versus 88.3 +/- 26.8 minutes (mean +/- sd). There were no statistically significant differences in mortality and stroke for both the groups (mortality P = 1, stroke P = .53). There were statistically significant differences in favor of the port access over the classical one for: intensive unit stay (P = .004), postoperative stay in days (P < .0001), blood transfusion (P < .0001), postoperative thoracic bleeding (P < .0001), and extubation time in hours (P < .0001). Furthermore, costs analyses showed that the average total patient cost was less for port access (P < .0005). The differences between endo and classical type suggested that the port access type of surgery is 20% cheaper than the classical one. We may conclude that port access surgery is an acceptable alternative to classical type of surgery, also in complex pathology of the mitral and tricuspid valve. PMID:16099739

  17. Evaluation of, and Revision of Open Laboratory Procedures at the College Freshman Level.

    ERIC Educational Resources Information Center

    Downing, William L.

    This report focuses on the open laboratory procedures used in the freshman biology course at Hamline University. The study aimed to review a number of specific methods used in conducting the unstructured and unscheduled laboratory procedures and discover the most effective arrangement using those procedures. The report includes detailed…

  18. Combination of osteotomy of the first metatarsal according to Frejka with McBride operation procedure in surgical therapy of extreme hallux valgus.

    PubMed

    Kokavec, M; Novorolsky, K; Bdzoch, M

    2005-01-01

    Hallux valgus is to be perceived as a complex of deformities of the first ray of the foot, often accompanied by deformity of forefoot. Although, this deformity can be treated with as many as 200 surgical procedures, the authors would like to demonstrate the effect of their own approach. The authors evaluate the results of hallux valgus surgery combining the operation according to McBride and wedge osteotomy of the first metatarsal (MT) basis in 21 patients (37 surgeries) with post-surgical follow-up lasting from 29 to 45 months (i.e. 3 years in average). Pre-operative mean intermetatarsal 1-2 angle revealed by radiographs was surgically corrected from 21.7 degrees at the baseline to the mean degree of 8.8. The pre-surgical average 45.9-degree of great toe valgosity proved by radiographs was surgically improved to the mean of 13.5 degrees. 87% of patients expressed their personal satisfaction with their surgical results. The authors consider the combination of wedge osteotomy of the first metatarsal basis with the operation according to McBride to be suitable in the therapy of extreme valgosity of great toes with increased metatarsal angle between first and 2nd metatarsal in young patients with minimum of changes in the metatarsophalangeal joint developed due to arthrosis (Tab. 2, Fig. 6, Ref. 7). PMID:16642664

  19. A surgical procedure and tethering system for chronic blood sampling, infusion, and temperature monitoring in caged nonhuman primates.

    PubMed

    McNamee, G A; Wannemacher, R W; Dinterman, R E; Rozmiarek, H; Montrey, R D

    1984-06-01

    A jacket and tethering system was used to maintain chronic catheters in monkeys, which provided catheter access and manipulability without further restraint. Surgical placement of catheters and a temperature probe allowed for a common cutaneous exit and interface with the jacket and tether. Monkeys were fitted in a sterile leather or denim jacket which was attached to a sterilized flexible stainless steel cable. Through this conduit, an indwelling temperature probe, as well as catheters from the internal jugular and femoral veins, were attached to a swivel unit located on the upper portion of the cage. The internal jugular catheter was used for the continuous infusion of support solution. The catheter from the femoral vein was maintained with a heparin lock and used for serial blood sampling. Using this system, it was possible to obtain frequent blood samples and body temperature readings, and to administer a continuous intravenous infusion without chemical or excessive physical restraint. To date, 367 monkeys, 322 cynomolgus (Macaca fasicularis), 16 rhesus (Macaca mulatta), and 21 African green (Cercopithecus aethiops) have been studied using this procedure. PMID:6748610

  20. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation

    PubMed Central

    Mardanpour, Keykhosro; Rahbar, Mahtab

    2013-01-01

    Abstract: Background: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients’ age was 37 years (range 20 to 67). Twenty six patients were men (4patients with type B and 22 patients with type C fracture) and 12 women (7 patients with type B and 5 patients with type C fracture). The commonest cause was a road traffic accident (N=37, about 97%). Internal fixation was done by plaque with ilioinguinal and kocher-langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. Results: There were 11 type-C and 27 type-B pelvic fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months).The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005). Conclusions: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks. PMID:23103962

  1. The minimally invasive open video-assisted approach in surgical thyroid diseases

    PubMed Central

    Ruggieri, Massimo; Straniero, Andrea; Mascaro, Alessandra; Genderini, Mariapia; D'Armiento, Massimino; Gargiulo, Patrizia; Fumarola, Angela; Trimboli, Pierpaolo

    2005-01-01

    Background The targets of minimally invasive surgery (MIVA) could be summarised by: achievement of the same results as those obtained with traditional surgery, less trauma, better post-operative course, early discharge from hospital and improved cosmetic results. The minimally invasive techniques in thyroid surgery can be described as either endoscopic "pure" approach (completely closed approach with or without CO2 insufflation), or "open approach" with central neck mini-incision or "open video-assisted approach". Traditionally, open thyroidectomy requires a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is much shorter (1.5 cm for small nodules, up to 2–3 cm for the largest ones, in respect of the exclusion criteria) upon the suprasternal notch. Patients also experience much less pain after MIVA surgery than after conventional thyroidectomy. This is due to less dissection and destruction of tissues. Pathologies treated are mainly nodular goiter; the only kind of thyroid cancer which may be approached with endoscopic surgery is a small differentiated carcinoma without lymph node involvement. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria, such as gland volume and the kind of disease. In our experience we have chosen the minimally invasive open video-assisted approach of Miccoli et al. (2002). The aim of this work was to verify the suitability of the technique and the applicability in clinical practice. Methods A completely gasless procedure was carried out through a 15–30 mm central incision about 20 mm above the sternal notch. Dissection was mainly performed under endoscopic vision using conventional endoscopic instruments. The video aided group included 11 patients. All patients were women with a average age of 54. Results We performed thyroidectomy in 8 cases and hemithyroidectomy in 3 cases. The operative average time has been 170 minutes. Conclusion Nowadays this minimally invasive surgery, in selected patients, clearly demonstrates excellent results regarding patient cure rate and comfort, with shorter hospital stay, reduced postoperative pain and most attractive cosmetic results. PMID:15857503

  2. Development of remote surgical navigation and biopsy needle guidance system using Open-MRI and high-speed network

    NASA Astrophysics Data System (ADS)

    Okura, Yasuhiko; Matsumura, Yasushi; Kuwata, Shigeki; Takeda, Hiroshi

    2004-05-01

    This study describes a remote surgical guidance and navigation system developed for surgery using "Open-MRI" and high-speed network. We connected Osaka University Hospital and Kawasaki Hospital which has deployed Open- MRI with high speed IP over ATM network. The distance between two hospitals is approximately 50 km. Two video cameras were installed with an angle of 40 degrees on an open-MRI gantry to obtain intraoperative images. Two pairs of CODEC (AD/DA converter) were equipped on the network to transfer both images and sound in real time. A pointer system to indicate a region on an image was also developed. MRI images obtained by Open-MRI were transferred to a 3D workstation in Osaka University Hospital. The system was designed for a senior surgeon in Osaka University to advise regarding accurate needle direction for a remote patient by checking the reconstructed 3D images and schemata shown by the navigation software. The schemata were also superimposed on intraoperative images from two cameras, and the superimposed images were sent back to Kawasaki Hospital. This system allowed a surgeon in the operation room at Kawasaki Hospital to accurately view navigation schema under supervision by a senior surgeon in a remote university hospital with superimposion of intraoperative images. The pointer system allowed both doctors to share intraoperative images during a virtual-real surgical operation. A successful biopsy case using this newly developed system illustrates the effectiveness of this system.

  3. Mastectomy -- The Surgical Procedure

    MedlinePLUS Videos and Cool Tools

    ... About Breast Cancer View About Breast Cancer Facts & Statistics View Facts & Statistics What is Breast Cancer View What is Breast ... Benign Breast Conditions Warning Signs & Symptoms Breast Cancer Statistics Breast Cancer in Men Research Studies View Research ...

  4. IC Treatment: Surgical Procedures

    MedlinePLUS

    ... questions to take with you to the doctor. Laser Surgery Laser surgery has been used successfully to treat Hunner’s ... of IC patients. A type of transurethral fulguration, laser surgery works by destroying a layer of tissue ...

  5. An integrated visualization system for surgical planning and guidance using image fusion and an open MR

    Microsoft Academic Search

    David T. Gering; Arya Nabavi; Ron Kikinis; Noby Hata; Lauren J. O'Donnell; W. Eric L. Grimson; Ferenc A. Jolesz; Peter M. Black; William M. Wells

    2001-01-01

    A surgical guidance and visualization system is presented, which uniquely integrates capabilities for data analysis and on-line interventional guidance into the setting of interven- tional MRI. Various pre-operative scans (T1- and T2-weighted MRI, MR angiography, and functional MRI (fMRI)) are fused and automatically aligned with the operating field of the interventional MR system. Both pre-surgical and intra-oper- ative data may

  6. Open-loop recycling: Criteria for allocation procedures

    Microsoft Academic Search

    Tomas Ekvall; Anne-Marie Tillman

    1997-01-01

    If the aim of an LCA is to support decisions or to generate and evaluate ideas for future decisions, the allocation procedure\\u000a should generally be effect-oriented rather than cause-oriented. It is important that the procedure be acceptable to decision\\u000a makers expected to use the LCA results. It is also an advantage if the procedure is easy to apply. Applicability appears

  7. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth.

    PubMed

    Costa, Fabio; Robiony, Massimo; Toro, Corrado; Sembronio, Salvatore; Politi, Massimo

    2006-01-01

    There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth. PMID:17090337

  8. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth

    PubMed Central

    Costa, Fabio; Robiony, Massimo; Toro, Corrado; Sembronio, Salvatore; Politi, Massimo

    2006-01-01

    There have been reports on the migration of teeth or implants into the maxillary sinus. We know of only one report on the migration of a gutta-percha point that had been used to fill a root canal into the ethmoid sinus. We report such a case treated with an endoscopically assisted procedure for removal of the foreign body and contemporary endodontic surgical treatment of the tooth. PMID:17090337

  9. The effect of muscle-tone-reducing procedures in athetotic head movements: partial nerve block by lidocaine and surgical release of the neck muscles

    Microsoft Academic Search

    K Saiki; N Tsuzuki; R Tanaka

    1999-01-01

    Objective: To investigate the effect of muscle-tone-reducing procedures (MTRPs), i.e. partial nerve block by lidocaine (PNB) and surgical release of muscle attachment to bone (SRMAB), on incessant involuntary head movements in athetotic patients.Methods: Pre\\/post-MTRP changes in neck-muscle activities, glabella movement and maximum isometric forces of the head were measured in six athetotic patients with severe spondylotic myelopathy resulting from incessant

  10. Non-Surgical Procedures Open Blocked Arteries to Prevent and Treat Stroke

    MedlinePLUS

    ... breast Cancer - kidney Cancer - liver Cancer - lung Deep vein thrombosis Endovascular Treatment of CCSVI for MS Gastrostomy ( ... Trauma Uterine fibroids Varicoceles and male infertility Varicose veins Venous access catheters Vertebroplasty Women and vascular disease ...

  11. Students' Approaches to Open-Ended Science Investigation: The Importance of Substantive and Procedural Understanding

    ERIC Educational Resources Information Center

    Roberts, Ros; Gott, Richard; Glaesser, Judith

    2010-01-01

    This paper investigates the respective roles of substantive and procedural understanding with regard to students' ability to carry out an open-ended science investigation. The research is a case study centred on an intervention in which undergraduate initial teacher training students are taught the basic building blocks of procedural

  12. Extraction of a foreign body in the liver using single incision laparoscopic surgery: a new application for minimally invasive surgical procedures.

    PubMed

    Belgrano, Valerio; Bagge, Roger Olofsson; Scordamaglia, Chiara; Scordamaglia, Renato

    2015-04-01

    Ingestion of foreign bodies is a common medical problem frequently observed in children, psychiatric patients and prisoners. Various cases have been found in the medical literature, with different diagnostic and therapeutic approaches. We report a case of a 41-year-old male inmate, hospitalized for right upper quadrant pain of the abdomen due to the ingestion of two syringe needles two weeks previously. We describe the diagnostic procedure and the removal of one of the two needles that had migrated into the liver parenchyma, using a single-incision laparoscopic surgical technique. The operation was carried out safely through a 2.5 cm transverse incision below the umbilicus. The dissection and the removal of the foreign body were easily conducted under direct visualization using a minimally invasive surgical technique. Our case report demonstrates the efficacy and the security of the laparoscopic treatment in such a challenging area, employing a single port access only. PMID:25960804

  13. Unusual causes of reduced mouth opening and it's suitable surgical management: Our experience

    PubMed Central

    Gupta, Sunil Kumar; Rana, Amar S.; Gupta, Deepak; Jain, Gaurav; Kalra, Puneet

    2010-01-01

    Reduced mouth opening is a common clinical problem and many individuals experience it at least once in his or her life and most dental practitioners see patients with restricted mouth opening quite often. It can occur due to a variety of underlying conditions which may involve complex factors. Hence, it is essential for the clinician to thoroughly investigate and examine these cases for proper diagnosis and its appropriate management. PMID:22442560

  14. Periodontal Treatments and Procedures

    MedlinePLUS

    ... Procedures Non-Surgical Periodontal Treatments Gum Graft Surgery Laser Treatment for Gum Disease Regenerative Procedures Dental Crown Lengthening ... dental implants. Non-Surgical Treatments Gum Graft Surgery Laser Treatment Regenerative Procedures Dental Crown Lengthening Dental Implants Pocket ...

  15. Surgical lead extraction for total occlusion of the superior vena cava by chronic lead infection after mustard procedure.

    PubMed

    Steinberg, Christian; Calvaruso, Davide; Guimond, Jean; Bédard, Elisabeth; Perron, Jean

    2014-05-01

    We present a case of total occlusion of the superior vena cava (SVC) with extensive thrombosis of the adjacent large veins secondary to multiple abandoned pacemaker leads with a superimposed chronic lead infection by Corynebacterium jeikeium. A surgical lead extraction was performed with an extensive en-bloc resection of the SVC together with the right subclavian vein and the right innomate vein. No venous reconstruction was required because of an unobstructed runoff via a well-developed azygos system. PMID:24438576

  16. A New Approach to Restoring Root-End Cavity Preparation in Surgical Endodontic Procedures—A Scanning Electron Microscopy Study

    Microsoft Academic Search

    Donald C. Yu

    While many different restorative materials are now available for filling root-end preparations in surgical endodontic therapy, each one has drawbacks. The current study suggests that a flowable composite resin, cured by a high-power curing light in 10 seconds, may be the material of choice. The significance of coating the resected root surface with a dentin-bonding agent is also discussed. Learning

  17. Assessing the performance characteristics and clinical forces in simulated shape memory bone staple surgical procedure: The significance of SMA material model.

    PubMed

    Saleeb, A F; Dhakal, B; Owusu-Danquah, J S

    2015-07-01

    This work is focused on the detailed computer simulation of the key stages involved in a shape memory alloy (SMA) osteosynthesis bone stapling procedure. To this end, a recently developed three-dimensional constitutive SMA material model was characterized from test data of three simple uniaxial-isothermal-tension experiments for powder metallurgically processed nickel-rich NiTi (PM/NiTi-P) material. The calibrated model was subsequently used under the complex, thermomechanical loading conditions involved in the surgical procedure using the body-temperature-activated PM/NiTi-P bone staple. Our aim here is to assess the immediate and post-surgical performance characteristics of the stapling operation using the material model. From this study: (1) it was found that adequate compressive forces were developed by the PM/NiTi-P bone staple, with the tendency of this force to even increase under sustained thermal loading due to the intrinsic "inverse relaxation phenomena" in the SMA material, (2) the simulation results correlated well with those from experimental measurements, (3) the body-temperature-activated PM/NiTi-P staple was proved to be clinically viable, providing a stable clamping force needed for speedy coaptation of the fractured bones, and (4) these realistic assessments crucially depend on the use of suitable and comprehensive SMA material models. PMID:25956346

  18. Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25?cmH?O: prospective, blind, and randomised study.

    PubMed

    Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60?cmH?O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25?cmH?O, L group) and high (at 60?cmH?O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25?cmH?O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334. PMID:24778598

  19. Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic surgical techniques.

    PubMed

    Mierdl, S; Byhahn, C; Lischke, V; Aybek, T; Wimmer-Greinecker, G; Dogan, S; Viehmeyer, S; Kessler, P; Westphal, Klaus

    2005-02-01

    Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO(2) insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures. PMID:15673848

  20. The Effect of Medicaid Expansion in New York State on Use of Subspecialty Surgical Procedures by Medicaid Beneficiaries and the Uninsured

    PubMed Central

    Giladi, Aviram M; Aliu, Oluseyi; Chung, Kevin C

    2014-01-01

    BACKGROUND Understanding the benefits of Medicaid is crucial as states decide whether to expand Medicaid under the Patient Protection and Affordable Care Act. We used the 2001 Medicaid expansion in New York to evaluate changes in use by Medicaid beneficiaries and the uninsured of breast cancer reconstruction, panniculectomy, and lower-extremity trauma management. METHODS Data for all patients 19 to 64 years old having undergone the selected procedures between 1998 and 2006 were obtained from the State Inpatient Database. We used an interrupted time series using variance weighted least squares regression to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients received the procedures. We also determined the predicted use had there been no expansion. New York Census data were used for population-adjusted case-volume calculations. RESULTS Likelihood of Medicaid as the primary payer increased significantly after expansion, 0.34% per quarter (95% CI, 0.28–0.40), without a decrease in uninsured patients receiving these procedures. This resulted in a 7.2% increase in the proportion of Medicaid beneficiaries receiving these procedures, an additional 1.9 Medicaid cases per quarter per 100,000 New York residents. In subgroup analysis, the proportion of Medicaid beneficiaries increased for breast reconstruction (0.28% per quarter; 95% CI, 0.21–0.35) and panniculectomy (0.19% per quarter; 95% CI, 0.1–0.28) without a decrease for the uninsured. Lower-extremity trauma procedures had a decreasing trend in use by uninsured patients with a slight increase for Medicaid beneficiaries (not significant). CONCLUSIONS Subspecialty surgeons responded to expansion by increasing volume of procedures for Medicaid beneficiaries. This occurred without decline in care for the uninsured, suggesting that Medicaid expansion resulted in increased access for underserved patients. Although more patients received needed care once they had coverage, subgroup analysis identified persistence of additional barriers to use of certain surgical services. PMID:24661853

  1. Apneumic laparoscopy in surgical oncology.

    PubMed

    Schneider, J J; Smith, R S; Organ, C H

    1994-01-01

    Minimally invasive techniques now play an important role in virtually every aspect of general surgery. While it is unlikely that celiotomy for malignant disease will fall into obscurity as rapidly as open cholecystectomy, greater use of videoscopic techniques in surgical oncology are inevitable and will undoubtably improve patient care. Techniques of isopneumic laparoscopy have already proven useful in trauma, cholecystectomy, bowel resection, herniorrhaphy, and a variety of other procedures. Further advances in this technique are dependent on the development of "user friendly" abdominal wall retraction systems. PMID:7855473

  2. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

    2000-01-01

    Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

  3. Product of Tracking Experts for Visual Tracking of Surgical Tools Suren Kumar, Madusudanan Sathia Narayanan, Pankaj Singhal, Jason J. Corso and Venkat Krovi

    E-print Network

    Krovi, Venkat

    ) procedures result in minimal pre- and post- surgical trauma and faster recovery for the patients. However deformations, image specularities and clutter, tool open/closed states, occlusion of tools due to blood and

  4. The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998–2004)

    PubMed Central

    O'Malley, Sue P

    2006-01-01

    Background In 1998 a formal process using the criteria of safety, effectiveness and cost-effectiveness (evidence based medicine) on the introduction and use of new medical procedures was implemented in Australia. As part of this process an expert panel, the Medical Services Advisory Committee (MSAC) was set up. This paper examines the effectiveness of this process based on the original criteria, that is, evidence based medicine. Method The data for this analysis was sourced primarily from that made available in the public domain. The MSAC web site provided Minutes from MSAC meetings; Annual Reports; Assessment and Review reports; Progress status; and Archived material. Results The total number of applications submitted to the MSAC has been relatively low averaging approximately only fourteen per year. Additionally, the source of applications has quickly shifted to the medical devices, equipment and diagnostic industry as being the major source of applications. An overall average time for the processing of an application is eighteen months. Negative recommendations were in most cases based on insufficient clinical evidence rather than clinical evidence that clearly demonstrated a lack of clinical effectiveness. It was rare for a recommendation, either positive or negative, to be based on cost-effectiveness. Conclusion New medical procedures are often the result of a process of experimentation rather than formally conducted research. Affordability and the question of who should pay for the generation, collection and analysis of the clinical evidence is perhaps the most difficult to answer. This is especially the case where the new procedure is the result of a process of experimentation with an old procedure. A cost-effective way needs to be found to collect acceptable levels of evidence proving the clinical effectiveness of these new procedures, otherwise the formal processes of evaluation such as that used by the Australian MSAC since 1998 will continue to run the risk of committing Type II errors, that is, denying access to medical procedures that are beneficial and efficient. PMID:16684362

  5. An inexpensive modified transobturator vaginal tape inside-out procedure for the surgical treatment of female stress urinary incontinence

    Microsoft Academic Search

    Xinliang Chen; Huaifang Li; Bozhen Fan; Xiang Yang; Xiaowen Tong

    2009-01-01

    Introduction and hypothesis  The purpose of this study was to evaluate the safety and efficacy of a modified transobturator vaginal tape inside-out (TVT-O)\\u000a procedure for stress urinary incontinence (SUI) using custom-tailored polypropylene mesh and helical needles.\\u000a \\u000a \\u000a \\u000a Methods  A 1×15-cm mesh made from the Gynemesh is positioned without tension under the mid-urethra using custom-made helical needles\\u000a through the obturator.\\u000a \\u000a \\u000a \\u000a Results  The procedure was carried

  6. Surgical procedures and postsurgical tissue processing significantly affect expression of genes and EGFR-pathway proteins in colorectal cancer tissue

    PubMed Central

    David, Kerstin A.; Unger, Florian T.; Uhlig, Philipp; Juhl, Hartmut; Moore, Helen M.; Compton, Carolyn; Nashan, Björn; Dörner, Arnulf; de Weerth, Andreas; Zornig, Carsten

    2014-01-01

    An understanding of tissue data variability in relation to processing techniques during and postsurgery would be desirable when testing surgical specimens for clinical diagnostics, drug development, or identification of predictive biomarkers. Specimens of normal and colorectal cancer (CRC) tissues removed during colon and liver resection surgery were obtained at the beginning of surgery and postsurgically, tissue was fixed at 10, 20, and 45 minutes. Specimens were analyzed from 50 patients with primary CRC and 43 with intrahepatic metastasis of CRC using a whole genome gene expression array. Additionally, we focused on the epidermal growth factor receptor pathway and quantified proteins and their phosphorylation status in relation to tissue processing timepoints. Gene and protein expression data obtained from colorectal and liver specimens were influenced by tissue handling during surgery and by postsurgical processing time. To obtain reliable expression data, tissue processing for research and diagnostic purposes needs to be highly standardized. PMID:25526028

  7. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    PubMed Central

    Jannati, Yadollah; Bagheri-Nesami, Masoumeh; Sohrabi, Maryam; Yazdani-Cherati, Jamshid; Mazdarani, Shahrzad

    2014-01-01

    Objective The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Method This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. Results We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium. PMID:25337310

  8. Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy

    PubMed Central

    Nath, Rahul K.; Somasundaram, Chandra

    2012-01-01

    Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5–9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1–17.9 years). Results: The mean preoperative total Mallet score was 14.8 (range, 10–20), and active abduction was 84° (range, 20°–140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13–25, P < .0001), and the mean active abduction improved to 132° (range, 40°–180°, P < .0003). Conclusion: The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder. PMID:23308301

  9. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period

    PubMed Central

    Lucio, John C; VanConia, R Brent; DeLuzio, Kevin J; Lehmen, Jeffrey A; Rodgers, Jody A; Rodgers, WB

    2012-01-01

    Background There is great debate about the costs and benefits of technology-driven medical interventions such as instrumented lumbar fusion. With most analyses using charge data, the actual costs incurred by medical institutions performing these procedures are not well understood. The object of the current study was to examine the differences in hospital operating costs between open and minimally invasive spine surgery (MIS) during the perioperative period. Methods Data were collected in the form of a prospective registry from a community hospital after specific Institutional Review Board approval was obtained. The analysis included consecutive adult patients being surgically treated for degenerative conditions of the lumbar spine, with either an MIS or open approach for two-level instrumented lumbar fusion. Patient outcomes and costs were collected for the perioperative period. Hospital operating costs were grouped by hospitalization/operative procedure, transfusions, reoperations, and residual events (health care interactions). Results One hundred and one open posterior lumbar interbody fusion (Open group) and 109 MIS patients were treated primarily for stenosis coupled with instability (39.6% and 59.6%, respectively). Mean total hospital costs were $27,055.53 for the Open group and $24,320.16 for the MIS group. This represents a statistically significant cost savings of $2,825.37 (10.4% [95% confidence interval: $522.51–$5,128.23]) when utilizing MIS over traditional Open techniques. Additionally, residual events, complications, and blood transfusions were significantly more frequent in the Open group, compared to the MIS group. Conclusions/level of evidence Utilizing minimally invasive techniques for instrumented spinal fusion results in decreased hospital operating costs compared to similar open procedures in the early perioperative period. Additionally, patient benefits of minimally invasive techniques include significantly less blood loss, shorter hospital stays, lower complication rate, and a lower number of residual events. Long-term outcome comparisons are needed to evaluate the efficacy of the two treatments. Level of evidence: III Clinical relevance This work represents a true cost-of-operating comparison between open and MIS approaches for lumbar spine fusion, which has relevance to surgeons, hospitals and payers in medical decision-making. PMID:22952415

  10. Flexible delivery of Er:YAG radiation at 2.94 µm with negative curvature silica glass fibers: a new solution for minimally invasive surgical procedures

    PubMed Central

    Urich, A.; Maier, R. R. J.; Yu, Fei; Knight, J. C.; Hand, D. P.; Shephard, J. D.

    2012-01-01

    We present the delivery of high energy microsecond pulses through a hollow-core negative-curvature fiber at 2.94 µm. The energy densities delivered far exceed those required for biological tissue manipulation and are of the order of 2300 J/cm2. Tissue ablation was demonstrated on hard and soft tissue in dry and aqueous conditions with no detrimental effects to the fiber or catastrophic damage to the end facets. The energy is guided in a well confined single mode allowing for a small and controllable focused spot delivered flexibly to the point of operation. Hence, a mechanically and chemically robust alternative to the existing Er:YAG delivery systems is proposed which paves the way for new routes for minimally invasive surgical laser procedures. PMID:23413120

  11. Comparison of I-gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study

    PubMed Central

    Kini, Gurudas; Devanna, Gopalkrishna Mettinadka; Mukkapati, Koteswara Rao; Chaudhuri, Souvik; Thomas, Daniel

    2014-01-01

    Background: We compared i-gel and ProSeal laryngeal mask airway (PLMA) regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Materials and Methods: In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident. Results: The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001). Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H2O. The fiberoptic view of glottis, ease of Ryle's tube insertion, and incidence of complications were comparable. Conclusion: Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H2O were more in PLMA group which indicates its better suitability for controlled ventilation. PMID:24803754

  12. Perioperative red blood cell transfusion requirement for various surgical procedures in dogs: 207 cases (2004-2013).

    PubMed

    Haley, Adrienne L; Mann, F A; Middleton, John; Nelson, Courtney A

    2015-07-01

    Objective-To compare perioperative RBC transfusion among dogs undergoing liver lobectomy, splenectomy, partial gastrectomy, rhinotomy, thyroidectomy, perineal herniorrhaphy, and intrathoracic surgery. Design-Retrospective case series. Animals-207 client-owned dogs that underwent various surgeries. Procedures-Medical records were reviewed for dogs that had undergone liver lobectomy, splenectomy, partial gastrectomy, rhinotomy, neoplastic thyroidectomy, perineal herniorrhaphy, or intrathoracic surgery. Transfusion requirement (packed RBC, whole blood, and bovine hemoglobin-based oxygen carrier) and survival rate at 2 weeks after surgery were compared among dogs undergoing the various surgeries. Results-Patients undergoing splenectomy and liver lobectomy were significantly more likely to receive RBC transfusion when each was compared with patients undergoing all other procedures. A significant association was found between body weight and perioperative RBC transfusion, with greater odds of transfusion as body weight increased. Dogs receiving perioperative RBC transfusions were significantly less likely to survive to 2 weeks after surgery. Conclusions and Clinical Relevance-Results indicated that dogs undergoing splenectomy and liver lobectomy may require RBC transfusion perioperatively. Veterinarians who perform these procedures should plan accordingly and have packed RBCs or whole blood donors readily available. PMID:26086233

  13. Comparison between three mini-sling surgical procedures and the traditional transobturator vaginal tape technique for female stress urinary incontinence

    PubMed Central

    LEANZA, V.; INTAGLIATA, E.; LEANZA, A.; FERLA, F.; LEANZA, G.; VECCHIO, R.

    2014-01-01

    Objectives To compare mini-sling and traditional tension-free operations for female stress urinary incontinence. Study design A systematic review of articles in the Literature published between 2002 and 2012, was conducted. A Pubmed search was performed. Primary outcomes were subjective and objective cure rates at 12 months comparing the three single-incision mini-slings techniques (TVT-Secur, MiniArc and Monarc systems) with the standard mid-urethral sling procedure TOT (Transobturator Vaginal Tape). Secondary outcomes included peri-operative (vaginal and/or bladder perforation, urine retention, urinary tract infection, bleeding, pain) and post-operative (mesh exposure, de novo urgency, and dyspareunia) complications. Results In term of objective cure rate at 12 month after surgery, it is evident that TOT at first, and MiniArc are the most effective procedures. The incidence of post-operative urgency and UTI was lower in TOT technique, while vaginal perforation was described in equal frequency both in TOT and in MiniArc procedures. The advantages of the three above described mini-invasive techniques seem to consist into lower cases of urinary retention, pain and bleeding. Furthermore, bladder perforation and bleeding are not described in the Literature for TVT-Secur and Monarc systems. Conclusions Some single-incision slings look promising and as effective as conventional sub-urethral slings at short term evaluation. However, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques. PMID:24841685

  14. Prevention of Surgical Site Infection After Open Prosthetic Inguinal Hernia Repair: Efficacy of Parenteral Versus Oral Prophylaxis with Amoxicillin-Clavulanic Acid in a Randomized Clinical Trial

    Microsoft Academic Search

    Mehmet A. Kuzu; Selçuk Hazinedaro?lu; ?ükrü Dolalan; Nam?k Özkan; Samet Yalç?n; A. Bülent Erkek; Hatem Mahmoudi; Acar Tüzüner; Atilla H. Elhan; Ercümet Kuterdem

    2005-01-01

    The aim of this prospective study was to compare the efficacy of oral versus parenteral prophylactic amoxicillin–clavulanic acid for preventing surgical site infection after open prosthetic mesh repair of inguinal hernia. A total of 480 inguinal-hernia patients were randomly assigned to two groups. Group I (n = 240) received 1.313 g oral amoxicillin–clavulanic acid 2 hours before operation, and group

  15. Electrocautery-Ignited Surgical Field Fire Caused by a High Oxygen Level during Tracheostomy

    PubMed Central

    Kim, Myung-Su; Lee, Jang-Hoon; Lee, Dong-Hyup; Lee, Young Uk; Jung, Tae-Eun

    2014-01-01

    Tracheostomy is a relatively common surgical procedure that is performed easily in an operating room or intensive care unit. Open tracheostomy is needed in patients requiring prolonged ventilation when percutaneous tracheostomy is inappropriate. Sometimes, it is difficult to achieve bleeding control in the peritracheal soft tissue, and in such cases, we usually use diathermy. However, the possibility of an electrocautery-ignited surgical field fire can be overlooked during the procedure. This case report serves as a reminder that the risk of a surgical field fire during tracheostomy is real, particularly in patients requiring high-oxygen therapy. PMID:25346908

  16. Anatomy of the Round Window and Hook Region of the Cochlea With Implications for Cochlear Implantation and Other Endocochlear Surgical Procedures

    PubMed Central

    Li, Peter M. M. C.; Wang, Haobing; Northrop, Clarinda; Merchant, Saumil N.; Nadol, Joseph B.

    2008-01-01

    Hypothesis The goal of this study was to create a three-dimensional model of the anatomy of the hook region to identify the optimal site for cochleostomy in cochlear implant surgery. Background The anatomy of the hook region is complex, and spatial relationships can be difficult to evaluate using two-dimensional histological slides or cadaveric temporal bones. Methods The right temporal bone of a 14-year-old adolescent boy was used to create a three-dimensional model. Sections containing the round window membrane (RWM) and surrounding cochlear structures were stained, digitized, and imported into a general purpose three-dimensional rendering and analysis software program (Amira, version 4.1). Three-dimensional models of the RWM, basilar membrane, osseous spiral lamina, spiral ligament, cochlear aqueduct, inferior cochlea vein, scala media, ductus reuniens, scala vestibuli, scala tympani, and surrounding bone were generated. The relationship between these structures and the RWM and adjacent otic capsule was evaluated. Histological sections from a different temporal bone were also analyzed. This temporal bone was sectioned in a plane perpendicular to the axis corresponding to the surgical view of the RWM, seen through the facial recess. Results The anteroinferior margin of the RWM or adjacent otic capsule was identified as the site for a cochleostomy that will avoid damage to critical cochlear structures and allow implantation directly into the scala tympani. The model can be downloaded from: https://research.meei.harvard.edu/otopathology/3dmodels. Conclusion This three-dimensional model has implications for surgical procedures to the inner ear that aim to minimize insertional trauma. PMID:17667773

  17. Ramirez's abdominoplasty technique combined with intraperitoneal chemohyperthermia after surgical cytoreductive procedures for the treatment of advanced intraperitoneal cancer in patients with ventral hernia.

