Science.gov

Sample records for open surgical procedure

  1. Abstract--Replacing open-heart surgical procedures with beating-heart interventions substantially decreases the trauma

    E-print Network

    Dupont, Pierre

    Abstract-- Replacing open-heart surgical procedures with beating-heart interventions substantially on the beating heart is valve repair. To address this need, this paper proposes a tool for replacing mitral valve replacement and reduction of regurgitation was demonstrated in an ex-vivo heart simulator. I. INTRODUCTION UE

  2. Surgical procedures for voice restoration

    PubMed Central

    Nawka, Tadeus; Hosemann, Werner

    2005-01-01

    Surgical procedures for voice restoration serve to improve oral communication by better vocal function. They comprise of phonomicrosurgery, with direct and indirect access to the larynx; laryngoplasty; laryngeal injections; and surgical laryngeal reinnervation. The basis for modern surgical techniques for voice disorders is the knowledge about the ultrastructure of the vocal folds and the increasing experience of surgeons in voice surgery, while facing high social and professional demands on the voice. Vocal activity limitation and participation restriction has become more important in the artistic and social areas. A number of surgical methods that have been developed worldwide for this reason, are presented in this article. Functional oriented surgery has to meet high standards. The diagnostics of vocal function has to be multi-dimensional in order to determine the indication and the appropriate surgical intervention. PMID:22073062

  3. Aesthetic Surgical Crown Lengthening Procedure

    PubMed Central

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  4. Open Surgical Approaches for Pulmonary Metastasectomy.

    PubMed

    Downey, Robert J; Bains, Manjit S

    2016-02-01

    Surgeons differ in the approach to resection of pulmonary metastases from nonpulmonary primary malignancies, with some favoring procedures that minimize trauma to the patient, and others performing open procedures with the goal of maximizing likelihood of resection of all detectable sites of disease. This article reviews how pulmonary metastasectomy emerged as a therapy for metastatic disease. Discussed is how surgical approaches used for this procedure have evolved, the available literature addressing whether open procedures lead to more complete resections, and if so whether resection by open procedures increases the likelihood of cure following resection. The technical aspects of the various thoracotomy techniques are also reviewed. PMID:26611506

  5. Laparoscopic-Assisted Surgical Procedures.

    PubMed

    Steffey, Michele A

    2016-01-01

    Laparoscopic-assisted procedures allow a balance between the improved patient recoveries often associated with smaller incisions and the need for appropriate visualization of visceral organs/identification of lesions. The organ systems of small animal veterinary patients that are highly amenable to laparoscopic-assisted procedures include the urinary bladder, the gastrointestinal tract, and the reproductive tracts. Laparoscopic-assisted procedures are especially beneficial in the approach to luminal organs, allowing the organ incision to be exteriorized through the body wall, protecting the peritoneal cavity from contamination from luminal contents. Procedure-specific morbidities and patient selection should be considered when choosing between assisted laparoscopic and open approaches. PMID:26410563

  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. Augmented reality in surgical procedures

    NASA Astrophysics Data System (ADS)

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, Ø.; Gersak, B.

    2008-02-01

    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers substantially improved cost-effectiveness for the hospital and the society. However, the introduction of MIT has also led to new problems. The manipulation of structures within the body through small incisions reduces dexterity and tactile feedback. It requires a different approach than conventional surgical procedures, since eye-hand co-ordination is not based on direct vision, but more predominantly on image guidance via endoscopes or radiological imaging modalities. ARIS*ER is a multidisciplinary consortium developing a new generation of decision support tools for MIT by augmenting visual and sensorial feedback. We will present tools based on novel concepts in visualization, robotics and haptics providing tailored solutions for a range of clinical applications. Examples from radio-frequency ablation of liver-tumors, laparoscopic liver surgery and minimally invasive cardiac surgery will be presented. Demonstrators were developed with the aim to provide a seamless workflow for the clinical user conducting image-guided therapy.

  8. 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.; Turner, R.S.

    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.

  9. 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…

  10. A modified surgical procedure for concealed penis

    PubMed Central

    Cheng, Gong; Liu, Bianjiang; Guan, Zhaolong; Huang, Yuan; Qin, Chao; Song, Ninghong; Wang, Zengjun

    2015-01-01

    Introduction: We described a modified surgical procedure for repairing a concealed penis and compared the efficacy and feasibility of modified repair with traditional repair. Methods: From March 2003 to December 2012, 96 patients with a concealed penis were recruited to undergo penile repair at our centre. Modified repair and traditional repair were performed respectively on 46 and 50 cases. We compared operative time, intraoperative blood loss, cosmetic result of operative scars, postoperative penile retraction, and complications. Results: All operations were completed successfully without serious complications. The mean operative time, intraoperative blood loss, and cosmetic result of the operative scar between the two surgical methods were similar. However, the postoperative penile retraction rate in patients undergoing modified repair decreased significantly than in the traditional repair. Conclusions: Our modified surgical procedure is effective and feasible for a concealed penis. Although extra procedures were needed for the modified repair, the operative time, intraoperative blood loss and cosmetic result of operative scar between the two procedures were similar. Compared with traditional repair, modified repair has better clinical outcomes.

  11. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered surgical procedures may not be of a...

  12. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered surgical procedures may not be of a...

  13. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered surgical procedures may not be of a...

  14. A comparison of surgical procedures and postoperative cares for minimally invasive laparoscopic gastrectomy and open gastrectomy in gastric cancer

    PubMed Central

    Tang, Hong-Na; Hu, Jun-Hong

    2015-01-01

    Minimally invasive, laparoscopic gastrectomy (LG) has assumed an ever-expanding role in gastric cancer treatment. Accumulating data so far seem to suggest that LG is at least a viable alternative of conventional open gastrectomy (OG) in different contexts. However, even though reviews and meta-analyses have compared the advantages and limitations of each option, it is still controversial whether LG is a better alternative to OG, especially in advanced gastric cancer (AGC). The major goal of this study is to evaluate the readouts of LG, in comparison with OG. A literature search was performed for studies published from 2009 to 2013. Medical records of 20868 gastric cancer patients from 32 independent studies were reviewed and analyzed. All 32 studies concluded that LG is at least comparable with OG. LG is superior to OG in offering less blood loss, shorter hospital stay, and lower risk of complications, although LG is probably inferior in operative time, and not different from OG in mortality. Considering the merits and the potential future technical improvement, it is reasonable to speculate that LG may eventually replace OG in most clinical contexts. PMID:26379823

  15. Pectoralis major tendon rupture. Surgical procedures review.

    PubMed Central

    Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2012-01-01

    Summary Pectoralis major (PM) muscle is the powerful dynamic stabiliser of the shoulder that acts as a flexor, adductor and internal rotator. The rupture of the PM tendon is a relatively rare injury that was firstly described in a French boy by Patissier in 1822 and later, in 1861, by Letenneur who reported another similiar case. To date, over 200 cases have been published. In this article we describe the clinical anatomy and the mechanism of injuries of PM and we review the surgical procedures for acute and chronic ruptures. PMID:23738281

  16. Cosmetic Surgical Procedures for the Aging Face

    PubMed Central

    Owsley, John Q.

    1982-01-01

    In the past decade there has been a remarkable increase in the number of patients having cosmetic operations to achieve a more youthful appearance. Demographic, social and economic factors in our society have contributed to this phenomenon, along with an increase in the number of trained plastic surgeons. Moreover, there recently have been major technical advances in aesthetic surgical procedures, including innovations in anesthetic techniques. The newer procedures for forehead-plasty, blepharoplasty and face lift are based on improved understanding of the facial anatomy. The operations are more complex and extensive, but experience has shown that they can be done safely. Correction of the changes of facial aging has been enhanced and the duration of the result has been prolonged. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:7090369

  17. Non-surgical deep intrauterine transfer of superfine open pulled straw (SOPS)-vitrified porcine embryos: evaluation of critical steps of the procedure.

    PubMed

    Gomis, J; Cuello, C; Sanchez-Osorio, J; Gil, M A; Parrilla, I; Angel, M A; Maside, C; del Olmo, D; Vazquez, J M; Roca, J; Martinez, E A

    2012-10-01

    Previous trials achieved extremely poor results when using the one-step warming method in a syringe in combination with non-surgical deep intrauterine transfer (NET) of superfine open pulled straw (SOPS)-vitrified embryos. This study aimed to assess the effect of the warming procedure on the in vitro and in vivo development of SOPS-vitrified embryos. The effect of the passage of the vitrified-warmed (VW) embryos through the NET catheter was also evaluated. Groups of 4 to 6 morulae and blastocysts, collected from weaned sows, were SOPS-vitrified in 1 ?L of vitrification medium, warmed by the one-step warming method in a dish or in a 1-mL syringe and cultured in vitro for 48 h to evaluate the embryo survival (ES) and hatching rates (HR). Warming in syringe had a deleterious effect (P < 0.05) on the in vitro ES (60.5 ± 10.4%) and HR (39.6 ± 9.5%) of VW embryos in comparison with embryos warmed in a dish (85.4 ± 10.6% and 69.0 ± 8.4%, respectively). This decreased embryonic development was due to the increased time required between the removal of the straws from the liquid nitrogen and the contact of the embryos with the warming medium when the warming was performed in a syringe in comparison with that for the warming in a dish. After verifying that the passage of VW embryos through the NET catheter does not have a damaging effect on their further in vitro development, the negative effect of warming in a syringe was also confirmed after NET. Fifteen fresh and SOPS-vitrified embryos warmed in a syringe or in a dish were transferred to each recipient (n = 28) and recovered 24 h later to assess their developmental progression. All embryos from the syringe group were found to have degenerated at recovery. The in vivo ES and HR from the dish group (80.4 ± 3.4% and 14.2 ± 7.2%, respectively) were lower (P < 0.05) than those from the fresh group (94.0 ± 4.1% and 36.8 ± 7.8%, respectively). Combining the warming in a dish and the NET procedure, 35 VW embryos were transferred to each of 10 gilts. Five recipients farrowed an average of 10.4 ± 0.9 piglets. In conclusion, the method of one-step warming in a syringe has a negative effect on the in vitro and in vivo viability of SOPS-vitrified porcine embryos. In addition, NET of SOPS-vitrified embryos warmed by the one-step method in a dish showed promising reproductive performance of recipients. However, despite the great potential of this technology, further developments are required for large-scale commercial applications. PMID:22898027

  18. Finishing procedures in orthodontic-surgical cases.

    PubMed

    Brunel, Jean-Michel

    2015-09-01

    To ensure optimal results, we must do our utmost to achieve targets based on order, symmetry and precision, our ultimate aim being to strive towards the desired harmony, planned contrast and exact proportions. Orthodontic-surgical treatments require specific finishing procedures, which most often call for multidisciplinary, or even transdisciplinary, collaboration. Finishing will involve the dental arches just as much as the orofacial environment. Above all, treatment of this kind demands a highly targeted approach in combination with well-defined and perfectly executed techniques. To finish a case satisfactorily, reasonable targets should be aimed for to ensure they are achieved. One must be ambitious and yet wise. A tight alliance of surgeon and orthodontist will nurture convincing and achievable projects and good, lifelong outcomes. Following the consolidation phase, roughly 4 to 6 weeks post-surgery, we can initiate the final orthodontic treatment, which, in effect, constitutes a mini-treatment in its own right. "Details make perfection, but perfection is not a detail" (Leonardo Da Vinci). "A lucid mind is the ante-chamber of intelligence" (Léo Ferré). In the order of life, every form of unity is always unique, and if each of us is unique, it is because everyone else is too. Ambition, wisdom, lucidity and efficiency will guarantee a successful result, the successful result. We must not be mere observers of our treatments, but the architect, project manager and site foreman at one and the same time. One could talk ad infinitum about finishing orthodontic-surgical cases because everything else leads up to the case-finishing and even the fullest description could never be exhaustive. PMID:26316452

  19. Fish Surgery: Presurgical Preparation and Common Surgical Procedures.

    PubMed

    Sladky, Kurt K; Clarke, Elsburgh O

    2016-01-01

    Fish surgical procedures are commonplace in aquaria, zoos, laboratory facilities, and pet clinical practice. To incorporate fish surgery into a clinical setting, an understanding of anatomic differences between mammals and fish, bath anesthetics, and recirculating anesthesia techniques must be developed; a system or different size systems to accommodate anesthesia and surgery of particular species of concern at an institution or practice constructed; and familiar mammalian surgical principles applied with some adaptations. Common surgical procedures in fish include coeliotomy for intracoelomic mass removal, reproductive procedures, gastrointestinal foreign body removal, radiotransmitter placement, and integumentary mass excision. PMID:26611924

  20. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

  1. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

  2. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

  3. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

  4. 42 CFR 416.65 - Covered surgical procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...recovery or convalescent time. (2) If the covered surgical procedures require anesthesia, the anesthesia must be— (i) Local or regional anesthesia; or (ii) General anesthesia of 90 minutes or less duration. (3) Covered...

  5. A Comprehensive Surgical Procedure in Conservative Management of Placenta Accreta

    PubMed Central

    Kelekci, Sefa; Ekmekci, Emre; Aydogmus, Serpil; Gencdal, Servet

    2015-01-01

    Abstract We aimed to present a combined surgical procedure in conservative treatment of placenta accreta based on surgical outcomes in our cohort of patients. The study was designed as a prospective cohort series study. The setting involved two education and research hospitals in Turkey. This study included 12 patients with placenta accreta who were prenatally diagnosed and managed. We offered the patients the choice of conservative or nonconservative treatment. We then offered 2 choices for patients who had preferred conservative treatment, leaving the placenta in situ as is the classical procedure, or our surgical procedure. One patient preferred nonconservative treatment, the others opted for our procedure. We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes. We operated on 11 patients using this surgical procedure that we have developed for placenta accreta cases. We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients. No patient presented any septic complication or secondary vaginal bleeding. Our surgical procedure seems to be effective and useful in the conservative treatment of placenta accreta. PMID:25700315

  6. Immersive Electronic Books for Teaching Surgical Procedures

    E-print Network

    Pollefeys, Marc

    with the use of immersive virtual reality technology for trauma surgery training. We discuss our technical for trauma surgery. We focus on a class of trauma injuries that are both potentially lethal and also for surgical training and re-training suffer from inflexible and overconstrained timing for both instructors

  7. Randomised Trial Support for Orthopaedic Surgical Procedures

    PubMed Central

    Lim, Hyeung C.; Adie, Sam; Naylor, Justine M.; Harris, Ian A.