    PubMed

    Fraccalvieri, Marco; Simone, Paolo; Bruno, Francesco; Gaglia, Piero; Ribero, Franco; Scuderi, Stefano; Seghesio, Raffaele; Monni, Manuela; Zanon, Claudio

    2010-02-01

    Patients affected by peritoneal carcinomatosis are frequently submitted to repeated laparotomies to reduce intra-abdominal bulky lesions and to enhance the systemic chemotherapeutic action. Aim of our study is to evaluate feasibility and results of cytoreductive surgery and intraperitoneal chemohypertermic (IPCH) perfusion combined with Ramirez's abdominoplastic technique in selected patients with voluminous ventral hernias.At the same time, we support the hypothesis that Ramirez' technique would allow a normal intra-abdominal pressure leading to an optimal capability of penetration of chemotherapeutic agents in IPCH.From January 1998 to December 2003, 30 patients were submitted to a surgical debulking and IPCH through a laparotomic approach involving a ventral hernia. After extensive cytoreductive surgery, we closed the large abdominal wall damage with Ramirez's abdominoplasty technique, followed by IPCH. The technique described by Ramirez uses bilateral muscle flap complexes transposed medially to reconstruct the central abdominal wall without using meshes to supply or reinforce the abdominal reconstruction.A total of 23 patients (76.7%) were completely cytoreducted and subjected to IPCH. Postoperative mortality was 1/30 (3.3%). Major morbidity was 5/30 (16.7%). After a mean follow-up of 3 years, no sign of recurrent ventral hernia was noted in the survivors.This study suggests that surgical debulking combined with IPCH is feasible in patients with a previously large abdominal wall defect using the functional Ramirez's abdominoplasty technique. The reconstructive technique allows a regular IPCH procedure without recurrence of the ventral hernia confirmed by clinical examination and abdominal computed tomography. PMID:20098105

  18. Free software, Open source software, licenses. A short presentation including a procedure for research software and data dissemination

    E-print Network

    Free software, Open source software, licenses. A short presentation including a procedure for research software and data dissemination T. Gomez-Diaz CNRS, Universit´e Paris-Est, Laboratoire d to revisit the basic concepts in software distribution such as free software, open source software, licenses

  19. Haptics-constrained motion for surgical intervention.

    PubMed

    Ren, Jing; Zhang, Huaijing; Patel, Rajni V; Peters, Terry M

    2007-01-01

    Current open-heart procedures requiring the use of a medial sternotomy and a heart-lung machine can potentially be performed by entering the heart through the cardiac wall. A new procedure in cardiac surgery involves introducing an ablation tool through the appendage of the left atrium. This method, intended for the treatment of atrial fibrillation, septal defect repair and valve replacement, provides increased control over the ablating instrument. It is believed that this procedure will ultimately be performed under robotic control and image-guidance provided by intra-cardiac ultrasound. However, the intra-cardiac guidance presents several drawbacks, such as limited field of view, temporary loss of signal, and, in some cases, difficulty with interpreting the signal. We believe that the introduction of haptic feedback into this environment will enhance the procedure by providing tactile cues to assist in the location of the surgical targets. PMID:17377307

  20. Minimally invasive procedures

    PubMed Central

    Baltayiannis, Nikolaos; Michail, Chandrinos; Lazaridis, George; Anagnostopoulos, Dimitrios; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Lampaki, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Kioumis, Ioannis; Pitsiou, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Rapti, Aggeliki; Trakada, Georgia; Zissimopoulos, Athanasios; Zarogoulidis, Konstantinos

    2015-01-01

    Minimally invasive procedures, which include laparoscopic surgery, use state-of-the-art technology to reduce the damage to human tissue when performing surgery. Minimally invasive procedures require small “ports” from which the surgeon inserts thin tubes called trocars. Carbon dioxide gas may be used to inflate the area, creating a space between the internal organs and the skin. Then a miniature camera (usually a laparoscope or endoscope) is placed through one of the trocars so the surgical team can view the procedure as a magnified image on video monitors in the operating room. Specialized equipment is inserted through the trocars based on the type of surgery. There are some advanced minimally invasive surgical procedures that can be performed almost exclusively through a single point of entry—meaning only one small incision, like the “uniport” video-assisted thoracoscopic surgery (VATS). Not only do these procedures usually provide equivalent outcomes to traditional “open” surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well: (I) faster recovery; (II) the patient remains for less days hospitalized; (III) less scarring and (IV) less pain. In our current mini review we will present the minimally invasive procedures for thoracic surgery. PMID:25861610

  1. Protocol for the surgical and large bore procedures in malignant pleural mesothelioma and radiotherapy trial (SMART Trial): an RCT evaluating whether prophylactic radiotherapy reduces the incidence of procedure tract metastases

    PubMed Central

    Clive, Amelia O; Wilson, Paula; Taylor, Hazel; Morley, Anna J; de Winton, Emma; Panakis, Niki; Rahman, Najib; Pepperell, Justin; Howell, Timothy; Batchelor, Timothy J P; Jordan, Nikki; Lee, Y C Gary; Dobson, Lee; Maskell, Nick A

    2015-01-01

    Introduction Patients with malignant pleural mesothelioma (MPM) may develop painful ‘procedure tract metastasis’ (PTM) at the site of previous pleural interventions. Prophylactic radiotherapy has been used to minimise this complication; however, three small randomised trials have shown conflicting results regarding its effectiveness. The surgical and large bore procedures in malignant pleural mesothelioma and radiotherapy trial (SMART Trial) is a suitably powered, multicentre, randomised controlled trial, designed to evaluate the efficacy of prophylactic radiotherapy within 42?days of pleural instrumentation in preventing the development of PTM in MPM. Methods and analysis 203 patients with a histocytologically proven diagnosis of MPM, who have undergone a large bore pleural intervention (thoracic surgery, large bore chest drain, indwelling pleural catheter or local anaesthetic thoracoscopy) in the previous 35?days, will be recruited from UK hospitals. Patients will be randomised (1:1) to receive immediate radiotherapy (21?Gy in 3 fractions over 3 working days within 42?days of the pleural intervention) or deferred radiotherapy (21?Gy in 3 fractions over 3 working days given if a PTM develops). Patients will be followed up for 12?months. The primary outcome measure is the rate of PTM until death or 12?months (whichever is sooner), as defined by the presence of a clinically palpable nodule of at least 1?cm diameter felt within 7?cm of the margins of the procedure site as confirmed by two assessors. Secondary outcome measures include chest pain, quality of life, analgaesic requirements, healthcare utilisation and safety (including radiotherapy toxicity). Ethics and dissemination The trial has received ethical approval from the Southampton B Research Ethics Committee (11/SC/0408). There is a Trial Steering Committee, including independent members and a patient and public representative. The trial results will be published in a peer-reviewed journal and presented at international conferences. Trial registration number ISRCTN72767336. PMID:25575875

  2. Open Retrograde Endovascular Stenting for Left Common Carotid Artery Dissection Secondary to Surgical Repair of Acute Aortic Dissection: A Case Report and Review of the Literature.

    PubMed

    Gao, Peng; Wang, Yabing; Chen, Yanfei; Jiao, Liqun

    2015-07-01

    A 30-year-old male presented with an acute aortic artery dissection (Stanford type A) and underwent total arch replacement using a stented elephant trunk technique. One month later, the patient developed dissections in the innominate and left common carotid artery (CCA). The innominate artery dissection caused occlusion in the right internal carotid artery (ICA) and a major stroke. Dissection of the left CCA progressed and extended to the bifurcation site. Antegrade access for a left carotid intervention was deemed as difficult because of the previously implanted stent and the additional risks of embolic events and dissection enlargement. Hybrid procedures combining left carotid bifurcation exposure and retrograde endovascular stenting were successfully completed. This report is a rare case of retrograde endovascular reconstruction for the left CCA dissection following surgical repair of an aortic artery dissection. Here, we also review previous cases of iatrogenic carotid dissections following surgical intervention. PMID:25765635

  3. Daunorubicin versus 5-fluoro-uracil in surgical treatment of primary open angle glaucoma: a prospective study.

    PubMed

    Demailly, P; Kretz, G

    1992-09-01

    In a prospective randomized study, we compare the results at 20 months of 5 Fluoro-Uracil and Daunorubicin filtering surgery in two groups of 25 patients with primary open-angle glaucoma. For the first group of 14 eyes, 10 injections of 5FU are done and only one subconjunctival preoperative injection of Daunorubicin in the second group of 13 eyes. 5FU group consists of 13 patients: 9 males, 4 females. The mean age is 52.3 +/- 18.4 years. The mean follow-up is 6.9 +/- 7 months. Daunorubicin group consists of 12 patients: 9 males, 3 females. The mean age is 50.2 +/- 21.4 years. The mean follow-up is 7.3 +/- 7 months. By Kaplan-Meier method, the probability success rate is 79 per 100 with 5FU and 68 per 100 with Daunorubicin. After 5FU procedure, the most disturbing complication is related to the decrease in IOP during the first postoperative days: flat anterior chamber (9 eyes) (7 eyes after Daunorubicin), choroďdal detachment (6 eyes) (2 eyes after Daunorubicin), cataract (3 eyes in the two groups). After Daunorubicin, corneal complications are less frequent: corneal ulcer (2 eyes) (3 eyes after 5FU), corneal dystrophy (1 eye in the two groups). Transient chemosis and local palpebral oedema are constant after Daunorubicin. We compared the IOP reduction rate and visual function loss in the two groups. PMID:1428573

  4. New methods for image guidance and visualization for cardiac procedures

    NASA Astrophysics Data System (ADS)

    Guttman, Michael A.; McVeigh, Elliot R.

    2007-03-01

    Interventional cardiac MRI has been undergoing rapid development because of the availability of MRI compatible interventional catheters, and the increased performance of the MRI systems. Intravascular techniques do not require an open access scanner, and hence higher imaging performance during procedures can be achieved. Now, with the availability of a short, relatively open cylindrical bore scanner high imaging performance is also available to guide direct surgical procedures.

  5. Short bowel syndrome in children: surgical and medical perspectives.

    PubMed

    Coletta, Riccardo; Khalil, Basem A; Morabito, Antonino

    2014-10-01

    The main cause of intestinal failure in children is due to short bowel syndrome (SBS) resulting from congenital or acquired intestinal lesions. From the first lengthening procedure introduced by Bianchi, the last three decades have seen lengthening procedures established as fundamental components of multidisciplinary intestinal rehabilitation programs. Debate on indications and timing of the procedures is still open leaving SBS surgical treatment a great challenge. However, enteral autonomy is possible only with an individualized approach remembering that each SBS patient is unique. Current literature on autologous gastrointestinal reconstruction technique was reviewed aiming to assess a comprehensive pathway in SBS non-transplant management. PMID:25459014

  6. Conscious sedation for surgical procedures

    MedlinePLUS

    Anesthesia - conscious ... have, what medicines you are taking, and what anesthesia or sedation you have had before. You may ... Eriksson LI, Fleisher LA, et al., eds. Miller's Anesthesia. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009: ...

  7. Insertion slanting strabismus surgical procedures.

    PubMed

    Kushner, Burton J

    2011-12-01

    Insertion slanting recessions or biased resections have been reported to be useful for treating A- and V-pattern strabismus, convergence insufficiency, and convergence excess esotropia. Paradoxically, good results have been reported with methods that are opposite in nature. For example, some researchers would recess the medial rectus muscles and slant the superior pole of each muscle back farther than the inferior pole (Simonsz/von Graefe method) for a V-pattern esotropia, and others would slant the inferior poles back farther (Bietti method). The Simonsz/von Graefe method seems to be based on sound concepts of oculomotor mechanics. The Bietti method has been justified based on a misquoting and misinterpretation of previous work by Alan Scott, MD. Probably neither method contributes substantially to the outcome of strabismus surgery because sarcomere remodeling should rapidly negate the effect of the slanting. Most likely it is the recession or resection itself that affects the outcome. PMID:22159685

  8. A selective sac extraction method: another minimally invasive procedure for inguinal hernia repair in children: a technical innovation with satisfactory surgical and cosmetic results

    Microsoft Academic Search

    Hitoshi Ikeda; Masahiro Hatanaka; Makoto Suzuki; Junko Fujino; Kazunori Tahara; Yuki Ishimaru

    2009-01-01

    PurposeTo achieve satisfactory surgical and cosmetic results with minimal surgical invasiveness without laparoscopic assistance in childhood inguinal hernia repair, a novel technique, the selective sac extraction method (SSEM), was devised. The technical feasibility of this method was retrospectively examined.

  9. Surgical management of upper tract urothelial carcinoma

    PubMed Central

    Bird, Vincent G.; Kanagarajah, Prashanth

    2011-01-01

    Upper tract urothelial cell carcinoma accounts for 5% of all urothelial tumors. Compared to lower urinary tract tumors, upper tract urothelial carcinoma is diagnosed more frequently at advanced stages. Open radical nephroureterectomy remains the gold standard treatment option for upper tract tumors. However, with the advancement of minimally invasive techniques and the benefits of these procedures regarding perioperative morbidity, cosmesis, and earlier convalescence, these options have shown promise in managing the patients with upper tract urothelial carcinoma. Despite the perioperative advantages, concerns exist on the oncological safety after minimally invasive surgery. In this article, we provide a comprehensive overview of the surgical management of upper tract urothelial carcinoma. PMID:21716884

  10. Clinical strategies at the docking site of distraction osteogenesis: are open procedures superior to the simple compression of Ilizarov?

    PubMed

    Lovisetti, Giovanni; Sala, Francesco

    2013-01-01

    This retrospective review reports on forty-five tibial non-unions who underwent docking site treatment for non-union using closed versus open and endoscopic strategies. In this cohort of patients, all but twelve were infected non-unions. Sixteen patients initially treated with single compression were compared to twenty-three patients treated with open revision of the docking site, and six endoscopic procedures. In the single compression group, an average of 6.4 cm of bone was resected and index lengthening was 2.01. In the open revision group, a mean of 9.4 cm was resected and the index lengthening was 1.72. In the endoscopic group, an average of 8.6 cm of bone was resected and index lengthening was 1.71. Consolidation at the docking site occurred in 41 cases out of 45 following the first procedure. There was no statistical difference between the three groups. Conclusive evidence of superiority of one modality of treatment over the other cannot be drawn from our data. The simple compression procedure requires less invasive surgery and is probably less demanding and more cost-effective in short transports, although the two cases of failure due to recurrence of sepsis were observed after this procedure. Further studies are desirable to investigate the effectiveness of open docking site grating procedures. PMID:23351874

  11. Surgical virtual reality - highlights in developing a high performance surgical haptic device.

    PubMed

    Custur?-Cr?ciun, D; Cochior, D; Constantinoiu, S; Neagu, C

    2013-01-01

    Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices. PMID:24331310

  12. SCIENTIFIC APPLICATIONS IN SURGICAL SIMULATION

    E-print Network

    Grether, Gregory

    SCIENTIFIC APPLICATIONS IN SURGICAL SIMULATION OF SOFT TISSUES Scientific Overview INSTITUTE FOR PURE AND APPLIED MATHEMATICS Los Angeles, California January 7-11, 2008 Surgical simulation of soft and residents. Simulated procedures include laproscopic surgery, craniofacial reconstruction, z-plasty, breast

  13. EuroSCORE Models in a Cohort of Patients with Valvular Heart Disease and a High Prevalence of Rheumatic Fever Submitted to Surgical Procedures

    PubMed Central

    Casalino, Ricardo; Tarasoutchi, Flávio; Spina, Guilherme; Katz, Marcelo; Bacelar, Antonio; Sampaio, Roney; Ranzani, Otavio T.; Pomerantzeff, Pablo M.; Grinberg, Max

    2015-01-01

    Objectives Epidemiological differences can be found between Brazilian and European valvular heart disease patients. The prevalence of heart valve diseases due to rheumatic disease is significantly higher in the Brazilian compared with the European population. Therefore, they could have different risks during and after cardiac surgery. The aim of this study was to evaluate the applicability of the additive and logistic EuroSCORE and EuroSCORE II in a cohort of high-risk patients with valvular heart disease of predominantly rheumatic aetiology submitted to surgery. Methods Between 1 February and 30 December 2009, 540 consecutive patients scheduled for valvular heart surgery were included in this study. In this set of patients, we examined the performance of the additive, logistic, and EuroSCORE II models for predicting in-hospital mortality. Calibration of each model was assessed by comparing predicted and observed in-hospital mortality and by the goodness of fit of the Hosmer-Lemeshow chi-square test. Discrimination performance of the model was evaluated with the receiver operating characteristic (ROC) curve analysis. Results The mean age was 56 ± 16 years, 50.6% were female, and the mortality rate was 16.0% (6.0% in elective surgery and 34.0% in emergency/urgency surgery). Mortality rates were estimated according to the additive and logistic EuroSCORE and EuroSCORE II at 6.1%, 8.7%, and 4.3%, respectively. The AUC was 0.76 (95% confidence interval [95% CI] 0.70–0.81) for the additive EuroSCORE, 0.76 (95% CI 0.70–0.81) for the logistic EuroSCORE and 0.81 (95% CI 0.76–0.86) for EuroSCORE II. Hosmer-Lemeshow goodness-of-fit statistics were P = 0.52, P = 0.07, and P = 0.12 for additive, logistic EuroSCORE, and EuroSCORE II. Conclusions In this cohort of Brazilian patients with valvular heart disease submitted to surgical procedure, the EuroSCORE models had a good discriminatory capacity; however, the calibration was compromised because of an underestimation of the mortality rate. PMID:25714474

  14. [da Vinci surgical system].

    PubMed

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years. PMID:25138939

  15. Surgical Simulation

    PubMed Central

    Sutherland, Leanne M.; Middleton, Philippa F.; Anthony, Adrian; Hamdorf, Jeffrey; Cregan, Patrick; Scott, David; Maddern, Guy J.

    2006-01-01

    Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. Methods: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. Results: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. Conclusions: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training. PMID:16495690

  16. A Hyperelastic Finite-Element Model of Human Skin for Interactive Real-Time Surgical Simulation

    Microsoft Academic Search

    Rudy J. Lapeer; Paul D. Gasson; Vasudev Karri

    2011-01-01

    A finite-element (FE) model of human skin is pro- posed for future use in an interactive real-time surgical simulation to teach surgeons procedures, such as facial reconstruction using skin-flap repair. For this procedure, skin is cut into flaps that are stretched to cover openings in the face. Thus, the model must recre- ate the visual, haptic, and force feedback expected

  17. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience

    Microsoft Academic Search

    Vincent Grégoire; Emmanuel Coche; Guy Cosnard; Marc Hamoir; Hervé Reychler

    2000-01-01

    The increasing use of 3D treatment planning in head and neck radiation oncology has created an urgent need for new guidelines for the selection and the delineation of the neck node areas to be included in the clinical target volume. Surgical literature has provided us with valuable information on the extent of pathological nodal involvement in the neck as a

  18. Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy

    Microsoft Academic Search

    THOMAS E. AHLERING; DOUGLAS SKARECKY; DAVID LEE; RALPH V. CLAYMAN

    2003-01-01

    PurposeFor a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naďve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naďve laparoscopic surgeon. To our

  19. Medical and surgical options in the treatment of severe obesity.

    PubMed

    Fisher, Barry L; Schauer, Philip

    2002-12-01

    Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). Laparoscopic adjustable gastric banding with the LAP-BAND system (INAMED Health, Santa Barbara, CA), a restrictive procedure involving placement of a silicone band around the upper stomach, was introduced in the early 1990s and approved by the US Food and Drug Administration for use in the United States in June 2001. Outside the United States, LAP-BAND surgery is the most commonly performed operation for severe obesity. The BPD, BPD-DS, and DGBP are all malabsorptive procedures offered primarily by laparotomy. They have been shown to induce good long-term weight loss but have a higher rate of adverse nutritional complications. Many safe and effective surgical options for severe obesity are available. More scientific appraisals comparing different procedures and open and laparoscopic approaches are needed. PMID:12527344

  20. Pediatric tonsillectomy and adenoidectomy procedures.

    PubMed

    Derkay, C S; Darrow, D H; LeFebvre, S M

    1995-12-01

    The most common pediatric surgical procedures performed in the United States today are tonsillectomies and adenoidectomies (T&A). Surgical team members must be highly trained and efficient to ensure optimal patient outcomes, reduce surgical costs, and decrease the risk and potential complications inherent in T&A procedures. The authors review current surgical indications for T&A procedures; recommended preoperative, intraoperative, and postoperative patient care; and the management of potential complications. PMID:9128745

  1. Initial single-port thoracoscopy to reduce surgical trauma during open en bloc chest wall and pulmonary resection for locally invasive cancer

    PubMed Central

    Bayarri, Clara I.; de Guevara, Antonio Cueto Ladron; Martin-Ucar, Antonio E.

    2013-01-01

    OBJECTIVES En bloc pulmonary and chest wall resection is the preferred method of treatment for locally invasive lung carcinoma. However, it carries major trauma to the chest wall, especially in cases with chest wall involvement distant to the potential location of ‘traditional’ thoracotomies. We describe an alternative method of estimating the boundaries of chest wall resection employing video assisted thoracoscopic surgery (VATS) and hypodermic needles. METHODS VATS delineation of boundaries of chest wall involvement by lung cancer has been performed in six patients who gave written consent. In one case the single–port thoracoscopic examination revealed unexpected distant pleural metastases thus preventing from resection. The other 5 patients, three males and two females [median age of 60.5 (range 39 to 75) years] underwent en bloc anatomical lung resection in addition to chest wall excision and reconstruction for T3N0 lung cancer. RESULTS In these five cases the chest wall opening was restricted to the extent of the rib excision, and the pulmonary resection was performed via the existing chest wall opening without requiring extension of the thoracotomy or any rib spreading. DISCUSSION Minimally invasive techniques aid to delineate the boundaries of chest wall involvement of lung cancer and intraoperative staging. This helped tailoring the surgical approach and location of the thoracotomy, and prevented rib-spreading or additional thoracotomies in our cases. PMID:23592724

  2. [Estimation for bugeting and evaluation of surgical procedures within the scope of comparative hospital administration. Value of LKA, PPR and DRG systems].

    PubMed

    Pinnau, R; Rostock, K; Gudath, R; Mansky, T; Meyer-Pannwitt, U

    1998-01-01

    Comparison of costing and performances of individual departments or hospitals are required by the statute book of social affairs (Sozialgesetzbuch V; SGB V), but have not been fully introduced in Germany. LBK Hamburg, a trust of 8 hospitals with 17 surgical departments, evaluated the significance of performance and cost-accounting systems such as performance and cost-accounting (LKA), nursing staff regulation (PPR), and the diagnosis-related group system in order to distribute a three-year budget (1996-1998) and to compare, e.g., performance of surgical departments. The DRG system seems to be the best choice, since it weights all cases by means in 640 groups according to the degree of difficulty. With a given closed budget, the DRG system may compare the actual cost with the target figures. PMID:9931741

  3. Multi-site study of surgical practice in neurosurgery based on surgical process models.

    PubMed

    Forestier, Germain; Lalys, Florent; Riffaud, Laurent; Louis Collins, D; Meixensberger, Jurgen; Wassef, Shafik N; Neumuth, Thomas; Goulet, Benoit; Jannin, Pierre

    2013-10-01

    Surgical Process Modelling (SPM) was introduced to improve understanding the different parameters that influence the performance of a Surgical Process (SP). Data acquired from SPM methodology is enormous and complex. Several analysis methods based on comparison or classification of Surgical Process Models (SPMs) have previously been proposed. Such methods compare a set of SPMs to highlight specific parameters explaining differences between populations of patients, surgeons or systems. In this study, procedures performed at three different international University hospitals were compared using SPM methodology based on a similarity metric focusing on the sequence of activities occurring during surgery. The proposed approach is based on Dynamic Time Warping (DTW) algorithm combined with a clustering algorithm. SPMs of 41 Anterior Cervical Discectomy (ACD) surgeries were acquired at three Neurosurgical departments; in France, Germany, and Canada. The proposed approach distinguished the different surgical behaviors according to the location where surgery was performed as well as between the categorized surgical experience of individual surgeons. We also propose the use of Multidimensional Scaling to induce a new space of representation of the sequences of activities. The approach was compared to a time-based approach (e.g. duration of surgeries) and has been shown to be more precise. We also discuss the integration of other criteria in order to better understand what influences the way the surgeries are performed. This first multi-site study represents an important step towards the creation of robust analysis tools for processing SPMs. It opens new perspectives for the assessment of surgical approaches, tools or systems as well as objective assessment and comparison of surgeon's expertise. PMID:23810856

  4. Two Different Surgical Approaches for Prostatic Stromal Sarcoma: Robot-Assisted Laparoscopic Radical Prostatectomy and Open Radical Cysto-Prostatectomy With Ileal Conduit

    PubMed Central

    Choi, Seock Hwan; Kim, Tae-Hwan; Yoon, Ghil Suk; Chung, Sung Kwang; Kim, Bup Wan

    2014-01-01

    Stromal sarcoma of the prostate is very rare and shows rapid growth, which consequently is related to poor prognosis. Recently, we treated two cases of prostatic stromal sarcoma: one with robot-assisted laparoscopic radical prostatectomy and the other with open radical cysto-prostatectomy with an ileal conduit. To the best of our knowledge, this is the first case report of a prostatic stromal sarcoma managed by use of a robotic procedure. Here, we report of our experiences in the treatment of prostatic stromal sarcoma by use of two different methods. PMID:25237465

  5. Two different surgical approaches for prostatic stromal sarcoma: robot-assisted laparoscopic radical prostatectomy and open radical cysto-prostatectomy with ileal conduit.

    PubMed

    Choi, Seock Hwan; Kim, Tae-Hwan; Yoon, Ghil Suk; Chung, Sung Kwang; Kim, Bup Wan; Kwon, Tae Gyun

    2014-09-01

    Stromal sarcoma of the prostate is very rare and shows rapid growth, which consequently is related to poor prognosis. Recently, we treated two cases of prostatic stromal sarcoma: one with robot-assisted laparoscopic radical prostatectomy and the other with open radical cysto-prostatectomy with an ileal conduit. To the best of our knowledge, this is the first case report of a prostatic stromal sarcoma managed by use of a robotic procedure. Here, we report of our experiences in the treatment of prostatic stromal sarcoma by use of two different methods. PMID:25237465

  6. Minimally invasive procedures on the lumbar spine

    PubMed Central

    Skovrlj, Branko; Gilligan, Jeffrey; Cutler, Holt S; Qureshi, Sheeraz A

    2015-01-01

    Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine. PMID:25610845

  7. Postoperative Pharyngolaryngeal Adverse Events with Laryngeal Mask Airway (LMA Supreme) in Laparoscopic Surgical Procedures with Cuff Pressure Limiting 25?cmH2O: Prospective, Blind, and Randomised Study

    PubMed Central

    Kang, Joo-Eun; Choi, Jae Won; Son, Il Soon

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60?cmH2O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25?cmH2O, L group) and high (at 60?cmH2O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25?cmH2O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334. PMID:24778598

  8. Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures

    PubMed Central

    Khutia, Samit Kumar; Mandal, Mohan C; Das, Sabyasachi; Basu, SR

    2012-01-01

    Background: Paediatric patients often present with different painful conditions that require immediate surgical interventions. Despite a plethora of articles on the ketamine–propofol combination, comprehensive evidence regarding the suitable sedoanalgesia regime is lacking due to heterogeneity in study designs. Methods: This prospective, randomized, double-blind, active–controlled trial was conducted in 100 children, of age 3–14 years, American Society of Anesthesiologist physical status IE-IIE, posted for emergency short surgical procedures. Patients were randomly allocated to receive either 2 mL of normal saline (pre-induction) plus calculated volume of drug from the 11 mL of ketamine–propofol solution for induction (group PK, n=50) or fentanyl 1.5 ?g/kg diluted to 2 mL with normal saline (pre-induction) plus calculated volume of drug from the 11 mL of propofol solution for induction (group PF, n=50). In both the groups, the initial bolus propofol 1 mg/kg i.v. (assuming the syringes contained only propofol, for simplicity) was followed by adjusted infusion to achieve a Ramsay Sedation Scale score of six. Mean arterial pressure (MAP) was the primary outcome measurement. Results: Data from 48 patients in group PK and 44 patients in group PF were available for analysis. Hypotension was found in seven patients (14.6%) in group PK compared with 17 (38.6%) patients in group PF (P=0.009). Intraoperative MAP was significantly lower in group PF than group PK when compared with baseline. Conclusion: The combination of low-dose ketamine and propofol is more effective and a safer sedoanalgesia regimen than the propofol–fentanyl combination in paediatric emergency short surgical procedures in terms of haemodynamic stability and lesser incidence of apnoea. PMID:22701205

  9. Changes in hospitalisation and surgical procedures among the oldest-old: a follow-up study of the entire Danish 1895 and 1905 cohorts from ages 85 to 99 years

    PubMed Central

    Oksuzyan, Anna; Jeune, Bernard; Juel, Knud; Vaupel, James W.; Christensen, Kaare

    2013-01-01

    Objective: to examine whether the Danish 1905 cohort members had more active hospital treatment than the 1895 cohort members from ages 85 to 99 years and whether it results in higher in-hospital and post-operative mortality. Methods: in the present register-based follow-up study the complete Danish birth cohorts born in 1895 (n = 12,326) and 1905 (n = 15,477) alive and residing in Denmark at the age of 85 were followed from ages 85 to 99 years with regard to hospitalisations and all-cause and cause-specific surgical procedures, as well as in-hospital and post-operative mortality. Results: the 1905 cohort members had more frequent hospital admissions and operations, but they had a shorter length of hospital stay than the 1895 cohort at all ages from 85 to 99 years. The increase in primary prosthetic replacements of hip joint was observed even within the 1895 cohort: no patients were operated at ages 85–89 years versus 2.2–3.6% at ages 95–99 years. Despite increased hospitalisation and operation rates, there was no increase in post-operative and in-hospital mortality rates in the 1905 cohort. These patterns were similar among men and women. Conclusions: the observed patterns are compatible with more active treatment of the recent cohorts of old-aged persons and reduced age inequalities in the Danish healthcare system. No increase in post-operative mortality suggests that the selection of older patients eligible for a surgical treatment is likely to be based on the health status of old-aged persons and the safety of surgical procedures rather than chronological age. PMID:23531440

  10. The Relationship Between Time to Surgical Débridement and Incidence of Infection After Open High-Energy Lower Extremity Trauma

    PubMed Central

    Pollak, Andrew N.; Jones, Alan L.; Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.

    2010-01-01

    Background: Urgent débridement of open fractures has been considered to be of paramount importance for the prevention of infection. The purpose of the present study was to evaluate the relationship between the timing of the initial treatment of open fractures and the development of subsequent infection as well as to assess contributing factors. Methods: Three hundred and fifteen patients with severe high-energy lower extremity injuries were evaluated at eight level-I trauma centers. Treatment included aggressive débridement, antibiotic administration, fracture stabilization, and timely soft-tissue coverage. The times from injury to admission and operative débridement as well as a wide range of other patient, injury, and treatment-related characteristics that have been postulated to affect the risk of infection within the first three months after injury were studied, and differences between groups were calculated. In addition, multivariate logistic regression models were used to control for the effects of potentially confounding patient, injury, and treatment-related variables. Results: Eighty-four patients (27%) had development of an infection within the first three months after the injury. No significant differences were found between patients who had development of an infection and those who did not when the groups were compared with regard to the time from the injury to the first débridement, the time from admission to the first débridement, or the time from the first débridement to soft-tissue coverage. The time between the injury and admission to the definitive trauma treatment center was an independent predictor of the likelihood of infection. Conclusions: The time from the injury to operative débridement is not a significant independent predictor of the risk of infection. Timely admission to a definitive trauma treatment center has a significant beneficial influence on the incidence of infection after open high-energy lower extremity trauma. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. PMID:20048090

  11. Variation in Surgical Readmissions and Relationship to Quality of Hospital Care

    PubMed Central

    Tsai, Thomas C.; Joynt, Karen E.; Orav, E. John; Gawande, Atul A.; Jha, Ashish K.

    2014-01-01

    Background Reducing readmissions is a clinical and policy priority, but little is known about variations in readmission rates after major surgery and whether a hospital's surgical readmission rates are related to other markers of high-quality surgical care. Methods Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (AAA), colectomy, and hip replacement. We used bivariate and multivariable techniques to assess the relationship between readmission rates and other measures of surgical quality, including performance on surgical process measures, procedure volume, and mortality. Results There were 479,471 discharges following one of the six index procedures from 3,004 hospitals. The median risk-adjusted six-procedure composite 30-day readmission rate was 13.1% [interquartile range, IQR 9.9%-17.1%}. Adjusting for hospital characteristics, we found that hospitals in the highest quartile of surgical volume had lower readmission rates than the lowest-volume hospitals (12.7% vs. 16.8%, p<0.001), and hospitals with the lowest mortality rates had significantly lower readmission rates than hospitals with high mortality rates (13.3% vs. 14.2%, p<0.001). High performance on surgical process of care performance measures was only marginally associated with readmission rates (13.1% versus 13.6%, p=0.021). Patterns were similar when each of the six major surgeries was examined individually. Conclusion Nearly one in seven patients is readmitted within 30 days of discharge following a major surgical procedure. High volume and low mortality hospitals have lower surgical readmissions than other hospitals. PMID:24047062

  12. Surgical Reconstruction of Tuberous Breasts

    Microsoft Academic Search

    Andreas Foustanos; Harris Zavrides

    2006-01-01

    Background:  Tuberous breast deformity is a rare entity affecting young women bilaterally or unilaterally. It requires surgical correction,\\u000a depending on the severity of the clinical expression, because of its aesthetic appearance. Since the presentation of the malformation\\u000a by Rees and Aston in 1976, many surgical procedures have been developed, but the deformity still is one of the most challenging\\u000a congenital breast

  13. Surgical Skills Beyond Scientific Management.

    PubMed

    Whitfield, Nicholas; Schlich, Thomas

    2015-07-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  14. Surgical treatment of pediatric rhinosinusitis.

    PubMed

    Isaacson, G

    2015-08-01

    Pediatric rhinosinusitis is a common sequela of upper respiratory infections in children. It is usually a self-limited disease, sometimes requiring antibiotic therapy. Surgery may be indicated in children who suffer complication of acute rhinosinusitis, severe recurrent acute rhinosinusitis, rhinosinusitis in cystic fibrosis with or without polyposis, chronic rhinosinusitis refractory to maximal medical management, allergic fungal sinusitis, and paranasal sinus mucoceles. Surgical options include, adenoidectomy, sinus puncture and lavage, open surgical approaches, endoscopic sinus surgery, balloon sinuplasty, and turbinectomy or turbinate reduction. This paper reviews the anatomy and physiology of rhinosinusitis in children and current knowledge of the indications and best methods of surgical treatment. PMID:25369207

  15. Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction

    PubMed Central

    Thiruchelvam, Nikesh

    2014-01-01

    Monopolar transurethral resection of the prostate (TURP) with endoscopic electrocautery remains the gold standard surgical technique for benign prostatic hypertrophy (BPH) by which all new procedures are compared. We reviewed the current literature, and international urological guidelines and consensus opinion on various surgical options for BPH and present a brief overview of alternative techniques including bipolar TURP, transurethral incision of the prostate, transurethral vaporization of the prostate, laser prostatectomy (with holmium, thulium and potassium titanyl phosphate greenlight lasers) and open prostatectomy (with mention of new techniques including laparoscopic and robotic prostatectomy). Emerging, experimental and less established techniques are also described including endoscopic heat generation (transurethral microwave thermotherapy, radiofrequency transurethral needle ablation of the prostate, high intensity focused ultrasound, hot water induced thermotherapy, pulsed electromagnetic radiofrequency), injection therapy (transurethral ethanol ablation and botulinum toxin) and mechanical devices (intraprostatic stents and urethral lift devices). Despite a plethora of surgical options, none have realistically improved outcomes in the long-term compared with TURP. Improvements have been made on improving surgical morbidity and time in hospital. Questions remain in this area, including what specific elements of bladder outflow obstruction (BOO) result in damage to the urinary tract, how does BPH contribute to BOO and how much prostate volume reduction is necessary to relieve BOO or lower urinary tract symptoms. Given these unanswered questions and the multitude of procedures available, it is clear that appropriate counselling is necessary in all men who undergo BPH surgery. PMID:24744521

  16. Current Surgical Aspects of Palliative Treatment for Unresectable Pancreatic Cancer

    PubMed Central

    Karapanos, Konstantinos; Nomikos, Iakovos N.

    2011-01-01

    Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results. PMID:24212633

  17. [Surgical management of renal hyperparathyroidism].

    PubMed

    Lorenz, K; Sekulla, C; Dralle, H

    2013-12-01

    Conservative management of renal hyperparathyroidism has changed recently. Innovative substances, especially the advent of calcimimetics, have influenced the therapeutic concept. Consequently, a decline in surgical frequency for renal hyperparathyroidism has been reported. In this context it is now mandatory to evaluate the role of surgery, the surgical strategy and procedures for renal hyperparathyroidism anew. Based on a review of the literature the current position of surgical indications and care for renal hyperparathyroidism as well as possible influences of innovative medical treatment are highlighted. In summary, the timing and indications for surgery have been influenced, however, surgery still remains the only permanently effective treatment option for renal hyperparathyroidism. PMID:21344367

  18. Laparoscopic gastric bypass as a reoperative bariatric surgery for failed open restrictive procedures

    Microsoft Academic Search

    J. de Csepel; R. Nahouraii; M. Gagner

    2001-01-01

    An estimated 2% of men and 6% of women in the United States are morbidly obese. These patients have a mortality rate that\\u000a is six to twelve times greater than their normal-weight peers. In these extreme cases of overweight, only surgical intervention\\u000a can produce substantial and sustained weight loss. However, up to 20% of these patients will require reoperation for

  19. Laryngotracheal stenosis: clinical profile, surgical management and outcome.

    PubMed

    Pookamala, S; Kumar, Rakesh; Thakar, Alok; Venkata Karthikeyan, C; Bhalla, Ashu Seith; Deka, R C

    2014-01-01

    Despite the availability of various surgical options, management of laryngotracheal stenosis (LTS) still remains an enigma. Proper selection of surgical technique in each clinical setting is the key for successful outcome. The purpose of this article is to guide one in selection of appropriate surgical procedures depending upon various stenosis parameters. Aim To record the clinical profile of cases with LTS. To assess the outcome following various surgical interventions based on site, severity, cause of stenosis and to derive conclusions regarding treatment options in various stenosis. Materials and Methods It is a study of 60 cases with chronic LTS. It includes retrospective study of 30 cases treated from 2004 and prospective study of 30 cases from Jan 2007 to Dec 2009. A total of 60 cases with LTS were enrolled in the study. Patients were assessed clinically by eliciting detailed history and analyzing previous records. After assessment of extent of stenosis, they were subjected to surgical interventions (endoscopic/open approach). Outcome after surgical interventions was assessed. Results 60 patients were included in the study, in the age group of 2.5-50 years. There were 46 (77%) male patients and 14 (23%) female patients. Intrinsic trauma, secondary to prolonged intubation was the most common cause of LTS, seen in 23 (38%) cases followed by post traumatic stenosis (strangulation-18 (30%), blunt injury-15 (25%), penetrating neck injury-4 (7%)). Stenosis was divided into 6 types based on subsite involvement. Of which, cervical trachea was the commonest site of involvement (25/60 cases). Majority of cases had fixed vocal cords at presentation (55%), more commonly due to post traumatic injury. 60 cases had undergone a total of 110 surgical procedures (endoscopic-56,open approach-54). In the end, overall decannulation rate is 93.3%. In site wise tracheal stenosis, isolated subglottis, combined glottis and subglottic stenosis had decannulation rate of 100% each and with mobile vocal cords, the success rate is 96%. Conclusions Post traumatic stenosis with fixed vocal cords is more common in our practice. Categorizing stenosis into various subtypes helps in treatment planning and predicts surgical outcome. Tracheal or subglottic stenosis with mobile vocal cords has better success rate. PMID:24533383

  20. Postoperative change of the cross-sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging.

    PubMed

    Motosuneya, Takao; Asazuma, Takashi; Tsuji, Takashi; Watanabe, Hironobu; Nakayama, Yoshikazu; Nemoto, Koichi

    2006-07-01

    Many investigators have reported that persistent low back pain may occur after posterior surgical intervention, and studies have investigated the histologic and histochemical changes in back muscle after posterior lumbar spine surgery. The purpose of the current study is to compare the pre- and postoperative cross-sectional area of the back musculature among 5 surgical groups including anterior lumbar interbody fusion, which has no direct invasion of the back musculature, using magnetic resonance imaging, and to correlate the clinical results with the degree of atrophy. The cross-sectional area of the back musculature was measured before and after surgery in T2-weighted axial magnetic resonance images using a computer-linked digitizer. The degree of atrophy (atrophy ratio) was calculated as a ratio of the postoperative cross-sectional area to the preoperative cross-sectional area. Clinical results were evaluated using the Japanese Orthopaedic Association's scores for the management of low back pain. Atrophy of the back musculature was confirmed in each group. However, no significant difference was seen in the atrophy ratio between the groups. Back musculature atrophy occurred even in anterior lumbar interbody fusion, which does not involve any direct surgery of the back muscle. A positive correlation was noted between the atrophy ratio and operation time only in posterior surgery, especially in nonfusion surgery. In conclusion, the current study suggests that a shorter operation time may minimize back muscle injury, and shows that factors inducing back musculature atrophy include not only direct invasion of the back muscle via a posterior approach, but also postoperative external fixation. PMID:16826001

  1. Modeling surgical skill learning with cognitive simulation.

    PubMed

    Park, Shi-Hyun; Suh, Irene H; Chien, Jung-hung; Paik, Jaehyon; Ritter, Frank E; Oleynikov, Dmitry; Siu, Ka-Chun

    2011-01-01

    We used a cognitive architecture (ACT-R) to explore the procedural learning of surgical tasks and then to understand the process of perceptual motor learning and skill decay in surgical skill performance. The ACT-R cognitive model simulates declarative memory processes during motor learning. In this ongoing study, four surgical tasks (bimanual carrying, peg transfer, needle passing, and suture tying) were performed using the da Vinci© surgical system. Preliminary results revealed that an ACT-R model produced similar learning effects. Cognitive simulation can be used to demonstrate and optimize the perceptual motor learning and skill decay in surgical skill training. PMID:21335834

  2. Extended Left Hepatic Lobectomy for Hepatic Hilar Bile Duct Cancer: A Novel Surgical Procedure in Which the Right Hepatic Duct Is Transected before the Hepatoduodenal Ligament Is Skeletonized

    Microsoft Academic Search

    Mitsuo Miyazawa; Masayasu Aikawa; Katsuya Okada; Takahiro Torii; Kojun Okamoto; Yasuko Toshimitsu; Isamu Koyama

    2009-01-01

    As a general principle, the procedure of isolating a cancer region from surrounding tissues (skeletonization) is not taken until the last stage of a cancer operation. This principle is often disregarded in surgery for cancers of the hepatic hilar duct, however, as it may be mandatory to skeletonize the region before resecting the liver. Our group invented ‘extended left hepatic

  3. Surgical treatment of osteoarthritis in the middle-aged athlete: new horizons in high tibial osteotomies.

    PubMed

    Scordino, Laura E; DeBerardino, Thomas M

    2013-03-01

    Middle-aged athletes represent adults from the age of 35 to 60 years for the purposes of this discussion. The prevalence of knee osteoarthritis increases with age, and older people are staying active longer. The indications for opening wedge high tibial osteotomy (owHTO) continue to grow. owHTO correct malalignment to unload the medial joint in middle-aged athletes with a varus knee who want to return to high-impact activities. owHTO may be combined with cartilage preserving procedures, or with ligament reconstructions. We describe our preferred surgical technique and surgical implant with advanced guidance system to create predictable accurate results. PMID:23314268

  4. Successful surgical treatment of visceral artery aneurysms. After failure of percutaneous treatment.

    PubMed Central

    Melissano, G; Chiesa, R

    1998-01-01

    We report 2 cases involving aneurysms of visceral arteries that needed surgical treatment after unsuccessful percutaneous treatment. In the 1st case, repeated embolizations with Gianturco coils and angiographic guidewires had failed to obliterate a large aneurysm of the hepatic artery. In the 2nd case, a peripancreatic pseudoaneurysm caused recurrent gastrointestinal bleeding despite embolization with Gianturco coils. In both patients, left medial rotation of the viscera provided access to the origin of the affected artery at the aorta, enabling the surgeon to control bleeding before opening the aneurysm. The advantages and limitations of the most commonly performed percutaneous procedures are discussed, as are the surgical options. Images PMID:9566069

  5. Surgical considerations and controversies in thyroid and parathyroid surgery.

    PubMed

    Affleck, Brian D; Swartz, Keith; Brennan, Joseph

    2003-02-01

    The techniques of thyroid surgery have been fully elucidated in several surgical texts and atlases. This article discuss surgical pearls of thyroid and parathyroid surgery. We discuss preoperative, intraoperative, and postoperative considerations and controversies for both procedures. PMID:12803015

  6. Procedure for Applying an Open-Cycle Heat Pump to An Existing Evaporator

    E-print Network

    Wagner, J. R.; Brush, F. C.

    1984-01-01

    An open-cycle heat pump, or mechanical vapor compression (MVC) system, is often an attractive technique for increasing the energy efficiency of an evaporator. With proper design, an MVC system is capable of dramatic cost savings when retrofitted...

  7. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

    PubMed

    Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

    2014-09-01

    Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. PMID:24485271

  8. Surgical management of presbyopia

    PubMed Central

    Torricelli, André AM; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J

    2012-01-01

    Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages. PMID:23055664

  9. Minimally invasive surgical adjuncts to upper blepharoplasty.

    PubMed

    Briceńo, César A; Zhang-Nunes, Sandy X; Massry, Guy G

    2015-05-01

    A variety of surgical adjuncts can be added to upper eyelid blepharoplasty with the goal of enhancing surgical results and patient satisfaction. All of these procedures are minimally invasive and most are performed through a standard eyelid crease incision. These procedures can be added to stabilize or conservatively lift the outer brow, prevent the stigmata of postoperative volume loss, improve the brow-eyelid transition and contour, and reposition a prolapsed lacrimal gland. The procedures are generally straightforward, easily learned, and complication free. Familiarity with these techniques provides the aesthetic eyelid surgeon with added options to improve surgical results. PMID:25921565

  10. Surgical Correction of Fixed Kyphosis

    PubMed Central

    Cho, Woo-Jin; Kang, Chang-Nam; Park, Ye-Soo; Kim, Hyoung-Jin

    2007-01-01

    Study Design A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. Purpose To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. Overview of Literature Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. Methods There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. Results The average kyphotic angle was 71.8° preoperatively, 31.0° postoperatively, and the average final angle was 39.2°. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. Conclusions Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees. PMID:20411147

  11. Surgical Management of Early Endometrial Cancer: An Update and Proposal of a Therapeutic Algorithm

    PubMed Central

    Falcone, Francesca; Balbi, Giancarlo; Di Martino, Luca; Grauso, Flavio; Salzillo, Maria Elena; Messalli, Enrico Michelino

    2014-01-01

    In the last few years technical improvements have produced a dramatic shift from traditional open surgery towards a minimally invasive approach for the management of early endometrial cancer. Advancement in minimally invasive surgical approaches has allowed extensive staging procedures to be performed with significantly reduced patient morbidity. Debate is ongoing regarding the choice of a minimally invasive approach that has the most effective benefit for the patients, the surgeon, and the healthcare system as a whole. Surgical treatment of women with presumed early endometrial cancer should take into account the features of endometrial disease and the general surgical risk of the patient. Women with endometrial cancer are often aged, obese, and with cardiovascular and metabolic comorbidities that increase the risk of peri-operative complications, so it is important to tailor the extent and the radicalness of surgery in order to decrease morbidity and mortality potentially derivable from unnecessary procedures. In this regard women with negative nodes derive no benefit from unnecessary lymphadenectomy, but may develop short- and long-term morbidity related to this procedure. Preoperative and intraoperative techniques could be critical tools for tailoring the extent and the radicalness of surgery in the management of women with presumed early endometrial cancer. In this review we will discuss updates in surgical management of early endometrial cancer and also the role of preoperative and intraoperative evaluation of lymph node status in influencing surgical options, with the aim of proposing a management algorithm based on the literature and our experience. PMID:25063051

  12. SURgical interventions with FEIBA (SURF): international registry of surgery in haemophilia patients with inhibitory antibodies.

    PubMed

    Négrier, C; Lienhart, A; Numerof, R; Stephens, D; Wong, W Y; Baghaei, F; Yee, T T

    2013-05-01

    Factor VIII Inhibitor Bypassing Activity (FEIBA) can effectively achieve haemostasis in haemophilia patients with inhibitors. Further evaluation of FEIBA in surgical settings is of significant interest considering the relatively limited prospective data published to date. The aim of the study is to evaluate the perioperative efficacy and safety of FEIBA in haemophilia patients with inhibitors. Haemophilia patients with inhibitors who underwent surgical procedures and received FEIBA for perioperative haemostatic control were prospectively enrolled in an open-label, noninterventional, postauthorization study [SURgical interventions with FEIBA (SURF)]. Outcome measures included haemostatic efficacy, safety, FEIBA exposure and blood loss associated with the perioperative use of FEIBA. Thirty-five surgical procedures were performed at 19 centres worldwide in patients with congenital haemophilia A, congenital haemophilia B, or acquired haemophilia A. Haemorrhagic risk was severe in 37.1% (13 of 35) of the procedures, moderate in 25.7% (9 of 35) and mild in 37.1% (13 of 35). One moderate risk surgery was excluded from the efficacy analyses because it did not meet all protocol requirements. Haemostasis was judged to be 'good' or 'excellent' in 91.2% (31 of 34) of surgical procedures and 'fair' in 8.8% (3 of 34). Among the 12 adverse events, three were serious adverse events (SAEs), two of which were unrelated to FEIBA therapy; one SAE, a clot in an arteriovenous fistula, was deemed to be possibly related to therapy. This prospective investigation confirms that FEIBA can be safely and effectively used when performing surgical procedures in haemophilia patients with inhibitors. PMID:23282031

  13. Surgical management of Parkinson's disease.

    PubMed

    Foltynie, Thomas; Hariz, Marwan I

    2010-06-01

    There has been a renaissance in the surgical treatment of Parkinson's disease (PD) over the last 15-20 years as a result of the long-term complications of L-DOPA use. The current cornerstone of surgical treatment for PD is high-frequency deep-brain stimulation (DBS) of the subthalamic nucleus (STN) using implantable electrodes and an implantable pulse generator/battery. Among well-selected patients, that is, patients with idiopathic PD, L-DOPA-responsive symptoms and no significant psychiatric comorbidities or cognitive decline, STN DBS can provide improvements in motor symptoms and quality of life, with low risks of adverse effects. In this article, we briefly describe the evolution of surgical treatments for PD, and the rationale for current DBS procedures. We also provide details of our practice, including patient selection, surgical technique and postoperative stimulation programming and medication adjustment. Current and possible future alternatives to DBS of the STN are also discussed. PMID:20518607

  14. A dietary intervention to elicit rapid and complex dietary changes for studies investigating the effects of diet on tissues collected during invasive surgical procedures.

    PubMed

    Schenk, Jeannette M; Neuhouser, Marian L; Lin, Daniel W; Kristal, Alan R

    2009-03-01

    Nutrition intervention trials in patients undergoing surgical treatment for cancer offer a unique opportunity to study the mechanisms and pathways that underlie diet and cancer associations in target tissues. However, due to the short time period between diagnosis and treatment, traditional dietary intervention methods are not feasible. This report describes a novel dietary intervention program designed to elicit rapid and complex dietary change during a condensed study period. The intervention, based on Consumer Information Processing, used standardized menus and exchange lists to guide food choices, and was delivered using a single, in-person session followed by telephone-based counseling. This intervention program was used in a small pilot study evaluating the short-term effects of dietary change in men with newly diagnosed prostate cancer. Eight men were randomly assigned to either a low-fat/low-glycemic load or standard American diet during the 4 weeks preceding prostate surgery. Participants completed 24-hour dietary recalls each week, and were weighed at baseline and at surgery. Compared to men in the standard American arm (n=4), men in the low-fat/low-glycemic arm (n=4) reported consuming less total fat (51.0+/-36.0 vs 93.5+/-8.4 g/day, P=0.06), and had a lower glycemic load (134.8+/-6.0 vs 266.3+/-36.8 units/day, P<0.001). Men in the low-fat/low-glycemic arm lost a mean of 5.3+/-1.7 kg and men in the standard American arm gained 0.8+/-4.5 kg (P=0.04). Results of this small pilot study suggest that a relatively simple and minimally burdensome dietary intervention can elicit rapid and complex dietary changes that are maintained over a 4-week study period. Further studies in larger and more diverse populations are needed to fully understand the potential of this novel intervention approach. PMID:19248862

  15. Infrared laser spectroscopy on surgical smoke

    Microsoft Academic Search

    M. Gianella; M. W. Sigrist

    2009-01-01

    Surgical smoke (Barrett and Garber, 2003) consists of gases, vapors and aerosols produced during surgery with lasers, ultrasonic scalpels and electroknives. In open surgery this smoke is produced in air, whereas in laparoscopic (minimally invasive surgery) it is usually produced in a carbon dioxide atmosphere. Three aspects of surgical smoke are important with respect to patient and medical staff safety:

  16. A Surgical Approach to Pediatric Glaucoma

    PubMed Central

    Khan, Arif O

    2015-01-01

    Glaucoma in children differs from adult-onset disease and typically requires surgical intervention. However, affected children exhibit a spectrum of disease severity and prospective data guiding the choice of operation are lacking. This article reviews common procedures and a surgical approach to pediatric glaucoma.

  17. A Surgical Approach to Pediatric Glaucoma.

    PubMed

    Khan, Arif O

    2015-01-01

    Glaucoma in children differs from adult-onset disease and typically requires surgical intervention. However, affected children exhibit a spectrum of disease severity and prospective data guiding the choice of operation are lacking. This article reviews common procedures and a surgical approach to pediatric glaucoma. PMID:26069523

  18. Validation Tests of Open-Source Procedures for Digital Camera Calibration and 3d Image-Based Modelling

    NASA Astrophysics Data System (ADS)

    Toschi, I.; Rivola, R.; Bertacchini, E.; Castagnetti, C.; Dubbini, M.; Capra, A.

    2013-07-01

    Among the many open-source software solutions recently developed for the extraction of point clouds from a set of un-oriented images, the photogrammetric tools Apero and MicMac (IGN, Institut Géographique National) aim to distinguish themselves by focusing on the accuracy and the metric content of the final result. This paper firstly aims at assessing the accuracy of the simplified and automated calibration procedure offered by the IGN tools. Results obtained with this procedure were compared with those achieved with a test-range calibration approach using a pre-surveyed laboratory test-field. Both direct and a-posteriori validation tests turned out successfully showing the stability and the metric accuracy of the process, even when low textured or reflective surfaces are present in the 3D scene. Afterwards, the possibility of achieving accurate 3D models from the subsequently extracted dense point clouds is also evaluated. Three different types of sculptural elements were chosen as test-objects and "ground-truth" data were acquired with triangulation laser scanners. 3D models derived from point clouds oriented with a simplified relative procedure show a suitable metric accuracy: all comparisons delivered a standard deviation of millimeter-level. The use of Ground Control Points in the orientation phase did not improve significantly the accuracy of the final 3D model, when a small figure-like corbel was used as test-object.

  19. Modified Widman flap and non-surgical therapy using chlorhexidine chip in the treatment of moderate to deep periodontal pockets: A comparative study

    PubMed Central

    Paul, Grace Tara; Hemalata, M.; Faizuddin, Mohamed

    2010-01-01

    Introduction: It is a well established fact that periodontitis is caused by a group of highly specific microorganisms, organized as a bio-film on the tooth surface. Hence, therapeutic modalities are directed against elimination or adequate suppression of these organisms. Thorough debridement of these sites is possible mainly by scaling and root planing (SRP) and open- flap debridement in deeper sites. Open- flap debridement includes conventional surgical procedures such as the modified Widman flap procedure. Surgical procedures, however, have a number of disadvantages and hence efforts have been on at improving various non-surgical approaches, which are directed more specifically at the microbial nature of periodontal disease. Use of local drug-delivery devices is one such approach. The combined therapy of SRP and local drug delivery has been showing promising results in improving all the parameters in periodontal disease. Materials and Methods: This study compares the clinical, as well as, microbiological results of a split-mouth trial using modified Widman flap and non-surgical therapy of SRP and the use of a controlled release drug-delivery device (Chlorhexidine chip), in the management of moderate to deep pockets. Results and Conclusion: The results showed that the non-surgical most sites subjected to the non-surgical treatment were found to be maintainable without further deterioration, during the study period. PMID:21731252

  20. New developments in the surgical therapy of cervical carcinoma.

    PubMed

    Dornhöfer, Nadja; Höckel, Michael

    2008-09-01

    For almost a century abdominal radical hysterectomy has been the standard surgical treatment of early-stage macroscopic carcinoma of the uterine cervix. The excessive parametrial resection of the original procedures of Wertheim, Okabayashi, and Meigs has later been "tailored" to tumor extent. Systematic pelvic and eventually periaortic lymph node dissection is performed to identify and treat regional disease. Adjuvant (chemo)radiation therapy is liberally added to improve locoregional tumor control when histopathological risk factors are present. The therapeutic index of the current surgical treatment, particularly if combined with radiation, appears to be inferior to that of primary chemoradiation as an oncologically equivalent therapeutic alternative. Several avenues of new conceptual and technical developments have been used since the 1990s with the goal of improving the therapeutic index. These are: surgical staging, including sentinel node biopsy and nodal debulking; minimal access and recently robotic radical hysterectomy; fertility-preserving surgery; nerve-sparing radical hysterectomy; total mesometrial resection based on developmentally defined surgical anatomy; and supraradical hysterectomy. The superiority of these new developments over the standard treatment remains to be demonstrated by controlled prospective trials. Multimodality therapy including surgery for locally advanced disease represents another area of clinical research. Both neoadjuvant chemotherapy followed by radical surgery, with or without adjuvant radiation, and completion surgery after (chemo)radiation are feasible and have to be compared to primary chemoradiation as the new nonsurgical treatment standard. Surgical treatment of postirradiation persisting or recurrent cervical carcinoma has been traditionally limited to pelvic exenteration for central disease. Applying the principle of developmentally derived anatomical compartments increases R0 resectability. The laterally extended endopelvic resection allows even the extirpation of a subset of visceral pelvic side wall tumors with clear margins. Many questions regarding the indication for these "ultraradical" operations, the surgery of irradiated tissues, and the optimal reconstructive procedures are still open and demand multi-institutional controlled trials to be answered. PMID:18837903

  1. [Robot-assisted laparoscopic prostatectomy: surgical technique].

    PubMed

    Rocco, B; Coelho, R F; Albo, G; Patel, V R

    2010-09-01

    Prostate tumours are among the most frequently diagnosed solid tumours in males (a total of 192,280 new cases in the USA in 2009); since the approval of the PSA test by the Food and Drug Administration in 1986, incidence has risen significantly, particularly in the '90s; furthermore the spread of the PSA test has led to an increased frequency of cancer diagnosis at the localised stage. The standard treatment for tumour of the prostate is retropubic radical prostatectomy (RRP) which however is not morbidity-free, e.g. intraoperative bleeding, urinary incontinence and erectile dysfunction. This is why the interest of the scientific community has turned increasingly to mini-invasive surgical procedures able to achieve the same oncological results as the open procedure, but which also reduce the impact of the treatment on these patients' quality of life. The first step in this direction was laparoscopic prostatectomy described by Schuessler in 1992 and standardised by Gaston in 1997. However, the technical difficulty inherent in this procedure has limited its more widespread use. In May 2000 Binder and Kramer published a report on the first robot-assisted prostatectomy (RARP) using the Da Vinci system (da Vinci TM, Intuitive Surgical, Sunnyvale, CA, USA). From the original experience, RARP, which exploits the advantages of an enlarged, three-dimensional view and the ability of the instruments to move with 7 degrees of freedom, the technique has spread enormously all over the world. At the time of writing, in the USA, RARP is the most common therapeutic option for the treatment of prostate tumour at localised stage. In the present study we describe the RARP technique proposed by dr. Vipul Patel, head of the Global Robotic Institute (Orlando Fl). PMID:20940698

  2. Special Procedures

    MedlinePLUS

    ... Advanced heart disease may require special procedures to open an artery and improve blood flow. These operations are usually done to ease severe ... tip, which is repeatedly inflated and deflated to open and stretch the artery, improving blood flow. Often, a tiny tube called a stent is ...

  3. An open source software project for obstetrical procedure scheduling and occupancy analysis

    Microsoft Academic Search

    Mark W. Isken; Timothy J. Ward; Steven J. Littig

    2011-01-01

    Increases in the rate of births via cesarean section and induced labor have led to challenging scheduling and capacity planning\\u000a problems for hospital inpatient obstetrical units. We present occupancy and patient scheduling models to help address these\\u000a challenges. These patient flow models can be used to explore the relationship between procedure scheduling practices and the\\u000a resulting occupancy on inpatient obstetrical

  4. Surgical correction of congenital entropion in related Boer goat kids using a combination Hotz-Celsus and lateral eyelid wedge resection procedure.

    PubMed

    Donnelly, Kevin S; Pearce, Jacqueline W; Giuliano, Elizabeth A; Fry, Pamela R; Middleton, John R

    2014-11-01

    Five related Boer goat kids (?4 months of age) were presented to the University of Missouri, Veterinary Teaching Hospital (MU-VMTH) with epiphora and blepharospasm of several weeks duration and commencing prior to 1 month of age in all animals. Clinical examination confirmed euryblepharon and entropion bilaterally in two females and one male and unilaterally in two female kids. Deep stromal corneal ulceration was present in two eyes, and corneal granulation tissue and fibrosis were present in half (5/10) the affected eyes. A combination Hotz-Celsus and lateral eyelid wedge resection procedure was performed on all affected eyelids. Recheck examinations and long-term follow-up confirmed resolution of the entropion, preservation of normal eyelid conformation, and restoration of ocular comfort. Pedigree analysis ruled out sex-linked and autosomal dominant inheritance patterns; a specific mode of inheritance could not be determined. The Boer goat breed may be at increased risk for the development of entropion. This cases series represents the first report of entropion in the caprine species. PMID:25338664

  5. Does Preoperative Urodynamic Testing Improve Surgical Outcomes in Patients Undergoing the Transobturator Tape Procedure for Stress Urinary Incontinence? A Prospective Randomized Trial

    PubMed Central

    Rathi, Sudheer; Patnaik, Pranab; Shaw, Dipak; Jain, Madhu; Trivedi, Sameer; Dwivedi, Udai Shankar

    2014-01-01

    Purpose Urodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes. Materials and Methods Patients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/or Valsalva leak point pressure [VLPP]<60 cm H2O and/or maximum urethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively. Results A total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the "urodynamic testing" and "office evaluation only" groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes). Conclusions Our findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions. PMID:25512817

  6. Sepsis of the hip due to pressure sore in spinal cord injured patients: advocacy for a one-stage surgical procedure.

    PubMed

    Le Fort, M; Rome-Saulnier, J; Lejeune, F; Bellier-Waast, F; Touchais, S; Kieny, P; Duteille, F; Perrouin-Verbe, B

    2014-11-01

    Study design:Retrospective study reporting characteristics and management of septic arthritis of the hip due to pressure sores in spinal cord-injured patients.Objectives:To describe clinical and biological data of septic arthritis of the hip and its treating management.Setting:The database of the regional SCI referral center, Nantes, France.Methods:We retrospectively collected data from 33 cases of septic arthritis of the hip in the medical files of 26 patients.Results:We analyzed 33 cases of septic arthritis of the hip treated in one French referent center for spinal cord-injured patients from January 1988 to December 2009. Most patients had a thoracic complete paraplegia and nearly two-third (17 out of 26) had no systematic follow-up. In 25 out of 33 cases, the septic arthritis of the hip was due to a trochanteric pressure sore. The causal pressure sore was most frequently associated with a persistent drainage. The standard radiological examination led to the diagnosis in 30 cases and, in 7 questionable cases, magnetic resonance imaging was more contributory. Surgery always consisted of a wide carcinological-like excision and of a subtrochanteric proximal femoral resection including both greater and lesser trochanters. A musculocutaneous flap was realized for all cases and the choice of the muscle depended on the localization of the causal pressure sore but also of the remaining choices, as most of the patients had already undergone a prior surgery. An antibiotic treatment was adapted to multiple samples during surgery.Conclusion:We do advocate for a one-stage procedure including a subtrochanteric proximal femoral resection and a musculocutaneous flap.Spinal Cord advance online publication, 4 November 2014; doi:10.1038/sc.2014.170. PMID:25366526

  7. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

    Ong, Cliff K. S.; Seymour, R. A.

    2003-01-01

    Pain is a major postoperative symptom in many oral surgical procedures. It is a complex and variable phenomenon that can be influenced by many factors. Good management of oral surgical pain requires a detailed understanding of the pathogenesis of surgical pain. This article aims at reviewing postoperative pain from a broad perspective by looking into the nociception, neuroanatomy, neurophysiology, and neuropharmacology of pain. Therapeutic recommendations are made after reviewing the evidence from the literature for maximizing the efficacy of pain management techniques for oral surgical pain. PMID:12722900

  8. Local Irrigation of the Surgical Field with Antibiotics in the End of Procedure Reduces the Infection Rate in Herniated Lumbar Disc Surgery

    PubMed Central

    Kërveshi, Armend; Halili, Nehat; Kastrati, Bujar; Qosja, Faik; Kabashi, Serbeze; Muçaj, Sefedin

    2014-01-01

    Introduction: Reported rate of infections after lumbar discectomy is 1%–15 %. This complication may result in disability or even the death. Aim The aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed. Patients and methods: In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatient’s clinic along postoperative course of three months. Results: A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 20–65 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus. Conclusion: Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only. PMID:25685087

  9. Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient

    PubMed Central

    2013-01-01

    Introduction Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. Methods In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. Results No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ. PMID:23556553

  10. Stereolithographic surgical template: a review.

    PubMed

    Dandekeri, Shilpa Sudesh; Sowmya, M K; Bhandary, Shruthi

    2013-09-01

    Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures. PMID:24179955

  11. [Surgical treatment of arteriovenous malformations].

    PubMed

    Casanova, D; Bardot, J; Bartoli, J-M; Magalon, G

    2006-01-01

    MAV surgery remains still today one of most difficult in the surgery of vascular malformations. Embolisation the most selective possible follow-up of a surgical removal carrying the totality of the nidus is the only effective treatment. Usually, MAV of small size, quiescent, should not be operated, the surgery being reserved for the evolutionary or complicated forms. This surgical procedure must allow the complete eradication of the lesion without which the cure is not possible. The incomplete removal causes repetition, sometimes aggravation with, sometimes, life threatening problems. PMID:17007986

  12. [Surgical sepsis].

    PubMed

    Sganga, Gabriele

    2015-06-11

    Sepsis represents a clinical syndrome following an infection and it is characterized by classical signs of systemic inflammatory response syndrome (SIRS): fever or ipothermia, tachycardia, tachipnea, leucocytosis or leucopenia. There may also be symptoms related to a specific infection such as a cough in pneumonia or burning with urination in a kidney infection, and abdominal pain in an intraabdominal sepsis. Common locations for the primary infection include lungs, brain, urinary tract, skin and soft tissues, and mainly abdominal organs. Patients who develop sepsis have an increased risk of complications and death and face higher healthcare costs and longer treatment. The infection is caused most commonly by bacteria, but can also be by fungi, viruses, or parasites. Severe sepsis is sepsis causing poor organ function or insufficient blood flow; septic shock is the situation with ipotension and/or need for high dosage of inotropes or vasopressors and multiple organ failure syndrome is when multiple organ dysfunction or failure is present. Outcomes depend on the severity of disease with the risk of death from sepsis being as high as 30%, severe sepsis as high as 50%, and septic shock as high as 80%. Prevention, early diagnosis, and treatment, both medical (antibiotics) and surgical (source control), together with the prompt intensive care and organ support are crucial to increase survival rate. PMID:25754409

  13. Haptics in minimally invasive surgical simulation and training

    Microsoft Academic Search

    C. Basdogan; S. De; Jung Kim; Manivannan Muniyandi; Hyun Kim; M. A. Srinivasan

    2004-01-01

    Haptics is a valuable tool in minimally invasive surgical simulation and training. We discuss important aspects of haptics in MISST, such as haptic rendering and haptic recording and playback. Minimally invasive surgery has revolutionized many surgical procedures over the last few decades. MIS is performed using a small video camera, a video display, and a few customized surgical tools. In

  14. The UCLA surgical approach to sphincteric incontinence in women

    Microsoft Academic Search

    Eric S. Rovner; David A. Ginsberg; Shlomo Raz

    1997-01-01

    Stress urinary incontinence (SUI) in the female may be treated by a variety of non-surgical and surgical therapies. However, once the patient has chosen to undergo operative repair the ideal procedure is based on three considerations: the degree of anterior vaginal wall prolapse, the degree of incontinence and associated anatomic abnormalities requiring surgical repair. In the vast majority of cases

  15. RESEARCH PAPER Surgical implantation techniques for electronic tags in fish

    E-print Network

    Cooke, Steven J.

    RESEARCH PAPER Surgical implantation techniques for electronic tags in fish Glenn N. Wagner, and other surgery related techniques; however, the tools and techniques used in the surgical process vary guidelines for surgical procedures on fish are to know the anatomy, minimize tissue damage and surgery times

  16. Sevoflurane versus propofol sedation during periocular anesthetic injections in oculoplastic procedures: An open-label randomized comparison

    PubMed Central

    Tawfik, Hatem A.; Mostafa, Mohsen

    2014-01-01

    Purpose The purpose of the current investigation was to make an objective controlled comparison of pain tolerance, patient satisfaction and potential complications during the injection of local anesthesia in oculoplastic procedures under short-term sedation using inhalational versus parenteral sedatives. Methods This was an open-label, randomized clinical trial where patients were randomized to 3 groups. Group I: Sedation with intravenous propofol. Group II: Sedation with inhaled sevoflurane. Group 3: Control group receiving no sedation. Results A total of 396 patients were randomly assigned, and 375 were included in the final analysis. Study groups were similar in age, gender, and distribution of operative procedures performed. There was no statistically significant difference in the adjusted primary composite outcome measure between propofol and sevoflurane (pain scores and patient satisfaction). Significantly more patients in group I required restraining during periocular injections than group II or III (p < 0.001). Significantly more patients sneezed in group I than group II (p < 0.001) and none in the control group. Three patients in group II suffered severe excitation–disinhibition during emergence from sedation which was rapidly reversible, and 3 more suffered a severe bout of postoperative nausea and vomiting (PONV). Conclusion Sevoflurane and propofol during periocular anesthetic injections produce an equally favorable experience. Sevoflurane is introduced painlessly, and offers better patient control with less induction of the sneezing reflex which may provide a higher safety profile, however short-term aggression/disinhibition and PONV may be an issue in some patients. PMID:25892931

  17. [Possibilities of surgical therapy of lymphedema].

    PubMed

    Döller, Walter

    2013-04-01

    The surgical treatment of lymphedema, which was mainly used on limbs, was, up until the beginning of the last century marked by radical resection methods. Over the last 20 years, through the development of microsurgical techniques, lymphatics and lymph nodes are anastomosed after autologous transplantation to bypass blockages that occur after lymphonodal dissection after cancer therapy. As a further efferent surgical method, the lympho-venous anastomosis was propagated during the recent decades.In addition, other minimal invasive surgical techniques concerning dissection have been developed. The well known liposuction technique, which has been frequently and successfully used in cosmetic surgery, is capable of removing tissue changes that are caused by lymphedema with satisfying cosmetic results.Other surgical procedures are so called "additive lymphologic surgical treatments", such as dermatolipectomy and surgical resection of secondary lymphedema-lesions, like papillomatosis cutis, lymphcysts, lymphatic fistulas, which occur especially in lymphedema of the genitals. PMID:23591856

  18. Minimally invasive surgical management of ureteropelvic junction obstruction: laparoscopic and robot-assisted laparoscopic pyeloplasty.

    PubMed

    Munver, Ravi; Del Pizzo, Joseph J; Sosa, R Ernest; Poppas, Dix P

    2003-01-01

    Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by an intrinsic or extrinsic obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital in origin; however, acquired conditions at the level of the ureteropelvic junction may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options, with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy and robot-assisted applications has allowed for minimally invasive reconstructive surgery that mirrors open surgical techniques. These techniques offer substantial benefits to patients by reducing morbidity, hastening postoperative recovery, and improving cosmetic outcome. During the last decade, laparoscopic pyeloplasty has garnered much interest. However, because of the technically challenging nature of this procedure, it is performed only at select medical centers by surgeons with advanced laparoscopic training. The recent introduction of robotics to the field of minimally invasive surgery may facilitate this procedure and allow for more widespread implementation by surgeons of varying skill levels. This review is limited primarily to the treatment of congenital or acquired UPJ obstruction via laparoscopic and robot-assisted laparoscopic pyeloplasty. Herein, we report the early results, ongoing evolution, and potential future role for these novel surgical procedures. PMID:14649575

  19. Nonsurgical deep uterine transfer of vitrified, in vivo-derived, porcine embryos is as effective as the default surgical approach

    PubMed Central

    Martinez, Emilio A.; Martinez, Cristina A; Nohalez, Alicia; Sanchez-Osorio, Jonatan; Vazquez, Juan M.; Roca, Jordi; Parrilla, Inmaculada; Gil, Maria A.; Cuello, Cristina

    2015-01-01

    Surgical procedures are prevalent in porcine embryo transfer (ET) programs, where the use of vitrified embryos is quasi non-existent. This study compared the effectiveness of surgical vs nonsurgical deep uterine (NsDU) ET using vitrified, in vivo-derived embryos (morulae and blastocysts) on the reproductive performance and welfare of the recipients. The recipient sows (n?=?122) were randomly assigned to one of the following groups: surgical ET with 30 vitrified-warmed embryos (S-30 group, control); NsDU-ET with 30 vitrified-warmed embryos (NsDU-30 group) and NsDU-ET with 40 vitrified-warmed embryos (NsDU-40 group). Regardless of embryo stage, the NsDU-ET with 40 embryos presented similar rates of farrowing (72.7%) and litter size (9.9?±?2.1 piglets) as the customary surgical procedure (75.0% and 9.6?±?2.7 piglets). Numbers of ET-embryos appeared relevant, since the NsDU-ET with 30 embryos resulted in a decrease (P?procedure increase in function of a larger number of transferred vitrified embryos, with fertility equalizing that obtained with the invasive surgical approach. The results open new possibilities for the widespread use of non-invasive ET in pigs. PMID:26030839

  20. Surgical management of Peyronie's disease.

    PubMed

    Zaid, Uwais B; Alwaal, Amjad; Zhang, Xiaoyu; Lue, Tom F

    2014-10-01

    Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another. PMID:25118854

  1. [Heart myxoma. Surgical treatment].