    2014-01-01

    We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked according to frequency. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures. Included studies were categorised as “supportive” or “not supportive” of operative treatment. A risk of bias analysis was conducted for included studies using the Cochrane Collaboration's Risk of Bias tool. A total of 9,392 orthopaedic procedures were performed across the index period. 94.6% (8886 procedures) of the total volume, representing the 32 most common operative procedure categories, were used for this analysis. Of the 83 included RCTs, 22.9% (19/83) were classified as supportive of operative intervention. 36.9% (3279/8886) of the total volume of procedures performed were supported by at least one RCT showing surgery to be superior to a non-operative alternative. 19.6% (1743/8886) of the total volume of procedures performed were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative. The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine. PMID:24927114

  8. Percutaneous A1 pulley release by the tip of a 20-g hypodermic needle before open surgical procedure in trigger finger management.

    PubMed

    Mishra, Sudhir R; Gaur, Anil K; Choudhary, Mahesh M; Ramesh, Jayshree

    2013-06-01

    The objective of the study was to assess the safety, the efficacy, and the result of percutaneous A1 pulley release, using the tip of a 20-G hypodermic needle; the study included 17 patients with 27 trigger digits (18 grade IIIA, 8 grade IIIB, and 1 grade IV). All the patients were assessed by the total range of motion of the affected digit, the visual analog scale score, and the Disability of Arm Shoulder Hand score, before and after the procedure and during the follow-up at 2, 6, 12, and 24 weeks, and then every 3 months, and the improvement was assessed by one sample t test. Sixteen patients with 26 trigger digits (95.4%) showed complete relief of symptoms with no recurrence and a statistically significant improvement in the range of motion, the visual analog scale score, and the Disability of Arm Shoulder Hand score with a P-value <0.0001, which concludes that the procedure is safe, effective, and highly successful with good results and lower complications, comparable to those reported in papers on open release for grade III and IV trigger fingers. PMID:23689860

  9. Methodologic requirements for assessing surgical procedures in current medical literature.

    PubMed

    Jiménez, Rosa E; Gutiérrez, Angela R; Benitez, Iralys M

    2003-02-01

    Even though, in theory, a new surgical technique should traverse all the stages established for drugs before being introduced into medical practice, it is suspected that many surgical procedures are utilized without having rigorously evaluated their efficacy and safety. With the aim of identifying the methodologic aspects currently employed for assessing new surgical procedures, a descriptive bibliographic study was carried out. Altogether, 75 journal articles published from 1996 to 1998 were reviewed. The papers must have come from studies carried out with the expressed objective of evaluating a surgical procedure and were selected through MEDLINE or directly from six prestigious medical journals (three specifically surgical and three general). Of the reviewed articles, 47% were retrospective studies, and the rest were prospective studies. More than 40% of the retrospective studies omitted some basic methodologic features, namely a description of the patients' source or a definition of the inclusion criteria. Among the 41 prospective articles, only 35 used a control group and 15 did not employ random allocation. Other basic issues, such as the sample size or inclusion of prognostic factors in the analysis, were present in fewer than 50% of the articles. It seems there is consensus about admitting that rigorous assessment of new surgical treatments should be an unavoidable condition before introducing such treatment into practice. The facts demonstrate that this principle is not being followed. PMID:12616442

  10. 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

  11. 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

  12. Characterization of aerosols produced by surgical procedures: A summary

    SciTech Connect

    Yeh, Hsu-Chi; Muggenburg, B.A.; Lundgren, D.L.; Turner, R.S.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.

    1994-11-01

    In many types of surgery, especially orthopedic procedures, power tools such as saws and drills are used. These tools can impart considerable energy in disrupting tissue and may produce aerosolized blood and material from bone and other tissues. Surgical lasers and electrocautery tools can also produce aerosols due to vaporization of blood and tissues. A number of studies have been reported concerning production of aerosols during surgery, and some of the aerosols produced may contain infectious materials. Health care workers have expressed concern and questions pertaining to the occupational transmission of blood-borne pathogens including the human immunodeficiency virus (HIV) and hepatitis B virus (HBV) via blood aerosols during surgery. Little or no data existed characterizing the aerosols produced performing surgical procedures. Because of this lack of data, the National Institute for Occupational Safety and Health funded a project at ITRI to assess the extent of aerosolization of blood and other tissues during surgical procedures in the laboratory and in a hospital surgical suite.

  13. Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study

    PubMed Central

    Cota, Luís Otávio Miranda; Cyrino, Renata Magalhães; Lages, Eugênio José Pereira

    2015-01-01

    Background and Objective Prospective studies that investigated the influence of surgical and nonsurgical procedures in the recurrence of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs have not been previously reported. The objective of this study was to evaluate longitudinally the recurrence of periodontitis in regular compliers (RC) and irregular compliers (IC) individuals undergoing surgical and non-surgical procedures over 5 years in a program of PMT. Materials and Methods A total of 212 individuals participated in this study. Full-mouth periodontal examination including bleeding on probing, probing depth, and clinical attachment level were determined at all PMT visits over 5 years. The recurrence of periodontitis was evaluated in RC and IC individuals undergoing surgical and non-surgical procedures in PMT. The influences of risk variables of interest were tested through univariate analysis and multivariate logistic regression. Results Recurrence of periodontitis was significantly lower among RC when compared to IC. Individuals with recurrence of periodontitis and undergoing surgical procedures showed higher probing depth and clinical attachment loss than those who received non-surgical procedures. Recurrence of periodontitis was higher in individual undergoing surgical procedures and irregular compliance during PMT. Conclusions Irregular compliance and surgical procedures in individuals undergoing PMT presented higher rates of recurrence of periodontitis when compared to regular compliant patients undergoing non-surgical procedures. PMID:26496187

  14. Surgical motion characterization in simulated needle insertion procedures

    NASA Astrophysics Data System (ADS)

    Holden, Matthew S.; Ungi, Tamas; Sargent, Derek; McGraw, Robert C.; Fichtinger, Gabor

    2012-02-01

    PURPOSE: Evaluation of surgical performance in image-guided needle insertions is of emerging interest, to both promote patient safety and improve the efficiency and effectiveness of training. The purpose of this study was to determine if a Markov model-based algorithm can more accurately segment a needle-based surgical procedure into its five constituent tasks than a simple threshold-based algorithm. METHODS: Simulated needle trajectories were generated with known ground truth segmentation by a synthetic procedural data generator, with random noise added to each degree of freedom of motion. The respective learning algorithms were trained, and then tested on different procedures to determine task segmentation accuracy. In the threshold-based algorithm, a change in tasks was detected when the needle crossed a position/velocity threshold. In the Markov model-based algorithm, task segmentation was performed by identifying the sequence of Markov models most likely to have produced the series of observations. RESULTS: For amplitudes of translational noise greater than 0.01mm, the Markov model-based algorithm was significantly more accurate in task segmentation than the threshold-based algorithm (82.3% vs. 49.9%, p<0.001 for amplitude 10.0mm). For amplitudes less than 0.01mm, the two algorithms produced insignificantly different results. CONCLUSION: Task segmentation of simulated needle insertion procedures was improved by using a Markov model-based algorithm as opposed to a threshold-based algorithm for procedures involving translational noise.

  15. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Frank, Rachel M.; Pulido, Luis

    2015-01-01

    Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI. PMID:26697431

  16. Preoperative testing before low-risk surgical procedures

    PubMed Central

    Kirkham, Kyle R.; Wijeysundera, Duminda N.; Pendrith, Ciara; Ng, Ryan; Tu, Jack V.; Laupacis, Andreas; Schull, Michael J.; Levinson, Wendy; Bhatia, R. Sacha

    2015-01-01

    Background: There is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures. Methods: For this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure. Results: Endoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%–31.1%) and 10.8% (95% CI 10.8%–10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%–2.9%) and 2.1% (95% CI 2.1%–2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66–75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6–19.0; for radiography, adjusted OR 2.9, 95% CI 2.8–3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5–8.8; for radiography, adjusted OR 2.2, 95% CI 2.1–2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7–6.9; for radiography, adjusted OR 3.6, 95% CI 3.5–3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively. Interpretation: Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient- and institution-level factors. PMID:26032314

  17. Quantifying Surgical Complexity through Textual Descriptions of Current Procedural Terminology Codes

    PubMed Central

    Van Esbroeck, Alexander; Rubinfeld, Ilan; Syed, Zeeshan

    2012-01-01

    Models for surgical complications are a requirement for evaluating patients by the bedside or for risk-adjusted quality and outcomes assessment of healthcare providers. Developing such models requires quantifying the complexities of surgical procedures. Existing approaches to quantify procedural complexity rely on coding system generalities or factors designed for reimbursement. These approaches measure complexity of surgical procedures through the time taken for the procedures or their correspondence to rough anatomical ranges. We address this limitation through a novel approach that provides a fine-grained estimate of individual procedural complexity by studying textual descriptions of current procedure terminology (CPT) codes associated with these procedures. We show that such an approach can provide superior assessment of procedural complexity when compared to currently used estimates. This text-based score can improve surgical risk adjustment even after accounting for a large array of patient factors, indicating the potential to improve quality assessment of surgical care providers. PMID:23304420

  18. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat).

    PubMed

    Lewis, Kevin Michael; Kuntze, Carl Erik; Gulle, Heinz

    2016-01-01

    The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat) is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG). NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies. PMID:26730213

  19. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat)

    PubMed Central

    Lewis, Kevin Michael; Kuntze, Carl Erik; Gulle, Heinz

    2016-01-01

    The need for advanced hemostatic agents increases with the complexity of surgical procedures and use of anticoagulation and antiplatelet treatments. HEMOPATCH (Sealing Hemostat) is a novel, advanced hemostatic pad that is composed of a synthetic, protein-reactive monomer and a collagen backing. The active side is covered with a protein-reactive monomer: N-hydroxysuccinimide functionalized polyethylene glycol (NHS-PEG). NHS-PEG rapidly affixes the collagen pad to tissue to promote and maintain hemostasis. The combined action of the NHS-PEG and collagen is demonstrated to have benefit relative to other hemostatic agents in surgery and preclinical surgical models. This paper reviews the published investigations and case reports of the hemostatic efficacy of HEMOPATCH, wherein HEMOPATCH is demonstrated to be an effective, easy-to-use hemostatic agent in open and minimally invasive surgery of patients with thrombin- or platelet-induced coagulopathies.

  20. TOPICAL REVIEW: Image-guidance for surgical procedures

    NASA Astrophysics Data System (ADS)

    Peters, Terry M.

    2006-07-01

    Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further.

  1. Small Mammals: Common Surgical Procedures of Rodents, Ferrets, Hedgehogs, and Sugar Gliders.

    PubMed

    Miwa, Yasutsugu; Sladky, Kurt K

    2016-01-01

    Small mammal surgical procedures are a part of clinical veterinary practice and are performed with regularity. Anesthetic and analgesic techniques are important components of any successful small mammal surgical procedure. Many basic surgical principles used in dogs and cats can be directly applied to small mammals, but tissues tend to be smaller and thinner, and hemostasis is critical with small patients due to risk of death with minimal blood loss. Common surgical procedures in small mammals include integumentary mass and abscess excision, reproductive procedures, gastrointestinal foreign body removal, urolith removal, prolapsed tissues associated with the gastrointestinal tract, intra-abdominal mass excision, and hepatic surgery. PMID:26611930

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

    E-print Network

    Patil, Sachin

    Abstract--Robotic surgical assistants (RSAs) are enhancing physician performance, enabling them to performAutomated Tissue Retraction for Robot-Assisted Surgical Procedures Sachin Patil Ron Alterovitz avoidance and heterogeneous tissues. I. INTRODUCTION Robotic surgical assistants (RSAs), such as Intuitive

  3. Open surgical decompression of celiac axis compression by division of the median arcuate ligament.

    PubMed

    Kim, Sang Jin; Park, Yang Jin; Yang, Shin-Seok; Kim, Young-Wook

    2013-08-01

    Median arcuate ligament syndrome is a rare cause of abdominal pain which results from compression of the celiac artery (CA) or rarely, the superior mesenteric artery by a ligament formed by the right and left crura of the diaphragm. We report a case of open surgical decompression of the CA by division of the median arcuate ligament for a 37-year-old female patient who had suffered from chronic postprandial epigastric pain and severe weight loss. We described clinical features, characteristic angiographic findings and details of the surgical procedure for the patient with this rare vascular problem. PMID:23908968

  4. Acute necrotizing pancreatitis: Surgical indications and technical procedures.

    PubMed

    Aranda-Narváez, José Manuel; González-Sánchez, Antonio Jesús; Montiel-Casado, María Custodia; Titos-García, Alberto; Santoyo-Santoyo, Julio

    2014-12-16

    Necrosis of pancreatic parenchyma or extrapancreatic tissues is present in 10%-20% of patients with acute pancreatitis, defining the necrotizing presentation frequently associated with high morbidity and mortality rates. During the initial phase of acute necrotizing pancreatitis the most important pillars of medical treatment are fluid resuscitation, early enteral nutrition, endoscopic retrograde colangiopancreatography if associated cholangitis and intensive care unit support. When infection of pancreatic or extrapancreatic necrosis occurs, surgical approach constitutes the most accepted therapeutic option. In this context, we have recently assited to changes in time for surgery (delaying the indication if possible to around 4 wk to deal with "walled-off" necrosis) and type of access for necrosectomy: from a classical open approach (with closure over large-bore drains for continued postoperative lavage or semiopen techniques with scheduled relaparotomies), trends have changed to a "step-up" philosophy with initial percutaneous drainage and posterior minimally invasive or endoscopic access to the retroperitoneal cavity for necrosectomy if no improvement has been previously achieved. These approaches are progressively gaining popularity and morbidity and mortality rates have decreased significantly. Therefore, a staged, multidisciplinary, step-up approach with minimally invasive or endoscopic access for necrosectomy is widely accepted nowadays for management of pancreatic necrosis. PMID:25516858

  5. Acute necrotizing pancreatitis: Surgical indications and technical procedures

    PubMed Central

    Aranda-Narváez, José Manuel; González-Sánchez, Antonio Jesús; Montiel-Casado, María Custodia; Titos-García, Alberto; Santoyo-Santoyo, Julio

    2014-01-01

    Necrosis of pancreatic parenchyma or extrapancreatic tissues is present in 10%-20% of patients with acute pancreatitis, defining the necrotizing presentation frequently associated with high morbidity and mortality rates. During the initial phase of acute necrotizing pancreatitis the most important pillars of medical treatment are fluid resuscitation, early enteral nutrition, endoscopic retrograde colangiopancreatography if associated cholangitis and intensive care unit support. When infection of pancreatic or extrapancreatic necrosis occurs, surgical approach constitutes the most accepted therapeutic option. In this context, we have recently assited to changes in time for surgery (delaying the indication if possible to around 4 wk to deal with “walled-off” necrosis) and type of access for necrosectomy: from a classical open approach (with closure over large-bore drains for continued postoperative lavage or semiopen techniques with scheduled relaparotomies), trends have changed to a “step-up” philosophy with initial percutaneous drainage and posterior minimally invasive or endoscopic access to the retroperitoneal cavity for necrosectomy if no improvement has been previously achieved. These approaches are progressively gaining popularity and morbidity and mortality rates have decreased significantly. Therefore, a staged, multidisciplinary, step-up approach with minimally invasive or endoscopic access for necrosectomy is widely accepted nowadays for management of pancreatic necrosis. PMID:25516858

  6. 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

  7. [The clinical estimation of ketoprofen lysine salt effect on the intensitivity of acute pain syndrome in the oral cavity during surgical procedures and postoperative period].