    PubMed

    Miralles, A; Bracamonte, L; Rábago, G; Bors, V; Petrie, J; Pavie, A; Gandjbakhch, I; Cabrol, C

    1989-12-01

    We reviewed all the patients who underwent surgical excision of cardiac myxomas at La Pitié during the last fifteen years. Fifty-one cases were found (32 female and 19 male) aging from 16 to 75 years (mean 51). Congestive heart failure was the primary symptom present in 28 patients. Thirteen patients presented peripheral embolization, four with syncope and 11 with tachyarrhythmias. The diagnosis was made either by echocardiography or angiography. All of them had correct preoperative diagnoses, and no tumors were found incidentally at operation. Forty-six myxomas were localized in the left atrium, four in the right atrium and one in the right ventricle. All the patients underwent open-heart operation and myxomas were successfully removed with excision of a portion of normal atrial septum or wall. Path reconstruction of the atrial septum was required thirty-six times. Mortality after surgical excision is very low. Only one death (1.96%) occurred as a result of a postoperative low output syndrome. Late recurrences have been reported in other series, but no recurrences were diagnosed in our patients up to the present. Although the recurrence rate is low, long-term clinical and echocardiographic follow-up is recommended. PMID:2623302

  2. An innovative surgical suture and needle evaluation and selection program.

    PubMed

    Szarmach, Robin R; Livingston, Jean; Rodeheaver, George T; Thacker, John G; Edlich, Richard F

    2002-01-01

    This report describes an innovative suture and needle clinical evaluation program jointly designed by hospital representatives of Consorta, Inc., a healthcare resource management and group purchasing organization, and United States Surgical/Davis & Geck Sutures (USS/D&G), manufacturer of surgical biomaterials. Nineteen Consorta shareholder hospitals enrolled 699 surgeons to participate in Phase I of this nonexperimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by USS/D&G, which were evaluated in 3407 surgical procedures, included packaging and ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, and clinically acceptable and unacceptable determinations. In these 30-day studies, the surgeons concluded that the needles and sutures were clinically acceptable in 98.1% of the evaluations. The general, cardiothoracic, and orthopedic surgeons, who performed 73.8% of the product evaluations, reported that the suture and needle products were clinically acceptable in 97.2% of the evaluations. More than half (50.1%) of the evaluations involved the POLYSORB* braided synthetic sutures,which received a clinically acceptable rating in 98.4% of the evaluation. The next most frequently used sutures were the SOFSILK*, followed by the monofilament nylon suture. SOFSILK* was found to be clinically acceptable in 98.7% of the evaluations, whereas the monofilament nylon was noted to be clinically acceptable in 96.3% of the evaluations. Surgical needles made by USS/D&G had a 97.9% clinical acceptability rating. PMID:12627784

  3. Open-heart surgery in Jehovah's Witness patients

    Microsoft Academic Search

    M. Chikada; A. Furuse; Y. Kotsuka; K. Yagyu

    1996-01-01

    Open-heart surgery has been performed since 1975 on 25 patients who are Jehovah's Witnesses by religion. The patients' ages ranged from 6–60 years, and their body weights from 18–51 kg. Surgical procedures included correction of congenital heart disease in 14 patients and valve repair or replacement in 11. Six procedures were reoperations. The lowest mean haematocrits, during perfusion and the

  4. Electronic surgical record management.

    PubMed

    Rockman, Justin

    2010-01-01

    This paper explores the challenges surgical practices face in coordinating surgeries and how the electronic surgical record management (ESRM) approach to surgical coordination can solve these problems and improve efficiency. Surgical practices continue to experience costly inefficiencies when managing surgical coordination. Application software like practice management and electronic health record systems have enabled practices to "go digital" for their administrative, financial, and clinical data. However, surgical coordination is still a manual and labor-intensive process. Surgical practices need to create a central and secure record of their surgeries. When surgical data are inputted once only and stored in a central repository, the data are transformed into active information that can be outputted to any form, letter, calendar, or report. ESRM is a new approach to surgical coordination. It enables surgical practices to automate and streamline their processes, reduce costs, and ensure that patients receive the best possible care. PMID:20480775

  5. Predictors of ARF after cardiac surgical procedures

    Microsoft Academic Search

    Katherine R. Tuttle; Neil K. Worrall; Lynn R. Dahlstrom; Radha Nandagopal; Annamaria T. Kausz; Connie L. Davis

    2003-01-01

    Background: In a pilot study, a low preoperative serum ferritin level predicted increased risk for acute renal failure (ARF) after cardiopulmonary bypass. It was hypothesized that this may reflect a decreased ability to bind free iron and defend against oxidative stress. However, the pilot study was performed in a small number of patients (n = 30) operated on by a

  6. Surgical treatment of diffuse pigmented villonodular synovitis of the knee.

    PubMed

    Yang, Bo; Liu, Duan; Lin, Jin; Jin, Jin; Weng, Xi-Sheng; Qian, Wen-Wei; Qian, Jun

    2015-05-01

    Objective To compare the roles of open synovectomy and arthroscopic synovectomy in the treatment of diffuse pigmented villonodular synovitis(D-PVNS).Methods Forty-seven patients suffered from D-PVNS of knee joint who underwent surgical treatment with complete follow-up data from March 1994 to October 2013 were retrospectively analyzed. All patients were divided into two groups as open synovectomy group(n=17)and arthroscopic synovectomy group(n=30)according to the surgical procedure. Routine radiation therapy was applied in both groups after the surgery. The mean follow-up period was(15.7±16.3)months(range:10-?30 month). The range of motion,International Knee Documentation Committee(IKDC)score and Lysholm score before the surgery and at the final follow-up were compared respectively.Results Recurrence was noted in 8 patients(17.0%),among whom 3 were from the open synovectomy group and 5 from the arthroscopic synovectomy group,resulting a recurrence rate of 17.6% and 16.7%,respectively,in these two groups(P>0.05). The range of motion,IKDC score,and Lysholm score at final follow-up and before the operation were(97.5±14.3)? vs.(69.7±12.6)?,(74.5±6.1) vs. (38.6±5.4)scores,and (77.5±5.8) vs. (42.4±4.6)scores,respectively,in the open synovectomy group,and were(128.6±13.9)? vs.(64.9±13.2)?,(87.4±6.7) vs. (37.2±4.9)scores,and (86.2±6.2) vs. (41.9±5.3)scores,respectively,in the arthroscopic synovectomy group(all P<0.05). Obviously,the range of motion,IKDC score,and Lysholm score at the final follow-up were significantly superior to the pre-operative findings,and were also significantly better in the arthroscopic synovectomy group than in the open synovectomy group(P<0.05).Conclusions Open synovetomy and arthroscopic synovetomy have similar recurrent rates in treating D-PVNS of the knee joint,while the latter has better postoperative range of motion and functional scores. Thus,arthroscopic synovectomy is a better option for the surgical treatment of D-PVNS. PMID:25936715

  7. Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southampton

    Microsoft Academic Search

    Christos Alexiou; Qiang Chen; Stephen M. Langley; Anthony P. Salmon; Barry R. Keeton; Marcus P. Haw; James L. Monro

    2001-01-01

    Objective: The most appropriate management of aortic stenosis (AS) in children remains controversial. The purpose of this study was to determine the outcome following open valvotomy for AS in children. Methods: Ninety-seven consecutive, unselected, children (mean age 3.2±3.6 years, 1 day–15 years) underwent an open valvotomy for critical (n=36) or severe (n=61) AS between 1979 and 2000 in Southampton. Twenty-six

  8. Enhancement of re-closure capacity by the intra-amniotic injection of human embryonic stem cells in surgically induced spinal open neural tube defects in chick embryos

    Microsoft Academic Search

    Do-Hun Lee; Eun Young Kim; Seung-Ki Kim; You-Nam Chung; Byung-Kyu Cho; Young Jae Lee; Jinho Lim; Kyu-Chang Wang

    2004-01-01

    To evaluate the re-closure promoting capacity of human embryonic stem (hES) cells injected into the amniotic cavity on spinal open neural tube defects (ONTDs) of chick embryos, neural tubes were opened at Hamburger and Hamilton stage 18 or 19 and the embryos were divided into three groups: a control group (no injection), a vehicle group, and a hES cell group

  9. Postirradiation lesions of the brachial plexus. Results of surgical treatment

    SciTech Connect

    LeQuang, C.

    1989-02-01

    In a series of 103 cases of postirradiation lesions of the brachial plexus operated on between 1978 and 1986--of which 60 patients have been reviewed with a follow up from 2 to 9 years--the surgical results are analyzed according to an anatomic classification, a clinical classification, and the surgical procedures. We conclude that the radiation plexitis should be treated surgically and at the earliest possible time after the onset of paresthesias. Also, the surgical procedure which gives the best results is neurolysis with pedicled omentoplasty.

  10. [Surgical managment of retinal detachment].

    PubMed

    Haritoglou, C; Wolf, A

    2015-05-01

    The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90?% can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. PMID:25393439

  11. Ethical issues in surgical innovation.

    PubMed

    Miller, Megan E; Siegler, Mark; Angelos, Peter

    2014-07-01

    Innovation is responsible for most advances in the field of surgery. Innovative approaches to solving clinical problems have significantly decreased morbidity and mortality for many surgical procedures, and have led to improved patient outcomes. While innovation is motivated by the surgeon's expectation that the new approach will be beneficial to patients, not all innovations are successful or result in improved patient care. The ethical dilemma of surgical innovation lies in the uncertainty of whether a particular innovation will prove to be a "good thing." This uncertainty creates challenges for surgeons, patients, and the healthcare system. By its very nature, innovation introduces a potential risk to patient safety, a risk that may not be fully known, and it simultaneously fosters an optimism bias. These factors increase the complexity of informed consent and shared decision making for the surgeon and the patient. Innovative procedures and their associated technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare environment. Surgeons and institutions must identify and address conflicts of interest created by the development and application of an innovation, always preserving the best interest of the patient above the academic or financial rewards of success. Potential strategies to address the challenges inherent in surgical innovation include collecting and reporting objective outcomes data, enhancing the informed consent process, and adhering to the principles of disclosure and professionalism. As surgeons, we must encourage creativity and innovation while maintaining our ethical awareness and responsibility to patients. PMID:24728580

  12. Echols’ Procedure for Treating Syringomyelia: Case Report and Historical Review

    PubMed Central

    Peterson, Matthew M.; Cracium, Liviu; Heiss, John D.

    2009-01-01

    A 9 year-old girl with syringomyelia and scoliosis was treated with Echols’ procedure, a surgical technique that employs a metal stent to maintain drainage of fluid from the syrinx into the subarachnoid space. The patient presented to our institution 34 years later with a history of progressive myelopathy and surgically-treated deformities of the thoracic spine, lumbar spine, and right foot. Computer-assisted myelography indicated that the metal wire remained in place and that the syrinx had collapsed. Neurological examination and neurophysiological testing confirmed the presence of thoracic myelopathy, which may be due to the wire tethering the thoracic spinal cord to the dorsal dura. This is believed to be the sole long-term report of the effects of Echols’ procedure. The history of direct treatment of syringomyelia is reviewed and is contrasted with indirect treatment of syringomyelia, which relieves the condition by opening obstructed CSF pathways within the foramen magnum or spine. PMID:19119937

  13. Are Costs of Robot-Assisted Surgery Warranted for Gynecological Procedures?

    PubMed Central

    van Dam, Peter; Hauspy, Jan; Verkinderen, Luc; Trinh, Xuan Bich; van Dam, Pieter-Jan; Van Looy, Luc; Dirix, Luc

    2011-01-01

    The exponential use of robotic surgery is not the result of evidence-based benefits but mainly driven by the manufacturers, patients and enthusiastic surgeons. The present review of the literature shows that robot-assisted surgery is consistently more expensive than video-laparoscopy and in many cases open surgery. The average additional variable cost for gynecological procedures was about 1600?USD, rising to more than 3000?USD when the amortized cost of the robot itself was included. Generally most robotic and laparoscopic procedures have less short-term morbidity, blood loss, intensive care unit, and hospital stay than open surgery. Up to now no major consistent differences have been found between robot-assisted and classic video-assisted procedures for these factors. No comparative data are available on long-term morbidity and oncologic outcome after open, robotic, and laparoscopic gynecologic surgery. It seems that currently only for very complex surgical procedures, such as cardiac surgery, the costs of robotics can be competitive to open surgical procedures. In order to stay viable, robotic programs will need to pay for themselves on a per case basis and the costs of robotic surgery will have to be reduced. PMID:21941556

  14. Towards automatic skill evaluation: Detection and segmentation of robot-assisted surgical motions

    Microsoft Academic Search

    Henry Lin; Izhak Shafran; David Yuh; Gregory Hager

    2006-01-01

    Abstract This paper reports our progress in developing,techniques,for “parsing” raw motion,data from a simple surgical task into a labeled sequence,of surgical gestures. The ability to automatically,detect and segment,surgical motion,can be useful in evalua- ting surgical skill, providing surgical training feedback, or documenting essential aspects of a procedure. If processed online, the information can be used to provide context-specific information or

  15. Surgical outcome in 87 patients with Zenker's diverticulum.

    PubMed

    Bonafede, J P; Lavertu, P; Wood, B G; Eliachar, I

    1997-06-01

    Surgical treatment of Zenker's diverticulum is controversial because many different procedures exist. We retrospectively reviewed 87 consecutive patients surgically treated for Zenker's diverticulum at a tertiary care institution from 1976 through 1993. Four surgical procedures were performed: cricopharyngeal myotomy alone (n = 16), excision (hand-sewn) plus myotomy (n = 51), excision (stapler) plus myotomy (n = 11), and diverticulopexy plus myotomy (n = 9). There were three surgical mortalities (3.5%) and a complication rate of 24%. Eighty patients (92%) were available for follow up. Sixty-eight patients (78%) reported excellent relief of symptoms, 10 (13%) reported improvement with occasional symptoms, and two (3%) described persistent dysphagia. No statistical difference in complication rate was found among surgical groups (P = 0.15). Myotomy alone patients had worse outcomes (P = 0.04) compared with the other surgical groups. Median follow-up was 7.5 months. PMID:9185726

  16. Procedures for restoring vestibular disorders

    PubMed Central

    Walther, Leif Erik

    2005-01-01

    This paper will discuss therapeutic possibilities for disorders of the vestibular organs and the neurons involved, which confront ENT clinicians in everyday practice. Treatment of such disorders can be tackled either symptomatically or causally. The possible strategies for restoring the body's vestibular sense, visual function and co-ordination include medication, as well as physical and surgical procedures. Prophylactic or preventive measures are possible in some disorders which involve vertigo (bilateral vestibulopathy, kinetosis, height vertigo, vestibular disorders when diving (Tables 1 (Tab. 1) and 2 (Tab. 2)). Glucocorticoid and training therapy encourage the compensation of unilateral vestibular loss. In the case of a bilateral vestibular loss, it is important to treat the underlying disease (e.g. Cogan's disease). Although balance training does improve the patient's sense of balance, it will not restore it completely. In the case of Meniere's disease, there are a number of medications available to either treat bouts or to act as a prophylactic (e.g. dimenhydrinate or betahistine). In addition, there are non-ablative (sacculotomy) as well as ablative surgical procedures (e.g. labyrinthectomy, neurectomy of the vestibular nerve). In everyday practice, it has become common to proceed with low risk therapies initially. The physical treatment of mild postural vertigo can be carried out quickly and easily in outpatients (repositioning or liberatory maneuvers). In very rare cases it may be necessary to carry out a semicircular canal occlusion. Isolated disturbances of the otolith function or an involvement of the otolith can be found in roughly 50% of labyrinth disturbances. A specific surgical procedure to selectively block the otolith organs is currently being studied. When an external perilymph fistula involving loss of perilymph is suspected, an exploratory tympanotomy involving also the round and oval window niches must be carried out. A traumatic rupture of the round window membrane can, for example, also be caused by an implosive inner ear barotrauma during the decompression phase of diving. Dehiscence of the anterior semicircular canal, a relatively rare disorder, can be treated conservatively (avoiding stimuli which cause dizziness), by non-ablative „resurfacing" or by „plugging" the semicircular canal. A perilymph fistula can cause a Tullio-phenomenon resulting from a traumatic dislocation or hypermobility of the stapes, which can be surgically corrected. Vestibular disorders can also result from otosurgical therapy. When balance disorders persist following stapedectomy it is necessary to carry out a revision operation in order to either exclude a perilymph fistula or shorten the piston. Surgically reducing the size of open mastoid cavities (using for example porous hydroxylapatite or cartilage) can result in a reduction of vertiginous symptoms while nursing or during exposure to ambient air. Vestibular disturbances can occur both before and after vestibular nerve surgery (acoustic neuroma). Initially, good vestibular compensation can be expected after surgically removing the acoustic neuroma. An aberrant regeneration of nerve fibers of the vestibulocochlear nerve has been suggested as a cause for secondary worsening. Episodes of vertigo can be caused by an irritation of the vestibular nerve (vascular loop). Neurovascular decompression is generally regarded as the best surgical therapy. In the elderly, vestibular disturbances can severely limit quality of life and are often aggravated by multiple comorbidities. Antivertiginous drugs (e.g. dimenhydrinate) in combination with movement training can significantly reduce symptoms. Administering antivertiginous drugs over varying periods of time (e.g. transdermal scopolamine application via patches) as well as kinetosis training can be used as both prophylactically and as a therapy for kinetosis. Exposure training should be used as a prophylactic for height vertigo. PMID:22073053

  17. Hemorrhoidectomy - making sense of the surgical options.

    PubMed

    Yeo, Danson; Tan, Kok-Yang

    2014-12-01

    While debate continues as to which is the best surgical method for the treatment of hemorrhoids, none of the currently available surgical methods approach the ideal surgical option, which is one that is effective while being safe and painless. In reality, the less painful the procedure, the more likely it is to be associated with recurrence post-op. Where hemorrhoids surgery is concerned, there isn't a "one size fits all" option. Most of the randomized controlled trials performed to date include hemorrhoids of various grades and with a focus on only comparing surgical methods while failing to stratify the outcomes according to the grade of hemorrhoid. We believe that surgery needs to be tailored not only to the grade of the hemorrhoids, but also to the size, circumferential nature of the disease, and prevailing symptomatology. PMID:25493010

  18. Intraoperative nursing activities performed by surgical technologists.

    PubMed

    Abbott, C A

    1994-09-01

    In this study of delegated intraoperative nursing activities performed by surgical technologists (STs) in low-risk and high-risk surgical procedures, 343 OR directors, perioperative nurses, and STs from rural, community, and medical center hospitals reported that STs frequently perform activities related to surgical counts, the sterile field, and equipment and supplies. Surgical technologists do not frequently perform tasks related to patient transportation, teaching, medication administration, OR environment, patient monitoring, and patients' rights. The investigator used nine competency statements of intraoperative nursing as a framework for the research instrument. Data analysis determined that the levels of risk in patient situations affects how frequently STs perform transportation, teaching, sterile field, OR environment, and patients' rights activities. PMID:7979325

  19. Novel Totally Laparoscopic Endolumenal Rectal Resection With Transanal Natural Orifice Specimen Extraction (NOSE) Without Rectal Stump Opening: A Modification of Our Recently Published Clean Surgical Technique in a Porcine Model.

    PubMed

    Kvasha, Anton; Hadary, Amram; Biswas, Seema; Szvalb, Sergio; Willenz, Udi; Waksman, Igor

    2015-06-01

    Our group has recently described a novel technique for clean endolumenal bowel resection, in which abdominal and transanal approaches were used. In the current study, 2 modifications of this procedure were tested for feasibility in a porcine model. A laparoscopic approach to the peritoneal cavity was employed in rectal mobilization; this was followed by a transanal rectorectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. Once IPT was established, a second ligature was placed around the rectum approximating the proximal and distal resection margins. This was followed by a purse string suture through 2 bowel walls, encircling the shaft of the anvil just proximal to the ligatures. The specimen was resected and extracted by making a full-thickness incision through the 2 bowel walls distal to the previously placed purse string suture and ligatures. The anastomosis was achieved by applying the stapler. The technique was found to be feasible. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. Although, this is a novel and evolving procedure, its minimally invasive nature, as well as aseptic bowel manipulation during endolumenal rectal resection, has the potential to limit the complications associated with abdominal wall incision and surgical site infection. PMID:25057141

  20. Online orthopaedic surgical anatomical study using the visible human server

    Microsoft Academic Search

    Timour F. El Husseini; Mahmoud A. Mahran

    2011-01-01

    Practicing orthopaedic surgeons may face day to day challenge in planning certain operations that require a special study\\u000a of the anatomical part on which a complicated or rare surgical procedure is required. The standard options to obtain such\\u000a special surgical anatomical data has been traditionally the reference of anatomical text books, special surgical exposure\\u000a literature and books, or a special

  1. Role of catheter and surgical ablation in congenital heart disease.

    PubMed

    Hebe, Joachim

    2002-08-01

    The role of surgery and radiofrequency current ablation for the treatment of tachycardias in patients with congenital heart disease The use of radiofrequency current application as a treatment strategy has stimulated a revolution in our understanding of tachycardia mechanisms. The extension of its use to patients with congenital heart defects and tachyarrhythmias has opened the door to new treatments with known success rates and known risks for mortality and morbidity. Antiarrhythmic surgery aims to dissect or excavate a responsible substrate and is especially worth considering if cardiac surgery is being undertaken for other reasons. With suitable surgical skill and interest, and with strong electrophysiologic support, high success rates have been documented. Antiarrhythmic surgical incisions have the advantage of being visually controllable regarding the extent and location of damage to myocardial tissue. In other situations, radiofrequency current ablation is preferred because of its less-invasive character, its use of local anesthesia, and the avoidance of surgical trauma. Both surgery and catheter ablation require precise clarification of the tachycardia mechanism and precise localization of the underlying substrate. The importation of such techniques into the realm of open chest surgery would be difficult in light of the need for multiple intracardiac catheters and repeated fluoroscopically guided catheter positioning. Electrophysiologic studies performed during the antiarrhythmic surgical procedure cannot provide complete information, and their use is thus restricted to the arrhythmogenic myocardial target only [32,45]. In contrast, catheter-mediated electrophysiologic studies offer the option of exact diagnosis, precise substrate localization, and interventional treatment in a single session. Moreover, validation of the linear lesion's completeness has become a reliable predictor for mid- and long-term success in avoiding recurrences. As a result, the application of catheter-mediated ablation has exploded within the past 15 years. Antiarrhythmic surgery has survived as a discipline in a decreasing number of experienced hands [43,44]. As a result of recent experiences and modern technology, success rates above 90% [74-76, 81,88] for the interventional treatment of congenital tachycardias have become comparable to those reported in patients with "normal" hearts. For acquired tachycardias, acute success rates today range about 80% at the atrial level. The rate of recurrence is still relatively high at about 10-25% [73,76,77,79,91,96,102]. Further improvements are being pursued. Data on the treatment of acquired tachycardias at the ventricular level is largely anecdotal. Good early success rates are combined with a tendency to recurrence in longer-term follow-up [50,76,103-108]. Some of the late VT ablation recurrences may be explained by the fact that fibrotic, scarred, and hypertrophic myocardial tissue at the targeted site often prevents effective radiofrequency current application and lesion generation. In order to improve RF lesion depth and continuity, newly designed technologies for radiofrequency current ("cooled tip electrode", Cordis Webster, Baldwin Park, CA), and alternative energy sources (cryo-ablation, micro-wave, or ultrasound) are being readied for introduction in the very near future. For patients suffering from recurrent tachycardias and having other reasons for open-heart surgery, a hybrid concept can be created, utilizing modern 3-D electro-anatomical reconstruction as a basis for an electrophysiologically informed surgical procedure. Following such a concept, a hemodynamic catheterization can be combined with an electrophysiologic study to define critical myocardial zones for induced macro-re-entry tachycardias, or of those zones expected to play an arrhythmogenic role in the future. With such information, surgical incisions for cardiac access and repair can be planned and performed. The role of surgery in antiarrhythmic treatment can become preventive. Myocardial tissue is i

  2. Risk factors for surgical site infection of pilon fractures

    PubMed Central

    Ren, Tingting; Ding, Liang; Xue, Feng; He, Zhimin; Xiao, Haijun

    2015-01-01

    OBJECTIVES: Pilon fracture is a complex injury that is often associated with severe soft tissue damage and high rates of surgical site infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among patients undergoing surgical fixation of a pilon fracture. METHODS: The medical records of all pilon fracture patients who underwent surgical fixation from January 2010 to October 2012 were reviewed to identify those who developed a surgical site infection. Then, we constructed univariate and multivariate logistic regressions to evaluate the independent associations of potential risk factors with surgical site infection in patients undergoing surgical fixation of a pilon fracture. RESULTS: A total of 519 patients were enrolled in the study from January 2010 to October 2012. A total of 12 of the 519 patients developed a surgical site infection, for an incidence of 2.3%. These patients were followed for 12 to 29 months, with an average follow-up period of 19.1 months. In the final regression model, open fracture, elevated postoperative glucose levels (?125 mg/dL), and a surgery duration of more than 150 minutes were significant risk factors for surgical site infection following surgical fixation of a pilon fracture. CONCLUSIONS: Open fractures, elevated postoperative glucose levels (?125 mg/dL), and a surgery duration of more than 150 minutes were related to an increased risk for surgical site infection following surgical fixation of a pilon fracture. Patients exhibiting the risk factors identified in this study should be counseled regarding the possible surgical site infection that may develop after surgical fixation. PMID:26106960

  3. Debridement of vaginal radiation ulcers using the surgical Ultrasonic Aspirator

    SciTech Connect

    Vanderburgh, E.; Nahhas, W.A. (Wright State Univ. School of Medicine, Dayton, OH (USA))

    1990-10-01

    The surgical Ultrasonic Aspirator (USA) is a fairly new surgical instrument used for an increasingly wide range of procedures. This paper introduces a new application: debridement of vulvovaginal necrotic ulcers resulting from intracavitary radiation therapy. The ultrasonic aspirator allowed removal of the soft, necrotic tissue while preserving underlying healthy, firm tissue and blood vessels.

  4. Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial

    PubMed Central

    Bressan, Alexsander K; Roberts, Derek J; Edwards, Janet P; Bhatti, Sana U; Dixon, Elijah; Sutherland, Francis R; Bathe, Oliver; Ball, Chad G

    2014-01-01

    Introduction Among surgical oncology patients, incisional surgical site infection is associated with substantially increased morbidity, mortality and healthcare costs. Moreover, while adults undergoing pancreaticoduodenectomy with preoperative placement of an intrabiliary stent have a high risk of this type of infection, and wound protectors may significantly reduce its risk, no relevant studies of wound protectors yet exist involving this patient population. This study will evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among adults undergoing pancreaticoduodenectomy with preoperatively-placed intrabiliary stents. Methods and analysis This study will be a parallel, dual-arm, randomised controlled trial that will utilise a more explanatory than pragmatic attitude. All adults (?18?years) undergoing a pancreaticoduodenectomy at the Foothills Medical Centre in Calgary, Alberta, Canada with preoperative placement of an intrabiliary stent will be considered eligible. Exclusion criteria will include patient age <18?years and those receiving long-term glucocorticoids. The trial will employ block randomisation to allocate patients to a commercial dual-ring wound protector (the Alexis Wound Protector) or no wound protector and the current standard of care. The main outcome measure will be the rate of surgical site infection as defined by the Centers for Disease Control and Prevention criteria within 30?days of the index operation date as determined by a research assistant blinded to treatment allocation. Outcomes will be analysed by a statistician blinded to allocation status by calculating risk ratios and 95% CIs and compared using Fisher's exact test. Ethics and dissemination This will be the first randomised trial to evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among patients undergoing pancreaticoduodenectomy. Results of this study are expected to be available in 2016/2017 and will be disseminated using an integrated and end-of-grant knowledge translation strategy. Trial registration number ClinicalTrials.gov identifier NCT01836237. PMID:25146716

  5. Decision making in surgical oncology.

    PubMed

    Lamb, B; Green, J S A; Vincent, C; Sevdalis, N

    2011-09-01

    Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients. PMID:20719499

  6. [Surgical treatment of dilated cardiomyopathy].

    PubMed

    Konstantinov, B A; Korotkov, A V; Belianko, I E; Sandrikov, V A; Dolotov V K; Ternovskaia, E A; Eremenko, A A; Kolpakov, P E

    2006-01-01

    The efficacy and safety of different variants of left ventricular geometrical reconstruction (LVGR) in patients with dilated cardiomyopathy (DKMP) were studied in 2-stage clinical trial during 4 years. Results of left ventricle plication, "Myosplint" surgery and implantation of extracardial net framework (ECNF) complemented with mitral insufficiency correction (in case of need) have been evaluated on the first stage of the study. Based on this study, the implantation of ECNF and correction of mitral insufficiency are recognized as the most effective and safe method of DKMP surgical treatment. Short- and long-term results of these surgical procedures have been studied on the second stage of the study. Overall 30 surgeries of LVGR have been performed (18 on stage 1 and 12 on stage 2 of the study). Hospital lethality on stage 1 was 27%, 4-year actuarial survival rate (taking into account hospital lethality)--54+/-12%. Original protocols of surgical, anesthetic and intensive care management led to decrease of hospital lethality to 8% and an increase of 2-year actuarial survival rate to 91.6+/-7.9% (that significantly higher than in the control group treated with therapeutic methods only). PMID:17047625

  7. Surgical smoke and ultrafine particles

    PubMed Central

    Brüske-Hohlfeld, Irene; Preissler, Gerhard; Jauch, Karl-Walter; Pitz, Mike; Nowak, Dennis; Peters, Annette; Wichmann, H-Erich

    2008-01-01

    Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine (<100 nm) and accumulation mode particles (< 1 ?m). Epidemiological and toxicological studies have shown that exposure to particulate air pollution is associated with adverse cardiovascular and respiratory health effects. Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc.) was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3) of particles in the diameter range of 10 nm to 1 ?m. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure. PMID:19055750

  8. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...procedures, LPNs and surgical technologists may assist in circulatory duties under the surpervision of a qualified registered nurse...must be available to the operating room suites: call-in-system, cardiac monitor, resuscitator, defibrillator,...

  9. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...procedures, LPNs and surgical technologists may assist in circulatory duties under the surpervision of a qualified registered nurse...must be available to the operating room suites: call-in-system, cardiac monitor, resuscitator, defibrillator,...

  10. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...procedures, LPNs and surgical technologists may assist in circulatory duties under the surpervision of a qualified registered nurse...must be available to the operating room suites: call-in-system, cardiac monitor, resuscitator, defibrillator,...

  11. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...procedures, LPNs and surgical technologists may assist in circulatory duties under the surpervision of a qualified registered nurse...must be available to the operating room suites: call-in-system, cardiac monitor, resuscitator, defibrillator,...

  12. 42 CFR 482.51 - Condition of participation: Surgical services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...procedures, LPNs and surgical technologists may assist in circulatory duties under the surpervision of a qualified registered nurse...must be available to the operating room suites: call-in-system, cardiac monitor, resuscitator, defibrillator,...

  13. Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

    PubMed Central

    Lee, Sung-Moon; Lee, Young-Kuk; Shin, Hong-Kwan

    2014-01-01

    Background The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results. Methods Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively. Results The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient. Conclusions Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint. PMID:25177460

  14. Ultra–fast track hospital discharge using conventional cardiac surgical techniques 1 1 This article has been selected for the open discussion forum on the STS Web site: http:\\/\\/www.sts.org\\/section\\/atsdiscussion

    Microsoft Academic Search

    Salim Walji; Richard J Peterson; Pat Neis; Robert DuBroff; William A Gray; William Benge

    1999-01-01

    Background. Recent introduction of minimally invasive adult cardiac surgical techniques has emphasized the advantage of early hospital discharge. However, we chose an alternative approach to determine the safety, efficacy, and feasibility of ultra–fast track protocols while retaining both standard surgical exposure (median sternotomy) and conventional cardiac surgical techniques (hypothermia, cardiopulmonary bypass with cardiac arrest, and optimal myocardial protection).Methods. From September

  15. A virtual reality model of the clivus and surgical simulation via transoral or transnasal route

    PubMed Central

    Wang, Shou-Sen; Li, Jun-Feng; Zhang, Shang-Ming; Jing, Jun-Jie; Xue, Liang

    2014-01-01

    Background: Neurosurgery in areas with restricted space and complicated anatomy can be greatly aided by the virtual reality (VR) technique. The clivus represents one of such challenging surgical areas, but its VR has not been established. The present study aimed to document a VR model of clival anatomy that may be useful in clival surgery. Methods: High resolution CT angiography and MRI were used. The study included a total of 20 patients who did not have any obvious abnormalities detected in the oral, nasal, and clival areas. The images were fused with a Dextroscope. Results: In the VR model, the key structures such as the clival bone, basilar artery, brainstem, pituitary gland, and paranasal sinuses were clearly observed. The morphology of the clivus and its spatial relationships with the neighboring structures were also illustrated. Visualization of the clival model can be made flexible from various planes, angles, or orientations. In addition, surgical access to the clivus via the transoral route or transnasal route was simulated in detail. Conclusion: The simulation of the VR model offers a straightforward, three-dimensional, interactive understanding of the size and shape of the clivus, and its relationships with the surrounding blood vessels and bones. It also demonstrates simulated operational procedures such as opening the surgical window, measuring the exposure distance and angles, and determining the critical boundaries in relation to key structures such as the brainstem and arteries. Digitalized VR modeling appears to be helpful for understanding the anatomy of the clivus and its surgical approaches. PMID:25419358

  16. Concept of the aortic aneurysm repair-related surgical stress: a review of the literature

    PubMed Central

    Moris, Demetrios N; Kontos, Michalis I; Mantonakis, Eleftherios I; Athanasiou, Antonios K; Spartalis, Eleftherios D; Bakoyiannis, Chris N; Chrousos, George P; Georgopoulos, Sotirios E

    2014-01-01

    Objective: Abdominal aorta aneurysm (AAA) is a serious threat for human life. AAA repair is a high-risk procedure which results in a severe surgical stress response. We aim to give a conceptual description of the underlying pathophysiology of stress after surgical repair of AAA. Methods: The MEDLINE/PubMed database was searched for publications with the medical subject heading “surgical stress” and keywords “abdominal aortic aneurysms (AAA)”, or “cytokines” or “hormones” or “open repair (OR)” or “endovascular repair (EVAR)”. We restricted our search to English till 2012 and only in cases of abdominal and thoracoabdominal aneurysms (TAAA). Results: We identified 93 articles that were available in English as abstracts or/and full-text articles that were deemed appropriate for our review. Conclusions: Literature highlights no statistical significance for early acute TNF-? production in EVAR and no TNF-? production in OR. IL-6 and IL-8 levels are higher after OR especially when compared with those of EVAR. IL-10 peak was observed during ischemic phase in aneurysm surgical repair. Cortisol and epinephrine levels are higher in OR patients in comparison to EVAR patients. Finally, the incidence of systemic inflammatory response syndrome was significantly higher in OR than EVAR patients. PMID:25356092

  17. Collagen-Glycosaminoglycan Matrix Implantation Promotes Angiogenesis following Surgical Brain Trauma

    PubMed Central

    Hsu, Wei-Cherng; Hsiao, Jong-Kai; Chen, Gunng-Shinng; Wang, Jia-Yi

    2014-01-01

    Surgical brain injury (SBI) is unavoidable during many neurosurgical procedures intrinsically linked to postoperative neurological deficits. We have previously demonstrated that implantation of collagen glycosaminoglycan (CG) following surgical brain injury could significantly promote functional recovery and neurogenesis. In this study we further hypothesized that this scaffold may provide a microenvironment by promoting angiogenesis to favor neurogenesis and subsequent functional recovery. Using the rodent model of surgical brain injury as we previously established, we divided Sprague-Dawley male rats (weighting 300–350?g) into three groups: (1) sham (2) surgical injury with a lesion (L), and (3) L with CG matrix implantation (L + CG). Our results demonstrated that L + CG group showed a statistically significant increase in the density of vascular endothelial cells and blood vessels over time. In addition, tissue concentrations of angiogenic growth factors (such as VEGF, FGF2, and PDGF) significantly increased in L + CG group. These results suggest that implantation of a CG scaffold can promote vascularization accompanied by neurogenesis. This opens prospects for use of CG scaffolds in conditions such as brain injury including trauma and ischemia. PMID:25309917

  18. A systematic approach to the surgical treatment of gynaecomastia.

    PubMed

    Fruhstorfer, B H; Malata, C M

    2003-04-01

    Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Patient satisfaction was assessed using a linear analogue scale with a maximum score of 10. In total, 48 breasts in 29 patients were treated--31 breasts by liposuction alone (19 by conventional liposuction, 12 by ultrasound-assisted liposuction), eight breasts by liposuction and open excision, and nine breasts by liposuction, open excision and skin reduction (concentric or Lejour mastopexy). There were no early postoperative complications, such as haematoma, seroma or infection, and 91% of patients were very satisfied (score: 8-10) with their cosmetic outcome. The most frequently encountered complication was a residual subareolar lump (five breasts), all in patients treated by conventional liposuction alone. In order to avoid the common complication of an uncomfortable residual subareolar nodule, the threshold for open excision in patients undergoing conventional liposuction should be low. Ultrasound-assisted liposuction extends the role of liposuction in gynaecomastia patients. Although skin excess remains a challenge, it can be satisfactorily managed without excessive scarring. A practical approach to the surgical management of gynaecomastia, which takes into account breast size, consistency, skin excess and skin quality, is proposed. PMID:12859919

  19. Robotic Surgical Training in an Academic Institution

    PubMed Central

    Chitwood, W. Randolph; Nifong, L. Wiley; Chapman, William H. H.; Felger, Jason E.; Bailey, B. Marcus; Ballint, Tara; Mendleson, Kim G.; Kim, Victor B.; Young, James A.; Albrecht, Robert A.

    2001-01-01

    Objective To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Summary Background Data Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. Methods Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors’ two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. Results Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. Conclusion Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely. PMID:11573041

  20. Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection.

    PubMed

    Higashiyama, Masahiko; Tokunaga, Toshiteru; Nakagiri, Tomoyuki; Ishida, Daisuke; Kuno, Hidenori; Okami, Jiro

    2015-06-01

    According to a recent report by the Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery, pulmonary metastasectomy accounted for as many as 10.2 % of all entry cases of general thoracic surgery, and its use is increasing year by year. Accordingly, many studies have examined the surgical procedures used during pulmonary metastasectomy for metastases from primary tumors affecting various organs as well as the outcomes of and indications for such procedures, but some problems remain. In this article, the following questions related to the surgical approach and the type of resection used during pulmonary metastasectomy are reviewed: (1) Wedge resection-what is a safe margin for preventing local recurrence? (2) What is the clinical significance of node sampling/dissection during pulmonary metastasectomy? and (3) When is segmentectomy necessary? In addition, we discuss: (4) open thoracotomy vs. video-assisted thoracoscopic surgery (VATS), (5) repeated metastasectomy for pulmonary metastases, (6) the surgical approach for bilateral pulmonary metastasectomy, (7) pneumonectomy, and (8) pulmonary metastasectomy combined with resection of the neighboring organs. PMID:25836329

  1. Minimally Invasive Surgical Treatment for Kidney Stone Disease.

    PubMed

    Rodríguez, Dayron; Sacco, Dianne E

    2015-07-01

    Minimally invasive interventions for stone disease in the United States are mainly founded on 3 surgical procedures: extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy. With the advancement of technology, treatment has shifted toward less invasive strategies and away from open or laparoscopic surgery. The treatment chosen for a patient with stones is based on the stone and patient characteristics. Each of the minimally invasive techniques uses an imaging source, either fluoroscopy or ultrasound, to localize the stone and an energy source to fragment the stone. Extracorporeal shock wave lithotripsy uses a shock wave energy source generated outside the body to fragment the stone. In contrast, with ureteroscopy, laser energy is placed directly on the stone using a ureteroscope that visualizes the stone. Percutaneous nephrolithotomy requires dilation of a tract through the back into the renal pelvis so that instruments can be inserted directly onto the stone to fragment or pulverize it. The success of the surgical intervention relies on performing the least invasive technique with the highest success of stone removal. PMID:26088070

  2. Army field surgical experience.

    PubMed

    Jackson, D S; Batty, C G; Ryan, J M; McGregor, W S P

    2007-01-01

    In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent campaigns. PMID:18214085

  3. Surgical Techniques and Priorities

    Microsoft Academic Search

    E. A. Barker

    1977-01-01

    This paper compares contemporary western surgical needs (e.g. the surgery of physical decay) with the surgical needs of less developed countries and shows that these are a function of expectations, real and unreal. An outline of the needs of poor societies follows, with examples from practical experience in the Zulu country: e.g. surgery of trauma, including burns; obstruction; childbirth; congenital

  4. Cochlear implant simulator for surgical technique analysis

    NASA Astrophysics Data System (ADS)

    Turok, Rebecca L.; Labadie, Robert F.; Wanna, George B.; Dawant, Benoit M.; Noble, Jack H.

    2014-03-01

    Cochlear Implant (CI) surgery is a procedure in which an electrode array is inserted into the cochlea. The electrode array is used to stimulate auditory nerve fibers and restore hearing for people with severe to profound hearing loss. The primary goals when placing the electrode array are to fully insert the array into the cochlea while minimizing trauma to the cochlea. Studying the relationship between surgical outcome and various surgical techniques has been difficult since trauma and electrode placement are generally unknown without histology. Our group has created a CI placement simulator that combines an interactive 3D visualization environment with a haptic-feedback-enabled controller. Surgical techniques and patient anatomy can be varied between simulations so that outcomes can be studied under varied conditions. With this system, we envision that through numerous trials we will be able to statistically analyze how outcomes relate to surgical techniques. As a first test of this system, in this work, we have designed an experiment in which we compare the spatial distribution of forces imparted to the cochlea in the array insertion procedure when using two different but commonly used surgical techniques for cochlear access, called round window and cochleostomy access. Our results suggest that CIs implanted using round window access may cause less trauma to deeper intracochlear structures than cochleostomy techniques. This result is of interest because it challenges traditional thinking in the otological community but might offer an explanation for recent anecdotal evidence that suggests that round window access techniques lead to better outcomes.

  5. Identifying and reducing errors with surgical simulation

    PubMed Central

    Fried, M; Satava, R; Weghorst, S; Gallagher, A; Sasaki, C; Ross, D; Sinanan, M; Uribe, J; Zeltsan, M; Arora, H; Cuellar, H

    2004-01-01

    The major determinant of a patient's safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills—which are at the core of the profession—are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without risk to patients, should allow for the detection and analysis of errors and "near misses". Studies have validated the use of a sophisticated endoscopic sinus surgery simulator (ES3) for training residents on a procedural basis. Assessments are proceeding as to whether the integration of a comprehensive ES3 training programme into the residency curriculum will have long term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified on the simulator and intraoperatively. Through a web based database, individual performance can be compared against a national standard. An upgraded version of the ES3 will be developed which will support patient specific anatomical models. This advance will allow study of the effects of simulated rehearsal of patient specific procedures (mission rehearsal) on patient outcomes and surgical errors during the actual procedure. The information gained from these studies will help usher in the next generation of surgical simulators that are anticipated to have significant impact on patient safety. PMID:15465950

  6. An ultrasound image-guided surgical workflow model

    NASA Astrophysics Data System (ADS)

    Guo, Bing; Lemke, Heinz; Liu, Brent; Huang, H. K.; Grant, Edward G.

    2006-03-01

    A 2003 report in the Journal of Annual Surgery predicted an increase in demand for surgical services to be as high as 14 to 47% in the workload of all surgical fields by 2020. Medical difficulties which are already now apparent in the surgical OR (Operation Room) will be amplified in the near future and it is necessary to address this problem and develop strategies to handle the workload. Workflow issues are central to the efficiency of the OR and in response to today's continuing workforce shortages and escalating costs. Among them include: Inefficient and redundant processes, System Inflexibility, Ergonomic deficiencies, Scattered Data, Lack of Guidelines, Standards, and Organization. The objective of this research is to validate the hypothesis that a workflow model does improve the efficiency and quality of surgical procedure. We chose to study the image-guided surgical workflow for US as a first proof of concept by minimizing the OR workflow issues. We developed, and implemented deformable workflow models using existing and projected future clinical environment data as well as a customized ICT system with seamless integration and real-time availability. An ultrasound (US) image-guided surgical workflow (IG SWF) for a specific surgical procedure, the US IG Liver Biopsy, was researched to find out the inefficient and redundant processes, scattered data in clinical systems, and improve the overall quality of surgical procedures to the patient.

  7. Feature classification for tracking articulated surgical tools.

    PubMed

    Reiter, Austin; Allen, Peter K; Zhao, Tao

    2012-01-01

    Tool tracking is an accepted capability for computer-aided surgical intervention which has numerous applications, both in robotic and manual minimally-invasive procedures. In this paper, we describe a tracking system which learns visual feature descriptors as class-specific landmarks on an articulated tool. The features are localized in 3D using stereo vision and are fused with the robot kinematics to track all of the joints of the dexterous manipulator. Experiments are performed using previously-collected porcine data from a surgical robot. PMID:23286097

  8. Surgical scar endometrioma.

    PubMed

    Koger, K E; Shatney, C H; Hodge, K; McClenathan, J H

    1993-09-01

    Relatively few instances of surgical scar endometrioma have been reported. Herein we review 24 patients treated for this condition at the institutions at which we work between 1972 and 1992. The age of the patients ranged from 17 to 47 years, with an average age of 31.7 years. Surgical scar endometriomas occurred after operations including cesarean section (19 patients), appendectomy (two patients), episiotomy (two patients) and hysterectomy (one patient). The interval between prior surgical treatment and the onset of symptoms ranged from one to 20 years, with an average of 4.8 years. All patients were treated by wide excision. Seventeen of 24 patients were available for follow-up evaluation. The interval between excision and follow-up evaluation ranged from 1.2 to 14.0 years, with an average of 6.4 years. None of the patients had recurrence of surgical scar endometrioma. Patients with the classic presentation of a painful surgical scar mass that increases in size or tenderness during menstruation need no further evaluation of the lesion before excision. Ultrasonographic examination and fine needle aspiration biopsy should be used preoperatively in women who have a constantly painful or asymptomatic mass in a surgical scar. Because medical management yields poor results, wide excision of surgical scar endometriomas is the treatment of choice. PMID:8356497

  9. Transparency in Parliament: A Review of the Procedures and Practices in South Asia along with Recommended Guidelines for Increasing Openness

    Microsoft Academic Search

    South Asians for Human Rights SAHR

    2012-01-01

    This paper examines the functioning of Parliaments in Bangladesh, India, Pakistan and Sri Lanka1 in order to gauge the extent of openness and access from the point of view of both Members of Parliament (MPs) and citizens. The rule books, secondary literature and the websites of Parliament are the chief sources of information. In this paper it is tried to

  10. Update on Schlemm's Canal Based Procedures

    PubMed Central

    Mansouri, Kaweh; Shaarawy, Tarek

    2015-01-01

    Surgical options for glaucoma have expanded in recent years. This article provides an evidence-based update on the novel or emerging surgical techniques for the treatment of open-angle glaucoma that are based on the Schlemm's canal (SC). Canaloplasty is an ab externo approach and was developed as an alternative to traditional filtering surgeries. The Hydrus microstent (Ivantis Inc., Irvine, CA) is a so-called SC scaffold that directly bypasses the trabecular meshwork to drain aqueous humor into the SC, which it keeps dilated over approximately one quadrant. Canaloplasty has also been shown to lower intraocular pressure (IOP) by up to 40% and combined with cataract surgery. IOP was lowered 44% at 24 months while maintaining a favorable safety profile. The Hydrus device has been proposed as an adjunct to cataract extraction surgery. To date, no published evidence from clinical trials is available on its in vivo safety and efficacy. Schlemm's canal based glaucoma procedures show promise as alternative treatments to traditional glaucoma surgery. Surgeons must be comfortable with angle anatomy. A prerequisite for functionality of these techniques is the integrity of the distal outflow system. At present, however, it is not possible to conclude whether these novel procedures will be viable alternatives to standard filtering surgery over the long-term. PMID:25624672

  11. Local anesthesia for urologic procedures.

    PubMed

    Leach, G E

    1996-08-01

    The ability to perform a variety of urologic procedures (urethrotomy, prostate surgery, penile prosthesis insertion, and bladder neck suspension) under local anesthesia in an outpatient setting is a significant advance in patient care. The surgical techniques are described that will allow the urologist to incorporate these procedures into practice. PMID:8753742

  12. American Pediatric Surgical Association

    MedlinePLUS

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... the latest scientific literature of interest to the pediatric surgeon’s practice, but which may be outside your ...

  13. Urogynecologic Surgical Mesh Implants

    MedlinePLUS

    ... available for use are made from man-made (synthetic) materials or animal tissue. Surgical mesh made of synthetic materials can be found in knitted mesh or non-knitted sheet forms. The synthetic materials ...

  14. Guide to Surgical Specialists

    MedlinePLUS

    ... tissues, abdomen, extremities, and the gastrointestinal, vascular, and endocrine systems. Surgeons may further specialize in an additional board ... neck, skin and soft tissues, and vascular and endocrine systems. Vascular Surgery A vascular surgeon is a surgical ...

  15. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

    PubMed Central

    Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N. A.; Hanscom, Brett; Skinner, Jonathan S.; Abdu, William A.; Hilibrand, Alan S.; Boden, Scott D.; Deyo, Richard A.

    2008-01-01

    Context Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial. Objective To assess the efficacy of surgery for lumbar intervertebral disk herniation. Design, Setting, and Patients The Spine Patient Outcomes Research Trial, a randomized clinical trial enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Patients were 501 surgical candidates (mean age, 42 years; 42% women) with imaging-confirmed lumbar intervertebral disk herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. Interventions Standard open diskectomy vs nonoperative treatment individualized to the patient. Main Outcome Measures Primary outcomes were changes from baseline for the Medical Outcomes Study 36-item Short-Form Health Survey bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons MODEMS version) at 6 weeks, 3 months, 6 months, and 1 and 2 years from enrollment. Secondary outcomes included sciatica severity as measured by the Sciatica Bothersomeness Index, satisfaction with symptoms, self-reported improvement, and employment status. Results Adherence to assigned treatment was limited: 50% of patients assigned to surgery received surgery within 3 months of enrollment, while 30% of those assigned to nonoperative treatment received surgery in the same period. Intent-to-treat analyses demonstrated substantial improvements for all primary and secondary outcomes in both treatment groups. Between-group differences in improvements were consistently in favor of surgery for all periods but were small and not statistically significant for the primary outcomes. Conclusions Patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis. Trial Registration clinicaltrials.gov Identifier: NCT00000410 PMID:17119140

  16. Utilization of Minimally Invasive Surgical Approach for Sacroiliac Joint Fusion in Surgeon Population of ISASS and SMISS Membership

    PubMed Central

    Lorio, Morgan P.; Polly Jr., David W.; Ninkovic, Ivana; Ledonio, Charles G.T.; Hallas, Kelli; Andersson, Gunnar

    2014-01-01

    Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their members to examine current preferences in surgeon practice of MIS SI fusion. Methods: To qualify for survey participation, the surgeon had to perform at least one open or MIS SIJ fusion procedure between 2009 and 2012. All surgeons were instructed to review their records. This included the number of surgical procedures performed annually from 2009-2012, site of service where each procedure was commonly performed, and average length of stay for each approach. Results: Twenty four percent (121/500) of the eligible members participated in this survey. This survey revealed that the percentage of MIS procedures increased from 39% in 2009 to over 87% in 2012. The survey showed a significant increase in average number of MIS surgeries and a significant difference between open and MIS surgeries in 2012 (p<0.0001). In addition, 80% of the survey respondents indicated a lack of preference toward open approach if that was the only available option. Conclusions: According to performed survey, MIS SIJ fusion is preferred over open technique. Incorporation of the MIS technique into the spine surgeon's specter of skills would allow an increased number of surgical options as well as possible increase in outcome quality. PMID:24551025

  17. Surgical Management in Sicklemia

    PubMed Central

    Warner, Clinton E.

    1979-01-01

    A review of the history and pathophysiology of sickle cell disease is given. The clinical types (crises) are discussed along with their relationship to surgical occurrences, both elective and emergency. Specifics of perioperative management are discussed and the cardinal features of importance are enumerated. A retrospective study of sickle cell disease in a community hospital is presented, outlining the surgical experience over a ten-year period. PMID:448754

  18. Smart surgical tool.

    PubMed

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control. PMID:25649628

  19. The frozen elephant trunk: an interesting hybrid endovascular-surgical technique to treat complex pathologies of the thoracic aorta.

    PubMed

    Schoenhoff, Florian S; Schmidli, Juerg; Eckstein, Friedrich S; Berdat, Pascal A; Immer, Franz F; Carrel, Thierry P

    2007-03-01

    The treatment of complex aortic pathologies involving the ascending aorta, the aortic arch, and the descending aorta remains a challenging issue in aortic surgery. The frozen elephant trunk procedure effectively combines surgical and interventional technologies in the treatment of extensive aortic aneurysms and dissections. We present two patients with complex aortic lesions involving all three segments of the thoracic aorta. The device used in our series is the new E-vita open hybrid prosthesis consisting of a proximal woven polyester tube and a distal self-expandable nitinol stent graft, which can be delivered antegrade into the descending aorta. PMID:17321346

  20. [Surgical volume. An American perspective].

    PubMed

    Greenberg, C C; Zinner, M J

    2007-11-01

    Due to an increasing interest in patient safety and quality health care, many studies attempt to show a relationship between procedural volume at the institutional and individual level and patient outcome. Despite the correlation between number of surgeons and institutional volume in major operative procedures such as coronary artery bypass graft, pancreatic resection, and esophagectomy, these parameters are likely to be proxy for individual factors such as experience and structural aspects. In general the relationship between case numbers and results is more convincing in cancer surgery than for cardiovascular procedures, and risk adjustment may play an important role for interpreting results of the various studies. Exact thresholds cannot be determined and thus remain speculative. It appears difficult to implement practical changes based on the observations, because the etiology and causality of the relationship between volume and outcome are still not understood. The simple focus on volume does not apply to measurements of quality but can be a starting point for further studies to identify more specific factors associated with surgical quality. PMID:17928975

  1. Surgical management of recurrent stress urinary incontinence: A 12-year experience

    Microsoft Academic Search

    Fons A. Amaye-Obu; Harold P. Drutz

    1999-01-01

    Objective: The goal of the study was to evaluate the surgical procedures used to manage recurrent stress urinary incontinence in a tertiary referral center, to compare the procedures with respect to efficacy and failure rates, and to identify risk factors for failure. Study Design: The health records of patients who underwent surgical treatment of recurrent stress urinary incontinence performed by

  2. Surgical therapy in Hashimoto's thyroiditis.

    PubMed

    Shimizu, Kazuo; Nakajima, Yuki; Kitagawa, Wataru; Akasu, Haruki; Takatsu, Keisuke; Ishii, Ritsuko; Tanaka, Shigeo

    2003-02-01

    Hashimoto's thyroiditis (HT) is usually considered to be manageable by levothyroxine (L-T4) administration, which can reduce the thyroid volume and supplement the lack of hormone. However, we sometimes encounter a huge goiter that has not shrunk in response to L-T4 therapy. These goiters continue to produce symptoms of compression and an unsightly appearance. Here we discuss the surgical indication and procedure for HT. Thirteen patients with clinically diagnosed Hashimoto's thyroiditis involving a huge diffuse goiter that produced pressure symptoms or nodular lesions were treated with surgery. The gender, age distribution, total dose and period of L-T4 administration prior to the operation, and clinical symptoms caused by the large goiter were evaluated in each case. The titer of antibodies was extremely elevated in 8 HT patients with a diffusely enlarged goiter. The total period of L-T4 medication ranged from 6 to 25 years. A subtotal thyroidectomy in which a small amount of thyroid was left in the posterior area of the bilateral lobes was performed in the 8 cases of diffusely enlarged goiter. Pressure symptoms and the unsightly appearance caused by the goiter were relieved by the surgery in all cases. No surgical complications developed. In conclusion, the surgery is an effective therapy for HT patients who have persistent compression symptoms and/or an unsightly neck appearance due to a large goiter despite long-term L-T4 treatment. PMID:12646974

  3. Surgical hand hygiene: scrub or rub?

    PubMed

    Widmer, A F

    2013-02-01

    Surgical hand hygiene is standard care prior to any surgical procedure. Per-operative glove punctures are observed in almost 30% of all interventions, and a risk factor for postoperative infections. In the past, washing hands with antimicrobial soap and water (surgical scrub) was the norm, mainly with chlorhexidine or iodine. More recently, alcohol-based hand rub has been successfully introduced, showing greater effectiveness, less irritation to the hands, and requiring less time than washing hands. All products should have a remnant effect that delays microbial growth under the gloved hand. Some of the alcohol-based compounds are effective (as determined by the European Norm EN 12791) within 90 s whereas others require 3-5 min, similar to the scrub. The short procedure relies heavily on proper technique and timing, since lowering the exposure time to <90 s leads to significantly lower effectiveness of bacterial killing. Today, surgical hand hygiene should meet EN 12791 in Europe, or other standards, such as the US Food and Drug Administration tentative final monograph norm in the USA. It is best performed by using an alcohol-based hand rub, but a scrub with chlorhexidine-containing soap also meets these standards. PMID:23453175

  4. [Surgical laboratory in pregraduate medicine.

    PubMed

    Tapia-Jurado, Jesús

    2011-01-01

    Surgical laboratory in pregraduate students in medicine is beneficial and improves learning processes in cognitive aspects and skills acquisition. It is also an early initiation into scientific research. The laboratory is the introductory pathway into basic concepts of medical science (meaningful learning). It is also where students gain knowledge in procedures and abilities to obtain professional skills, an interactive teacher-student process. Medicine works rapidly to change from an art to a science. This fact compromises all schools and medical faculties to analyze their actual lesson plans. Simulators give students confidence and ability and save time, money and resources, eliminating at the same time the ethical factor of using live animals and the fear of patient safety. Multimedia programs may give a cognitive context evolving logically with an explanation based on written and visual animation followed by a clinical problem and its demonstration in a simulator, all before applying knowledge to the patient. PMID:21477522

  5. Surgical management of acromioclavicular dislocations.

    PubMed

    Cook, Jay B; Tokish, John M

    2014-10-01

    AC injuries are common in the military population. Many AC injuries can be treated conservatively with good success. Due to requirements of a military population, however, conservative management may fail at a higher rate than in civilian populations. Surgical management is indicated for high-grade injuries and those that are refractory to nonoperative treatment, as well as in those patients at high risk for failure of conservative management. Many techniques exist and there is no single superior technique. The anatomic reconstruction is evolving into a more consistent procedure with good biomechanical support. However, complication rates and failures are higher than ideal; thus, the surgeon must approach this injury with meticulous attention to detail and technique. PMID:25280619

  6. Massive surgical emphysema following transanal endoscopic microsurgery

    PubMed Central

    Simkens, Geert AAM; Nienhuijs, Simon W; Luyer, Misha DP; de Hingh, Ignace HJT

    2014-01-01

    We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed massive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following a transanal endoscopic microsurgery (TEM) procedure for a rectal intramucosal carcinoma. Free intra-abdominal air after gastro-intestinal surgery can be a sign of a bowel perforation or anastomotic leakage. This is a serious complication often requiring immediate surgery. In our patient an abdominal computed tomography-scan with rectal contrast showed no signs of a rectal perforation. Therefore this emphysema was caused by the insufflation of CO2 gas in the rectum during the TEM-procedure. Conservative treatment resulted in an uneventful recovery. With the increasing usage of TEM for rectal lesions we expect this complication to occur more often. After ruling out a full thickness rectal wall perforation in patients with surgical emphysema following TEM, conservative treatment is the treatment of choice. PMID:25161765

  7. Surgical Treatment of Pediatric Epileptic Encephalopathies

    PubMed Central

    Fridley, J.; Reddy, G.; Curry, D.; Agadi, S.

    2013-01-01

    Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed. PMID:24288601

  8. Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature

    PubMed Central

    Fu, Richard Z; Lin, David D

    2013-01-01

    This review was undertaken to better understand the debate regarding the issue of osteoarthritis associated with anterior cruciate ligament (ACL) injuries, from a surgical and biomechanical standpoint. Much of the current debate focuses on contributory surgical factors and their relative roles in increasing or decreasing the risk of future osteoarthritis development, primarily highlighting the controversy over whether reconstructive surgery itself is necessarily protective. This review addresses the evolution of ACL reconstruction techniques over time, and with a view to thoroughly examine the role of surgery, outcome differences in procedural technique are reviewed, with a focus on open versus arthroscopic methods, graft choice and the use of a double versus single bundle reconstruction technique. Moreover, other potentially important contributory factors are identified and discussed, such as intrinsic biomechanical alterations sustained at the time of initial injury, and how these may have a more significant role with regard to future osteoarthritic changes in the knee than previously attributed. PMID:24015160

  9. Surgical technique of lower lobe lung transplantation.

    PubMed

    Deuse, Tobias; Sill, Bjoern; von Samson, Patrick; Yildirim, Yalin; Kugler, Christian; Oldigs, Maike; Klose, Hans; Meierling, Stephan; Rabe, Klaus F; Reichenspurner, Hermann

    2011-08-01

    Among patients with end-stage lung disease awaiting lung transplantation, pediatric and small adult patients have a significantly lower chance of getting size-matched pulmonary grafts in time because of the severe scarcity of small donors. It is our strategy to perform lobar lung transplantations in small recipients with restrictive pulmonary disease once their clinical status demands urgent transplantation. Here we describe our surgical technique and discuss the benefits and risks of this procedure. PMID:21801900

  10. The Pathfinder image-guided surgical robot.

    PubMed

    Deacon, G; Harwood, A; Holdback, J; Maiwand, D; Pearce, M; Reid, I; Street, M; Taylor, J

    2010-01-01

    This paper first describes the workflow of the Pathfinder image-guided surgical robot that has been designed to replace the stereotactic frame in neurosurgery, and then details the calibration stages employed in order to achieve submillimetre positioning accuracy of a tool tip. The process uses non-linear parameter identification techniques in conjunction with some procedures for camera calibration, which exploit the fact that the camera is mounted to a calibrated robot arm that executes precise motions. PMID:20718271

  11. Surgical Replacement of the Entire Aorta

    Microsoft Academic Search

    LiZhong Sun; JunMing Zhu; RuiDong Qi

    \\u000a Simultaneous total aortic replacement that involves the aortic root, ascending aorta, aortic arch, descending thoracic aorta,\\u000a and abdominal aorta is the most complex surgical procedure in the field of aortic surgery. Due to involvement of multiple\\u000a vital organ systems, total replacement of the entire aorta is associated with substantial operative mortality and morbidity\\u000a rates. By rational protection of the vital

  12. Surgical management of necrotizing pancreatitis: An overview

    PubMed Central

    Kokosis, George; Perez, Alexander; Pappas, Theodore N

    2014-01-01

    Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease. PMID:25473162

  13. [Surgical management of cutaneous malignant melanoma. Review].

    PubMed

    Lavie, A; Desouches, C; Casanova, D; Bardot, J; Grob, J-J; Legré, R; Magalon, G

    2007-02-01

    Nowadays managing a cutaneous malignant melanoma can concern different kind of physicians: dermatologists, general or plastic surgeons The primary surgical procedure is a major step of the treatment. Biopsy must be total to properly determine the thickness of the tumor in case of malignancy. Wide local excision of the scar is often necessary to decrease the local and general recurrence rates. Wide local excision must be performed conforming to its own surgical rules. Managing tumor located on the face or limb extremities is a matter of plastic surgery. Sentinel node biopsy has succeeded to elective lymph node dissection. This procedure allows research of lymphatic spreading of the disease. Practice of sentinel node biopsy must be achieved in a protocolar way. Topography of the lesion can modified achievement and results of this procedure. Prognosis benefit of sentinel biopsy is now clear. Elective lymph node dissection is only performed in case of invaded sentinel node or clinically invaded lymph nodes. Local or locoregional recurrences mainly respond to surgical treatment using wide excision. However, alternative solutions are being evaluated (isolated limb perfusion). PMID:17030081

  14. Supramalleolar Osteotomy: Indications and Surgical Techniques.

    PubMed

    Mulhern, Jennifer L; Protzman, Nicole M; Brigido, Stephen A; Deol, Premjit Pete S

    2015-07-01

    Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications. PMID:26117578

  15. Robotic surgical simulation.

    PubMed

    Liss, Michael A; McDougall, Elspeth M

    2013-01-01

    Robotic surgery has undergone exponential growth and has ever developing utilization. The explosion of new technologies and regulation have led to challenges in training surgeons who desire this skill set. We review the current state of robotic simulation and incorporation of simulation into surgical training curricula. In addition to the literature review, results of a questionnaire survey study of 21 expert and novice surgeons attending a Urologic Robotic Oncology conference using 3 different robotic skill simulation devices are discussed. An increasing number of robotic surgery simulators have had some degree of validation study of their use in surgical education curricula and proficiency testing. Although simulators are advantageous, confirmation of construct and predictive validity of robotic simulators and their reliability as a training tool will be necessary before they are integrated into the surgical credentialing process. PMID:23528719

  16. [Electoro-surgical device].

    PubMed

    Matsumura, Yuji

    2009-07-01

    Electro-surgical device is an essential instrument for bloodless surgery after the 1st introduction by Harvey Cushing in 1926. Basal mechanisms of electric scalpels (monopolar and bipolar), current waveforms (cut, coagulation and blend), high-frequency currents and electrical shocks were commented. After 1990s, several new electro-surgical devices such as argon beam coagulator, bipolar scissors and vessel sealing system (LigaSure) were developed and introduced in chest surgery. Argon beam coagulator is useful in sealing and hemostasis of bleeding from chest walls after extrapleural dissections. Bipolar scissors can seal small vessels less than diameter 2 mm and is useful in mediastinal lymphnode dissections. Vessel sealing system is able to seal and cut vessels up to diameter 7 mm. LigaSure V is the most suitable instrument for thymic vein handling in thoracoscopic thymectomy. Clinical applications of these new surgical devices in chest surgery are discussed. PMID:20715684

  17. Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study

    PubMed Central

    2014-01-01

    Background The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study. Methods Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant. Results During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC. Conclusion Under the studied conditions, the authors’ hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture. PMID:24991234

  18. Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.

    PubMed

    Liu, Xinyu; Yuan, Suomao; Tian, Yonghao; Wang, Lianlei; Zheng, Yanping; Li, Jianmin

    2015-07-01

    OBJECT The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis. METHODS A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3-5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°-75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B). RESULTS In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°-24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200-8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°-34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05). CONCLUSIONS An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method. PMID:25909274

  19. Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique

    PubMed Central

    LEANZA, V.; INTAGLIATA, E.; LEANZA, G.; CANNIZZARO, M.A.; ZANGHĚ, G.; VECCHIO, R.

    2013-01-01

    Summary Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers’ transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons. PMID:24342163

  20. Reducing depth uncertainty in large surgical workspaces, with applications to veterinary medicine

    NASA Astrophysics Data System (ADS)

    Audette, Michel A.; Kolahi, Ahmad; Enquobahrie, Andinet; Gatti, Claudio; Cleary, Kevin

    2010-02-01

    This paper presents on-going research that addresses uncertainty along the Z-axis in image-guided surgery, for applications to large surgical workspaces, including those found in veterinary medicine. Veterinary medicine lags human medicine in using image guidance, despite MR and CT data scanning of animals. The positional uncertainty of a surgical tracking device can be modeled as an octahedron with one long axis coinciding with the depth axis of the sensor, where the short axes are determined by pixel resolution and workspace dimensions. The further a 3D point is from this device, the more elongated is this long axis, and the greater the uncertainty along Z of this point's position, in relation to its components along X and Y. Moreover, for a triangulation-based tracker, its position error degrades with the square of distance. Our approach is to use two or more Micron Trackers to communicate with each other, and combine this feature with flexible positioning. Prior knowledge of the type of surgical procedure, and if applicable, the species of animal that determines the scale of the workspace, would allow the surgeon to pre-operatively configure the trackers in the OR for optimal accuracy. Our research also leverages the open-source Image-guided Surgery Toolkit (IGSTK).

  1. Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents

    PubMed Central

    2010-01-01

    Background To analyse in a prospective trial the long-term results of Lichtenstein hernioplasty performed by surgical trainees. Methods Training of tension-free Lichtenstein hernia operation was started in our ambulatory unit as an outpatient procedure under local anaesthesia in 1996. After performing 36 teaching operations together with residents and their supervising specialist, 281 patients were operated during 1996-2000 either by one senior consultant (n = 141) or by 12 surgical trainees (n = 140). After 10 years, 247 (88%) patients were available for the long-term assessment. Results After one month postoperatively, the rate of wound infections (consultant 1.1%, residents 0.7%) and hematomas (consultant 1.1%, residents 3.0%) were low and not related to surgeon's training level (ns). Only 6 (2.1%) clinically evident recurrences were found after 10 years: two after specialist repair and four after trainee repair (ns). Although one third of the patients reported some discomfort after 3 and 10 years, 93-95% of the patients were very satisfied with the operation, with no statistical difference between the surgeons. Conclusion Ambulatory open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees. PMID:20684783

  2. Recent advances and limitations of surgical treatment for pancreatic cancer.

    PubMed

    Kubota, Keiichi

    2011-05-10

    Recent advances in surgical treatment for pancreatic cancer have been remarkable. Pancreatoduodenectomy is a standard surgical procedure for cancer of the pancreatic head, and is now indicated even for elderly patients over 80 years of age. Pancreatoduodenectomy with combined resection of the peripancreatic vessels has improved survival, but extended resection including lymph nodes is considered to have no extra survival benefit. Furthermore, laparoscopic resection procedures including pancreatoduodenectomy, distal pancreatectomy, enucleation and central pancreatectomy can now be performed safely. Neoadjuvant or adjuvant chemotherapy using gemcitabine may further improve the surgical outcome. An understanding of the oncological aspects of pancreatic cancer and the development of surgical techniques and chemotherapy may further contribute to improving the outcome of surgery for pancreatic cancer. PMID:21611099

  3. A new complication of retained surgical gauze: development of malignant fibrous histiocytoma – report of a case with a literature review

    PubMed Central

    2012-01-01

    Background Primary visceral malignant fibrous histiocytoma (MFH) is a rare disease, and few cases have been reported in the English literature. However, retained foreign bodies in the abdomen after surgical procedures are important causes of intra-abdominal infections. For legal and ethical reasons, there are few publications in the literature. In this article, we describe for the first time a case of malign abdominal fibrous histiocytoma associated with a surgical sponge forgotten in the abdominal cavity a long time ago. Case presentation A 64-year-old male presented to our surgical department with cachexia, abdominal pain, distention and pyrexia of unknown origin. He had a medical history of abdominal surgery for peptic ulcer perforation 32?years ago. Clinical examination revealed fever with a distended and painful abdominal wall. Radiological imaging of the abdomen showed multiple heterogeneous masses in one large cystic cavityalmost completely filling the abdomen. The patient underwent a laparotomy, and interestingly, opening the cyst revealed retained surgical gauze (RSG). The origin of the tumor was the visceral peritoneum, and it was excised totally. Conclusions Primary intra-abdominal MFH can present as a complication of long-lasting RSG. Therefore, clinicians must remember this while establishing the differential diagnosis for patients with a history of previous abdominal surgery and presenting with symptoms associated with both the tumor and systemic inflammatory response. PMID:22776249

  4. Minimally invasive surgical approach to treat posterior urethral diverticulum.

    PubMed

    Alsowayan, Ossamah; Almodhen, Fayez; Alshammari, Ahmed

    2015-01-01

    Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum. PMID:25834967

  5. Migrated XLIF cage: case report and discussion of surgical technique.

    PubMed

    Daffner, Scott D; Wang, Jeffrey C

    2010-07-01

    Extreme lateral interbody fusion (XLIF; NuVasive, Inc, San Diego, California) is a minimally invasive technique developed to avoid complications associated with traditional or minimally invasive anterior or posterior approaches to lumbar interbody fusion. It uses a direct lateral, retroperitoneal, transpsoas approach for placement of an interbody cage. To date, no reports of cage-related complications or procedures for revising an XLIF have been published. This article describes a case of a complication unique to this procedure and the surgical technique used to treat it. A 49-year-old woman underwent XLIF at L3-4 with supplemental posterior pedicle fixation for treatment of a pseudarthrosis of a previous fusion performed for junctional degeneration below an old scoliosis construct. One month postoperatively, she reported increasing leg pain, and imaging studies demonstrated the cage to have extruded laterally. The cage was revised using a mini-open lateral approach. The presence of neurologic symptoms (leg pain) necessitated the cage to first be reimpacted before it could be safely extracted. A new cage was placed with the addition of a lateral plate. The patient's leg pain resolved shortly after the revision, and at 1-year follow-up, she appeared to have a solid fusion with no further complications. If required, XLIF may be safely and effectively revised through a minimally invasive or mini-open lateral approach. Use of a lateral plate as a buttress should be considered in cases associated with significant coronal deformity or lateral listhesis, even when planning use of supplemental posterior instrumentation. PMID:20608623

  6. Surgical treatment of the hallux valgus through mini-approach

    Microsoft Academic Search

    M. Bénichou

    2007-01-01

    A mini-invasive surgery implies a diminution of the morbidity of the surgical procedure, which relies on three conditions:\\u000a not only a reduction of the skin incision, but also a limited dissection applied to the approach and the preparation, and\\u000a a surgical step resulting in as little bleeding, debris, heat and fibrosis as possible. The recent, rapid and varied evolution\\u000a of

  7. Surgical Treatment of Winged Scapula

    PubMed Central

    Galano, Gregory J.; Bigliani, Louis U.; Ahmad, Christopher S.

    2008-01-01

    Injuries to the long thoracic and spinal accessory nerves present challenges in diagnosis and treatment. Palsies of the serratus anterior and trapezius muscles lead to destabilization of the scapula with medial and lateral scapular winging, respectively. Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles. Our preferred method of reconstruction for serratus anterior palsy is a two-incision, split pectoralis major transfer without fascial graft. For trapezius palsy, we prefer a modified version of the Eden-Lange procedure. At a minimum followup of 16 months (mean, 47 months), six patients who underwent the Eden-Lange procedure showed improvement in mean American Shoulder and Elbow Surgeons Shoulder scores (33.3–64.6), forward elevation (141.7–151.0), and visual analog scale (7.0–2.3). At a minimum followup of 16 months (mean, 44 months), 10 patients (11 shoulders) who underwent split pectoralis transfer also improved American Shoulder and Elbow Surgeons Shoulder scores (53.3–63.8), forward elevation (158.2–164.5), and visual analog scale (5.0–2.9). We encountered two complications, both superficial wound infections. These tendon transfers were effective for treating scapular winging in patients who did not respond to nonoperative treatment. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196359

  8. Surgical treatment of winged scapula.

    PubMed

    Galano, Gregory J; Bigliani, Louis U; Ahmad, Christopher S; Levine, William N

    2008-03-01

    Injuries to the long thoracic and spinal accessory nerves present challenges in diagnosis and treatment. Palsies of the serratus anterior and trapezius muscles lead to destabilization of the scapula with medial and lateral scapular winging, respectively. Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles. Our preferred method of reconstruction for serratus anterior palsy is a two-incision, split pectoralis major transfer without fascial graft. For trapezius palsy, we prefer a modified version of the Eden-Lange procedure. At a minimum followup of 16 months (mean, 47 months), six patients who underwent the Eden-Lange procedure showed improvement in mean American Shoulder and Elbow Surgeons Shoulder scores (33.3-64.6), forward elevation (141.7-151.0), and visual analog scale (7.0-2.3). At a minimum followup of 16 months (mean, 44 months), 10 patients (11 shoulders) who underwent split pectoralis transfer also improved American Shoulder and Elbow Surgeons Shoulder scores (53.3-63.8), forward elevation (158.2-164.5), and visual analog scale (5.0-2.9). We encountered two complications, both superficial wound infections. These tendon transfers were effective for treating scapular winging in patients who did not respond to nonoperative treatment. PMID:18196359

  9. Surgical Technician Curriculum.

    ERIC Educational Resources Information Center

    EASTCONN Regional Educational Services Center, North Windham, CT.

    This curriculum guide, developed for 10-month postsecondary programs in Connecticut, outlines a program for training surgical technicians. The program is divided into two components, didactic and clinical. Following a list of six general objectives of the program, the guide provides a curriculum outline by major areas with the number of hours…

  10. Surgical treatment of obesity

    Microsoft Academic Search

    Erik Näslund; John G Kral

    2007-01-01

    Obesity is very prevalent. Most treatments fail owing to hard-wired survival mechanisms, linking stress and appetite, which have become grossly maladaptive in the industrial era. Antiobesity (bariatric) surgery is a seemingly drastic, efficacious therapy for this serious disease of energy surfeit. Technical progress during the last two decades has greatly improved its safety. The surgical principles of gastric restriction and\\/or

  11. CULTIVATING NETWORKS: IMPLEMENTING SURGICAL

    E-print Network

    Sahay, Sundeep

    i CULTIVATING NETWORKS: IMPLEMENTING SURGICAL TELEMEDICINE Margunn Aanestad THE INTERVENTIONAL TELEMEDICINE by Margunn Aanestad Submitted as partial fulfilment of the requirements of the degree Doctor;iii TABLE OF CONTENTS 1. Introduction 1 2. Telemedicine ­ visions and challenges 3 3. Related research

  12. Anatomy in Surgical Examinations

    Microsoft Academic Search

    Andrew T Raftery

    2002-01-01

    Today, more than ever, the postgraduate surgical trainee requires instruction in anatomy, for no longer does the undergraduate get a thorough grounding in anatomy. In the past, the postgraduate trainee had formal tuition and examination in anatomy at 2nd M.B. and, therefore, only recall and reinforcement of knowledge were necessary to learn the anatomy required for the old Primary Examination

  13. Surgical Technology Curriculum.

    ERIC Educational Resources Information Center

    Connecticut State Dept. of Education, Hartford. Div. of Vocational-Technical Schools.