    PubMed

    Durnovo, E A; Shashurina, S V; Bespalova, N A; Khomutinnikova, N E; Gliavina, I A; Marochkina, M S; Iartseva, A V

    2013-01-01

    Is studying and control of the clinical efficacy and safety of ketoprofen lysine salt (?LS) (the commercial name is "Oki" manufacturer by Dompe CPA, Italy) in the form of sachets and solutions for application in postoperative period after dental surgeries procedures. The comparison of the analgetic effect of systemic and local forms of the "Oki" drug, depending on the type and extent of surgery procedures. Was carried out surgical treatment and patients examination in the postoperative period. Surgical procedures included: vestibulolasty, vestibulolasty with apically-displaced flap, vestibulolasty with apically-displaced flap and a free palatal mucogingival graft, removal impacted and dystopic teeth, periodontal surgery. The research was conducted in the Surgical stomatology and Maxillofacial surgery Department (stomatological policlinic of the Nizhny Novgorod State Medical Academy). Was noted rapid advanced of anesthesia when using sachets and solutions of the ketoprofen lysine salt (the commercial name is "Oki" manufacturer by Dompe CPA, Italy) in postoperative period after dental surgical procedures. Was noted a more advanced of analgetic effect in the application therapy by DCI solution when open surgical wound presented. Analgetic effect was observed after 20-30 min and was maintained in the postoperative period to an average of 8 hours. Local application sachets and solution of the ketoprofen lysine salt (KLS ), in our opinion, is the most appropriate and is highly effective when open surgical wound presented. Ketoprofen lysine salt (KLS) has a neutral pH and does not irritate the gastrointestinal tract, that determines the safety of its used. PMID:23528405

  8. Surgical Treatment of Canine Glaucoma: Filtering and End-Stage Glaucoma Procedures.

    PubMed

    Maggio, Federica; Bras, Dineli

    2015-11-01

    Canine glaucoma is a common cause of vision loss associated with raised intraocular pressure, and leads to damage of the retina and optic nerve head. In most cases, medical treatment alone cannot provide long-term management of intraocular pressure control and preservation of vision. Surgical intervention is usually recommended to either decrease aqueous humor production, or increase its outflow. Among the current available procedures, filtering techniques are aimed at increasing aqueous humor outflow. Proper surgical timing and a combination of cyclodestructive and filtering procedures have been recently suggested to improve the long-term success of surgical treatment in dogs. Bleb fibrosis and surgical failure are still common occurrences in filtration surgery with relapse of glaucoma and vision loss. End stage procedures, such as enucleation, evisceration with intrascleral prosthesis, and chemical ablation of the ciliary bodies are then recommended to address chronic discomfort in buphthalmic and blind eyes. PMID:26342762

  9. Surgical procedure logging with use of a hand-held computer

    PubMed Central

    Fischer, Sandra; Lapinsky, Stephen E.; Weshler, Jason; Howard, Frazer; Rotstein, Lorne E.; Cohen, Zane; Stewart, Thomas E.

    2002-01-01

    Objective To evaluate the feasibility of incorporating hand-held computing technology in a surgical residency program, by means of hand-held devices for surgical procedure logging linked through the Internet to a central database. Setting Division of General Surgery, University of Toronto. Design A survey of general surgery residents. Methods The 69 residents in the general surgery training program received hand-held computers with preinstalled medical programs and a program designed for surgical procedure logging. Procedural data were uploaded via the Internet to a central database. Survey data were collected regarding previous computer use as well as previous procedure logging methods. Main outcome measure Utilization of the procedure logging system. Results After a 5-month pilot period, 38% of surgical residents were using the procedure-logging program successfully and on a regular basis. Program use was higher among more junior trainees. Analysis of the database provided valuable information on individual trainees, hospital programs and supervising surgeons, data that would assist in program development. Conclusions Hand-held devices can be implemented in a large division of general surgery to provide a reference database and a procedure-logging platform. However, user acceptance is not uniform and continued training and support are necessary to increase acceptance. The procedure database provides important information for optimizing trainees’ educational experience. PMID:12387537

  10. Bedside Percutaneous Tracheostomy versus Open Surgical Tracheostomy in Non-ICU Patients

    PubMed Central

    Koyfman, Leonid; Frenkel, Amit; Semyonov, Michael; Peiser, Jochanan G.; Hayun-Maman, Hagit; Boyko, Matthew; Gruenbaum, Shaun E.; Zlotnik, Alexander; Klein, Moti

    2014-01-01

    Percutaneous bedside tracheostomy (PBT) is a one of the common and safe procedures in intensive care units through the world. In the present paper we published our clinical experience with a performance of PBTs in the regular ward by intensive care physicians' team. We found it safe and similar outcome in comparison to open surgical tracheostomy method in operation room by ENT team. The performance of PBT in the regular ward showed potential economic advantages in saving medical staff and operating room resources. PMID:24523960

  11. A comparative study of surgical and medical procedures: 932 pregnancy terminations up to 63 days gestation.

    PubMed

    Child, T J; Thomas, J; Rees, M; MacKenzie, I Z

    2001-01-01

    The aim of this retrospective study was to compare the efficacy and complications associated with early medical and surgical pregnancy termination. The study population comprised 932 consecutive women undergoing pregnancy termination at gestations of 63 days or less. There were no age or parity differences between the study groups. Medical termination was performed with mifepristone 200 mg orally and misoprostol 800 microgram vaginally; surgical aspiration termination was performed under general anaesthesia. Outcome measures were: surgical curettage for presumed retained products of conception; ongoing pregnancy; and planned and emergency review in the unit. Early medical and surgical termination were associated with a 90.2 and 94.5% complete abortion rate respectively (P = 0.025). The complete abortion rate with medical termination decreased significantly with increasing parity; no such relationship with surgical abortion was found. Women of parity three or more were less likely to have a complete abortion following a medical (83.3%) compared to surgical procedure (97.7%) (P = 0.028). The ongoing pregnancy rate was 0.9% with medical and 0.5% with surgical termination (P = NS). Medical termination was associated with a lower complete abortion rate than surgical termination, particularly for women of higher parity. However, early medical termination allows over 90% of women to avoid the risks of surgical instrumentation of the uterus and anaesthesia. PMID:11139539

  12. Abortion - surgical

    MedlinePLUS

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  13. Evaluation of surgical outcome of penile augmentation and lengthening procedures.

    PubMed

    Nabil, Nashaat; Hosny, Hossam; Kadah, Amr; Shamloul, Rany

    2013-01-01

    Our study included 280 patients complaining of small-sized penis. They were seen in the outpatient clinic of the Andrology Department, Kasr El Aini, Cairo University. Patients were collected from 2002 till 2008 and classified into 4 categories from an etiological point of view. Eleven patients (3.9%) were operated upon according to fine selection criteria; six patients were selected for lengthening procedures, while two patients were selected for increasing girth procedures and three patients for combined operation of lengthening and increasing girth techniques. Seven patients showed subjective satisfaction after lengthening procedures and four patients showed subjective satisfaction after increasing girth techniques. In conclusion, detailed analysis of short penis complaint with a proper diagnosis and patient education are required for accurate management of patients complaining of a short penis. PMID:23548799

  14. Surgical care burden in orbito-temporal neurofibromatosis: Multiple procedures and surgical care duration analysis in 47 consecutive adult patients.

    PubMed

    Pessis, Rachel; Lantieri, Laurent; Britto, Jonathan A; Leguerinel, Caroline; Wolkenstein, Pierre; Hivelin, Mikaël

    2015-10-01

    Patients with orbito-temporal neurofibromatosis (OTNF) bear a heavy burden of surgical care. We studied 47 consecutive patients with OTNF from the French Neurofibromatosis 1 Referral Center cohort (n > 900), over a 15-year period to determine the clinical features most likely to predict repeat surgery and longer duration of surgical care. Forty-seven patients (5.2% of the NF1 patients' cohort) underwent 79 procedures with a 4.8 years average follow-up. Soft-tissue surgery had a high revision rate (19/45 patients), skeletal surgery did not (2/13 patients). Transosseous wire canthopexy and facial aesthetic unit remodeling were associated with stable outcome. Ptosis repair carried an unfavorable outcome, particularly in the presence of sphenoid dysplasia. Stable skeletal remodeling was achieved with polyethylene implants and/or cementoplasty. Multiple procedures were undertaken in 70% of patients and were predicted by the NF volume, canthopexy, skeletal dysplasia, or a Jackson's classification 2 and/or 3; but not by declining visual acuity. A classification based upon predictive risk of repeated procedures is proposed: Group 1: Isolated soft tissue infiltration not requiring levator palpebrae or canthal surgery; Group 2: Soft tissue involvement requiring ptosis repair or canthopexy, or NF great axis over 4.5 cm; Group 3: Presence of sphenoid dysplasia with pulsatile proptosis, regardless of visual acuity. PMID:26210305

  15. [Quality control in the implementation of new surgical procedures: Da Vinci robot-assisted systems].

    PubMed

    Niegisch, G; Rabenalt, R; Albers, P

    2011-10-01

    Robot assistance in the surgical treatment of urological malignancies is gaining increasing importance. As is the case in already established surgical procedures, the quality of robot-assisted surgery needs to be controlled and evaluated by appropriate measures. Baseline-parameters of treated patients should be documented precisely. General and operation type-specific parameters should be evaluated in short- as well as in mid-term follow-up. Appropriate and validated instruments should be used. Only by using these measures will it be possible to compare robot-assisted procedures of different institutions and historical data of conventional surgery with regard to oncological and functional efficacy. PMID:21800194

  16. Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

    PubMed

    Myers, Douglas J; Lipscomb, Hester J; Epling, Carol; Hunt, Debra; Richardson, William; Smith-Lovin, Lynn; Dement, John M

    2016-01-01

    OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ?15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ?6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87. PMID:26434696

  17. Refractive effect of two scleral-buckling surgical procedures

    NASA Astrophysics Data System (ADS)

    Kuhne, Francois; Parel, Jean-Marie A.; Takesue, Yoshiko; Villain, Franck L.; Trivedi, Bavia; Ducournau, Didier; Le Rebeller, Marie-Jose

    1993-06-01

    To reattach the retina, in many instances, biological or synthetic belt-shaped exoplants are inserted in the orbit and tightened around the globe's equator to inwardly depress the sclera until its inner layers contact the retina. In deforming the globe these `buckling procedures' are thought to affect the eye's optical system and thus vision. A new non-contact optical technique was devised to quantify the refractive effect of the two most common techniques used in retinal detachment surgery.

  18. Knowing the operative game plan: a novel tool for the assessment of surgical procedural knowledge

    PubMed Central

    Balayla, Jacques; Bergman, Simon; Ghitulescu, Gabriela; Feldman, Liane S.; Fraser, Shannon A.

    2012-01-01

    Background What is the source of inadequate performance in the operating room? Is it a lack of technical skills, poor judgment or a lack of rocedural knowledge? We created a surgical procedural knowledge (SPK) assessment tool and evaluated its use. Methods We interviewed medical students, residents and training program staff on SPK assessment tools developed for 3 different common general surgery procedures: inguinal hernia repair with mesh in men, laparoscopic cholecystectomy and right hemicolectomy. The tools were developed as a step-wise assessment of specific surgical procedures based on techniques described in a current surgical text. We compared novice (medical student to postgraduate year [PGY]-2) and expert group (PGY-3 to program staff) scores using the Mann–Whitney U test. We calculated the total SPK score and defined a cut-off score using receiver operating characteristic analysis. Results In all, 5 participants in 7 different training groups (n = 35) underwent an interview. Median scores for each procedure and overall SPK scores increased with experience. The median SPK for novices was 54.9 (95% confidence interval [CI] 21.6–58.8) compared with 98.05 (95% CP 94.1–100.0) for experts (p = 0.012). The SPK cut-off score of 93.1 discriminates between novice and expert surgeons. Conclusion Surgical procedural knowledge can reliably be assessed using our SPK assessment tool. It can discriminate between novice and expert surgeons for common general surgical procedures. Future studies are planned to evaluate its use for more complex procedures. PMID:22854153

  19. Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures

    PubMed Central

    Souza, Juliana; Santos-Pinto, Lourdes; Pansani, Cyneu

    2014-01-01

    ABSTRACT Aim: This paper reports two clinical cases in which the application of low-level laser therapy (LLLT) enhanced the postoperative symptoms after pediatric surgical procedures. Background: The uses of novel technologies allow more comfort to the patients and ensure a rapid procedure, and LLLT application has shown a positive effect in the prevention of discomfort after invasive procedures. Case description: Low-level laser therapy protocol was applied after surgical removal of supernumerary tooth and frenectomy resulting in less swallow and pain with no need of medication intake. Conclusion: The laser application was well accepted by both children and parents and showed a clinical efficiency in the follow-up examinations beyond the satisfactory quality of wound healing. Clinical significance: The LLLT approach is an excellent adjuvant therapy resource for delivery an optimal postoperative after surgical procedures in children. How to cite this article: Paschoal M, Souza J, Santos-Pinto L, Pansani C. Alternative Approach to the Management of Postoperative Pain after Pediatric Surgical Procedures. Int J Clin Pediatr Dent 2014;7(2):125-129. PMID:25356012

  20. 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

  1. Management of surgical and procedural pain in a critical care setting.

    PubMed

    Summer, G J; Puntillo, K A

    2001-06-01

    Critical care nurses can serve as pain management advocates so that those patients who undergo surgery and other procedures do not suffer needless pain. Research findings indicate that surgical and procedural pain can contribute to pathologic pain states related to nerve injury, tissue inflammation, and prolonged peripheral nociceptive input. Animal research findings support clinical practices that avoid the development of these conditions by effectively interrupting ongoing nociceptive input from the injured site. Knowledge of analgesic interventions, including pharmacologic and nonpharmacologic techniques, is essential to the professional practice of nursing the critically ill. The critical care nurse plays a pivotal role in preventing suffering, discomfort, and long-term negative consequences related to surgical and procedural pain. PMID:11866405

  2. 78 FR 66932 - Scientific Information Request on Core Needle and Open Surgical Biopsy for Diagnosis of Breast...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-07

    ... and Open Surgical Biopsy for Diagnosis of Breast Lesions AGENCY: Agency for Healthcare Research and... core needle and open surgical biopsy for diagnosis of breast lesions. Scientific information is being solicited to inform our review of Core Needle and Open Surgical Biopsy for Diagnosis of Breast...