    This curriculum guide contains materials for a 10-month postsecondary program to educate qualified adults to function as surgical technicians in association with surgeons and nurses in operating rooms and delivery rooms. The program provides for both a didactic and a clinical component. Contents include general information, a listing of major…

  14. An introduction to the practical and ethical perspectives on the need to advance and standardize the intracoelomic surgical implantation of electronic tags in fish

    USGS Publications Warehouse

    Brown, R.S.; Eppard, M.B.; Murchie, K.J.; Nielsen, J.L.; Cooke, S.J.

    2011-01-01

    The intracoelomic surgical implantation of electronic tags (including radio and acoustic telemetry transmitters, passive integrated transponders and archival biologgers) is frequently used for conducting studies on fish. Electronic tagging studies provide information on the spatial ecology, behavior and survival of fish in marine and freshwater systems. However, any surgical procedure, particularly one where a laparotomy is performed and the coelomic cavity is opened, has the potential to alter the survival, behavior or condition of the animal which can impair welfare and introduce bias. Given that management, regulatory and conservation decisions are based on the assumption that fish implanted with electronic tags have similar fates and behavior relative to untagged conspecifics, it is critical to ensure that best surgical practices are being used. Also, the current lack of standardized surgical procedures and reporting of specific methodological details precludes cross-study and cross-year analyses which would further progress the field of fisheries science. This compilation of papers seeks to identify the best practices for the entire intracoelomic tagging procedure including pre- and post-operative care, anesthesia, wound closure, and use of antibiotics. Although there is a particular focus on salmonid smolts given the large body of literature available on that group, other life-stages and species of fish are discussed where there is sufficient knowledge. Additional papers explore the role of the veterinarian in fish surgeries, the need for minimal standards in the training of fish surgeons, providing a call for more complete and transparent procedures, and identifying trends in procedures and research needs. Collectively, this body of knowledge should help to improve data quality (including comparability and repeatability), enhance management and conservation strategies, and maintain the welfare status of tagged fish. ?? 2010 Springer Science+Business Media B.V.

  15. Situs inversus totalis and abdominal aortic aneurysm: Surgical repair of an extremely uncommon association

    PubMed Central

    Riera Hernández, Claudia; Pérez Ramírez, P.; Esteban Gracia, C.; Jiménez Olivera, M.A.; Llagostera Pujol, S.

    2015-01-01

    Introduction Situs inversus totalis (SIT) is an uncommon congenital syndrome, which refers to a reversal mirror-image of the normal thoracoabdominal organs position. The coexistence of SIT and abdominal aortic aneurysm has been seldom previously reported. Presentation of the case We report a case of a 69-year-old man with SIT and infrarenal abdominal aortic aneurysm (AAA) that underwent open repair with a straight graft through a minilaparatomy without evisceration. Discussion There is no consensus on which should be the optimum approach in cases of open surgical repair of AAA due to the limited number of cases described. The fact of intestinal scrolling to the left abdomen, unlike usual, is due to the anatomical arrangement of the root of the mesentery which is directed obliquely from duodenojejunal on the left side of the vertebra L2 to the ileocecal junction and right sacroiliac joint. Conclusion A minilaparotomy without evisceration and with intestinal scrolling to left hemiabdomen, can be very useful and beneficial on those cases of congenital anatomical abnormalities that may add difficulty during the surgical procedure. PMID:25884612

  16. Bacterial migration through punctured surgical gloves under real surgical conditions

    Microsoft Academic Search

    Nils-Olaf Hübner; Anna-Maria Goerdt; Natalie Stanislawski; Ojan Assadian; Claus-Dieter Heidecke; Axel Kramer; Lars Ivo Partecke

    2010-01-01

    BACKGROUND: The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. METHODS: An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were

  17. Open fenestration for complicated acute aortic B dissection

    PubMed Central

    Segreti, Sara; Grassi, Viviana; Lomazzi, Chiara; Cova, Marta; Piffaretti, Gabriele; Rampoldi, Vincenzo

    2014-01-01

    Acute type B aortic dissection (ABAD) is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. Visceral, renal, and limb ischemia occur in up to 30% of patients with ABAD and are associated with higher in-hospital mortality. The aim of the open fenestration is to resolve the malperfusion by creating a single aortic lumen at the suprarenal or infrarenal level. This surgical procedure is less invasive than total aortic replacement, thus not requiring extracorporeal support and allowing preservation of the intercostal arteries, which results in decreased risk of paraplegia. Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD, particularly for patients with no aortic dilatation. In the current endovascular era, this open technique serves as an alternative option in case of contraindications or failure of endovascular management of complicated ABAD. PMID:25133107

  18. Essential Tremor (ET): Surgical Options

    MedlinePLUS

    ... dressing, working, or enjoying their hobbies. Essential Tremor (ET) Deep Brain Stimulation Deep brain stimulation (DBS) surgery ... over) Surgical Options for Essential Tremor: Essential Tremor (ET) Surgical Options This information was reviewed by Kelly ...

  19. Principles of surgical treatment of Zenker diverticulum

    PubMed Central

    Constantin, A; Mates, IN; Predescu, D; Hoara, P; Achim, FI; Constantinoiu, S

    2012-01-01

    Background: Pharyngo-esophageal diverticula are most frequently described in elderly patients, having symptoms such as dysphagia, regurgitation, chronic cough, aspiration and weight loss. The etiology remains controversial, although most of the theories are linked to structural or functional abnormalities of the crico-pharyngeal muscle. With the therapeutic attitude varying from conservative to surgical (with associated morbidity and mortality), the importance of knowing the etiopathology and clinical implications of the disease for establishing the management of the case is mandatory. The aim of the study is the reevaluation of the methods and therapeutic principles in pharyngo-esophageal diverticular disease, starting from the etio pathogeny. Materials and Methods: Our study group is made up of 11 patients with surgical indication for Zenker diverticulum, operated between 2001 and 2011. Results: During that period, more patients were diagnosed with this pathology, but the surgical indication was carefully established, in conformity with the actual practice guides, which involve the evaluation of the clinical manifestations determined by the diverticulum, as well as the identification and interception of the pathological mechanisms by the therapeutic gesture. Conclusion: Although it has a “benign” pathology, the esophageal diverticulum requires complex surgical procedure that implies significant morbidity. Abbreviations UES= upper esophageal sphincter; NPO= nothing by mouth PMID:22574094

  20. Surgical management of refractory trochanteric bursitis.

    PubMed

    Slawski, D P; Howard, R F

    1997-01-01

    We reviewed a single surgeon's experience with the surgical management of refractory trochanteric bursitis in an active population group. The surgical procedure consisted of simple longitudinal release of the iliotibial band over the greater trochanter and excision of the subgluteal bursa. To our knowledge, this is the first series to use this technique. Seven hips in five patients form the basis of the study, making it one of the largest surgical series reported. All patients had no improvement after a minimum of 1 year of nonoperative management consisting of nonsteroidal antiinflammatory medication, iliotibial band stretching, diathermy, ultrasound, and injections of local anesthetics combined with corticosteroids (average, 4.8 injections). Patients had experienced symptoms preoperatively for an average of 3.8 years and had noted marked limitation in vocational and recreational activities. The preoperative Harris hip score averaged 51.7. Four of the five patients (six hips) were available for evaluation at the time of this study, at an average of 20 months postoperatively. The average Harris hip score was 95.0. All patients were satisfied with the surgical results and had returned to unrestricted vocational and athletic activities. The remaining patient was last seen 6 months postoperatively and her Harris hip score had improved from 49 to 84. PMID:9006699

  1. Impact of Medicare payment reductions on access to surgical services.

    PubMed Central

    Mitchell, J B; Cromwell, J

    1995-01-01

    OBJECTIVE. This study evaluates the impact of surgical fee reductions under Medicare on the utilization of surgical services. DATA SOURCES. Medicare physician claims data were obtained from 11 states for a five-year time period (1985-1989). STUDY DESIGN. Under OBRA-87, Medicare reduced payments for 11 surgical procedures. A fixed effects regression method was used to determine the impact of these payment reductions on access to care for potentially vulnerable Medicare beneficiaries: joint Medicaid-eligibles, blacks, and the very old. DATA COLLECTION/EXTRACTION METHODS. Medicare claims and enrollment data were used to construct a cross-section time-series of population-based surgical rates from 1985 through 1989. PRINCIPAL FINDINGS. Reductions in surgical fees led to small but significant increases in use for three procedures, small decreases in use for two procedures, and no impact on the remaining six procedures. There was little evidence that access to surgery was impaired for potentially vulnerable enrollees; in fact, declining fees often led to greater rates of increases for some subgroups. CONCLUSIONS. Our results suggest that volume responses by surgeons to payment changes under the Medicare Fee Schedule may be smaller than HCFA's original estimates. Nevertheless, both access and quality of care should continue to be closely monitored. PMID:8537224

  2. Anatomical Basis for Surgical Approaches to the Hip

    PubMed Central

    Onyemaechi, NOC; Anyanwu, EG; Obikili, EN; Ekezie, J

    2014-01-01

    The hip joint is one of the most surgically exposed joints in the body. The indications for surgical exposure are numerous ranging from simple procedures such as arthrotomy for joint drainage in infection to complex procedures like revised total hip replacement. Tissue dissections based on sound knowledge of anatomic orientations is essential for best surgical outcomes. In this review, the anatomical basis for the various approaches to the hip is presented. Systematic review of the literature was done by using PubMed, Cochrane, Embase, OVID, and Google databases. Out of the initial 150 articles selected from the the review and selection criteria, only 37 that suited the study were eventually used. Selected articles included case reports, clinical trials, review and research reports. Each of these approaches has various modifications that seek to correct certain difficulties or problems encountered with previous descriptions. An ideal approach for a procedure should be safe and provide satisfactory exposure of the joint. It should avoid bone and soft tissue damage as well as avoid unnecessary devascularization. Among the factors that determine the choice of surgical approach to the hip are the indication for the procedure; the influence of previous surgical incisions as well as the personal preferences and training of the operating surgeon. PMID:25221692

  3. Surgical outcome of pulmonary aspergilloma

    Microsoft Academic Search

    Alaa Brik; Abdel Meged Salem; Al Rady Kamal; Mohamed Abdel-Sadek; Mohamed Essa; Mamdoh El Sharawy; Ahmed Deebes; Khaled Abdel Bary

    2008-01-01

    Introduction: Surgical resection offers the only realistic chance of permanent cure for pulmonary aspergilloma. This prospective study was designed to evaluate our indications and surgical outcome of pulmonary aspergilloma with analysis of postoperative complications. Patients and methods: Between 2001 and 2008, 42 patients underwent surgical treatment for pulmonary aspergilloma at Zagazig University Hospital. The patients were divided into two groups,

  4. Surgical outcome of pulmonary aspergilloma

    Microsoft Academic Search

    Alaa Brik; Abdel Meged Salem; Rady Kamal; Mohamed Abdel-Sadek; Mohamed Essa; Mamdoh El Sharawy; Ahmed Deebes; Khaled Abdel Bary

    2010-01-01

    Introduction: Surgical resection offers the only realistic chance of permanent cure for pulmonary aspergilloma. This prospective study was designed to evaluate our indications and surgical outcome of pulmonary aspergilloma with analysis of postoperative complications. Patients and methods: Between 2001 and 2008, 42 patients underwent surgical treatment for pulmonary aspergilloma at Zagazig University Hospital. The patients were divided into two groups,

  5. Improved tolerability of open carpal tunnel release under local anaesthetic: a patient satisfaction survey

    Microsoft Academic Search

    John Patrick Dillon; Alan Laing; Mochin Hussain; Andrew Macey

    2008-01-01

    Carpal tunnel decompression is the most commonly performed procedure in hand surgery. This study was done to assess the effectiveness\\u000a and acceptability by patients of open carpal tunnel release under local anaesthetic. We compare our results with both the\\u000a literature and those of our previous study, after which were made alterations to improve the surgical and anaesthetic technique.\\u000a These alterations

  6. A study of surgeons’ postural muscle activity during open, laparoscopic, and endovascular surgery

    Microsoft Academic Search

    G. P. Y. Szeto; P. Ho; A. C. W. Ting; J. T. C. Poon; R. C. C. Tsang; S. W. K. Cheng

    2010-01-01

    Background  Different surgical procedures impose different physical demands on surgeons and high prevalence rates of neck and shoulder\\u000a pain have been reported among general surgeons. Past research has examined electromyography in surgeons mainly during simulated\\u000a conditions of laparoscopic and open surgery but not during real-time operations and not for long durations. The present study\\u000a compares the neck-shoulder muscle activities in three

  7. Surgical Device Engineering

    NSDL National Science Digital Library

    Techtronics Program,

    This unit focuses on teaching students about the many aspects of biomedical engineering (BME). Students come to see that BME is a broad field that relies on concepts from many engineering disciplines. They also begin to understand some of the special considerations that must be made when dealing with the human body. Activities and class discussions encourage students to think as engineers to come up with their own solutions to some of medical challenges that have been solved throughout the history of BME. Class time iincludes brainstorming and presenting ideas to the class for discussion. Specific activities include examination of the material properties and functions of surgical instruments and prosthetics, a simulation of the training experience of a surgical resident, and an investigation of the properties of fluid flow in vascular tissue.

  8. Synthetic surgical gloves.

    PubMed

    2000-01-01

    Surgical gloves are used by healthcare workers primarily to minimize the transmission of bloodborne pathogens and other potential infectants. Gloves made of synthetic materials are getting more attention with the increasing prevalence of allergies to natural rubber latex (NRL) among patients and medical staff. However, synthetic gloves are perceived by some people as providing less protection and being less comfortable than NRL gloves. In this study, we evaluated eight models of synthetic surgical gloves from six manufacturers. We examined their barrier effectiveness (that is, their resistance to viral penetration, resistance to puncture, and strength) durability, and comfort and compared these characteristics to those of NRL gloves. We found that all the gloves offered good barrier protection, but that their level of comfort varied widely. Three gloves were rated Preferred, three were Acceptable, and the remaining two gloves were Not Recommended. PMID:10748995

  9. [The role of surgical education in pregraduate medical education.

    PubMed

    Patińo-Restrepo, José Félix

    2011-01-01

    Surgical education in pregraduate medicine is important because it is during this period where students acquire abilities that will allow them to make important future decisions when performing surgical procedures. Faculties of medicine make significant efforts to design innovative and rigorous curricula that will provide medical professionals with abilities to carryout medical procedures in a changing panorama of health systems as well as to provide scientific and technological advances. Intellectual and clinical proficiency, discipline, ethics and human values that a student acquires during pregraduate training and education will result in becoming a very efficient health professional. PMID:21477521

  10. Ablation Technology for the Surgical Treatment of Atrial Fibrillation

    PubMed Central

    Melby, Spencer J.; Schuessler, Richard B.; Damiano, Ralph J.

    2014-01-01

    The Cox maze procedure for the surgical treatment of atrial fibrillation has been simplified from its original cut-and-sew technique. Various energy sources now exist which create linear lines of ablation that can be used to replace the original incisions, greatly facilitating the surgical approach. This review article describes the anatomy of the atria that must be considered in choosing a successful energy source. Furthermore the device characteristics, safety profile, mechanism of tissue injury, and ability to create transmural lesions of the various energy sources that have been used in the Cox maze procedure, along with the strengths and weaknesses of each device is discussed. PMID:23995989

  11. [Orthognathic surgery: specific aspects of surgical-orthodontic preparations].

    PubMed

    Raberin, M; Mauhourat, S

    2014-09-01

    Orthodontic preparation, mandatory before surgery, has benefited from great innovations in periodontics and implantology. The objectives of current orthodontics are short procedures and compliance with dental capital. Using bone anchorage changes treatment modalities for dental compensation. Piezo-electric surgery has become the first line procedure for osteotomies by improving surgical precision and downgrading nerve complications. Alveolar corticotomy has allowed decreasing orthodontic preparation time by causing an acceleration of tooth displacement. Primary transverse and sagittal surgery allow improving or protecting periodontal and muscular systems during orthodontic preparation. Normalization of oro-facial functions is an essential factor of surgical stability. The initial dysfunction justifies an appropriate and rapid management. PMID:25081489

  12. Surgical Approaches Based on Biological Objectives: GTR versus GBR Techniques

    PubMed Central

    Pagni, Giorgio; Rasperini, Giulio

    2013-01-01

    Guided tissue regenerative (GTR) therapies are performed to regenerate the previously lost tooth supporting structure, thus maintaining the aesthetics and masticatory function of the available dentition. Alveolar ridge augmentation procedures (GBR) intend to regain the alveolar bone lost following tooth extraction and/or periodontal disease. Several biomaterials and surgical approaches have been proposed. In this paper we report biomaterials and surgical techniques used for periodontal and bone regenerative procedures. Particular attention will be adopted to highlight the biological basis for the different therapeutic approaches. PMID:23843792

  13. Surgical Gloves: Current Problems

    Microsoft Academic Search

    Maher O. Osman; Steen L. Jensen

    1999-01-01

    .   One century ago surgical gloves were introduced to practice as part of the new antiseptic technique and originally to protect\\u000a the hands of the surgeon and his assistants from the harmful dermatologic effects of powerful antiseptics (e.g., carbolic\\u000a acid) in use at that time. Since then, the wearing of gloves during surgery has been standard practice. Furthermore, the protection

  14. Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial.

    PubMed Central

    Lorgelly, Paula K.; Dias, Joseph J.; Bradley, Mary J.; Burke, Frank D.

    2005-01-01

    OBJECTIVE: There is insufficient evidence regarding the clinical and cost-effectiveness of surgical interventions for carpal tunnel syndrome. This study evaluates the cost, effectiveness and cost-effectiveness of minimally invasive surgery compared with conventional open surgery. PATIENTS AND METHODS: 194 sufferers (208 hands) of carpal tunnel syndrome were randomly assigned to each treatment option. A self-administered questionnaire assessed the severity of patients' symptoms and functional status pre- and postoperatively. Treatment costs were estimated from resource use and hospital financial data. RESULTS: Minimally invasive carpal tunnel decompression is marginally more effective than open surgery in terms of functional status, but not significantly so. Little improvement in symptom severity was recorded for either intervention. Minimally invasive surgery was found to be significantly more costly than open surgery. The incremental cost effectiveness ratio for functional status was estimated to be 197 UK pounds, such that a one percentage point improvement in functioning costs 197 UK pounds when using the minimally invasive technique. CONCLUSIONS: Minimally invasive carpal tunnel decompression appears to be more effective but more costly. Initial analysis suggests that the additional expense for such a small improvement in function and no improvement in symptoms would not be regarded as value-for-money, such that minimally invasive carpal tunnel release is unlikely to be considered a cost-effective alternative to the traditional open surgery procedure. PMID:15720906

  15. Robotic surgical training.

    PubMed

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey. PMID:23528718

  16. Surgical Treatment of Anorectal Crohn Disease

    PubMed Central

    Lewis, Robert T.; Bleier, Joshua I. S.

    2013-01-01

    Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario. PMID:24436656

  17. Surgical treatment of anorectal crohn disease.

    PubMed

    Lewis, Robert T; Bleier, Joshua I S

    2013-06-01

    Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario. PMID:24436656

  18. Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.

    PubMed

    2006-11-24

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. In this rule, we are finalizing additional quality measures for the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures. PMID:17133695

  19. Surgical experts: born or made?

    PubMed

    Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

    2013-01-01

    The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. PMID:23838344

  20. Orthopedic surgical analyzer for percutaneous vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically relevant finite element models. In conclusion, we were able to demonstrate the feasibility of our orthopedic surgical analyzer in a case for percutaneous vertebroplasty.

  1. Effects of tools inserted through snake-like surgical manipulators.

    PubMed

    Murphy, Ryan J; Otake, Yoshito; Wolfe, Kevin C; Taylor, Russell H; Armand, Mehran

    2014-01-01

    Snake-like manipulators with a large, open lumen can offer improved treatment alternatives for minimally-and less-invasive surgeries. In these procedures, surgeons use the manipulator to introduce and control flexible tools in the surgical environment. This paper describes a predictive algorithm for estimating manipulator configuration given tip position for nonconstant curvature, cable-driven manipulators using energy minimization. During experimental bending of the manipulator with and without a tool inserted in its lumen, images were recorded from an overhead camera in conjunction with actuation cable tension and length. To investigate the accuracy, the estimated manipulator configuration from the model and the ground-truth configuration measured from the image were compared. Additional analysis focused on the response differences for the manipulator with and without a tool inserted through the lumen. Results indicate that the energy minimization model predicts manipulator configuration with an error of 0.24 ± 0.22mm without tools in the lumen and 0.24 ± 0.19mm with tools in the lumen (no significant difference, p = 0.81). Moreover, tools did not introduce noticeable perturbations in the manipulator trajectory; however, there was an increase in requisite force required to reach a configuration. These results support the use of the proposed estimation method for calculating the shape of the manipulator with an tool inserted in its lumen when an accuracy range of at least 1mm is required. PMID:25571571

  2. Effects of Tools Inserted through Snake-like Surgical Manipulators

    PubMed Central

    Murphy, Ryan J.; Otake, Yoshito; Wolfe, Kevin C.; Taylor, Russell H.; Armand, Mehran

    2015-01-01

    Snake-like manipulators with a large, open lumen can offer improved treatment alternatives for minimally- and less-invasive surgeries. In these procedures, surgeons use the manipulator to introduce and control flexible tools in the surgical environment. This paper describes a predictive algorithm for estimating manipulator configuration given tip position for nonconstant curvature, cable-driven manipulators using energy minimization. During experimental bending of the manipulator with and without a tool inserted in its lumen, images were recorded from an overhead camera in conjunction with actuation cable tension and length. To investigate the accuracy, the estimated manipulator configuration from the model and the ground-truth configuration measured from the image were compared. Additional analysis focused on the response differences for the manipulator with and without a tool inserted through the lumen. Results indicate that the energy minimization model predicts manipulator configuration with an error of 0.24 ± 0.22mm without tools in the lumen and 0.24 ± 0.19mm with tools in the lumen (no significant difference, p = 0.81). Moreover, tools did not introduce noticeable perturbations in the manipulator trajectory; however, there was an increase in requisite force required to reach a configuration. These results support the use of the proposed estimation method for calculating the shape of the manipulator with an tool inserted in its lumen when an accuracy range of at least 1mm is required. PMID:25571571

  3. Role of coronoidectomy in increasing mouth opening

    PubMed Central

    Gupta, Hemant; Tandon, Parul; Kumar, Deepak; Sinha, Vijay Prakash; Gupta, Sumit; Mehra, Hemant; Singh, Jasmeet

    2014-01-01

    Aim: To evaluate the effectiveness of coronoidectomy in advanced (stage III-IV) oral submucous fibrosis (OSMF) and temporomandibular joint (TMJ) ankylosis. Materials and Methods: Five patients clinically diagnosed as grade III/IV OSMF (group 1) and seven patients clinically and radiographically confirmed as TMJ ankylosis (group 2) underwent surgery entailing coronoidectomy in addition to conventional surgical procedures required in both the conditions followed by vigorous mouth opening exercises. The results were evaluated using the interincisal distance at maximum mouth opening as the objective outcome over a follow-up period of 2 months. Results: OSMF patients (group I) showed a mean preoperative interincisal opening of 14.40 mm which increased to 24.60 mm after conventional procedures and showed further increment to 35 and 44.80 mm after unilateral and bilateral coronoidectomy, respectively; which was statistically significant (P = 0.043). Follow-up of 2 months showed a gradual increase in mean mouth opening compared to baseline which was also found to be statistically significant (P = 0.043). In TMJ ankylosis patients (group II), preoperative mean mouth opening of 6.71 mm increased to 24.29 mm after conventional procedures, and further to 37.29 mm after unilateral coronoidectomy which was statistically significant (P = 0.018). On subsequent follow-up of 2 months, a gradual increase in mean mouth opening compared to baseline was observed which was statistically significant (P = 0.018). Conclusion: Coronoidectomy is an effective adjunct in increasing intraoperative and stabilizing postoperative mouth opening. PMID:25298713

  4. A surgical support system for Space Station Freedom

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L.

    1992-01-01

    Surgical techniques in microgravity are being developed for the Health Maintenance Facility (HMF) on Space Station Freedom (SSF). This will be a presentation of the proposed surgical capabilities and ongoing hardware and procedural investigations. Methods: Procedures and prototype hardware, which include a medical restraint system, a surgical overhead isolation canopy, a suction device, and a regional laminar flow device were evaluated. This was accomplished by realistic sterile surgical simulations involving both mannequins and animals during KC-135 parabolic flight and in a high fidelity ground based HMF mockup. Results: Animal surgery in the environment of microgravity allowed the observation of unique arterial and venous bleeding characteristics for the first time. The ability to control bleeding and to prevent cabin atmosphere contamination was also demonstrated. Conclusions: The procedures and prototype hardware tested provided valuable information and should be investigated and developed further. The use of standard surgical techniques are possible in microgravity if the principles of personnel and supply restraint and operative field containment are adhered to.

  5. An expanded surgical suture and needle evaluation and selection program by a healthcare resource management group purchasing organization.

    PubMed

    Szarmach, Robin R; Livingston, Jean; Edlich, Richard E

    2003-01-01

    The purpose of this report is to describe an expanded suture and needle clinical evaluation program jointly designed by hospital representatives of Consorta, Inc. (Rolling Meadows, Illinois), a leading healthcare resource management and group purchasing organization, and United States Surgical/Davis & Geck Sutures (Division of United States Surgical, Norwalk, Connecticut). In this expanded evaluation program, 42 Consorta shareholder hospitals enrolled 1913 surgeons to participate in Phase II of this non-experimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by USS/DG that were evaluated in 25,545 surgical procedures included packaging/ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, clinically acceptable determinations, and clinically unacceptable determinations. In these 30-day studies, the surgeons found that the needles and sutures were clinically acceptable in 98.1% of the evaluations. The general, cardiothoracic, and orthopedic surgeons who performed 61.2% of the product evaluations reported that the suture and needle products were clinically acceptable in 98.2% of the evaluations. Nearly half (49.2%) of the evaluations involved the POLYSORB* braided synthetic sutures that received a clinically acceptable rating in 98.2% of the evaluation. The silk suture (SOFSILK*), followed by the monofilament nylon suture (MONOSOF*), were the next most frequently used sutures. The SOFSILK* was found to be clinically acceptable in 99.2% of the evaluations, while MONOSOF* was noted to be clinically acceptable in 98.7% of the evaluations. Surgical needles made by USS/DG Sutures also had a high rating of clinical acceptability (97.9%). PMID:14516182

  6. Prevention of surgical skill decay.

    PubMed

    Perez, Ray S; Skinner, Anna; Weyhrauch, Peter; Niehaus, James; Lathan, Corinna; Schwaitzberg, Steven D; Cao, Caroline G L

    2013-10-01

    The U.S. military medical community spends a great deal of time and resources training its personnel to provide them with the knowledge and skills necessary to perform life-saving tasks, both on the battlefield and at home. However, personnel may fail to retain specialized knowledge and skills if they are not applied during the typical periods of nonuse within the military deployment cycle, and retention of critical knowledge and skills is crucial to the successful care of warfighters. For example, we researched the skill and knowledge loss associated with specialized surgical skills such as those required to perform laparoscopic surgery (LS) procedures. These skills are subject to decay when military surgeons perform combat casualty care during their deployment instead of LS. This article describes our preliminary research identifying critical LS skills, as well as their acquisition and decay rates. It introduces models that identify critical skills related to laparoscopy, and proposes objective metrics for measuring these critical skills. This research will provide insight into best practices for (1) training skills that are durable and resistant to skill decay, (2) assessing these skills over time, and (3) introducing effective refresher training at appropriate intervals to maintain skill proficiency. PMID:24084308

  7. Totally minimally invasive robot-assisted unstented pyeloplasty using the Zeus Microwrist Surgical System: an animal study

    Microsoft Academic Search

    Attila Lorincz; Colin G. Knight; Adrien J. Kant; Scott E. Langenburg; Raja Rabah; Kelly Gidell; Elizabeth Dawe; Michael D. Klein; Gordon McLorie

    2005-01-01

    BackgroundMinimally invasive pyeloplasty is a difficult procedure even for an expert laparoscopic surgeon. The major difficulty is associated with the limitations of intracorporeal suturing and knot tying. Surgical robots, which hold minimally invasive surgical instruments, have wrists and provide tremor filtration and motion scaling that might be expected to facilitate complex procedures in newborns.

  8. [Surgical approaches in rhinoplasty].

    PubMed

    Nguyen, P S; Duron, J-B; Bardot, J; Levet, Y; Aiach, G

    2014-12-01

    In the first step of rhinoplasty, the surgical approach will expose through different types of incisions and dissection planes the osteocartilaginous framework of the nasal pyramid prior to performing actions to reduce or increase the latter. This exposure can be performed by a closed approach or by an external approach--the choice depends on the type of nose and the habits of the surgeon. Far from being opposites, closed and external approaches are complementary and should be known and mastered by surgeons performing rhinoplasty. PMID:25213490

  9. Surgical therapy of thymomas.

    PubMed

    Schützner, J; Smat, V; Pafko, P; Adámek, S; Sláma, J

    1999-01-01

    Surgical treatment of thymomas is indicated for Masaoka stage 1 to 3. We are not in favor of mini-invasive techniques. We consider a gold standard to be sternotomy followed by a tumor removal and extended thymectomy. We are convinced it is necessary to perform sternotomy, tumor removal and extended thymectomy after a thymoma resection through thoracotomy to prevent a late onset of myasthenia gravis. In stages 2 to 3 actinotherapy along with chemotherapy should follow surgery to increase the patient's chances for a prolonged survival (Tab. 10). PMID:10860122

  10. Primary surgical excision for pediatric orbital capillary hemangioma.

    PubMed

    Krema, Hatem

    2015-05-01

    We report the technique and outcome of surgical excision of subcutaneous orbital capillary hemangioma causing eye globe displacement in two children. Primary surgical excision was performed with blunt dissection along the tumor walls using a cotton-tipped applicator as the dissecting tool with simultaneous outward gentle traction on the tumor wall. Despite the deep and extensive orbital involvement, complete excision of the hemangiomas was achievable with this technique, which permitted excellent visualization of the surgical planes throughout the procedures. Deep and extensive pediatric orbital capillary hemangioma can be surgically excised with the suggested technique, which obviates the need for intralesional or systemic medical therapy, yielding optimal cosmetic and functional outcomes, shortly after surgery. PMID:24117453

  11. Surgical experimentation and clinical trials: differences and related ethical problems.

    PubMed

    Petrini, Carlo

    2013-01-01

    Surgical techniques are not introduced into clinical practice as the result of randomised clinical trials (RCT), but usually through the gradual evolution of existing techniques or, more rarely, through audacious departures from the norm that are decided by a surgical team on the basis of experience. Sham surgery is held by some to be not only an ethically acceptable procedure but also a perfectly fit and proper one, as it could endow surgical experiments with the strict methodological and statistical precision typically associated with RCTs. This article first briefly examines some of the methodological aspects of both RCTs and surgical experiments and then offers a few considerations regarding the ethical issues raised by sham surgery. PMID:23771267

  12. Perioperative Glucose Control and Infection Risk in Older Surgical Patients.

    PubMed

    Lee, Pearl; Min, Lillian; Mody, Lona

    2014-03-01

    The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations. PMID:25431751

  13. Surgical Management of Patients with Chiari I Malformation

    PubMed Central

    Siasios, John; Kapsalaki, Eftychia Z.; Fountas, Kostas N.

    2012-01-01

    Chiari malformations (CMs) constitute a variety of four mainly syndromes (I, II, III, and IV), which describe the protrusion of brain tissue into the spinal canal through the foramen magnum. These malformations frequently occur in combination with other pathological entities such as myelomeningocele, hydrocephalus, and/or hydrosyringomyelia. The recent improvement of imaging techniques has increased not only the rate of CM diagnosis but also the necessity for its early treatment. Several different surgical techniques have been employed in the treatment of patients with symptomatic CM-I. In our current study, a systematic and critical review of the pertinent literature was made for identifying the most commonly employed surgical procedures in the management of these patients. Emphasis was given in outlining the advantages and disadvantages of each surgical approach. Moreover, an attempt was made for defining those parameters that may be prognostic factors for their surgical outcome. There is a consensus that surgical treatment is reserved only for symptomatic patients with CM-I. It has also been postulated that early surgically intervention is usually associated with better outcome. Despite the large number of previously published clinical series, further clinical research with large-scale studies is necessary for defining surgical treatment guidelines in these patients. PMID:22811732

  14. [Navigated implant placement using a bone supported CT-guided surgical template. Case report].

    PubMed

    Teubner, Eckart; Rohner, Dennis; Deak, Alexander; Lorenzon, Andreas; Marinello, Carlo P

    2009-01-01

    Surgical navigation allows precise implant placement and minimizes the risk of interferences with anatomical structures. Computerized implant planning based on tomographic data can be clinically realized by surgical templates. These are normally produced by stereo lithographic rapid prototyping. Accurate placement of virtually planned dental implants depends on a precise fabrication and positioning of the surgical template. Bone-, tooth-, implant-, and/or soft tissue-supported surgical templates allow for different micromovements. This report documents the diagnostics and surgical procedures of implant placement in an edentulous patient. Implant fixed complete dentures in the maxilla and mandible were planned. In the maxilla implants were inserted with the aid of a conventional surgical template. In the mandible a bone supported CT-guided surgical template was used. PMID:20120091

  15. Trends in technical and team simulations: Challenging the status Quo of surgical training.

    PubMed

    Barsness, Katherine A

    2015-06-01

    Traditional opportunistic and experiential surgical training can expose patients to excess risk of harm, particularly when new technology or surgical approaches are applied to highly complex operations. Declining birth rates, decreasing academic regionalization of complex neonatal procedures, duty hour restrictions, and the increasing need for highly specialized surgical skills all serve to further degrade the educational opportunities for surgical trainees. Even more concerning, practicing pediatric surgeons are also struggling with declines in neonatal surgical volumes, with fewer opportunities to maintain established cognitive, technical, and nontechnical skills in the operating room. In an effort to balance patient safety with a deeply rooted commitment to surgical education, surgical educators have developed a number of innovative educational strategies to achieve these goals. PMID:25976149

  16. Surgical Treatment of Lumbar Spinal Stenosis in the Elderly

    Microsoft Academic Search

    A. Kalbarczyk; A. Lukes; R. W. Seiler

    1998-01-01

    Summary  ?148 elderly patients, aged 70 years or more, diagnosed as having lumbar spinal stenosis, were operated upon at our institution\\u000a during 1983 to 1995. Totally 161 operative procedures were performed. We analysed retrospectively the results of the surgical\\u000a treatment.\\u000a \\u000a ?The most frequently performed procedure was multisegmental laminectomy, in 32% interlaminar fenestration and laminotomy were\\u000a done. In 9 cases fusion was

  17. Risk factors for deep surgical site infections after spinal fusion.

    PubMed

    Schimmel, J J P; Horsting, P P; de Kleuver, M; Wonders, G; van Limbeek, J

    2010-10-01

    Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case-control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6-8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus. All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways. High-risk patients should be informed about the increased risk of complications. PMID:20445999

  18. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    Huang, Huan; Bai, Shuang; Yang, Lih-Mei; Liu, Jian

    2014-03-01

    In this paper, a LIBS guided smart surgical tool using a femtosecond (fs) fiber laser is investigated. This functional system includes a high energy fs fiber laser system (PolarOnyx Laser, Inc. - Uranus mJ Series) for material ablation, a 3D controllable motion stage, LIBS signal collecting fiber to a spectrometer and a computer for data analysis and process control. The laser source employed emits pulses with pulse duration of 750 fs at a repetition rate tunable from 1 Hz to 1 MHz. The centre wavelength is at 1030 nm and the pulse energy can be up to 500 ?J. General characteristics like ablation rate and LIBS signal are determined at first. Furthermore the LIBS data is processed and analyzed for material characterization and differentiation. Comparison methods to identify the different materials emissions are developed and algorithms are implemented into a real-time control system. This system allows processing of different materials with real time feedback and capability to the laser parameters (pulse energy and repetition rate) and processing parameters (speed) and provides a powerful LIBS guided smart surgical tool with fs fiber laser for delicate surgery applications.

  19. Surgical complications of ascariasis.

    PubMed

    Ochoa, B

    1991-01-01

    Over the past 25 years (1963-1988), a total of 311 children under 12 years of age were admitted to the Pediatric Surgical Service of the San Vicente de Paúl University Hospital, Medellín, Colombia, with complications resulting from infection with Entamoeba histolytica or Ascaris lumbricoides. In this group, the abdominal complications produced by ascariasis numbered 145, and included intestinal obstruction (n = 107), perforation of the appendix (n = 10), and migration of the parasite to the biliary tree or to the peritoneal cavity (n = 28). Evaluation of the living conditions of a significant subgroup of our patients confirms that intestinal parasitism is an endemic condition prevailing in nations that exhibit deep social and economic imbalance, where large sectors of the population remain deprived of the basic services of education, health, housing, and recreation. Massive infestation in children may give rise to grave complications that demand expert surgical care. Third World surgeons practicing in general hospitals that take care of patients of low economic capacity are usually familiar with the diagnosis and management of this pathology; surgeons who practice in the industrialized nations will only occasionally face such problems. The greater mobility of today's societies and the rather massive migrations that take place in current times have resulted in an increasing incidence of these entities in the hospital populations of the large urban centers of these nations. It is for the surgeons practicing in such centers that the information presented herein may be of greater value. PMID:2031358

  20. Surgical options for patients with osteoarthritis of the knee

    Microsoft Academic Search

    Jörg Lützner; Philip Kasten; Stephan Kirschner; Klaus-Peter Günther

    2009-01-01

    Osteoarthritis (OA) of the knee is a progressive disease that ultimately damages the entire joint. Knee OA should initially be treated conservatively, but surgery should be considered if symptoms persist. Surgical treatments for knee OA include arthroscopy, osteotomy and knee arthroplasty; determining which of these procedures is most appropriate will depend on several factors, including the location and severity of

  1. [Surgical technique in Cesarean section. Evidence or tradition?].

    PubMed

    Lorentzen, U; Philipsen, J P; Langhoff-Roos, J; Hornnes, P J

    1998-04-20

    The literature was reviewed in order to find clinical-epidemiological and physiological evidence for which surgical techniques should be preferred when performing Caesarean section. We found reasonable evidence for the following procedure: spontaneous placenta detachment, uterine repair in one layer and non-closure of the peritoneum. PMID:9599531

  2. Raven II Research Surgical Robot Prof. Blake Hannaford

    E-print Network

    for human surgery and must not be used for any human procedures. 2 Background Robotic Assisted Surgery began Biorobotics Lab and University of California, Santa Cruz Human Bionics Laboratory. Prof. Rosen's team at UCSCRaven II Research Surgical Robot Prof. Blake Hannaford Department of Electrical Engineering

  3. Design and development of a new endo biomedical surgical instrument

    Microsoft Academic Search

    J. Li

    2010-01-01

    This paper describes the recent research and development of an endo surgical\\/biomedical instrument for minimally invasive therapy procedure. The new mechanism design aids in better ergonomic design, reliable functionality, and continuous cost reduction. 3-D modeling technique, functionality analysis, and computer aided solution have been applied to the instrument design and development The improved instrument can prevent patient's vessels and tissues

  4. Surgical exposure for reverse total shoulder arthroplasty: differences in approaches and outcomes.

    PubMed

    Gillespie, Robert J; Garrigues, Grant E; Chang, Edward S; Namdari, Surena; Williams, Gerald R

    2015-01-01

    Reverse shoulder arthroplasty can relieve pain and restore function in properly selected patients. The procedure is commonly performed through one of 2 surgical approaches: deltopectoral or anterosuperior. This article describes the surgical approaches, discusses advantages and disadvantages of each approach, reviews the current literature, and presents data from our clinical experience. PMID:25435034

  5. Surgical Management of Endocrine Disorders

    Microsoft Academic Search

    Joseph B. Lillegard; Travis J. McKenzie; Geoffrey B. Thompson

    \\u000a The twentieth century saw rapid advances in the surgical management of endocrine and endocrine-related neoplastic diseases.\\u000a High cure rates along with low perioperative morbidity have resulted from an emphasis on specialized training and new techniques,\\u000a as well as improvements in diagnosis, imaging, and surgical pathology.\\u000a \\u000a \\u000a This chapter will focus on the surgical management of endocrine disorders that involve the thyroid,

  6. Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series

    PubMed Central

    Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

    2015-01-01

    Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2?min compared to 126.3?min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3?min in robotic group and 176.5?min in laparoscopic group. RH + BPLND surgical time was similar, 263.6?min (robotic arm) and 264.0?min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100?mL in both groups. Conclusion. Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach. PMID:25785195

  7. Electrical Bioimpedance-Controlled Surgical Instrumentation.

    PubMed

    Brendle, Christian; Rein, Benjamin; Niesche, Annegret; Korff, Alexander; Radermacher, Klaus; Misgeld, Berno; Leonhardt, Steffen

    2014-11-21

    A bioimpedance-controlled concept for bone cement milling during revision total hip replacement is presented. Normally, the surgeon manually removes bone cement using a hammer and chisel. However, this procedure is relatively rough and unintended harm may occur to tissue at any time. The proposed bioimpedance-controlled surgical instrumentation improves this process because, for example, most risks associated with bone cement removal are avoided. The electrical bioimpedance measurements enable online process-control by using the milling head as both a cutting tool and measurement electrode at the same time. Furthermore, a novel integrated surgical milling tool is introduced, which allows acquisition of electrical bioimpedance data for online control; these data are used as a process variable. Process identification is based on finite element method simulation and on experimental studies with a rapid control prototyping system. The control loop design includes the identified process model, the characterization of noise as being normally distributed and the filtering, which is necessary for sufficient accuracy ( ±0.5 mm). Also, in a comparative study, noise suppression is investigated in silico with a moving average filter and a Kalman filter. Finally, performance analysis shows that the bioimpedance-controlled surgical instrumentation may also performs effectively at a higher feed rate (e.g., 5 mm/s). PMID:25423656

  8. Surgical complications of Ascaris lumbricoides in children

    PubMed Central

    Ramareddy, Raghu S.; Alladi, Anand; Siddapa, O. S.; Deepti, V; Akthar, Tanveer; Mamata, B.

    2012-01-01

    Aim: To report the surgical complications of Ascaris lumbricoides infestation in children. Materials and Methods: This is a retrospective study and cases of intestinal ascariasis managed conservatively were excluded. Results: Sixteen children presented with Ascariasis sequelae, which included ileal volvulus (n=5), perforations (n=4), intussusception (n=1), biliary ascariasis (n-1) and impacted multiple worm boluses (n=5). Plain abdominal radiographs showed pneumoperitoneum (3), cigar bundle appearance (3) and multiple air and fluid levels (13). Sonography showed floating worms with free fluid (2), sluggish peristalsis and moderate free fluid (7) and intestinal worm bolus (11). The surgical procedures included milking of worms (in all), bowel resection (6), closure of perforation (3) and manual reduction of intussusception (1). Biliary ascariasis was managed conservatively and the progress monitored with sonography. There were 3 deaths all of whom had intestinal volvulus, bowel necrosis and toxemia. Conclusion: Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Early surgical intervention in those with worm bolus, peritonism, and volvulus may salvage bowel and reduce mortality. PMID:22869977

  9. [Surgical management of severe Peyronie's disease].

    PubMed

    Lipczy?ski, Wac?aw; Kusionowicz, Jacek; Habrat, Wojciech; Czech, Anna K; Zembrzuski, Micha?; Gawlas, Wojciech; Dyba?a, Micha?; Dudek, Przemys?aw; Szopi?ski, Tomasz; Ch?osta, Piotr

    2013-01-01

    Peyronie's disease (lat. induratio penis plastica) is a process of the fibrotic plaques oand other localized fibrotic conditions have been considered to be the result of an abnormal size, pain and improved penile curvature. At early stages intralesional injections may decrease penile curvature and decrease plaque volume although the exact mechanism of action on Peyronie disease is unknown. In serious cases surgery is recommended, based on ultrasound examination, cavernosography and cavernosometry. There are three mail surgical procedures to correct the curvature in Peyronie's disease: Nesbit plication, plaque excision followed by skin grafting, another autograft or synthetic material, and implantation of a penile prosthesis Aim of this study is to present our experience in surgical treatment of severe stadium in Peyronie's disease. Peyronie plaque was excised in 8 man, previously potent with severe satium of the disease. In every case saphenous autograft replacing excised plaque was used. In every case was not intra and postoperative complications. All patients reported satisfactory cosmetic and functional result. The satisfactory result of the treatment of severe stadium Peyronie disease is based on the surgical method. Saphenous graft is effective, safe and successful technique in our knowledge. PMID:23991557

  10. Intranasal procedures for successful lacrimal surgery.

    PubMed

    Wesley, R E; Bond, J B

    1986-01-01

    Successful lacrimal surgery requires specialized knowledge of intranasal surgical anatomy. The clearance of the lower nasolacrimal duct relative to the inferior turbinate and the relationship of dacryocystorhinostomy and conjunctivodac-ryocystorhinostomy sites to upper nasal septum and anterior middle turbinate are not encountered in traditional cosmetic rhinoplasty or procedures for nasal airway obstruction. Intranasal procedures to facilitate lacrimal surgery are described. PMID:3154556

  11. Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology

    Microsoft Academic Search

    Jeffrey A. Morgan; Mark E. Ginsburg; Joshua R. Sonett; David L. S. Morales; Takushi Kohmoto; Lyall A. Gorenstein; Craig R. Smith; Michael Argenziano

    2003-01-01

    Objective: Computer (robotic) enhancement has been used to facilitate simple thoracoscopic procedures such as internal mammary artery (IMA) mobilization. This report describes the use of robotic technology in advanced thoracoscopic procedures. Methods: Ten patients underwent advanced thoracoscopic procedures utilizing the Da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA) at our institution. Results: Patients 1–6 underwent endoscopic phrenic nerve

  12. Surgical Management of 3-Level Lumbar Spondylolyses.

    PubMed

    Peng, Baogan; Li, Duanming; Pang, Xiaodong

    2015-07-01

    Three-level lumbar spondylolyses are extremely rare. So far, only 11 cases were reported in the literature. Treatment of multilevel spondylolyses has not been consistent. Conservative treatment is commonly considered first in most patients, but those who remain symptomatic may benefit from operative treatment. We report here 3 cases of 3-level lumbar spondylolyses that were treated successfully with direct isthmic repair in 2 cases and a combined surgery of isthmic repair and interbody fusion in 1 case. Our clinical results indicated that direct defect repair using the screw-hook technique is a simple and safe procedure for the motion segment with normal disc. If the involved disc shows degenerative change, fusion surgery should be consideredSurgical treatment of multilevel spondylolyses varies between fusion, direct isthmic repair, and combined management associating 2 procedures at different levels. The success of management of the 3 patients with 3-level spondylolyses depends on the choice of appropriate treatment for every patient. PMID:26166116

  13. Surgical exposure of the internal auditory canal through the retrosigmoid approach with semicircular canals anatomical preservation.

    PubMed

    Leal, Andre Giacomelli; Silva, Erasmo Barros da; Ramina, Ricardo

    2015-05-01

    Objective Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). Method Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. Results The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. Conclusion A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals. PMID:26017209

  14. Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer

    PubMed Central

    Brockbank, Elly; Kokka, Fani; Bryant, Andrew; Pomel, Christophe; Reynolds, Karina

    2014-01-01

    Background Cervical cancer is the most common cause of death from gynaecological cancers worldwide. Locally advanced cervical cancer, FIGO stage equal or more than IB1 is treated with chemotherapy and external beam radiotherapy followed by brachytherapy. If there is metastatic para-aortic nodal disease radiotherapy is extended to additionally cover this area. Due to increased morbidity, ideally extended-field radiotherapy is given only when para-aortic nodal disease is proven. Therefore accurate assessment of the extent of the disease is very important for planning the most appropriate treatment. Objectives To evaluate the effectiveness and safety of pre-treatment surgical para-aortic lymph node assessment for woman with locally advanced cervical cancer (FIGO stage IB2 to IVA). Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (up to January 2011). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) that compared surgical para-aortic lymph node assessment and dissection with radiological staging techniques, in adult women diagnosed with locally advanced cervical cancer. Data collection and analysis Two reviewers independently assessed whether potentially relevant trials met the inclusion criteria, abstracted data and assessed risk of bias. One RCT was identified so no meta-analyses were performed. Main results We found only one trial, which included 61 women, that met our inclusion criteria. This trial reported data on surgical versus clinical staging and an assessment of the two surgical staging techniques; laparoscopic (LAP) versus extraperitoneal (EXP) surgical staging. The clinical staging was either a contrast-enhanced CT scan or MRI scan of the abdomen and pelvis to determine nodal status. In this trial, clinical staging appeared to significantly prolong overall and progression-free survival compared to surgical staging. There was no statistically significant difference in the number of women who experienced severe (grade 3 or 4) toxicity. There was no statistically significant difference in the risk of death, disease recurrence or progression, blood loss, severe toxicity and the duration of the operational procedure between LAP and EXP surgical staging techniques. The strength of the evidence is weak in this review as it is based on one small trial which was at moderate risk of bias. Authors’ conclusions From the one available RCT we found insufficient evidence that pre-treatment surgical para-aortic lymph node assessment for locally advanced cervical cancer is beneficial, and it may actually have an adverse effect on survival. However this conclusion is based on analysis of a small single trial and therefore definitive guidance or recommendations for clinical practice cannot be made. Therefore the decision to offer surgical pre-treatment assessment of para-aortic lymph nodes in locally advanced cervical cancer needs to be individualised. The uncertainty regarding any impact on survival from pre-treatment para-aortic lymph node assessment should be discussed openly with the women. PMID:21491407

  15. Class III Malocclusion Surgical-Orthodontic Treatment

    PubMed Central

    Furquim, Bruna Alves; de Freitas, Karina Maria Salvatore; Janson, Guilherme; Simoneti, Luis Fernando; de Freitas, Marcos Roberto; de Freitas, Daniel Salvatore

    2014-01-01

    The aim of the present case report is to describe the orthodontic-surgical treatment of a 17-year-and-9-month-old female patient with a Class III malocclusion, poor facial esthetics, and mandibular and chin protrusion. She had significant anteroposterior and transverse discrepancies, a concave profile, and strained lip closure. Intraorally, she had a negative overjet of 5?mm and an overbite of 5?mm. The treatment objectives were to correct the malocclusion, and facial esthetic and also return the correct function. The surgical procedures included a Le Fort I osteotomy for expansion, advancement, impaction, and rotation of the maxilla to correct the occlusal plane inclination. There was 2?mm of impaction of the anterior portion of the maxilla and 5?mm of extrusion in the posterior region. A bilateral sagittal split osteotomy was performed in order to allow counterclockwise rotation of the mandible and anterior projection of the chin, accompanying the maxillary occlusal plane. Rigid internal fixation was used without any intermaxillary fixation. It was concluded that these procedures were very effective in producing a pleasing facial esthetic result, showing stability 7 years posttreatment. PMID:25431691

  16. Surgical interventions for anterior shoulder instability in rugby players: A systematic review

    PubMed Central

    Sabharwal, Sanjeeve; Patel, Nirav K; Bull, Anthony MJ; Reilly, Peter

    2015-01-01

    AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability. METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubMed, EMBASE and Google Scholar using the following search terms: “rugby” and “shoulder” in combination with “instability” or “dislocation”. All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined. RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4 (poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 mo. CONCLUSION: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects. PMID:25992318

  17. Comparison of surgical treatments for knee dislocation.

    PubMed

    Mariani, P P; Santoriello, P; Iannone, S; Condello, V; Adriani, E

    1999-01-01

    This retrospective study compared three surgical procedures for acute knee dislocation. Eleven patients (group 1) underwent direct repair of the cruciate ligaments, 6 patients (group 2) underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons and posterior cruciate ligament (PCL) reattachment, and 6 patients (group 3) underwent PCL reconstruction with ipsilateral bone-patellar tendon-bone and ACL reconstruction with doubled semitendinosus and gracilis tendons. Average follow-up was 6.9 years (range: 24 months to 19 years). Surgical results were evaluated using the IKDC evaluation form, KT-2000 arthrometer, and Lysholm and Tegner scores. Statistical analysis was performed using Fisher's exact test and the Cochran-Mantel-Haenszel test to compare different surgical procedures. In terms of stability and range of motion, results were less favorable after direct repair and cruciate ligament reattachment. Better results were reported after combined ACL and PCL reconstruction. Average side-to-side total anteroposterior translation as measured by the KT-2000 arthrometer at 20 degrees +/- 5 degrees of knee flexion was 6.67 mm, 3.6 mm, and 3.2 mm in groups 1, 2, and 3, respectively. At final International Knee Documentation Committee (IKDC) evaluation, only 2 group 3 patients achieved a group qualification A, while a group qualification B was achieved by 5 patients (2 patients in group 1, 2 patients in group 2, and 1 patient in group 3). Nine patients in group 1, 4 patients in group 2, and 3 patients in group 3 achieved group qualifications C and D (fair or poor results). Based on these results, we do not recommend reattachment of the cruciate ligaments after knee dislocation for obtaining a stable knee with full range of motion. PMID:10626912

  18. Surgical management of Crohn's disease.

    PubMed

    Lu, Kim C; Hunt, Steven R

    2013-02-01

    Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. PMID:23177070

  19. Surgical Management of Esophageal Carcinoma

    Microsoft Academic Search

    CAROLYN E. REED

    Surgical management of esophageal carcinoma is reviewed. The anatomy and biology are briefly mentioned, since these factors mitigate against the success of surgery. Staging, the key to proper treatment allocation and prog- nosis, is discussed, including the use of endoscopic ultra- sonography, positron emission tomography, and thoracoscopy\\/laparoscopy. Patient selection and preparation for surgery are important considerations. Surgical tech- niques are

  20. An attempt at clinically defining and assessing minimally invasive surgery compared with traditional “open” spinal surgery

    PubMed Central

    McAfee, Paul C.; Garfin, Steven R.; Rodgers, W. Blake; Allen, R. Todd; Phillips, Frank; Kim, Choll

    2011-01-01

    Background The goal of this editorial and literature review is to define the term “minimally invasive surgery” (MIS) as it relates to the spine and characterize methods of measuring parameters of a spine MIS technique. Methods This report is an analysis of 105,845 cases of spinal surgery in unmatched series and 95,161 cases in paired series of open compared with MIS procedures performed by the same surgeons to develop quantitative criteria to analyze the success of MIS. Results A lower rate of deep infection proved to be a key differentiator of spinal MIS. In unmatched series the infection rate for 105,845 open traditional procedures ranged from 2.9% to 4.3%, whereas for MIS, the incidence of infection ranged from 0% to 0.22%. For matched paired series with the open and MIS procedures performed by the same surgeons, the rate of infection in open procedures ranged from 1.5% to 10%, but for spine MIS, the rate of deep infection was much lower, at 0% to 0.2%. The published ranges for open versus MIS infection rates do not overlap or even intersect, which is a clear indication of the superiority of MIS for one specific clinical outcome measure (MIS proves superior to open spine procedures in terms of lower infection rate). Conclusions It is difficult, if not impossible, to validate that an operative procedure is “less invasive” or “more minimally invasive” than traditional surgical procedures unless one can establish a commonly accepted definition of MIS. Once a consensus definition or precise definition of MIS is agreed upon, the comparison shows a higher infection rate with traditional spinal exposures versus MIS spine procedures. PMID:25802679

  1. Patient safety, competency, and the future of surgical simulation.

    PubMed

    Scott, Daniel J

    2006-01-01

    Despite its relatively short track record, simulation has been successfully introduced into the surgical arena in an effort to augment training. Initially a fringe endeavor at isolated centers, simulation has now become a mainstream component of surgical education. The surgical community is now aware that the old adage, "see one, do one, and teach one" is no longer acceptable from the ethical standpoint of practicing procedures on patients. Moreover, financial and time constraints have made teaching outside of the operating room an attractive proposition. Coupled with the growing body of validation, new procedures can now be practiced and proficiency can be acquired on a multitude of simulation platforms. Importantly, simulation standards are being established and there is an unprecedented national acceptance and endorsement of simulation as an invaluable educational tool; in fact, simulation is being mandated for surgical residency programs. Team training will likely expand the impact of surgical simulation considerably and help assure multidimensional competency verification. For both surgery residents and surgeons in practice, simulation holds great promise as a safe, effective, and efficient means of acquiring new skills. PMID:19088586

  2. 10 CFR 452.5 - Bidding procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

  3. 10 CFR 452.5 - Bidding procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

  4. 10 CFR 452.5 - Bidding procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

  5. 10 CFR 452.5 - Bidding procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

  6. 10 CFR 452.5 - Bidding procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PRODUCTION INCENTIVES FOR CELLULOSIC BIOFUELS § 452.5 Bidding procedures. ...only to pre-auction eligible cellulosic biofuels producers. The following procedures...from pre-auction eligible cellulosic biofuels producers during the open window...

  7. Surgical Pathway Seeding of Clivo-Cervical Chordomas

    PubMed Central

    Iloreta, Alfred Marc Calo; Nyquist, Gurston G.; Friedel, Mark; Farrell, Christopher; Rosen, Marc R.; Evans, James J.

    2014-01-01

    Objective?Clival chordomas are slow-growing aggressive tumors that originate from the extra-axial remnants of the notochord. Current management of these tumors use surgical resection combined with radiation therapy. Given the location and invasive nature of these tumors, complete resection is difficult. A variety of both open and endoscopic therapeutic approaches have evolved and combined with the improvements in proton therapy, long-term control of these tumors appears to be improving. However, in recent literature the relatively rare complication of surgical seeding or surgical pathway recurrence has been reported. We report a case of surgical seeding following primary resection and review the world literature regarding surgical pathway recurrence. Study Design?Retrospective chart review and review of current literature. Methods?We report a case of a patient with a large chordoma that required treatment with a staged endoscopic endonasal and external transcervical approach. The patient subsequently developed recurrent disease along the cervical skin incision due to surgical seeding. Literature review and case reports were identified by a comprehensive search of Medline for the years 1950 to 2012. Results?The overall surgical pathway recurrence rate for clival chordoma resection based on analysis of the open nonendoscopic published case studies was 14 of 497 (2.8%). Conclusion?Tumor seeding can occur anywhere along the operative route and is often outside the field of radiotherapy. Increased awareness of this rare occurrence is necessary. The use of novel techniques to minimize exposure to tumor including primary endoscopic resection and so-called clean oncologic technique may help limit tumor seeding. Level of evidence: 4. PMID:25485223

  8. Keratometry device for surgical support

    PubMed Central

    2009-01-01

    Background High astigmatisms are usually induced during corneal suturing subsequent to tissue transplantation or any other surgery which involves corneal suturing. One of the reasons is that the procedure is intimately dependent on the surgeon's skill for suturing identical stitches. In order to evaluate the influence of the irregularity on suturing for the residual astigmatism, a prototype for ophthalmic surgical support has been developed. The final intention of this prototype is to be an evaluation tool for guided suture and as an outcome diminish the postoperative astigmatism. Methods The system consists of hand held ring with 36 infrared LEDs, that is to be projected onto the lachrymal film of the cornea. The image is reflected back through the optics of the ocular microscope and its distortion from the original circular shape is evaluated by developed software. It provides keratometric and circularity measurements during surgery in order to guide the surgeon for uniformity in suturing. Results The system is able to provide up to 23D of astigmatism (32D - 55D range) and is ± 0.25D accurate. It has been tested in 14 volunteer patients intraoperative and has been compared to a commercial keratometer Nidek Oculus Hand-held corneal topographer. The correlation factors are 0.92 for the astigmatism and 0.97 for the associated axis. Conclusion The system is potentially efficient for guiding the surgeon on uniformity of suturing, presenting preliminary data indicating an important decrease on the residual astigmatism, from an average of 8D - for patients not submitted to the prototype guidance - to 1.4D - for patients who have actually been submitted to the prototype guidance - after the first 24 hours post-surgery and in the subsequent weeks. It also indicates that the surgeon should achieve circularity greater or equal to 98% in order to avoid postoperative astigmatisms over 1D. Trial Registration Trial registration number: CAAE - 0212.0.004.000-09. PMID:19995421

  9. Intracranial hypertension after surgical correction for craniosynostosis: a systematic review.

    PubMed

    Christian, Eisha A; Imahiyerobo, Thomas A; Nallapa, Swathi; Urata, Mark; McComb, J Gordon; Krieger, Mark D

    2015-05-01

    OBJECT The authors' aim was perform a systematic review on the incidence of intracranial hypertension (IH) after surgery for craniosynostosis. METHODS A systematic literature review was conducted using PubMed to assess the rate of postoperative IH in studies published between 1985 and 2014. Inclusion criteria were 1) English-language literature; 2) human subjects; 3) pediatric cases; and 4) postoperative IH confirmed with invasive intracranial pressure monitoring. RESULTS Seven studies met inclusion criteria. IH was reported to be present in 5% of patients postoperatively with sagittal synostosis and 4% of patients with all forms of nonsyndromic craniosynostosis. Inadequate numbers were available to determine the incidence of postoperative IH for syndromic and individual nonsyndromic sutural synostosis based on the inclusion criteria. Surgical groups were subdivided into cranial remodeling procedures without orbital advancement and craniofacial procedures with orbital advancement. IH was reported to be present in 5% of patients with all forms of nonsyndromic sutural stenosis after cranial remodeling procedures and 1% after craniofacial advancement. CONCLUSIONS Postoperative development of elevated intracranial pressure has been described by multiple institutions, but the variation in how IH is determined and the multiple surgical procedures to correct craniosynostosis has limited the number of studies subject to a meta-analysis. Nonetheless, this entity deserves special attention, and further studies are required to determine the true incidence of postoperative IH, including the role of various surgical procedures on its incidence. The long-term consequences of chronic IH in this group of patients also need to be evaluated. PMID:25929968

  10. Do surgical personnel really need to double-glove?

    PubMed

    Thomas-Copeland, Janet

    2009-02-01

    In 2007, AORN's Recommended Practices Task Force revised the "Recommended practices on prevention of transmissible infections in the perioperative practice setting" to recommend that health care practitioners double-glove during invasive procedures. Previously, AORN had suggested that wearing two pairs of gloves might be indicated for some procedures. Research on the protective effects of double gloving provides compelling evidence that surgical personnel should double-glove during all surgical procedures. Statistics on unreported injuries and conversion rates of HIV and hepatitis B indicate that change is difficult; however, research also suggests that objections to double-gloving can be overcome and a practice change implemented to ensure the safety of health care workers and patients alike. PMID:19297797

  11. Surgical patents and patients--the ethical dilemmas.

    PubMed

    To??oczko, Tadeusz

    2005-01-01

    It is obvious that every inventor should be rewarded for the intellectual effort, and at the same time be encouraged to successively improve his or her discovery and to work on subsequent innovations. Patents also ensure that patent owners are officially protected against intellectual piracy, but protection of intellectual property may be difficult to accomplish. Nevertheless, it all comes down to this basic question: Does a contradiction exist between medical ethics and the "Medical and Surgical Procedure Patents" system? It may well turn out that medical-procedure patents can have a negative influence on the standard of medical care. Medical-method patents may also interfere with the physician-patient relationship. At present, physicians do not question the usefulness of patent protection for medicines, biotechnology, equipment and devices, but they strongly oppose it for surgical procedures. PMID:15727000

  12. Surgical castration of the male common hippopotamus (Hippopotamus amphibius).

    PubMed

    Walzer, Chris; Petit, Thierry; Stalder, Gabrielle L; Horowitz, Igal; Saragusty, Joseph; Hermes, Robert

    2014-02-01

    In a prospective, clinical, surgery study we report here for the first time, in detail, on the surgical castration of 10 captive adult male common hippopotami (Hippopotamus amphibius). The successful procedures, a species-specific modification of standard equine castration techniques, provide valuable insight into the spatially dynamic nature of the common hippopotamus testis. The use of ultrasonography to locate the testis before and during the procedures and species-specific positioning during surgery greatly facilitated this distinctive procedure. Additionally, this surgical method provides an important additional tool for captive management of the common hippopotamus. Castration of individual males not only facilitates population control but can potentially also be employed to limit intermale aggression. PMID:24246424

  13. Evaluation of surgical training in the era of simulation

    PubMed Central

    Shaharan, Shazrinizam; Neary, Paul

    2014-01-01

    AIM: To assess where we currently stand in relation to simulator-based training within modern surgical training curricula. METHODS: A systematic literature search was performed in PubMed database using keywords “simulation”, “skills assessment” and “surgery”. The studies retrieved were examined according to the inclusion and exclusion criteria. Time period reviewed was 2000 to 2013. The methodology of skills assessment was examined. RESULTS: Five hundred and fifteen articles focussed upon simulator based skills assessment. Fifty-two articles were identified that dealt with technical skills assessment in general surgery. Five articles assessed open skills, 37 assessed laparoscopic skills, 4 articles assessed both open and laparoscopic skills and 6 assessed endoscopic skills. Only 12 articles were found to be integrating simulators in the surgical training curricula. Observational assessment tools, in the form of Objective Structured Assessment of Technical Skills (OSATS) dominated the literature. CONCLUSION: Observational tools such as OSATS remain the top assessment instrument in surgical training especially in open technical skills. Unlike the aviation industry, simulation based assessment has only now begun to cross the threshold of incorporation into mainstream skills training. Over the next decade we expect the promise of simulator-based training to finally take flight and begin an exciting voyage of discovery for surgical trainees. PMID:25228946

  14. Minimally Invasive versus Open Cervical Foraminotomy: A Systematic Review

    PubMed Central

    Clark, Jeffrey G.; Abdullah, Kalil G.; Steinmetz, Michael P.; Benzel, Edward C.; Mroz, Thomas E.

    2011-01-01

    Posterior cervical laminoforaminotomy is an effective treatment for cervical radiculopathy due to disc herniations or spondylosis. Over the last decade, minimally invasive (i.e., percutaneous) procedures have become increasingly popular due to a smaller incision size and presumed benefits in postoperative outcomes. We performed a systematic review of the literature and identified studies of open or percutaneous laminoforaminotomy that reported one or more perioperative outcomes. Of 162 publications found by our initial screening, 19 were included in the final analysis. Summative results indicate that patients undergoing percutaneous cervical laminoforaminotomy have lower blood loss by 120.7 mL (open: 173.5 mL, percutaneous: 52.8 mL, n?=?670), a shorter surgical time by 50.0 minutes (open: 108.3 minutes, percutaneous: 58.3 minutes, n?=?882), less inpatient analgesic use by 25.1 Eq (open: 27.6 Eq, percutaneous: 2.5 Eq, n?=?356), and a shorter hospital stay by 2.2 days (open: 3.2 days, percutaneous: 1.0 days, n?=?1472), compared with patients undergoing open procedures. However, the heterogeneous nature of published data calls into question the reliability of these summative results. Further structured trials should be conducted to better characterize the risks and benefits of percutaneous laminoforaminotomy. PMID:24353931

  15. The WHO surgical safety checklist: survey of patients’ views

    PubMed Central

    Russ, Stephanie Jane; Rout, Shantanu; Caris, Jochem; Moorthy, Krishna; Mayer, Erik; Darzi, Ara; Sevdalis, Nick; Vincent, Charles

    2014-01-01

    Background Evidence suggests that full implementation of the WHO surgical safety checklist across NHS operating theatres is still proving a challenge for many surgical teams. The aim of the current study was to assess patients’ views of the checklist, which have yet to be considered and could inform its appropriate use, and influence clinical buy-in. Method Postoperative patients were sampled from surgical wards at two large London teaching hospitals. Patients were shown two professionally produced videos, one demonstrating use of the WHO surgical safety checklist, and one demonstrating the equivalent periods of their operation before its introduction. Patients’ views of the checklist, its use in practice, and their involvement in safety improvement more generally were captured using a bespoke 19-item questionnaire. Results 141 patients participated. Patients were positive towards the checklist, strongly agreeing that it would impact positively on their safety and on surgical team performance. Those worried about coming to harm in hospital were particularly supportive. Views were divided regarding hearing discussions around blood loss/airway before their procedure, supporting appropriate modifications to the tool. Patients did not feel they had a strong role to play in safety improvement more broadly. Conclusions It is feasible and instructive to capture patients’ views of the delivery of safety improvements like the checklist. We have demonstrated strong support for the checklist in a sample of surgical patients, presenting a challenge to those resistant to its use. PMID:25038036

  16. Holmium:YAG surgical lasers.

    PubMed

    1995-03-01

    "Holmium:YAG (Ho:YAG)" is the shorthand name for a family of solid-state lasers that use the doping element holmium in a laser crystal (e.g., YAG [yttrium-aluminum-garnet]) and that emit energy at approximately 2.1 microns. This wavelength is relatively new to medicine and has been used in laser surgery for only about the last six years. Like the carbon dioxide (CO2) laser when it was first used clinically, the Ho:YAG laser is poised for rapid and wide-spread use. Ho:YAG lasers, like CO2 lasers, offer precise cutting with minimal damage to adjacent tissue; however, unlike CO2 lasers, they also offer fiberoptic delivery (which is ideal for endoscopic use) and the ability to treat tissue in a liquid-filled environment (e.g., saline, blood). The initial specialty for which the Ho:YAG laser was used was arthroscopic surgery, especially diskectomy. Today, it is effectively used in many surgical specialties, including general surgery, urology, laparoscopy, neurosurgery, lithotripsy, angioplasty, orthopedic surgery (which includes procedures such as meniscectomy, bone sculpting [may also be performed in plastic surgery], and some experimental surgery, such as cartilage shrinking to tighten loose joints), and dentistry. Because of its broad range of potential applications, it has been called the "Swiss Army Knife" of lasers. High-powered Ho:YAG lasers, which enable surgeons to work more quickly and cut more smoothly, have been made available only within the last three years (units offering > 20 W) to 18 months (units offering > 60 W). Because of this rapid increase, high-powered units are still relatively expensive, and it is not yet clear whether maximum power outputs will continue to increase or whether the cost of higher-power units will begin to come down. Although low-power and high-power Ho:YAG lasers can be used for the same procedures, their different ranges of possible clinical techniques make them better suited to different applications: low-power units are preferable for small-joint and some head-and-neck surgeries or for office use, and high-power units are more suitable for use in major surgery, such as gastrointestinal surgery or surgery in large joints. This evaluation includes two units at both ends of the Ho:YAG power spectrum--one 10 W and one 60 W--and thus provides a guide to evaluating other Ho:YAG lasers that are currently available or that will be entering the market.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7782226

  17. Considerations for regeneration procedures.

    PubMed

    Law, Alan S

    2013-03-01

    When pulp tissue becomes necrotic in immature teeth, the prognosis of the teeth is compromised. Disinfection of the root(s) presents several challenges including difficulties in cleaning and shaping large canals with open apices, obturation of canals with open apices, and potential root fractures caused by thin and/or weakened root walls. Regenerative endodontic procedures may increase the prognosis of the compromised immature tooth by re-establishment of a functional pulp tissue that fosters continued root development and immune competency. This article reviews the literature related to and discuss considerations for regenerative endodontic procedures and how these procedures may increase the prognosis for immature teeth with necrotic pulp tissue. PMID:23439044

  18. Results of different surgical procedures on total knee arthroplasty infections

    Microsoft Academic Search

    Ray C. Wasielewski; Regina M. Barden; Aaron G. Rosenberg

    1996-01-01

    Seventy-six consecutive infected total knee arthroplasties in 74 patients were treated between December 1981 and March 1990. The average follow-up period was 57 months (range, 24–121 months). No patients were lost to follow-up evaluation and 12 patients died from unrelated causes. Patients were classified, based on the duration of their symptoms prior to treatment, as acutely infected ( 2 weeks).

  19. On the Design of an Interactive, Patient-Specific Surgical Simulator for Mitral Valve Repair

    PubMed Central

    Tenenholtz, Neil A.; Hammer, Peter E.; Schneider, Robert J.; Vasilyev, Nikolay V.; Howe, Robert D.

    2011-01-01

    Surgical repair of the mitral valve is a difficult procedure that is often avoided in favor of less effective valve replacement because of the associated technical challenges facing non-expert surgeons. In the interest of increasing the rate of valve repair, an accurate, interactive surgical simulator for mitral valve repair was developed. With a haptic interface, users can interact with a mechanical model during simulation to aid in the development of a surgical plan and then virtually implement the procedure to assess its efficacy. Sub-millimeter accuracy was achieved in a validation study, and the system was successfully used by a cardiac surgeon to repair three virtual pathological valves. PMID:24511427

  20. Surgical evaluation of candidates for cochlear implants

    NASA Technical Reports Server (NTRS)

    Black, F. O.; Lilly, D. J.; Fowler, L. P.; Stypulkowski, P. H.

    1987-01-01

    The customary presentation of surgical procedures to patients in the United States consists of discussions on alternative treatment methods, risks of the procedure(s) under consideration, and potential benefits for the patient. Because the contents of the normal speech signal have not been defined in a way that permits a surgeon systematically to provide alternative auditory signals to a deaf patient, the burden is placed on the surgeon to make an arbitrary selection of candidates and available devices for cochlear prosthetic implantation. In an attempt to obtain some information regarding the ability of a deaf patient to use electrical signals to detect and understand speech, the Good Samaritan Hospital and Neurological Sciences Institute cochlear implant team has routinely performed tympanotomies using local anesthesia and has positioned temporary electrodes onto the round windows of implant candidates. The purpose of this paper is to review our experience with this procedure and to provide some observations that may be useful in a comprehensive preoperative evaluation for totally deaf patients who are being considered for cochlear implantation.