  3. 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

  4. Optically-guided scalpel with light-scattering module for carpal tunnel surgical procedure via minimally invasive surgery.

    PubMed

    Chiang, Ming-Che; Huang, Ching-Cheng

    2015-08-17

    A novel technique and product for carpal tunnel microscopic surgical procedures using a modified medical device containing a head as a surgical scalpel under light guidance were designed and studied. The novel design of the medical device was developed and applied in a new carpal tunnel microscopic surgical procedure in place of the traditional carpal tunnel surgical procedure. Biological and clinical evaluations of carpal tunnel surgical procedure using the designed optically guided medical device were studied. For commercialized reasons, some guidance was considered, such as ISO 10993-1:2009(E), for the biological evaluation of the device. Furthermore, a clinical evaluation was carried out. The designed optically guided medical device could provide a powerful medical device for carpal tunnel syndrome and related applications. PMID:26405940

  5. Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures

    PubMed Central

    Fleury, Anna Maria; da Silva, Antonio Carlos; de Castro Pochini, Alberto; Ejnisman, Benno; de Lira, Claudio Andre Barbosa; dos Santos Andrade, Marilia

    2011-01-01

    INTRODUCTION: Rupture of the pectoralis major muscle appears to be increasing in athletes. However, the optimal treatment strategy has not yet been established. OBJECTIVES: To compare the isokinetic shoulder performance after surgical treatment to that after non-surgical treatment for pectoralis major muscle rupture. METHODS: We assessed 33 pectoralis major muscle ruptures (18 treated non-surgically and 15 treated surgically). Horizontal abduction and adduction as well as external and internal rotation at 60 and 120 degrees/s were tested in both upper limbs. Peak torque, total work, contralateral deficiency, and the peak torque agonist-to-antagonist ratio were measured. RESULTS: Contralateral muscular deficiency did not differ between the surgical and non-surgical treatment modalities. However, the surgical group presented twice the number of athletes with clinically acceptable contralateral deficiency (<20%) for internal rotators compared to the non-surgical group. The peak torque ratio between the external and internal rotator muscles revealed a similar deficit of the external rotation in both groups and on both sides (surgical, 61.60% and 57.80% and non-surgical, 62.06% and 54.06%, for the dominant and non-dominant sides, respectively). The peak torque ratio revealed that the horizontal adduction muscles on the injured side showed similar weakness in both groups (surgical, 86.27%; non-surgical, 98.61%). CONCLUSIONS: This study included the largest single series of athletes reported to date for this type of injury. A comparative analysis of muscular strength and balance showed no differences between the treatment modalities for pectoralis major muscle rupture. However, the number of significant clinical deficiencies was lower in the surgical group than in the non-surgical group, and both treatment modalities require greater attention to the rehabilitation process, especially for the recovery of muscle strength and balance. PMID:21484052

  6. Development of a surgical procedure for implantation of a prototype suprachoroidal retinal prosthesis

    PubMed Central

    Saunders, Alexia L; Williams, Chris E; Heriot, Wilson; Briggs, Robert; Yeoh, Jonthan; Nayagam, David AX; McCombe, Mark; Villalobos, Joel; Burns, Owen; Luu, Chi D; Ayton, Lauren N; McPhedran, Michelle; Opie, Nicholas L; McGowan, Ceara; Shepherd, Robert K; Guymer, Robyn; Allen, Penelope J

    2014-01-01

    Background Current surgical techniques for retinal prosthetic implantation require long and complicated surgery, which can increase the risk of complications and adverse outcomes. Method The suprachoroidal position is known to be an easier location to access surgically, and so this study aimed to develop a surgical procedure for implanting a prototype suprachoroidal retinal prosthesis. The array implantation procedure was developed in 14 enucleated eyes. A full-thickness scleral incision was made parallel to the intermuscular septum and superotemporal to the lateral rectus muscle. A pocket was created in the suprachoroidal space, and the moulded electrode array was inserted. The scleral incision was closed and scleral anchor point sutured. In 9 of the 14 eyes examined, the device insertion was obstructed by the posterior ciliary neurovascular bundle. Subsequently, the position of this neurovascular bundle in 10 eyes was characterized. Implantation and lead routing procedure was then developed in six human cadavers. The array was tunnelled forward from behind the pinna to the orbit. Next, a lateral canthotomy was made. Lead fixation was established by creating an orbitotomy drilled in the frontal process of the zygomatic bone. The lateral rectus muscle was detached, and implantation was carried out. Finally, pinna to lateral canthus measurements were taken on 61 patients in order to determine optimal lead length. Results These results identified potential anatomical obstructions and informed the anatomical fitting of the suprachoroidal retinal prosthesis. Conclusion As a result of this work, a straightforward surgical approach for accurate anatomical suprachoroidal array and lead placement was developed for clinical application. PMID:24330322

  7. Open Conservative Surgical Management of Cystic Echinococcosis in a Tertiary Care Hospital, Nepal

    PubMed Central

    Batajoo, Hemant; Ghimire, Samikshya; Sathian, Brijesh

    2015-01-01

    Background: Cystic echinococcosis (CE) or hydatid disease caused by E. granulosus in Nepal is amenable to surgical treatment. Aim: Aim of the study is to evaluate the efficacy of surgical treatment of CE, by open partial pericystectomy with albendazole as adjuvant. Materials and Methods: Material of this prospective study were the consecutive series of 33 patients operated for CE, over a period of 8 years, at a single centre. Clinical examination, ultrasonography (USG) and computed tomography (CT) were used for establishing diagnosis. Patients were prescribed perioperative albendazole. Povidone iodine 10% (betadine)was used as contact scolicidal agent during operation. Cysts were evacuated from livers, lungs, retroperitoneum by partial pericystectomy. CE of mesentery was completely excised. Descriptive statistics was obtained using EPI- info windows version soft ware. Results: A total of 33 patients were operated for CE; 24 were females and 9 males. Age ranged from 4 years to 80 years. Organs/ site involved were: liver – 24, lungs – 4, combined liver and lungs – 2, retroperitoneum - 2 and mesentery – 1. Complication – bile leak for 2 weeks in an operated CE of liver. There was no mortality. Hospital stay (in days) was – mean 14 (range 7to21). Follow up for 3 years (average 2years) showed no recurrence. Conclusion: Evacuation of CE by partial pericystectomy is an effective, safe and simple procedure, and gives excellent cure rate with perioperative albendazole therapy. PMID:26393161

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

    PubMed

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

    1997-11-01

    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 reason 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 has to include five requirements: visual fidelity, interactivity, physical properties, physiological properties, sensory input and output. In this report we will describe how to get 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:9554121

  9. Changes of some functional speech disorders after surgical correction of skeletal anterior open bite.

    PubMed

    Knez Ambroži?, Mojca; Ho?evar Boltežar, Irena; Ihan Hren, Nataša

    2015-09-01

    Skeletal anterior open bite (AOB) or apertognathism is characterized by the absence of contact of the anterior teeth and affects articulation parameters, chewing, biting and voice quality. The treatment of AOB consists of orthognatic surgical procedures. The aim of this study was to evaluate the effects of treatment on voice quality, articulation and nasality in speech with respect to skeletal changes. The study was prospective; 15 patients with AOB were evaluated before and after surgery. Lateral cephalometric x-ray parameters (facial angle, interincisal distance, Wits appraisal) were measured to determine skeletal changes. Before surgery, nine patients still had articulation disorders despite speech therapy during childhood. The voice quality parameters were determined by acoustic analysis of the vowel sound /a/ (fundamental frequency-F0, jitter, shimmer). Spectral analysis of vowels /a/, /e/, /i/, /o/, /u/ was carried out by determining the mean frequency of the first (F1) and second (F2) formants. Nasality in speech was expressed as the ratio between the nasal and the oral sound energies during speech samples. After surgery, normalizations of facial skeletal parameters were observed in all patients, but no statistically significant changes in articulation and voice quality parameters occurred despite subjective observations of easier articulation. Any deterioration in velopharyngeal insufficiency was absent in all of the patients. In conclusion, the surgical treatment of skeletal AOB does not lead to deterioration in voice, resonance and articulation qualities. Despite surgical correction of the unfavourable skeletal situation of the speech apparatus, the pre-existing articulation disorder cannot improve without professional intervention. PMID:26164798

  10. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access.

    PubMed

    Leclercq, Florence; Akodad, Mariama; Macia, Jean-Christophe; Gandet, Thomas; Lattuca, Benoit; Schmutz, Laurent; Gervasoni, Richard; Nogue, Erika; Nagot, Nicolas; Levy, Gilles; Maupas, Eric; Robert, Gabriel; Targosz, Frederic; Vernhet, Hélène; Cayla, Guillaume; Albat, Bernard

    2015-11-01

    Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients. PMID:26414600

  11. 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. PMID:26167464

  12. Modified surgical procedure for velopharyngeal closure in adults: a preliminary report.

    PubMed

    Lu, P K

    1987-06-01

    A surgical approach to effect velopharyngeal closure in adults is presented. The three fundamental principles of the procedure are: the complete release of the palatal flap to allow its attachment to the posterior pharyngeal wall without tension; the coaptation of the pharyngeal flap deep into the posterior margin of the velum, with a short and superior based pharyngeal flap that provides a good base for velopharyngeal contact; and the swallow tail division of the pharyngeal flap to form 3 fissural communications between the nasal and oral cavities to maintain physiologic functions. The approach has been applied to eight patients, seven of whom showed no evidence of relapse. PMID:3473208

  13. Galactorrhoea following surgical procedures to the chest wall: the role of prolactin.

    PubMed Central

    MacFarlane, I. A.; Rosin, M. D.

    1980-01-01

    Normal prolactin levels were found in two cases of galactorrhoea following surgical procedures to the chest wall and one was treated successfully with bromocriptine. Studies were then carried out to test the claim that chest-wall injury is one of the common causes of hyperprolactinaemia. Serum prolactin levels were measured before and after thoracotomy in 7 patients, following traumatic rib fractures in 8 patients and after burns to the chest in one patient. No evidence was found to suggest that sustained hyperprolactinaemia follows chest wall surgery or injury, and the role of prolactin in the condition 'chest wall injury' galactorrhoea is discussed. PMID:7189882

  14. 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

  15. Automating Data Abstraction in a Quality Improvement Platform for Surgical and Interventional Procedures

    PubMed Central

    Yetisgen, Meliha; Klassen, Prescott; Tarczy-Hornoch, Peter

    2014-01-01

    Objective: This paper describes a text processing system designed to automate the manual data abstraction process in a quality improvement (QI) program. The Surgical Care and Outcomes Assessment Program (SCOAP) is a clinician-led, statewide performance benchmarking QI platform for surgical and interventional procedures. The data elements abstracted as part of this program cover a wide range of clinical information from patient medical history to details of surgical interventions. Methods: Statistical and rule-based extractors were developed to automatically abstract data elements. A preprocessing pipeline was created to chunk free-text notes into its sections, sentences, and tokens. The information extracted in this preprocessing step was used by the statistical and rule-based extractors as features. Findings: Performance results for 25 extractors (14 statistical, 11 rule based) are presented. The average f1-scores for 11 rule-based extractors and 14 statistical extractors are 0.785 (min=0.576,max=0.931,std-dev=0.113) and 0.812 (min=0.571,max=0.993,std-dev=0.135) respectively. Discussion: Our error analysis revealed that most extraction errors were due either to data imbalance in the data set or the way the gold standard had been created. Conclusion: As future work, more experiments will be conducted with a more comprehensive data set from multiple institutions contributing to the QI project. PMID:25848598

  16. 78 FR 19981 - Federal Open Market Committee; Rules of Procedure

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-03

    ... Market Committee; Rules of Procedure AGENCY: Federal Open Market Committee, Federal Reserve System. ACTION: Final rule. SUMMARY: The Federal Open Market Committee is amending its Rules of Procedure to...; or Deborah J. Danker, Deputy Director (202-452- 3253), Federal Open Market Committee, 20th and...

  17. 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

  18. Surgical reconstructive procedures for treatment of ischial, sacral and trochanteric pressure ulcers

    PubMed Central

    MARCHI, M.; BATTAGLIA, S.; MARCHESE, S.; INTAGLIATA, E.; SPATARO, C.; VECCHIO, R.

    2015-01-01

    Background Pressure ulcers are frequent complications for long term hospitalized bed-ridden patients which are not able to move or move very little. In fact, the lesion forms in a skin and muscle region which undergoes a constant pressure between an underlying bone protrusion and a support structure such as a bed or a wheelchair. Initially only the outer layers are involved but in time, the ulcer can spread to the deeper structures and reach the bone. Patients and methods In our work we described the anatomical areas that are most often subject to developing a pressure ulcer and we considered the surgical treatment and reconstructive procedures which are applied using a logical and rigorous sequence. Results We considered 4 clinical cases (2 ischiatic sores, 1 sacral sore and 1 gluteal-trochanteric sore) which demonstrate the surgical treatment and the reconstructive pro-cedures. Conclusions It is crucial to cover the defects with a thick flap to give more support and protection to the areas which undergo pressure and to lower the incidence of recurrences. PMID:26188755

  19. Improving the quality of discharge summaries for elective surgical procedures at North Bristol NHS Trust

    PubMed Central

    Ladds, Emma; Betteridge, Frederica; Yamamoto, Sarah; Gupta-Jessop, Thomas

    2015-01-01

    Following elective surgical procedures, hospital discharge summaries are essential in the handover to primary care. The information provided varies between institutions and is highly user-dependent. Various interventions have focused on improving information transfer to patients and primary care physicians including the development of electronic templates, electronic transmission to primary care, and training initiatives for junior doctors. An evaluation of the urological patient's journey at Southmead Hospital revealed a need for improved discharge summary advice. Urology specialists developed “gold standard” templates for elective urological procedures. Following a new rotation of junior doctors, discharge summaries were audited for one week. The templates were then made available on the urology ward, a teaching session was employed to encourage compliance, and the hospital electronic discharge summary template was edited. Following each intervention, summaries for one week of urology procedures were audited to assess the quality of advice provided to patients. At baseline, 18% of discharge summaries contained sufficient patient advice, this reduced to 10% after templates were made available on the wards, increasing to 45% following the education session and 84% once the electronic discharge summary proforma was edited. We conclude that discharge summaries are an effective time point for intervening to provide patients with specific post-operative information and this may be optimised for different elective procedures via the introduction of electronically-distributed standardised templates.

  20. [Specialized surgical care for children (victims of the earthquake) with open injuries].

    PubMed

    Roshal', L M; Mitish, V A; Medinski?, P V

    2014-01-01

    The article presents the authors' experience of providing specialized surgical care for 197 children who had been affected by the earthquake in Pakistan (2005), Indonesia (2006 and 2009) and Haiti (2010). All victims had open injuries of soft tissues and bones. The article recites the strategy and principles of work organization of the mobile team of specialists from the Research Institute of Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology in disaster areas. It includes the creation of a center for specialized surgical care for children, consultative work in all regional hospitals to where victims are initially evacuated, transportation and concentration of children with the most severe injuries in a specialized center. The basic principles of interaction with the central and local public health authorities and medical staff of hospitals were developed. The main characteristics of such injuries and their complications were defined as well. Mistakes made by the local and international surgical teams at the stages of primary and specialized surgical care were described. The effectiveness of the applied strategy of active surgical treatment of open injuries of soft tissue and bones complicated by surgical infection has been analyzed. PMID:24429717

  1. 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.

  2. Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats

    PubMed Central

    Martyn, Derek; Meckley, Lisa M; Miyasato, Gavin; Lim, Sangtaeck; Riebman, Jerome B; Kocharian, Richard; Scaife, Jillian G; Rao, Yajing; Corral, Mitra

    2015-01-01

    Background Adjunctive hemostats are used to assist with the control of intraoperative bleeding. The most common types are flowables, gelatins, thrombins, and oxidized regenerated celluloses (ORCs). In the US, Surgicel® products are the only US Food and Drug Administration-approved ORCs. Objective To compare the outcomes of health care resource utilization (HRU) and costs associated with using ORCs compared to other adjunctive hemostats (OAHs are defined as flowables, gelatins, and topical thrombins) for surgical procedures in the US inpatient setting. Patients and methods A retrospective, US-based cohort study was conducted using hospital inpatient discharges from the 2011–2012 calendar years in the Premier Healthcare Database. Patients with either an ORC or an OAH who underwent a cardiovascular procedure (valve surgery and/or coronary artery bypass graft surgery), carotid endarterectomy, cholecystectomy, or hysterectomy were included. Propensity score matching was used to create comparable groups of ORC and OAH patients. Clinical, economic, and HRU outcomes were compared. Results The propensity score matching created balanced patient cohorts for cardiovascular procedure (22,718 patients), carotid endarterectomy (10,890 patients), cholecystectomy (6,090 patients), and hysterectomy (9,348 patients). In all procedures, hemostatic agent costs were 28%–56% lower for ORCs, and mean hemostat units per discharge were 16%–41% lower for ORCs compared to OAHs. Length of stay and total procedure costs for patients treated with ORCs were lower for carotid endarterectomy patients (0.3 days and US$700) and for cholecystectomy patients (1 day and US$3,350) (all P<0.001). Conclusion Costs and HRU for patients treated with ORCs were lower than or similar to patients treated with OAHs. Proper selection of the appropriate hemostatic agents has the potential to influence clinical outcomes and treatment costs. PMID:26604807

  3. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States

    PubMed Central

    2015-01-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  4. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States.

    PubMed

    Thiel, Cassandra L; Eckelman, Matthew; Guido, Richard; Huddleston, Matthew; Landis, Amy E; Sherman, Jodi; Shrake, Scott O; Copley-Woods, Noe; Bilec, Melissa M

    2015-02-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  5. Interventional Radiological Procedures in Impaired Function of Surgically Implanted Catheter-Port Systems

    SciTech Connect

    Herrmann, Karin Anna; Waggershauser, Tobias; Heinemann, Volker; Reiser, Maximilian

    2001-01-15

    Purpose: System-related complications in surgically implanted catheter-port systems (CPS) for intraarterial (i.a.) chemotherapy are well known. In most cases of complications, the treatment must be interrupted and the catheter-port system must be repaired surgically. We describe microinvasive interventional radiological procedures to correct some dysfunctions of CPS.Methods: Five patients with repetitive dysfunction of CPS were treated with interventional techniques. Two patients presented with perfusion impairment, one patient had a pseudoaneurysm of the hepatic artery, and two patients presented with catheter displacement. Radiological interventions included mechanical recanalization with a guidewire, vascular stenting, and correction of catheter dislocation with a goose-neck snare.Results: In all cases, correct function of the CPS was restored. No intervention-related complications occurred and surgery was avoided. Chemotherapy could be continued for a period of 4-10 months.Conclusion: For some system-related complications, minimally invasive radiological interventions can be used to restore the function of CPS for i.a. chemotherapy.

  6. 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.

  7. Oncological and functional results of open, robot-assisted and laparoscopic radical prostatectomy: does surgical approach and surgical experience matter?

    PubMed

    Herrmann, T R; Rabenalt, R; Stolzenburg, J U; Liatsikos, E N; Imkamp, F; Tezval, H; Gross, A J; Jonas, U; Burchardt, M

    2007-04-01

    The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the methodology of the different treatments is commonly known to urologists, this article focuses on oncological and functional outcome of open retropubic (ORP), trans- or extraperitoneal endoscopical (LRP), and robot-assisted radical prostatectomy (RALP), based on personal experience and review of the literature. A MEDLINE search was performed to review the literature on LRP and RALP between 1982 and 2007 with special emphasis on oncological and functional results, technical considerations, comparison of LRP and RALP to ORP, laparoscopic training, historical aspects, and cost-efficiency of the techniques. Based on diligent training and proctoring programs, a continuous dissemination of laparoscopic techniques takes place. There is a trend towards the extraperitoneal access in most of the minimal invasive programs at least in the European community. Mid-term outcomes of LRP and short-term outcomes of RALP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower transfusion rates, shorter convalescence, and better cosmetics. In contrast to RALP, LRP reaches cost-equivalence with open surgery in selected centers. LRP and RALP reproduce the short-term results of open surgery while providing the advantages of a minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow, but the discussion about the longer learning curve for laparoscopy handling remains. The future will show if European centers adopt the use of robots comparable to the United States. PMID:17354014

  8. 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. PMID:26069522

  9. 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

  10. 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. PMID:26155264

  11. Minimally invasive surgical technique integrating multiple procedures with large specimen extraction via inguinal hernia orifice

    PubMed Central

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

    While laparoscopic surgery can be performed using small skin incisions, any resected specimen must still be able to fit through these opening. For procedures, such as cholecystectomies and appendectomies, this is not usually a problem; however, for large specimens such as bowel or large tumors, this becomes problematic. Currently, the standard technique is to attempt piecemeal removal of the specimen or enlarge one of the laparoscopic incisions, effectively creating a mini laparotomy. Creating a larger incision adds many of the drawbacks of open laparotomy and should be avoided whenever possible. In this article, we present a new technique of combining the repair of an inguinal hernia, umbilical hernia with a duodenal tumor resection in order to extract the specimen through the inguinal hernia orifice. PMID:26703927

  12. 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…

  13. Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy

    PubMed Central

    Hammad, Tariq A.; Alastal, Yaseen; Khan, Muhammad Ali; Hammad, Mohammad; Alaradi, Osama; Nigam, Ankesh; Sodeman, Thomas C.

    2015-01-01

    We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy. PMID:26504879

  14. Gender-Specific Differences in Surgical Site Infections: An Analysis of 438,050 Surgical Procedures from the German National Nosocomial Infections Surveillance System

    PubMed Central

    Langelotz, Corinna; Mueller-Rau, Carolin; Terziyski, Stoil; Rau, Beate; Krannich, Alexander; Gastmeier, Petra; Geffers, Christine

    2014-01-01

    Summary Background Surgical site infections (SSI) are among the most frequent healthcare-associated infections. They impose a substantial burden with increased morbidity and exceeding healthcare costs. Risk factors such as age, diabetes, and smoking status are commonly accounted for in the literature, but few studies address gender differences. Methods Data from the German Nosocomial Infections Surveillance System (Krankenhaus-Infektions-Surveillance-System (KISS)) from 2005 to 2010 were analysed for cardiac, vascular, visceral, and orthopaedic surgery, with a total of 438,050 surgical procedures and 8,639 SSI. Rates of SSI and isolated pathogens were analysed for gender. Results Women had a lower rate of SSI (SSI/100 procedures) in abdominal surgery than men (2.92 vs. 4.37; p < 0.001). No gender-specific differences were found in orthopaedic and vascular surgery, while women had a higher risk for SSI in cardiac surgery (5.50 vs. 3.02; p < 0.001). Isolated pathogens showed differences for sensitive Staphylococcus aureus and Pseudomonas aeruginosa, which were more frequent in women (both p = 0.007), while coagulase-negative staphylococci occurred more often in men (18.8 vs. 14.0%; p < 0.001). Conclusion Gender differences in SSI exist and are procedure-specific. The underlying mechanisms need to be further elucidated so that targeted measures for the prevention of SSI can be developed. PMID:26288585

  15. Laparoscopic solution of a vascular complication occurring during an open procedure in a child.

    PubMed

    Esposito, C; Sordino, D; Centonze, A; Settimi, A

    2002-10-01

    Usually the word conversion implies conversion from a laparoscopic procedure to an open procedure to solve complications occurring during laparoscopy. In this article we report a conversion from an open procedure to a laparoscopic one, to treat a vascular complication that occurred during an orchiectomy performed in open surgery. A 2-year-old boy came to our center for a right orchiectomy. The clinical history of this baby showed the presence of a right atrophic testis positioned in the medial part of the inguinal canal, a finding also confirmed by ultrasonography. One of our residents performed a right orchiectomy via an open inguinal procedure. After removing the testis, and before ligating the inner spermatic vessels at the level of the internal inguinal ring, the forceps that held the vessels was inadvertently opened, causing a contraction of the spermatic vessels. Since we were unable to identify the vessels and achieve hemostasis via the inguinal opening, a conversion to laparoscopic surgery was decided. A 10-mm 0 degrees optics was introduced through an umbilical trocar and revealed a large retroperitoneal hematoma along both the inner spermatic vessels and the deferential vessels, for about 3-4 cm from the internal inguinal ring. Two 5-mm trocars were positioned in triangulation and hemostasis was achieved by positioning clips on the vessels at the level of internal inguinal ring and proximally to the hematoma. Surgery lasted 1 hour; the laparoscopic procedure, 25 minutes. The baby was discharged 2 days after surgery. At a 9-month follow-up the clinical and ultrasonographical evaluation was normal. This case clearly shows the usefulness of laparoscopy in pediatric surgery, as well as to solve complications due to open surgery. We think that nowadays the use of laparoscopy should be considered indispensable by every pediatric surgical team. PMID:12098022

  16. 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-Peña, 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

  17. Surgical Procedures of the Elbow: A Nationwide Cross-Sectional Observational Study in the United States

    PubMed Central

    Kinaci, Ahmet; Neuhaus, Valentin; Ring, David

    2015-01-01

    Background: Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States. Methods: We used the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery (NSAS) data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US. Results: An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis) and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular). Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries. Conclusions: Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable that some of the most common elbow surgeries (those that address enthesopathy and radial head fracture) are some of the most variably utilized and debated. PMID:25692163

  18. Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma

    PubMed Central

    Fernandes, Miguel de Castro; Peres, Luciano Rodrigo; de Queiroz, Aristóteles Correia; Lima, José Queiroz; Turíbio, Flávio Moral; Matsumoto, Marcelo Hide

    2015-01-01

    Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective. PMID:26327794

  19. An overview of complications associated with open and percutaneous tracheostomy procedures

    PubMed Central

    Cipriano, Anthony; Mao, Melissa L; Hon, Heidi H; Vazquez, Daniel; Stawicki, Stanislaw P; Sharpe, Richard P; Evans, David C

    2015-01-01

    Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity. PMID:26557488

  20. 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

  1. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures.

    PubMed

    Dicks, Kristen V; Baker, Arthur W; Durkin, Michael J; Anderson, Deverick J; Moehring, Rebekah W; Chen, Luke F; Sexton, Daniel J; Weber, David J; Lewis, Sarah S

    2015-12-01

    OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38-0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79-1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43-0.64; P<.01). CONCLUSIONS Short operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. Infect. Control Hosp. Epidemiol. 2015;36(12):1431-1436. PMID:26391277

  2. 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

  3. Surgical smoke.

    PubMed

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown. PMID:19892630

  4. Comparison of the effects of propofol versus thiopental induction on postoperative outcomes following surgical procedures longer than 2 hours.

    PubMed

    Coolong, Kevin J; McGough, Eugene; Vacchiano, Charles; Pellegrini, Joseph E

    2003-06-01

    The use of propofol as an induction agent for surgeries lasting less than 2 hours has been shown to result in a faster emergence from anesthesia. Our study was performed to analyze the impact of propofol on surgical procedures lasting longer than 2 hours. A convenience sample of 84 men and women undergoing nonemergency laparoscopic procedures scheduled for longer than 2 hours were enrolled in this prospective study and randomly assigned to receive a standardized induction with thiopental or propofol. Nausea and pain were measured using a 0 to 10 verbal numeric rating scale. Recovery from anesthesia was measured using a modified Newman Bender Motor Gestalt Test. Statistical analysis was used to analyze all ordinal and interval data. A P value of less than, 05 was considered significant. No differences were found between the propofol and thiopental groups in demographics, total surgical time, anesthesia time, recovery times, postoperative analgesic and emetic requirements, satisfaction scores, or incidence of nausea and vomiting. Discharge times from the postanesthesia care unit and to home were similar between groups. Based on the results, we concluded that propofol offered no advantages over thiopental in postoperative outcomes in laparoscopic surgical procedures longer than 2 hours. PMID:12847946

  5. 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

  6. Multifactor Screener in OPEN: Scoring Procedures & Results

    Cancer.gov

    Scoring procedures were developed to convert a respondent's screener responses to estimates of individual dietary intake for percentage energy from fat, grams of fiber, and servings of fruits and vegetables.

  7. A Multiphysics Modeling Approach to Develop Right Ventricle Pulmonary Valve Replacement Surgical Procedures with a Contracting Band to Improve Ventricle Ejection Fraction

    PubMed Central

    Tang, Dalin; Yang, Chun; Geva, Tal; Rathod, Rahul; Yamauchi, Haruo; Gooty, Vasu; Tang, Alexander; Kural, Mehmet H.; Billiar, Kristen L.; Gaudette, Glenn; del Nido, Pedro J.