  1. Human-robot skills transfer interfaces for a flexible surgical robot.

    PubMed

    Calinon, Sylvain; Bruno, Danilo; Malekzadeh, Milad S; Nanayakkara, Thrishantha; Caldwell, Darwin G

    2014-09-01

    In minimally invasive surgery, tools go through narrow openings and manipulate soft organs to perform surgical tasks. There are limitations in current robot-assisted surgical systems due to the rigidity of robot tools. The aim of the STIFF-FLOP European project is to develop a soft robotic arm to perform surgical tasks. The flexibility of the robot allows the surgeon to move within organs to reach remote areas inside the body and perform challenging procedures in laparoscopy. This article addresses the problem of designing learning interfaces enabling the transfer of skills from human demonstration. Robot programming by demonstration encompasses a wide range of learning strategies, from simple mimicking of the demonstrator's actions to the higher level imitation of the underlying intent extracted from the demonstrations. By focusing on this last form, we study the problem of extracting an objective function explaining the demonstrations from an over-specified set of candidate reward functions, and using this information for self-refinement of the skill. In contrast to inverse reinforcement learning strategies that attempt to explain the observations with reward functions defined for the entire task (or a set of pre-defined reward profiles active for different parts of the task), the proposed approach is based on context-dependent reward-weighted learning, where the robot can learn the relevance of candidate objective functions with respect to the current phase of the task or encountered situation. The robot then exploits this information for skills refinement in the policy parameters space. The proposed approach is tested in simulation with a cutting task performed by the STIFF-FLOP flexible robot, using kinesthetic demonstrations from a Barrett WAM manipulator. PMID:24491285

  2. Surgical treatment of Aspergillus mycetomas of the maxillary sinus: review of the literature.

    PubMed

    Costa, Fabio; Polini, Francesco; Zerman, Nicoletta; Robiony, Massimo; Toro, Corrado; Politi, Massimo

    2007-06-01

    The present study reviews the literature concerning the surgical treatment of Aspergillus mycetoma (AM) in the last 20 years to identify a gold standard surgical technique. Aspergillus mycetoma of the maxillary sinus, or mycetoma (fungus ball), is a noninvasive or extramucosal mycotic infection. Surgical removal of the sinus fungal masses to ensure drainage and aeration is performed using the traditional Caldwell-Luc (CL) procedure or endoscopic sinus surgery (ESS). Results of this review suggest that the gold standard surgical technique for AM is ESS with middle meatal antrostomy. General or local antifungal drugs are not indicated. Combined approach with an intraoral surgical access from the anterolateral wall of the maxillary sinus has to be reserved for selected cases in which ESS doesn't permit complete extraction of all fungal concretions or foreign bodies. The CL procedure should be avoided, because it has detrimental consequences for sinus physiology. PMID:17449289

  3. Pleural Fibroma; A meandering path to surgical removal

    PubMed Central

    Hassan, Shafqat; Husain, Syed Shirjeel; Anwar, Muhammad Amim; Saeed, Saema

    2015-01-01

    A 52 Year old male was admitted with respiratory distress. Radiological examination revealed a large mass in patient’s right hemi thorax with mediastinal shift and partial lung collapse. Biopsies previously done conferred the diagnosis of solitary fibrous tumor; however, in order to avoid a surgical resection, patient didn’t follow the adviced procedure. After thorough counseling, surgical resection was done with few post operative complications and patient recovered well with ability to perform his daily activities with partial support. The histopathology results showed solitary fibrous tumor. Apart from pneumonia and local wound infection, patient status was well for the next six week follow-up. PMID:25878653

  4. Surgical instrument similarity metrics and tray analysis for multi-sensor instrument identification

    NASA Astrophysics Data System (ADS)

    Glaser, Bernhard; Schellenberg, Tobias; Franke, Stefan; Dänzer, Stefan; Neumuth, Thomas

    2015-03-01

    A robust identification of the instrument currently used by the surgeon is crucial for the automatic modeling and analysis of surgical procedures. Various approaches for intra-operative surgical instrument identification have been presented, mostly based on radio-frequency identification (RFID) or endoscopic video analysis. A novel approach is to identify the instruments on the instrument table of the scrub nurse with a combination of video and weight information. In a previous article, we successfully followed this approach and applied it to multiple instances of an ear, nose and throat (ENT) procedure and the surgical tray used therein. In this article, we present a metric for the suitability of the instruments of a surgical tray for identification by video and weight analysis and apply it to twelve trays of four different surgical domains (abdominal surgery, neurosurgery, orthopedics and urology). The used trays were digitized at the central sterile services department of the hospital. The results illustrate that surgical trays differ in their suitability for the approach. In general, additional weight information can significantly contribute to the successful identification of surgical instruments. Additionally, for ten different surgical instruments, ten exemplars of each instrument were tested for their weight differences. The samples indicate high weight variability in instruments with identical brand and model number. The results present a new metric for approaches aiming towards intra-operative surgical instrument detection and imply consequences for algorithms exploiting video and weight information for identification purposes.

  5. 21 CFR 878.4040 - Surgical apparel.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical...fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and shoe...

  6. 21 CFR 878.4040 - Surgical apparel.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical...fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and shoe...

  7. Optimization of surgical supply inventory and kitting

    E-print Network

    Schlanser, Matthew R. (Matthew Ross)

    2013-01-01

    This project centered on inventory optimization for operative custom surgical packs and soft good supplies for Massachusetts General Hospital (MGH), a 947-bed medical center. Custom surgical packs are used in every surgical ...

  8. [Surgical humour at Rigshospitalet].

    PubMed

    Andreassen, M

    1999-01-01

    Medical humour is often an important part of the treatment of patients in hospitals and in general practice. Therefore, medical humour should be distinguished from other forms of humour. The author of this article has served over forty years in Rigshospitalet of Copenhagen. He has observed the remarkable difference in the frequency of homour in the two surgical departments of the hospital. Department D had as a chief Wilhelm Schaldemose. He seemed to be completely without any sense of humour, and this spread to the rest of the department. When Schaldemose died Sigurd Kjaergard became head of the department. His sense of humour was limited, and he was not able to induce the humour to the rest of the department. It was first in 1953 when Erik Husfeldt took over as chief that the humour developed in the department, and it took several years before humour became a part of the daily treatment of patients. On the other department C the humour has always had good days starting with Thorkild Rovsing, the first chief, and later when Erling Dahl-Iversen was leader of the department. He had a special way to educate his staff in his sense of humour which became well known all over the hospital. In the beginning of this year a new society: >Nordic Society of Medical Humour< has been founded in Norway. This seems to be a remarkable positive development in the field of medical humour. PMID:11639163

  9. Syringobulbia: a surgical appraisal.

    PubMed Central

    Morgan, D; Williams, B

    1992-01-01

    Syringobulbia is a term which has been clinically applied to brain stem symptoms or signs in patients with syringomyelia. Syringobulbia clefts are found on investigation or at necropsy caused by cutting outwards of the CSF under pressure from the fourth ventricle into the medulla. These should be differentiated from the ascending syringobulbia which may occur from upward impulsive fluid movements in a previously established syringomyelia. Clinical analysis of 54 patients suggests that bulbar features are most often found with neither of the above mechanisms but are due to the effects of pressure differences acting downward upon the hind-brain with consequent distortion of the cerebellum and brainstem, traction on cranial nerves or indentation of the brain-stem by vascular loops. The commonest symptoms in the 54 patients were headache (35), vertigo (27), dysphonia or dysarthria (21), trigeminal paraesthesiae (27), dysphagia (24), diplopia (16), tinnitus (11), palatal palsy (11) and hypoglossal involvement (11). Careful attention to hydrocephalus is advisable before craniovertebral surgery, but the decompression of the hindbrain and the correction of craniospinal pressure dissociation remains the mainstay of surgical treatment. The results of careful surgery are good, 45 of the 54 cases reported improvement. Most of the reported deterioration occurred in a few patients who did conspicuously badly. Images PMID:1479391

  10. Surgical infection in art.

    PubMed

    Meakins, J L

    1996-12-01

    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians. PMID:8956770

  11. Long-term outcome after surgical and endovascular management of true and false subclavian artery aneurysms.

    PubMed

    Zehm, Sarah; Chemelli, Andreas; Jaschke, Werner; Fraedrich, Gustav; Rantner, Barbara

    2014-06-01

    Subclavian artery aneurysm is a rare but serious disease due to the risk of thrombosis, embolization, rupture and compression of adjacent structures. Treatment consists of surgical and endovascular techniques. Up to now few long-term follow-up results have been reported. In our study the results from 15 patients treated for subclavian artery aneurysms were evaluated. Eleven patients underwent open surgical reconstruction, four patients were treated endovascularly. After a mean follow-up period of 77 months (83 months for the open surgical group, 38 months for the endovascular group), 10 of 11 open surgical reconstructions and all primarily implanted stent grafts were patent. Secondary intervention was necessary in two patients. Thirty-day mortality for both treatment groups was 0%. Subclavian artery aneurysm-related symptoms disappeared in six out of 10 patients after the treatment. Long-term outcomes with good technical results, patency rates and low periprocedural morbidity could be shown in both treatment groups. PMID:23493279

  12. Resource utilization in surgery after the revision of surgical fee schedule in Japan.

    PubMed

    Nakata, Yoshinori; Yoshimura, Tatsuya; Watanabe, Yuichi; Otake, Hiroshi; Oiso, Giichiro; Sawa, Tomohiro

    2015-01-01

    Purpose - The purpose of this paper is to examine whether the current surgical reimbursement system in Japan reflects resource utilization after the revision of fee schedule in 2014. Design/methodology/approach - The authors collected data from all the surgical procedures performed at Teikyo University Hospital from April 1 through September 30, 2014. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated surgeons' efficiency scores using data envelopment analysis. Findings - The efficiency scores of each surgical specialty were significantly different (p=0.000). Originality/value - This result demonstrates that the Japanese surgical reimbursement scales still fail to reflect resource utilization despite the revision of surgical fee schedule. PMID:26156436

  13. Optimising surgical training: use of feedback to reduce errors during a simulated surgical procedure

    Microsoft Academic Search

    Emily Boyle; Musallam Al-Akash; Anthony G Gallagher; Oscar Traynor; Arnold D K Hill; Paul C Neary

    2011-01-01

    ObjectiveTo assess the effect of proximate or immediate feedback during an intensive training session. The authors hypothesised that provision of feedback during a training session would improve performance and learning curves.MethodsTwenty-eight trainee surgeons participated in the study between September and December 2008. They were consecutively assigned to group 1 (n=16, no feedback) or group 2 (n=12, feedback) All the participants

  14. Clinical application of stereolithographic surgical guide with a handpiece guidance apparatus: a case report.

    PubMed

    Ozan, Oguz; Seker, Emre; Kurtulmus-Yilmaz, Sevcan; Ersoy, Ahmet Ersan

    2012-10-01

    The success of implant-supported restorations depends on the treatment planning and the transfer of planning through the surgical field. Recently, new computer-aided design and manufacturing (CAD/CAM) techniques, such as stereolithographic (SLA) rapid prototyping, have been developed to fabricate surgical guides to improve the precision of implant placement. The objective of the present case is to introduce a recently developed SLA surgical guide system into the rehabilitation of a 62-year-old male patient with mandibular edentulism. After obtaining a cone-beam computerized tomography (CBCT) scan of the mandible with a radiographic template, the images were transferred into a 3-dimensional (3D) image-based software for implant planning. The StentCad Beyond SLA surgical guide system, which is a combination of a currently used surgical template with pilot hollows and a surgical handpiece guidance apparatus, was designed to transfer a preoperatively defined implant position onto the surgical site without any drill-surgical guide contact. For the fabrication of this system, a surgical handpiece was scanned by a laser optical scanner and a mucosa-supported surgical guide was designed according to the patient's 3D model, which was attained from the CBCT images. Four dental implants were inserted through the SLA surgical guide system by a torque-controlled surgical handpiece to the interforaminal region via a flapless surgical procedure. Implants were assessed 3 months after surgery, and an implant-retained mandibular overdenture was fabricated. The present case emphasizes that CAD/CAM SLA surgical guides, along with CBCT images and scanning data, may help clinicians plan and place dental implants. PMID:21767212

  15. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    PubMed Central

    Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effects, discovered and developed by a Japanese company because it has shown excellent pleiotropic effects on atheromatous arteries in the Japanese population. A randomized comparison study of dose-dependent effects of pitavastatin in patients with AAA with massive atheromatous aortic thrombus (PROCEDURE study) has begun. PROCEDURE has an enrollment goal of up to 80 patients with AAA with massive aortic atheroma (excluding intrasac atheroma), randomly allocated into 2 groups receiving pitavastatin at a dose of 1 or 4 mg/day. The endpoints of the PROCEDURE study include change in atheroma volume, major adverse events related to shower embolization after aneurysm repair, and lipid-lowering effects. When complete, results of the PROCEDURE study should provide objective evidence to use statins preoperatively for AAA with massive aortic atheroma. PMID:23641286

  16. Procedural Attachment

    E-print Network

    Steels, Luc

    1979-08-01

    A frame-based reasoning system is extended to deal with procedural attachment. Arguments are given why procedural attachment is needed in a symbolic reasoner. The notion of an infinitary concept is introduced. Conventions ...

  17. HoLEP: the gold standard for the surgical management of BPH in the 21st Century

    PubMed Central

    Michalak, John; Tzou, David; Funk, Joel

    2015-01-01

    Introduction: For many years, transurethral resection of the prostate (TURP) has been accepted as the gold standard to surgically alleviate obstructive voiding dysfunction in men with benign prostatic hyperplasia (BPH). This historical standard has been challenged repeatedly over the last decade by consistent data demonstrating the superiority of Holmium enucleation of the prostate (HoLEP). This review summarizes the literature comparing HoLEP and traditional therapies for BPH that are widely used and have long term efficacy data, primarily TURP, open prostatectomy (OP), and alternative laser therapies (PVP, ThuLEP, etc). Results: Patients undergoing HoLEP have greater improvements in post-operative Qmax, greater reduction in post-operative subjective symptom scores, and lower rates of repeat endoscopic procedures for recurrent symptoms at 5-10 year follow up compared with TURP, OP, and other laser therapies. Furthermore, patients undergoing HoLEP benefit from significantly shortened catheterization times, decreased length of hospital stay (LOS), and fewer serious post-operative complications. In particular, randomized controlled trials (RCT) have demonstrated that HoLEP can be used to resect adenomas greater than 100 grams with equivalent efficacy to open prostatectomy, but with radically decreased morbidity. Conclusion: Numerous large, RCTs demonstrate HoLEP to be objectively superior to other surgical therapies for BPH. The urologic community should embrace HoLEP as the new gold standard for surgical BPH therapy, especially in men with large prostates who would otherwise be considered for an OP or staged TURP. The only obstacle to widespread implementation of HoLEP remains its difficult learning curve when compared with traditional transurethral resection. Further allocation of resources towards appropriate mentoring and teaching of HoLEP is warranted, particularly in residency training programs.

  18. [Surgically curable hypertension (author's transl)].

    PubMed

    Gilloz, A; Tostain, J; Richard, A; Peyrard, A; Drogue, M

    A case of hypertension was cured by simultaneous surgical treatment of an obstructive urolithiasis associated with a pheochromocytoma. Primary devascularization of the adrenal tumor, reducing blood pressure and cardiac rhythm variations was allowed by preoperative arteriography. PMID:6275533

  19. [Surgical approach in Peyronie's disease].

    PubMed

    Carmignani, G; De Rose, A F; Simonato, A; Galli, S; Corbu, C

    1997-02-01

    The goal of surgical treatment of Induratio Penis Plastica should be the achievement of the best aesthetic and functional result with the lowest side-effects. During the last two years different techniques have been proposed for the cases with conserved erectile function, such as Nesbit's technique, excision or incision of the plaque followed by implants of autologous (dermal, saphena vein) or heterologous (dura madre, gore-tex) patches. The criteria for the choice of the most appropriated surgical technique include the curvature degree, the plaque dimension and the penis length. In our experience 6 months after the surgical correction a remaining curvature was observed in 4/38 patients (10%), only 1 of whom needed a new surgical treatment. One case of erectile disfunction occurred, treated by intra-cavernous injection of PgE1. PMID:9181914

  20. Colorectal cancer in aged patients. Toward the routine treatment through laparoscopic surgical approach

    PubMed Central

    VECCHIO, R.; MARCHESE, S.; FAMOSO, F.; LA CORTE, F.; MARLETTA, S.; LEANZA, G.; ZANGHĚ, G.; LEANZA, V.; INTAGLIATA, E.

    2015-01-01

    Aim Colorectal cancer is one of the most common malignancies in general population. The incidence seems to be higher in older age. Surgery remains the treatment of choice and laparoscopic approach offers numerous benefits. We report our personal experience in elderly patients operated on for colorectal cancer with laparoscopic resection. Patients and methods From January 2003 to September 2013, out of 160 patients aged 65 years or older and operated with minimally invasive techniques, 30 cases affected by colorectal cancer and operated on with laparoscopic approach were analyzed in this study. Results Male/female ratio was 1.35 and mean age 72 years. Constipation, weight loss, anemia and rectal bleeding were the most commonly reported symptoms. Lesions involved descending-sigmoid colon in 53% of cases, rectum in 37% and ascending colon in 10%. Among laparoscopic colorectal operations laparoscopic left colectomy was the most frequently performed, followed by right colectomy, abdominoperineal resection and Hartmann procedure. Operative times ranged from 3 to 5 hours depending on surgical procedure performed. Mean hospital stay was 6 days (range 4–9). Conversion to open approach occurred only in a case of laparoscopic right colectomy (3%) for uncontrolled bleeding. A single case of mortality was reported. In two cases (7%) anastomotic leakage was observed, conservatively treated in one patient and requiring reoperation in the other one. Conclusions Laparoscopic colorectal surgery is feasible and effective for malignancies in elderly population offering several advantages including immunologic and oncologic ones. However an experienced surgical team is essential in reducing risks and complications. PMID:25827663

  1. Surgical repair of anatomically corrected malposition of the great arteries.

    PubMed

    Rittenhouse, E A; Tenckhoff, L; Kawabori, I; Mansfield, P B; Hall, D G; Brown, J W; King, H

    1986-08-01

    Anatomically corrected malposition of the great arteries is a rare malformation in which the aorta and pulmonary artery arise from their appropriate ventricles but in an abnormal spatial relationship. This report describes 2 patients with anatomically corrected malposition who underwent closure of a ventricular septal defect and placement of a right ventricle-pulmonary artery conduit. A review of the literature indicates that surgical results have been good (92% survival) in those patients with situs solitus and atrioventricular concordance [S,D,L]. However, when there is atrioventricular discordance, that is, [S,L,D] or [I,D,L], hypoplastic right heart structures, or both conditions, the outcome after palliative procedures has been poor (29% survival). The results of surgical treatment should improve as this entity is recognized earlier and prompt surgical treatment is undertaken. PMID:3741020

  2. Surgical models for cardiac regeneration in neonatal mice.

    PubMed

    Mahmoud, Ahmed I; Porrello, Enzo R; Kimura, Wataru; Olson, Eric N; Sadek, Hesham A

    2014-02-01

    Although amphibian and fish models of heart regeneration have existed for decades, a mammalian equivalent has long remained elusive. Our discovery of a brief postnatal window for heart regeneration in neonatal mice has led to the establishment of surgical models for cardiac regenerative studies in mammals for the first time. This protocol describes a 10-min surgical procedure to induce cardiac injury in 1-d-old neonatal mice. This allows for the analysis of cardiac regeneration after surgical amputation of the left ventricle (LV) (apical resection) and coronary artery occlusion (myocardial infarction (MI)). A comparative analysis of neonatal and adult responses to myocardial injury should enable identification of the key differences between regenerative and nonregenerative responses to cardiac injury. This protocol can also be adapted to the growing repertoire of genetic models available in the mouse, and it provides a valuable tool for unlocking the molecular mechanisms that guide mammalian heart regeneration during early postnatal life. PMID:24434799

  3. [Current status of surgical treatment of short bowel syndrome].

    PubMed

    Selzner, M; Isenberg, J; Keller, H W

    1996-01-01

    Massive small bowel resection results in a short bowel syndrome, characterized by malabsorption, weight loss, diarrhea and steatorrhea. Different surgical techniques have been used to slow down intestinal transit time or to increase the area of absorption. Techniques for the deceleration of intestinal transit are reconstruction of the ileocecal-valve, antiperistaltic intestinal segments, colon interposition, recirculating intestinal loops and intestinal pacing. For increase of the area of absorption growth of neomucosa, mucosal autotransplantation, intestinal lengthening and small bowel transplantation have been performed. All these procedures are still at different experimental levels. Due to inconsistent results so far the surgical therapy of the short bowel syndrom cannot be recommended for routine use. However, some techniques offer hope of a successful surgical development. PMID:8852733

  4. Using laser irradiation for the surgical treatment of periodontal disease

    NASA Astrophysics Data System (ADS)

    Vieru, Rozana D.; Lefter, Agafita; Herman, Sonia

    2002-10-01

    In the marginal pr ogressive profound periodontities, we associated low level laser therapy (LLLT) to the classical surgical treatment with implant of biovitroceramics. From a total of 50 patients, 37 where irradiated with the laser. We used a diode laser, =830 nm, energy density up to 2 J cm2, in Nogier pulsed mode. The laser treatment is used in a complex of therapeutic procedures: odontal, local anti-inflammatory -- as well as in the cabinet and at home --, prosthetic, and for the morphologic and functional rebalancing. The immediate effects where: an evolution without bleeding and without post-surgical complications, as can appear at the patients who didn't benefit of laser irradiation (hematom, pain, functional alteration in the first post-surgical week). Operated tissue is recovering faster. The percentage of recurrences decreases and the success depends less on the biological potential and the immunity of each individual.

  5. [Surgical treatment of ventral hernia].

    PubMed

    Helgstrand, Frederik; Rosenberg, Jacob; Jřrgensen, Lars Nannestad; Kehlet, Henrik; Bisgaard, Thue

    2010-06-28

    The evidence for choice of surgical technique in ventral hernia treatment is poor. The outcomes have so far been associated with high recurrence rates and significant morbidity. Data from the Danish Ventral Hernia Database show large variations in the surgical approach. On the basis of a consensus meeting, agreement on a national strategy for ventral hernia surgery in Denmark is proposed in order to facilitate future interpretation of the outcomes. PMID:20654289

  6. Post-surgical back pain

    Microsoft Academic Search

    Dorte Jřrgenscn; Hazel Confait

    1997-01-01

    The incidence of post-surgical low back pain in patients who have been subjected to general anćsthesia or epidural has been found to be about 20%. The aim of this paper is to raise awareness about the ćtiology, clinical recognition and prevention of post-surgical low back pain. The case of a 51 year old male is detailed. He had a 5-year

  7. Candida infection in surgical patients

    Microsoft Academic Search

    Joseph S. Solomkin; Richard L. Simmons

    1980-01-01

    Candida infections have become a common and serious problem in non-neutropenic general surgical patients. This paper reviews the\\u000a etiologic factors, pathogenesis of systemic candidiasis, and the more common syndromes of infection in surgical patients.\\u000a Prophylactic and systemic therapy is detailed. The most significant factor inCandida infections is depression of host immune function. Significant abnormalities of T-cells, monocytes, and neutrophils have

  8. The surgical treatment of Balanitis Xerotica Obliterans

    PubMed Central

    Hartley, A.; Ramanathan, C.; Siddiqui, H.

    2011-01-01

    Background: Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This study looked at patients with pathologically proven BXO referred to the Plastic Surgery Unit at James Cook University Hospital between 2005 and 2009. The aim was to look at their management in the past and subsequent management by us. We also looked at whether early referral of progressive and recurrent BXO patients to reconstructive surgery could have prevented unnecessary delay in resolving symptoms at an earlier stage. Materials and Methods: Data was collected retrospectively and information regarding the exact anatomical location affected, the extent of the disease, the referring specialty and any previous surgical interventions was obtained. Alterations in urinary and sexual function and relief of symptoms following reconstructive surgery were analysed. Results: Of the 23 patients in the study, 43% had previous surgery and 60% of those had undergone two or more procedures. Twenty-one percent of patients had a history of BXO for over five years. Forty-seven percent of patients had alteration in their urinary function and 48% alteration in their sexual function due to the disease, prior to referral. Early results showed remarkable improvement in urinary and sexual function following reconstructive surgery in this group. Conclusions: Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases. Circumcision can be a curative procedure in early disease. Although there is conflicting evidence for treatment of recurring urethral strictures, repeated urethrotomy or urethral dilatation has poor long-term outcome. In patients with recurrent disease and associated complications we propose early referral to a plastic surgeon with genitourinary interest or reconstructive urologist for definitive treatment. PMID:21713168

  9. The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia

    PubMed Central

    2014-01-01

    Background Although minimally invasive repair of giant hiatal hernias is a very surgical challenge which requires advanced laparoscopic learning curve, several reports showed that is a safe and effective procedure, with lower morbidity than open approach. In the present study we show the outcomes of 13 patients who underwent a laparoscopic repair of giant hiatal hernia. Methods A total of 13 patients underwent laparoscopic posterior hiatoplasty and Nissen fundoplication. Follow-up evaluation was done clinically at intervals of 3, 6 and 12 months after surgery using the Gastro-oesophageal Reflux Health-Related Quality of Life scale, a barium swallow study, an upper gastrointestinal endoscopy, an oesophageal manometry, a combined ambulatory 24-h multichannel impedance pH and bilirubin monitoring. Anatomic recurrence was defined as any evidence of gastric herniation above the diaphragmatic edge. Results There were no intraoperative complications and no conversions to open technique. Symptomatic GORD-HQL outcomes demonstrated a statistical significant decrease of mean value equal to 3.2 compare to 37.4 of preoperative assessment (p?procedure and no hernia recurrence was recorded in the study group, treated respecting several crucial surgical principles, e.g., complete sac excision, appropriate crural closure, also with direct hiatal defect where possible, and routine use of antireflux procedure. PMID:24401085

  10. Update and revisions for Open-File Report 98-624, synthetic precipitation leaching procedure (SPLP) leachate chemistry data for solid mine-waste composite samples from the Silverton and Leadville districts in Colorado

    USGS Publications Warehouse

    Hageman, Philip L.; Desborough, George A.; Lamothe, Paul J.; Theodorakos, Peter M.

    2000-01-01

    This report supersedes, revises, and updates information and data previously released in Open-File Report 98-624 (Montour and others, 1998). Data for this report were derived from leaching of mine-waste composite samples using a modification of E.P. A. Method 1312, Synthetic Precipitation Leaching Procedure (SPLP). In 1997, members of the U.S. Geological Survey Mine Waste Characterization Project collected four mine-waste composite samples from mining districts near Silverton, Colorado (MAY and YUK), and near Leadville, Colorado (VEN and SUN). This report presents analytical results from these sites.

  11. Detection of surgical glove integrity.

    PubMed

    Sohn, R L; Murray, M T; Franko, A; Hwang, P K; Dulchavsky, S A; Grimm, M J

    2000-03-01

    Surgical glove integrity is essential for universal precautions; glove safety is verified by the water load test (WLT). Concerns regarding glove injury have prompted newer testing methodologies, including electrical conductance testing (ECT); however, the sensitivities of these tests are not known. We compared the sensitivity of WLT and ECT in detecting glove needle-stick injury in two commonly used brands of surgical gloves. Punctures were made with hollow-bore and solid surgical needles of various configurations. The WLT failed to detect glove holes from the smallest-caliber needles and only detected the injury in 60 per cent for the largest caliber. The ECT provided a graded index of glove injury in all holes made by both solid surgical needles and hollow-bore needles. The WLT is a poor test for clinical defects in latex surgical gloves; the ECT is significantly more sensitive and provides a gauge of the cross-sectional area of the defect. Interbrand differences in self-sealing properties of surgical gloves were evidenced and may be clinically relevant after glove perforation. PMID:10759204

  12. Radical perineal prostatectomy – the contemporary resurgence of a genuinely minimally invasive procedure: Procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ-confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy

    PubMed Central

    2012-01-01

    Introduction Surgery plays a central role in the management of organ-confined prostate cancer (PCa). Four types of prostatectomy are currently practiced: perineal, retropubic, laparoscopic, and robot-assisted. The qualification criteria for all types are similar. Radical perineal prostatectomy (RPP) was the first method introduced into clinical practice, however, it has been neglected in favor of other procedures. Its resurgence has been facilitated by a multitude of advantages. Unfortunately, nowadays most urologists are not familiar with the perineal approach though many centers have begun to implement it. Materials and methods This manuscript presents the technique of RPP used in the author's institution. It also reviews a vast body of literature on the four techniques of prostatectomy including their advantages and outcomes. The data was collected from the literature and medical databases. Conclusion RPP proves to be a very efficacious, cost-effective treatment option for localized PCa. The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods. PMID:24578960

  13. [Upper maxillary cysts: embryogenic and surgical considerations in our cases].

    PubMed

    Galletti, B; Bucolo, S; Abbate, G; Canton Bascuas, M; Romano, G; Fera, G; Freni, F

    2000-06-01

    Upper maxillary cysts are a chapter in otorhinolaryngological pathology which have been relatively neglected by the Literature. The reason for this most likely lies in the difficulty in producing a nosographic picture of these pathologies which border on other surgical fields (dentistry, maxillofacial surgery), and because they show significant clinical and etiopathogenic polymorphism. The elements that characterize upper maxillary cysts as a separate clinical entity are basically their cystic nature and origin within the upper maxillary bone, although they can expand widely within the medio-facial region (nasal vestibule, oral vestibule, nasolabial region, palate, maxillary sinus). After having reviewed the various classification schemes proposed over the years, and briefly examining the main clinical and etiopathogenic characteristics and principles for surgical treatment, the present work offers a surgical case study, together with the related iconography. Moreover this work does not neglect embryogenic considerations which are indispensable for the study of some of these pathologies. In this manner the results for 35 surgical procedures on upper maxillary cysts performed from 1989 to 1996 are presented and classified following the Cudennec classification module (1991). This study shows the variety of possible clinical manifestations for these pathologies. Such a variety makes correct diagnosis imperative--today facilitated by modern imaging techniques--and requires diversifying the surgical approach, conditioned not only by the site, extension and nature of the specific lesion, but also by the related symptoms. The significant progress in surgical techniques has made increasingly functional surgery possible and led to the abandonment of such conventional radical techniques as the Caldwell-Luc procedure. Moreover, CT and NMR have provided good image definition, specifying precisely the limits and extensions and, in most cases, facilitating diagnosis of the nature of the disorder with direct and indirect signs of the cystic nature of the lesions whenever the clinical data proves inadequate. PMID:11139876

  14. Protective procedures followign splenic rupture

    Microsoft Academic Search

    Ümit Topalo?lu; Ali Yilmazcan; Selçuk Ünalmi?er

    1999-01-01

    The aim of the present study was to improve spleen-preserving procedures in patients undergoing laparotomy following abdominal\\u000a trauma. Of a total 288 patients who underwent laparotomy for abdominal trauma in the Fourth General Surgical Department of\\u000a Hardarpa? a Teaching Hospital between 1989 and 1996, 94 patients with splenic injuries were retrospectively analyzed. The\\u000a mean age of these 94 patients, 69%

  15. [Renal function after surgical treatment of stag-horned nephrolithiasis].

    PubMed

    Akulin, S M; Ianenko, E K; Demin, A I; Nikitinskaia, L P

    2010-01-01

    Renal function in patients with stag-horn nephrolithiasis was assessed after two surgical treatments--percutaneous nephrolitholapaxy (PCN L) and pyelonephrolithotomy. The function of the operated and contralateral kidneys was studied early and late after operation by parameters of blood biochemistry, Doppler investigation of renal parenchyma, dynamic nephroscintigraphy. Stabilization or improvement of blood biochemical indices was observed in 58 (70%) patients. A secretory renal function late after surgery (from 6 months to 2 years) evidenced for improvement or stabilization of renal function (according to radionuclide test) in 71 (85.5%) patients. Integral parameters of renal blood flow were physiological or improved versus preoperative ones. PCNL was made in patients with deficient secretion less than 70%, 35 (87.5%) patients were diagnosed to have stabilization or functional improvement. After open intervention functional improvement took place in 11 (25.6%) patients, stabilization of renal function occurred in 25 (58.1%) patients. Tubular secretion deterioration was seen much more frequently in patients after open intervention. PCNL is less invasive surgical intervention than pyelonephrolithotomy as this technique produces milder surgical trauma and does not result in intraoperative renal ischemia. PCNL is the most effective surgical modality in stag-horn concrements of the kidneys and significantly expands potential of low-invasive treatment of such patients. PMID:20891042

  16. The surgical management of carotid artery disease.

    PubMed

    Persson, A V; Kopreski, M S

    1980-03-01

    A reduction in the incidence of strokes among the general population requires recognition and effective management of those who are at greatest risk for stroke. Surgical management of carotid artery disease is a valuable therapeutic approach, and is probably more effective than medical management in preventing strokes in certain patients. Not every patient is a candidate for surgery, and the surgeon must carefully weight the risks of angiography and surgery versus the risks of a stroke. Those patients at greatest surgical risk are those with significant coronary artery disease and those who are neurologically unstable. Carotid endarterectomy should only be considered if an experienced angiographer and surgeon who routinely perform this procedure with good results are available. Older patients scheduled for major surgery should be evaluated for carotid artery disease regardless of the presence of a bruit, particularly if they show evidence of atherosclerosis alsewhere. Noninvasive carotid studies are very valuable in assessing patients. With proper selection, carotid endarterectomy can decrease the incidence of the devastating stroke. PMID:6901186

  17. Surgical treatment of ovarian dermoid cysts

    Microsoft Academic Search

    Giuseppe Morgante; Antonino Ditto; Antonio la Marca; Valeria Trotta; Vincenzo De Leo

    1998-01-01

    Objective: To evaluate the efficacy of laparoscopic ovarian cystectomy and to compare the surgical course, post-surgical course and particularly post-surgical pain of the laparoscopic and laparotomic methods. Study design: We conducted a surgical study on dermoid cysts at the Gynecology Department of Siena University between 1 January 1992 and 31 December 1996. The selected cases were randomized into two groups

  18. Enhanced segmentation and skeletonization for endovascular surgical planning

    NASA Astrophysics Data System (ADS)

    Cheng, Irene; Firouzmanesh, Amirhossein; Leleve, Arnaud; Shen, Rui; Moreau, Richard; Brizzi, Vicenzo; Pham, Minh-Tu; Redarce, Tanneguy; Lermusiaux, Patrick; Basu, Anup

    2012-02-01

    Endovascular surgery is becoming widely deployed for many critical procedures, replacing invasive medical operations with long recovery times. However, there are still many challenges in improving the efficiency and safety of its usage, and reducing surgery time; namely, regular exposure to radiation, manual navigation of surgical tools, lack of 3D visualization, and lack of intelligent planning and automatic tracking of a surgical end-effector. Thus, our goal is to develop hardware and software components of a tele-operation system to alleviate the abovementioned problems. There are three specific objectives in this project: (i) to reduce the need for a surgeon to be physically next to a patient during endovascular surgery; (ii) to overcome the difficulties encountered in manual navigation; and, (iii) to improve the speed and experience of performing such surgeries. To achieve (i) we will develop an electro-mechanical interface to accurately guide mechanically controlled surgical tools from a close distance, along with a 3D visualization interface; for (ii) we will replace the current surgical tools with an "intelligent wire" controlled by the electro-mechanical system; for (iii) we will segment 3D medical images to extract precise shapes of blood vessels, following which we will perform automatic path planning for a surgical end-effector.

  19. Training general practitioners in surgical and obstetrical emergencies in Ethiopia.

    PubMed

    Loutfi, A; McLean, A P; Pickering, J

    1995-01-01

    A 6-month course for training general practitioners (GPs) in surgical emergencies was developed and piloted in Ethiopia. The course was designed after an assessment of the surgical manpower needs in Ethiopia. Seven GPs were selected by the Ministry of Health (MOH) from rural hospitals that had no surgical specialists but had operating facilities. The course consisted of 1 week of lectures followed by 11 weeks each in obstetrics/gynaecology and general surgery. The GPs trained in district hospitals under the supervision of surgical specialists. Emphasis was placed on practical experience in managing a limited number of previously identified surgical emergencies. Follow up 9 months after completion of the course showed that five of the seven GPs had completed significant numbers of life saving procedures. Complications occurred largely in advanced disease. Difficulties remain with the recognition of the GPs' training and their supervision. We conclude that GPs can be trained to provide life saving surgery in a short training programme at a modest cost, but mechanisms for ensuring ongoing support need to be established. PMID:7879265

  20. A review of wide surgical excision of hidradenitis suppurativa

    PubMed Central

    2012-01-01

    Background Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich of apocrine glands. It can be associated with fistulating sinus, scarring and abscesses formation. Hidradenitis suppurativa is a challenging aspect and requires a proper treatment plan which may involve different specialties. We present herein the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. Furthermore, review of the literature regarding surgical treatment of hidradenitis suppurativa is provided. Methods A retrospective analysis reviewed 50 operative procedures for 32 patients in 5 anatomical sites. These anatomical sites have been divided to 23 sites involving the axilla, 17 sites involving the inguinal region and 8 sites involving the perianal/perineal area, 1 site involving the gluteal region and 1 site involving the trunk region. Results Twenty six patients (81, 25 %) showed no recurrence after surgery and the average time of hospital stay period was 5 days. Recurrence was observed only in 6 patients (18, 75 %). Conclusion Elimination of the acute inflammatory process should occur in advance, including the use of antibiotics and minor surgeries such as abscess drainage with proper irrigations. After stabilizing the acute phase, wide surgical excision is recommended. Herein, planning of surgical reconstruction should be initiated to achieve the best outcome and consequently decreasing the risk of recurrence and complications after surgery. PMID:22734714