    2012-01-01

    Patients with repaired tetralogy of Fallot account for the majority of cases with late onset right ventricle (RV) failure. A new surgical procedure placing an elastic band in the right ventricle is proposed to improve RV function measured by ejection fraction. A multiphysics modeling approach is developed to combine cardiac magnetic resonance imaging, modeling, tissue engineering and mechanical testing to demonstrate feasibility of the new surgical procedure. Our modeling results indicated that the new surgical procedure has the potential to improve right ventricle ejection fraction by 2–7% which compared favorably with recently published drug trials to treat LV heart failure. PMID:23667272

  8. Risk of angioedema following invasive or surgical procedures in HAE type I and II – the natural history

    PubMed Central

    Aygören-Pürsün, E; Martinez Saguer, I; Kreuz, W; Klingebiel, T; Schwabe, D

    2013-01-01

    Background Hereditary angioedema (HAE), caused by deficiency in C1-inhibitor (C1-INH), leads to unpredictable edema of subcutaneous tissues with potentially fatal complications. As surgery can be a trigger for edema episodes, current guidelines recommend preoperative prophylaxis with C1-INH or attenuated androgens in patients with HAE undergoing surgery. However, the risk of an HAE attack in patients without prophylaxis has not been quantified. Objectives This analysis examined rates of perioperative edema in patients with HAE not receiving prophylaxis. Methods This was a retrospective analysis of records of randomly selected patients with HAE type I or II treated at the Frankfurt Comprehensive Care Centre. These were examined for information about surgical procedures and the presence of perioperative angioedema. Results A total of 331 patients were included; 247 underwent 700 invasive procedures. Of these procedures, 335 were conducted in 144 patients who had not received prophylaxis at the time of surgery. Categories representing significant numbers of procedures were abdominal (n = 113), ENT (n = 71), and gynecological (n = 58) procedures. The rate of documented angioedema without prophylaxis across all procedures was 5.7%; in 24.8% of procedures, the presence of perioperative angioedema could not be excluded, leading to a maximum potential risk of 30.5%. Predictors of perioperative angioedema could not be identified. Conclusion The risk of perioperative angioedema in patients with HAE type I or II without prophylaxis undergoing surgical procedures ranged from 5.7% to 30.5% (CI 3.5–35.7%). The unpredictability of HAE episodes supports current international treatment recommendations to consider short-term prophylaxis for all HAE patients undergoing surgery. PMID:23968383

  9. [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

  10. Multifactor Screener in OPEN: Scoring Procedures

    Cancer.gov

    Scoring procedures were developed to convert a respondent's screener responses to estimates of individual dietary intake for percentage energy from fat, grams of fiber, and servings of fruits and vegetables, using USDA's 1994-96 Continuing Survey of Food Intakes of Individuals (CSFII 94-96) dietary recall data.

  11. Comparison of standard surgical debridement versus the VERSAJET Plus™ Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized controlled trial.

    PubMed

    Oosthuizen, Beyers; Mole, Trevor; Martin, Robin; Myburgh, Johannes G

    2014-01-01

    The aim of this study was to assess the efficacy of an alternative debridement technology in the treatment of Gustilo & Anderson grade III A and III B open tibia fractures. The objective was to explore whether improvements to the debridement using tangential hydrosurgery (VERSAJET™ Plus Smith & Nephew) could reduce the number of debridement episodes and the days before closure. A pilot scale randomized controlled trial was conducted against conventional surgery. A total of 40 patients were recruited. Sixteen patients received hydrosurgery and 24 patients were treated with standard surgical debridement. Baseline characteristics were well balanced. There was significant evidence (p < 0.001) that VERSAJET patients required fewer debridement procedures than standard surgical debridement prior to wound closure (ratio standard: VERSAJET = 1.747). The median time to wound closure was 3 days (95% CI 3 days, 5 days) for VERSAJET and 5 days (95% CI 4 days, 8 days) for standard debridement, although the difference was not statistically significant (p = 0.275). There were no instances of post-operative infection. PMID:25356370

  12. "Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique.

    PubMed

    Marinis, A; Gkiokas, G; Argyra, E; Fragulidis, G; Polymeneas, G; Voros, D

    2013-01-01

    The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs. PMID:23820678

  13. Open Surgical Repair of Abdominal Aortic Aneurysm Coexisting with Horseshoe Kidney

    PubMed Central

    Han, Ahram; Kim, Suh Min; Choi, Chanjoong; Min, Sang-Il; Ha, Jongwon; Min, Seung-Kee

    2015-01-01

    Horseshoe kidney (HSK) is the most common congenital abnormality of the urologic system encountered during abdominal aortic aneurysm (AAA) surgery. Here, the authors report a case of AAA coexisting with HSK that was successfully treated by open surgery. Two accessory renal arteries of 2.5 mm and 3.1 mm were reimplanted. One of the implanted arteries later occluded and infarct of the isthmus developed, but there was no impairment of renal function. The authors discuss the complexity of the surgical treatment of AAA coexisting with HSK, and place focus on which accessory renal arteries should be reconstructed. PMID:26217645

  14. Medical Robots Surgical Assistants

    E-print Network

    Pulfrey, David L.

    1 Medical Robots Surgical Assistants · Efficacy of Procedure ­ Accuracy ­ Longevity ­ Invasiveness · Augment human capabilities ­ Enabling new procedures ­ Time under anaesthetic #12;2 Surgical Robots) ­ Sensei (Hansen Medical) Autonomous Surgical Robots Robodoc.com #12;3 Guided Surgical Robots Makosurgical

  15. Radiofrequency-Assisted Partial Splenectomy Plus Splenopexy--A Modified Surgical Procedure for Wandering Spleen: A Case Report.

    PubMed

    Hao, Fulong; Wang, Wenping; Yang, Xiaoli

    2015-09-01

    Wandering spleen is an extremely rare clinical condition characterized by abnormal anatomical position of the spleen. Up to now, its etiology remains unknown, and the best surgical procedure is still an area to explore in the future. In this article, we present the case of a 24-year-old woman with wandering spleen combined with congenital heart disease and pigeon chest. Based on the clinical features and our experiences of radiofrequency ablation for preservation of the spleen in traumatic spleen rupture, we successfully performed a modified splenectomy and splenopexy method. Since the operation, the organ has remained in place with good perfusion and function. PMID:26171637

  16. 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

  17. The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures

    PubMed Central

    Frizziero, Antonio; Ferrari, Raffaello; Giannotti, Erika; Ferroni, Costanza; Poli, Patrizia; Masiero, Stefano

    2012-01-01

    Summary Meniscal injuries represent one of the most frequent lesions in sport practicing and in particular in soccer players and skiers. Pain, functional limitation and swelling are typical symptoms associated with meniscal tears. Epidemiological studies showed that all meniscal lesions, in different sports athletes, involves 24% of medial meniscus, while 8% of lateral meniscus and about 20–30% of meniscal lesions are associated with other ligament injuries. Meniscal tears can be treated conservatively or surgically. Surgery leads in many cases to complete resolution of symptoms and allows the return to sport activity. However many studies show that this treatment can induce more frequently the development of degenerative conditions if not correctly associated to a specific rehabilitation protocol. The aim of this article is to compare different timing in specific rehabilitation programs related to the most actual surgical options. PMID:23738313

  18. Surgical treatment of infective endocarditis in active intravenous drug users: a justified procedure?

    PubMed Central

    2014-01-01

    Background Infective endocarditis is a life threatening complication of intravenous drug abuse, which continues to be a major burden with inadequately characterised long-term outcomes. We reviewed our institutional experience of surgical treatment of infective endocarditis in active intravenous drug abusers with the aim of identifying the determinants long-term outcome of this distinct subgroup of infective endocarditis patients. Methods A total of 451 patients underwent surgery for infective endocarditis between January 1993 and July 2013 at the University Hospital of Heidelberg. Of these patients, 20 (7 female, mean age 35?±?7.7 years) underwent surgery for infective endocarditis with a history of active intravenous drug abuse. Mean follow-up was 2504?±?1842 days. Results Staphylococcus aureus was the most common pathogen detected in preoperative blood cultures. Two patients (10%) died before postoperative day 30. Survival at 1, 5 and 10 years was 90%, 85% and 85%, respectively. Freedom from reoperation was 100%. Higher NYHA functional class, higher EuroSCORE II, HIV infection, longer operating time, postoperative fever and higher requirement for red blood cell transfusion were associated with 90-day mortality. Conclusions In active intravenous drug abusers, surgical treatment for infective endocarditis should be performed as extensively as possible and be followed by an aggressive postoperative antibiotic therapy to avoid high mortality. Early surgical intervention is advisable in patients with precipitous cardiac deterioration and under conditions of staphylococcal endocarditis. However, larger studies are necessary to confirm our preliminary results. PMID:24661344

  19. Impact of surgeon subspecialty training on surgical outcomes in open globe injuries

    PubMed Central

    Han, Ian C; Puri, Sidharth; Wang, Jiangxia; Sikder, Shameema

    2015-01-01

    Purpose The purpose of this study was to evaluate whether subspecialty training of the initial treating surgeon affects visual acuity and surgical outcomes in patients with open globe injuries. Design This study is a single-institution, retrospective case series. Methods The charts of adult patients with open globe injuries requiring surgical repair at the Wilmer Eye Institute between July 1, 2007 and July 1, 2012 were retrospectively reviewed. Clinical findings at presentation were recorded, and details of initial repair and follow-up surgeries were analyzed. Differences in visual acuity and surgical outcomes were compared based on subspecialty training of the initial surgeon. Results The charts of 282 adult patients were analyzed, and 193 eyes had at least 6 months of follow-up for analysis. Eighty-six eyes (44.6%) required follow-up surgery within the first year, and 39 eyes (20.2%) were enucleated. Eyes initially treated by a vitreoretinal (VR) surgeon were 2.3 times (P=0.003) more likely to improve by one Ocular Trauma Score (OTS) visual acuity category and 1.9 times (P=0.027) more likely to have at least one more follow-up surgery at 6 months compared to eyes treated by non-VR surgeons. Patients with more anterior injuries treated by a VR surgeon were more likely to improve by one OTS visual acuity category compared to those treated by non-VR surgeons (P=0.004 and 0.016 for Zones I and II, respectively). There was no difference in visual acuity outcomes for eyes with posterior injuries (P=0.515 for Zone III). Conclusion Eyes initially treated by a VR surgeon are more likely to improve by one OTS visual acuity category than those initially treated by a non-VR surgeon. However, patients initially treated by a VR surgeon also undergo more follow-up surgical rehabilitation, and improvement in visual acuity is more likely for anterior (Zone I and II injuries) than posterior (Zone III) injuries. PMID:26491240

  20. High-speed 3-dimensional imaging in robot-assisted thoracic surgical procedures.

    PubMed

    Kajiwara, Naohiro; Akata, Soichi; Hagiwara, Masaru; Yoshida, Koichi; Kato, Yasufumi; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2014-06-01

    We used a high-speed 3-dimensional (3D) image analysis system (SYNAPSE VINCENT, Fujifilm Corp, Tokyo, Japan) to determine the best positioning of robotic arms and instruments preoperatively. The da Vinci S (Intuitive Surgical Inc, Sunnyvale, CA) was easily set up accurately and rapidly for this operation. Preoperative simulation and intraoperative navigation using the SYNAPSE VINCENT for robot-assisted thoracic operations enabled efficient planning of the operation settings. The SYNAPSE VINCENT can detect the tumor location and depict surrounding tissues quickly, accurately, and safely. This system is also excellent for navigational and educational use. PMID:24882302

  1. Less Aggressive Surgical Procedure for Treatment of Solid Pseudopapillary Tumor: Limited Experience from a Single Institute

    PubMed Central

    Zhang, Chi; Liu, Fangfeng; Chang, Hong; Li, Hongguang; Zhou, Xu; Lu, Jun; Qin, Chengkun; Sun, Yongjie; Sun, Huidong; Lin, Jianbo

    2015-01-01

    Objectives To evaluate the clinical characteristics and radiological features of solid pseudopapillary tumor (SPT) and assess surgical therapy strategy. Methods A retrospective review was performed in 62 patients pathologically confirmed of SPT treated between 2003 and 2014. The clinical features, radiological examinations and surgical strategies were analyzed. Results 56 females and 6 males were included in this study, mean age was 26 years old (range: 8–66 years old) with mean size of the tumor was 7.2 cm (range: 3–15 cm), and most tumor were commonly located in the head of pancreas (n = 29). Among all the cases, 3 patients had liver metastasis and underwent resection of SPT and liver metastasis. Furthermore, we performed 29 cases of local tumor excision; other patients underwent pancreaticoduodenectomy, middle pancreatectomy, middle pancreatectomy with splenectomy, distal pancreatectomy with spleen preservation, distal pancreatectomy with splenectomy and duodenum-preserving pancreatic head resection. No patient suffered from lymph node metastases. After median follow-up of 46 months (range: 2–135 months), no mortality or local recurrence or distant metastasis was found. Conclusions Solid pseudopapillary tumor is a latent malignant tumor with excellent prognosis. If feasible, less aggressive resection without regular lymphadenectomy is recommended for treatment of patients with SPT. PMID:26599966

  2. Surgical sterilization: an underutilized procedure for evaluating the merits of induced sterility

    USGS Publications Warehouse

    Kennelly, James J.; Converse, Kathryn A.

    1993-01-01

    Despite more than 4 decades of effort, development of effective wildlife damage control programs based on sterilization of target species has met with limited success. This is partly due to the fact that investigators have assumed, rather than empirically tested, whether the reproductive strategies of the target populations were vulnerable to the planned treatment. Equally important, methods selected to include sterility usually involve a chemical agent that can affect sociosexual behaviors of the nuisance population. In this report, we illustrate how surgically induced sterility circumvents both problems--how the concept without the potentially confounding secondary effects of a chemical. We assessed the merits of initiating research to develop a male chemosterilant for Norway rats, red-winged blackbirds, beaver, and Canada geese by inducing sterility surgically. The infidelity of many red-winged females to their polygynous territorial male was surprising and argued against searching for a male sterilant. On the other hand, beaver and Canada goose studies confirmed previous reports that both form par-bonds and are monogamous. Both should be vulnerable to a male chemosterilant approach, and research toward this goal is justified.

  3. Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

    PubMed

    Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

    2016-01-01

    In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index. PMID:26678472

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

    PubMed

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

    2011-09-01

    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. PMID:22950313

  5. An Interactive Simulation Environment for Craniofacial Surgical Procedures Dan Morris1

    E-print Network

    Salisbury, Kenneth

    and Reconstructive Surgery, Stanford University {dmorris, barbagli, jks}@robotics.stanford.edu, sgirod, with an emphasis on both mandibular distraction procedures and traditional orthognathic surgeries. The simulator malformation, trauma, or disease ­ can result in cosmetic deformation and problems with chewing and

  6. Image Guided Surgical Interventions Surgeons have traditionally performed procedures to treat diseases by

    E-print Network

    with the developments in imaging modalities, endoscopic surgery has advanced with the introduction of rigid and flexible, resulting in an explosion of endoscopic procedures involving virtually every structure in the body. The only. This limitation has confined endoscopic surgery to areas where a natural body cavity or physical space can

  7. Intraocular Lens-Shell Technique: Adjustment of the Surgical Procedure Leads to Greater Safety When Treating Dense Nuclear Cataracts

    PubMed Central

    Chen, Weirong; Qu, Bo; Zhang, Xinyu; Lin, Zhuoling; Chen, Jingjing; Liu, Yizhi

    2014-01-01

    Objective To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts. Methods Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the “IOL-shell technique”, features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out. Results The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05). Conclusions Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT02138123). Trial Registration ClinicalTrials.gov NCT02138123 PMID:25401512

  8. Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

    PubMed Central

    Niccolaï, Patrick; Ouchchane, Lemlih; Libier, Maurice; Beouche, Fayçale; Belon, Monique; Vedrinne, Jean-Marc; El Drayi, Bilal; Vallet, Laurent; Ruiz, Franck; Biermann, Céline; Duchêne, Pascal; Chirat, Claudine; Soule-Sonneville, Sylvie; Dualé, Christian; Dubray, Claude; Schoeffler, Pierre

    2015-01-01

    Background A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified. Methods We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model. Results Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5–30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective. Conclusion We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed. PMID:25799247

  9. Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR

    PubMed Central

    Takahashi, Hideki; Tauchi, Yuya; Satoh, Hisashi; Matsuda, Hikaru

    2015-01-01

    Purposes: Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak. Method: Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment. Results: Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size. Conclusion: We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR. PMID:26421069

  10. Preoperative Ultrasonography as a Predictor of Difficult Laparoscopic Cholecystectomy that Requires Conversion to Open Procedure

    PubMed Central

    Chand, Prem; Singh, Rommel; Singh, Bimaljot; Singla, Rachan Lal; Yadav, Manish

    2015-01-01

    Aim: The present study was conducted to see whether preoperative ultrasonography can be used as a predictor of difficult lapariscopic cholecystectomy or not. Methods: 50 patients of cholelithiasis, selected from surgical OPD of Rajindra Hospital Patiala, who fulfilled all inclusion and exclusion criteria for the study underwent elective cholecystectomy. Ultrasonography was done pre-operatively on all cases in the same setup and with same probe and patients underwent laparoscopic cholecystectomy in same setup. Results: A significant prediction was found between ultrasonographic parameters and conversion of the procedure to open cholecystectomy which proved that pre-operative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in majority of the cases and should be used as a screening procedure. Conclusion: Preoperative ultrasonography should be used as a screening procedure as it is a good predictor of difficulty in laparoscopic cholecystectomy in majority of the cases. It can help surgeon to get an idea of potential difficulty that he can face in the particular patient. PMID:26425061

  11. Assessing the quality of written information provision for surgical procedures: a case study in oesophagectomy

    PubMed Central

    Blencowe, N S; Strong, S; McNair, A G K; Howes, N; Elliot, J; Avery, K N; Blazeby, J M

    2015-01-01

    Objective To examine the content and quality of written information provided by surgical centres for patients undergoing oesophagectomy for cancer. Design Cross-sectional study of the content of National Health Service (NHS) patient information leaflets (PILs) about oesophageal cancer surgery, using a modified framework approach. Data sources Written information leaflets from 41 of 43 cancer centres undertaking surgery for oesophageal cancer in England and Wales (response rate 95.3%). Eligibility criteria All English language versions of PILs about oesophagectomy. Results 32 different PILs were identified, of which 2 were generic tools (Macmillan ‘understanding cancer of the gullet’ and EIDO ‘oesophagectomy’). Although most PILs focused on describing in-hospital adverse events, information varied widely and was often misleading. Just 1 leaflet described survival benefits of surgery and 2 mentioned the possibility of disease recurrence. Conclusions Written information provided for patients by NHS cancer centres undertaking oesophagectomy is inconsistent and incomplete. It is recommended that surgeons work together with patients to agree on standards of information provision of relevance to all stakeholders’ needs. PMID:26459487

  12. [Ovum fertilization using surgically obtained sperm: additional risk to offspring unlikely with meticulous procedure].

    PubMed

    Meuleman, E J; van Moorselaar, R J

    1998-01-17

    In the Netherlands a presumed higher risk of transmission of genetic abnormalities to the offspring in programmes of intracytoplasmatic sperm injection (ICSI) using surgically retrieved sperm (microscopic epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE)) has triggered a moratorium. However, the ICSI-MESA/TESE-programme should be resumed under conditions for the following reasons: the source of the sperm is not a accurate standard of its genetic contents: the cause of the male infertility and the morphology and function of the injected spermatozoon appear to be better criteria; animal experiments and clinical results are reassuring as to the proposed risk; it is uncertain whether the complex genetical mechanisms involved in spermiogenesis and sperm maturation can be unraveled in the laboratory in due course; the exodus of patients to neighbouring countries will be stopped and biological material necessary for human research will become available. The conditions are that (a) only morphologically normal and motile sperm should be used, (b) ICSI should be preceded by genetical screening and succeeded by long term follow up of the offspring. PMID:9557005

  13. Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure.

    PubMed

    de Zélicourt, Diane A; Kurtcuoglu, Vartan

    2016-01-01

    The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework. PMID:26183962

  14. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

    PubMed Central

    2011-01-01

    Background Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. PMID:21995682

  15. Less Invasive Surgical Procedures Using Narrow-Diameter Implants: A Prospective Study in 20 Consecutive Patients.

    PubMed

    Lambert, France Emmanuelle; Lecloux, Geoffrey; Grenade, Charlotte; Bouhy, Alice; Lamy, Marc; Rompen, Eric Henri

    2015-12-01

    Narrow-diameter implants (NDIs) are increasingly produced and used in implant dentistry, especially since the introduction of new, more resistant materials. The objective of the present study was to evaluate the clinical performance of NDIs (3.3 mm) placed in thin alveolar crests. Twenty consecutive patients needing implant-supported fixed partial dentures and presenting an alveolar thickness ?6 mm were treated with 1 or several NDIs. The surgical protocol was chosen according to the clinical situation: (1) flapless, (2) mini-cervical flap, (3) wide flap, (4) wide flap + guided bone regeneration (GBR). Implants were immediately loaded if the primary stability was higher than 20 Ncm. Implant survival and success, prosthodontic success rates, and patient-centered outcomes were evaluated after a follow-up period of 1 year. A total of 39 implants were placed in 20 patients, 12 and 27 implants in the anterior regions and in the posterior mandible, respectively. All but 1 implant reached an insertion torque higher than 20 Ncm and were loaded within 48 hours. The implant survival and success rates both reached 94.7%. The need for GBR was avoided in 60% of the implant sites. The mean peri-implant bone remodeling after a follow-up period of 1 year was -0.35 mm at the implant level. Peri-implant bone remodeling was higher in the posterior region, when the alveolar crest was thinner than 4 mm and GBR was required in addition. In conclusion, use of NDIs to restore partial edentation in sites with limited horizontal thickness seems to be an effective treatment option that prevented GBR in the majority of the present cases. Immediate provisionalization of NDIs does not seem to impair the results. PMID:24766161

  16. Surgical correction of 639 pectus excavatum cases via the Nuss procedure

    PubMed Central

    Zhang, Dong-Kun; Tang, Ji-Ming; Ben, Xiao-Song; Xie, Liang; Zhou, Hai-Yu; Ye, Xiong; Zhou, Zi-Hao; Shi, Rui-Qing; Xiao, Pu

    2015-01-01

    Background To review the clinical experience and short- to middle-term effects of the Nuss procedure for correction of pectus excavatum (PE). Methods From September 2006 to August 2014, 639 patients with PE were treated using the Nuss procedure. Of these, 546 were male and 93 were female. The mean age was 15.3±5.8 years (2.5-49 years). Preoperative chest CT scans Haller index (HI) was 4.3±1.7 (2.9-17.4), with 75 cases of mild PE (HI <3.2), 114 cases of moderate PE (HI 3.2-3.5), 393 cases of severe PE (HI 3.6-6.0), and 57 cases of extremely severe PE (HI >6.0). Results A total of 638 patients successfully completed the surgery, an 11-year-old male patient who died after the surgery had undergone ventricular septal defect closure surgery through a sternal incision 7 years ago. The mean operative time was 64.3±41.7 min (40-310 min). Excluding the patient who died, the average blood loss was 24.5±17.8 mL (10-160 mL). The average length of postoperative hospital stay was 5.2±2.9 days (4-36 days). A total of 484 cases (75.7%) required 1 steel bar insertion, 153 cases (24.0%) required 2 steel bars, and 2 cases (0.3%) required 3 bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 504 cases, good in 105, fair in 28 and poor in 2, good quality rate was 95.3%. Conclusions Correction of PE via the Nuss procedure is minimally invasive and simple to perform with good short and mid-term effects, while long-term efficacy remains to be determined. PMID:26543607

  17. Surgical Efficiencies and Quality in the Performance of Voluntary Medical Male Circumcision (VMMC) Procedures in Kenya, South Africa, Tanzania, and Zimbabwe

    PubMed Central

    Rech, Dino; Bertrand, Jane T.; Thomas, Nicholas; Farrell, Margaret; Reed, Jason; Frade, Sasha; Samkange, Christopher; Obiero, Walter; Agot, Kawango; Mahler, Hally; Castor, Delivette; Njeuhmeli, Emmanuel

    2014-01-01

    Introduction This analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC), quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider’s time with the client (PPTC) and total elapsed operating time (TEOT). Methods Two serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed quality of surgical technique and timed 9 steps in the VMMC procedure. Four elements of efficiency (task-shifting, task-sharing [of suturing], rotation among multiple surgical beds, and use of electrocautery) and quality of surgical technique were assessed as explanatory variables. Mann Whitney and Kruskal Wallis tests were used in the bivariate analysis and linear regression models for the multivariate analyses to test the relationship between these five explanatory variables and two outcomes: PPTC and TEOT. The VMMC procedure TEOT and PPTC averaged 23–25 minutes and 6–15 minutes, respectively, across the four countries and two years. The data showed time savings from task-sharing in suturing and use of electrocautery in South Africa and Zimbabwe (where task-shifting is not authorized). After adjusting for confounders, results demonstrated that having a secondary provider complete suturing and use of electrocautery reduced PPTC. Factors related to TEOT varied by country and year, but task-sharing of suturing and/or electrocautery were significant in two countries. Quality of surgical technique was not significantly related to PPTC or TEOT, except for South Africa in 2012 where higher quality was associated with lower TEOT. Conclusions SYMMACS data confirm the efficiency benefits of task-sharing of suturing and use of electrocautery for decreasing TEOT. Reduced TEOT and PPTC in high volume setting did not result in decreased quality of surgical care. PMID:24802412

  18. High condylectomy procedure: a valuable resource for surgical management of the mandibular condylar hyperplasia.

    PubMed

    Pereira-Santos, Darklilson; De Melo, Willian Morais; Souza, Francisley Avila; de Moura, Walter Leal; Cravinhos, Julio César de Paulo

    2013-07-01

    Condylar hyperplasia is an overdevelopment of the condyle, which may manifest unilaterally or bilaterally. This pathological condition can lead to facial asymmetry, malocclusion, and dysfunction of the temporomandibular joint. The etiology and pathogenesis of condylar hyperplasia remain uncertain, but it has been suggested that its etiology may be associated with hormonal factors, trauma, and hereditary hypervascularity, affecting both genders. The diagnosis is made by clinical examination, and radiological imaging, and additionally, bone scintigraphy, is a fundamental resource for determining whether the affected condyle shows active growth. Patients with active condylar hyperplasia management have better results when they are subjected to the high condylectomy procedure. The authors report a case in a 20-year-old female subject with unilateral active condylar hyperplasia who was treated by high condylectomy. The patient has been followed up for 4 years without signs of recurrence and with good functional stability of the occlusion. PMID:23851829

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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…

  4. A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy.

    PubMed

    Je, Hyung Gon; Shuman, Deborah J; Ad, Niv

    2015-10-01

    There is a growing trend to perform off-bypass surgical ablation for atrial fibrillation (AF) because it is perceived to be safer and more effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB) support. In this systematic review, we compared three minimally invasive stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze procedure, epicardial surgical ablation and a hybrid epicardial surgical and catheter-based endocardial ablation procedure (hybrid procedure). Relevant studies were identified in MEDLINE and the Cochrane Database of Systematic Reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 565 initial studies, 37 were included in this review. The total number of patients across all studies was 1877 (range 10-139). Two studies reported on endocardial Cox-Maze procedures (n = 145), 26 reported on epicardial surgical ablation (n = 1382) and 9 reported on hybrid surgical ablation (n = 350). For minimally invasive Cox-Maze, epicardial and hybrid groups, operative mortality rates were 0, 0.5 and 0.9%, perioperative permanent pacemaker insertion rates were 3.5, 2.7 and 1.5%, incidence of conversion to median sternotomy was 0, 2.4 and 2.5%, and reoperation for bleeding was 1.0, 1.5 and 2.2%, with mean length of stay (days) of 5.4, 6.0 and 4.6, respectively. At 12 months, rates of sinus rhythm restoration were 93, 80 and 70%, and sinus restoration without anti-arrhythmic medications was 87, 72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively. Of the three procedures, the minimally invasive Cox-Maze procedure with CPB support was most effective for the treatment of stand-alone AF and had important safety advantages in conversion to sternotomy and major bleeding. The minimally invasive Cox-Maze procedure with CPB support also demonstrated the potential for a higher success rate 12 months following the procedure. PMID:25567961

  5. Lessons from the past: directions for the future. Do new marketed surgical procedures and grafts produce ethical, personal liability, and legal concerns for physicians?

    PubMed

    Ostergard, Donald R

    2007-06-01

    New procedures and materials for incontinence and prolapse are proliferating rapidly. Surgical procedures were developed by physicians and carried their names, but over the last 15 years, these procedures are developed by industry and bear the trade names of the companies selling the kits needed to perform them. The Food and Drug Administration (FDA) approves devices, not procedures, and does not require submission of efficacy or adverse-event data to gain this approval by the 510-K process. Evidence-based medicine is lacking in the performance of these procedures that may be considered experimental by an insurance company or malpractice carrier with denial of payment or coverage. Physicians and hospitals are exposing themselves to financial, legal, and ethical risks when performing or allowing such procedures to be performed. Informed consent from the patient cannot be obtained. We must not confuse medical marketing with evidence-based medicine. PMID:17364134

  6. Defining indications to ALPPS procedure: technical aspects and open issues.

    PubMed

    Ratti, Francesca; Cipriani, Federica; Gagliano, Annalisa; Catena, Marco; Paganelli, Michele; Aldrighetti, Luca

    2014-03-01

    The limit to surgical treatment of patients with hepatic tumors is represented by the proportion of residual hepatic parenchyma at the end of surgery (FLR, future liver remnant) that provides an estimation of the risk of postoperative liver failure. Recently, a new two-stage technique has been developed with the acronym (ALPPS) associating liver partitioning and portal vein ligation for staged hepatectomy with the aim of obtaining a more rapid and effective increase in FLR, even though indications are not clear yet. Between January and December 2012, eight patients were candidates to ALPPS at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milan. The first three patients (Series 1) underwent right trisectionectomy and were affected by tumors infiltrating biliary confluence, while the others (Series 2) were candidates to right hepatectomy for colorectal liver metastases. Two patients were then excluded from Series 2 because intraoperative finding of irresectable disease. Intra- and postoperative outcome was evaluated with the aim of defining indications to ALPPS. All patients reached an adequate FLR after a median of 7.5 days from the first procedure (rate of program completion 100 %). In Series 1 two patients developed complications related to bile leakage from the raw surface of the liver to be resected and septic events secondary to ischemic necrosis of the liver segment IV. One patient died following multi-organ failure secondary to sepsis. In Series 2 postoperative course was uneventful in all the patients, and in particular no patient showed disease progression between the two procedures or signs of postoperative liver failure. ALPPS approach was initially considered suitable for patients affected by Klatskin tumors who require, despite a small tumor volume, extended hepatectomies associated with surgery of the biliary tract: the analysis of this first series of patients has led to a re-evaluation of the indication to this strategy, as a consequence of encountered criticisms. Actually only a subset of patients affected by colorectal liver metastases are candidates to ALPPS. PMID:24343420

  7. Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome

    PubMed Central

    Yonguc, Tarik; Aydogdu, Ozgu; Bozkurt, Ibrahim Halil; Degirmenci, Tansu; Gunlusoy, Bulent; Sen, Volkan; Yarimoglu, Serkan

    2015-01-01

    Introduction: We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). Methods: In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m2) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative follow-up. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ?12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. Results: The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m2, respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. Conclusion: In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women. PMID:26609331

  8. Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients

    PubMed Central

    2014-01-01

    Background Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications. Methods A cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis. Results Preoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications. Conclusions The Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients’ comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration. PMID:25075222

  9. Urethral bulking agents versus other surgical procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis.

    PubMed

    Leone Roberti Maggiore, Umberto; Bogani, Giorgio; Meschia, Michele; Sorice, Paola; Braga, Andrea; Salvatore, Stefano; Ghezzi, Fabio; Serati, Maurizio

    2015-06-01

    Bulking agents provide an alternative option in the management of women with stress urinary incontinence and they seem to have an important role in the management flow chart of SUI. However, evidence on this issue is scanty. The most important aspect is to understand whether bulking agents are comparable with the other first-line anti-incontinence surgical procedure (MUS, Burch colposuspension and pubovaginal slings). Hence, the primary aim of the current review was to assess the objective and subjective outcomes of bulking agents in comparison with the other surgical procedures for the treatment of SUI. PubMed and Medline were systematically searched and we included studies evaluating the use of bulking agents in comparison with other surgical approaches for either primary or recurrent treatment of female SUI. Three studies meeting the inclusion criteria were identified. Two of these studies were RCTs evaluating the use of bulking agents versus other surgical procedures for the treatment of primary female SUI; the remnant article was a retrospective cohort study that compared the effectiveness and safety of repeat midurethral sling with urethral bulking after failed midurethral sling. The combined results of all analyses showed that the objective recurrence rate of peri- or trans-urethral injections is significantly higher in comparison with the other surgical procedures. Similar findings were observed when considering separately the treatment for primary or recurrent SUI. Furthermore, lower subjective recurrence rate was observed among patients undergoing other surgical treatment in comparison with those undergoing bulking agents; however, this trend was not statistically significant. Moreover, patients undergoing injection of bulking agents experienced a lower rate of voiding dysfunctions in comparison to the control group. According to current evidence, bulking agents should not be proposed as first-line treatment in those women seeking permanent cure for both primary and recurrent SUI. However, the effectiveness of a procedure should be balanced with its invasiveness and patients' expectations. Bulking agents are a minimally invasive approach to treat SUI and their use should be considered as an alternative strategy particularly in special conditions: patients who are fragile, in those who do not wish to have surgery, or in whom surgical options are restricted (postoperatively, after irradiation). PMID:25855326

  10. A Systematic Review of Systematic Reviews and Panoramic Meta-Analysis: Staples versus Sutures for Surgical Procedures

    PubMed Central

    Hemming, Karla; Pinkney, Thomas; Futaba, Kay; Pennant, Mary; Morton, Dion G.; Lilford, Richard J.

    2013-01-01

    Objective To systematically evaluate the evidence across surgical specialties as to whether staples or sutures better improve patient and provider level outcomes. Design A systematic review of systematic reviews and panoramic meta-analysis of pooled estimates. Results Eleven systematic reviews, including 13,661 observations, met the inclusion criteria. In orthopaedic surgery sutures were found to be preferable, and for appendicial stump sutures were protective against both surgical site infection and post surgical complications. However, staples were protective against leak in ilecolic anastomosis. For all other surgery types the evidence was inconclusive with wider confidence intervals including the possibly of preferential outcomes for surgical site infection or post surgical complication for either staples or sutures. Whilst reviews showed substantial variation in mean differences in operating time (I2 94%) there was clear evidence of a reduction in average operating time across all surgery types. Few reviews reported on length of stay, but the three reviews that did (I2 0%, including 950 observations) showed a non significant reduction in length of stay, but showed evidence of publication bias (P-value for Egger test 0.05). Conclusions Evidence across surgical specialties indicates that wound closure with staples reduces the mean operating time. Despite including several thousand observations, no clear evidence of superiority emerged for either staples or sutures with respect to surgical site infection, post surgical complications, or length of stay. PMID:24116028

  11. IC Treatment: Surgical Procedures

    MedlinePLUS

    ... Study Boston Area Community Health (BACH) Survey ICA Pilot Research Program Funding Opportunities Clinical Trial Recruitment Urological ... Study Boston Area Community Health (BACH) Survey ICA Pilot Research Program Funding Opportunities Clinical Trial Recruitment Urological ...

  12. Mastectomy -- The Surgical Procedure

    MedlinePLUS Videos and Cool Tools

    ... Chemotherapy Hormone Therapies Targeted Therapies Neoadjuvant Therapies Precision Medicine Emerging Areas in Treatment Treatments by Breast Cancer ... Chemotherapy Hormone Therapies Targeted Therapies Neoadjuvant Therapies Precision Medicine Emerging Areas in Treatment Treatments by Breast Cancer ...

  13. IC Treatment: Surgical Procedures

    MedlinePLUS

    ... Management of IC Pain Complementary Therapies Complementary vs. Alternative Herbs, Dietary Supplements, & Biologicals Mind-body Medicine Massage, Manipulation, & Body-based Practices Energy Medicine Bringing Treatments to Market IC Healthcare Provider ...

  14. A surgical procedure for resecting the mouse rib: a model for large-scale long bone repair.

    PubMed

    Tripuraneni, Nikita; Srour, Marissa K; Funnell, John W; Thein, Thu Zan Tun; Mariani, Francesca V

    2015-01-01

    This protocol introduces researchers to a new model for large-scale bone repair utilizing the mouse rib. The procedure details the following: preparation of the animal for surgery, opening the thoracic body wall, exposing the desired rib from the surrounding intercostal muscles, excising the desired section of rib without inducing a pneumothorax, and closing the incisions. Compared to the bones of the appendicular skeleton, the ribs are highly accessible. In addition, no internal or external fixator is necessary since the adjacent ribs provide a natural fixation. The surgery uses commercially available supplies, is straightforward to learn, and well-tolerated by the animal. The procedure can be carried out with or without removing the surrounding periosteum, and therefore the contribution of the periosteum to repair can be assessed. Results indicate that if the periosteum is retained, robust repair occurs in 1 - 2 months. We expect that use of this protocol will stimulate research into rib repair and that the findings will facilitate the development of new ways to stimulate bone repair in other locations around the body. PMID:25651082

  15. Flooding the Surgical Field With Carbon Dioxide During Open Heart Surgery Improves Segmental Wall Motion

    PubMed Central

    Skidmore, Kimberly L.; Jones, Clinton; DeWet, Charl

    2006-01-01

    Abstract: Air embolization to the coronary arteries is a common cause of myocardial ischemia during open heart surgery. Carbon dioxide emboli may be absorbed faster than air emboli. In this randomized, double blind, placebo-controlled trial, we determined that flooding the surgical field with carbon dioxide is associated with improved myocardial function assessed by trans-esophageal echocardiography. Forty-three valve surgeries were randomized to insufflation of 6 L/min of carbon dioxide or placebo through a Jackson Pratt drain into the pericardium during cardiopulmonary bypass. During rewarming, as pulse pressure rose above 10 mmHg, two observers graded severity of bubbles in the left heart. Two other observers evaluated wall motion in the transgastric midpapillary short axis view of the left ventricle using transesophageal echocardiography. Compared with baseline average scores among all walls (carbon dioxide, 1.42 ± 0.46; placebo, 1.39 ± 0.45), worsening of wall motion was less at 1 minute in the carbon dioxide (1.60 ± 0.62) than in the placebo group (1.95 ± 0.54; p = 0.0266). Better wall motion tended to persist in the carbon dioxide group at 10 (1.58 ± 0.59 vs. 1.77 ± 0.6) and 60 minutes (1.61 ± 0.45 vs. 1.66 ± 0.58). Particularly, the inferior wall tended toward transiently better function in the carbon dioxide group (at baseline and 1, 10, and 60 minutes: placebo, 1.62 ± 0.72, 2.68 ± 0.79, 2.48 ± 0.95, 2.10 ± 0.9 vs. 1.88 ± 0.97, 2.33 ± 1.1, 2.18 ± 0.96, 2.20 ± 0.94). Preoperative characteristics, length of bypass, anesthesia time, hospitalization, and intensive care unit stay were not different. We recommend administration of carbon dioxide because it may improve myocardial function. We describe how to avoid adverse effects of giving carbon dioxide by filtering the supply, continuously managing its level during bypass, increasing sweep speeds, continuously analyzing the in-line blood gas, and avoiding suctioning gases in the field into the cardiotomy reservoir. PMID:16921684

  16. Assessment of the risk of haemorrhage and its control following minor oral surgical procedures in patients on anti-platelet therapy: a prospective study.

    PubMed

    Girotra, C; Padhye, M; Mandlik, G; Dabir, A; Gite, M; Dhonnar, R; Pandhi, V; Vandekar, M

    2014-01-01

    Controversy exists concerning the suspension or maintenance of anti-platelet drugs before elective surgical procedures. We assessed the association of the risk of prolonged postoperative bleeding with anti-platelet therapy by type of minor surgical procedure and the association between anti-platelet therapy and the level of hemostatic measures required. Five hundred and forty-six patients were included in the study group: those on aspirin (n = 310), clopidogrel (n = 97), and aspirin + clopidogrel dual therapy (n = 139); the control group comprised 575 healthy individuals. Cramer's V test was significant (P < 0.05) but showed a weak association between anti-platelet therapy and prolonged immediate postoperative bleeding. Compared to controls, the odds ratio revealed that the risk of prolonged bleeding in the immediate postoperative period was significantly higher with dual therapy, followed by clopidogrel and aspirin. Prolonged bleeding occurred in 22 patients in the study group and 20 in the control group, and was successfully controlled with local hemostatic measures. Fisher's exact test showed a significant association between dual therapy and higher levels of hemostatic measures (P = 0.004; P = 0.035). Prolonged bleeding in patients on anti-platelet therapy was independent of the type of minor surgical procedure. The greatest risk of prolonged bleeding was found in patients on dual therapy; this required higher levels of hemostatic measures. PMID:24074486

  17. Wound Edge Protectors in Open Abdominal Surgery to Reduce Surgical Site Infections: A Systematic Review and Meta-Analysis

    PubMed Central

    Mihaljevic, André L.; Müller, Tara C.; Kehl, Victoria; Friess, Helmut; Kleeff, Jörg

    2015-01-01

    Importance Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality. Objective To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections. Evidence Review A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted. Findings We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51–0.83; p = 0.0007; I2 = 52%). The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44–0.97; p = 0.04; I2 = 56%). Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15–0.55) than single-ring devices (risk ratio 0.71; 95%CI, 0.54–0.92), but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28–0.67; p = 0.0002, I2 = 23%) than in clean-contaminated surgeries (0.72, 95%CI, 0.57–0.91; p = 0.005; I2 = 46%) and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24–0.82; p = 0.001; I2 = 72%). Conclusions and Relevance Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to explore their effectiveness in different risk constellations. PMID:25816365

  18. Relation of Surgical Volume to Outcome in Eight Common Operations

    PubMed Central

    Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Hossain, Monir; Soybel, David; Kizer, Kenneth W.; Aust, J. Bradley; Bell, Richard H.; Chong, Vernon; Demakis, John; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick; Hammermeister, Karl; McDonald, Gerald; Passaro, Edward; Phillips, Lloyd; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

    1999-01-01

    Objective To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. Summary Background Data In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. Methods The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). Results Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. Conclusions In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care. PMID:10493488

  19. CLINICAL RESULTS WITH THE TRABECTOME, A NOVEL SURGICAL DEVICE FOR TREATMENT OF OPEN-ANGLE GLAUCOMA

    PubMed Central

    Minckler, Don; Baerveldt, George; Ramirez, Marina Alfaro; Mosaed, Sameh; Wilson, Richard; Shaarawy, Tarek; Zack, Barend; Dustin, Laurie; Francis, Brian

    2006-01-01

    Purpose To describe treatment outcomes after Trabectome surgery in an initial series of 101 patients with open-angle glaucoma. Methods A 19-gauge microelectrosurgical device enabled ab interno removal of a strip of trabecular meshwork and inner wall of Schlemm’s canal under gonioscopic control with continual infusion and foot-pedal control of aspiration and electrosurgery. A smooth, pointed ceramic-coated insulating footplate was inserted into Schlemm’s canal to act as a guide within the canal and to protect adjacent structures from mechanical or heat injury during ablation of a 30- to 90-degree arc of angle tissue. Results Mean preoperative intraocular pressure (IOP) in the initial 101 patients was 27.6 ± 7.2 mm Hg. Thirty months postoperatively, mean IOP was 16.3 ± 3.3 mm Hg (n = 11). The mean percentage drop over the whole course of follow-up was 40%. At all times postoperatively, the absolute and percent decrease in IOP from preoperative levels were statistically significant (paired t test, P < .0001). Overall success (IOP ? 21 mm Hg with or without medications and no subsequent surgery) was 84%. Nine eyes subsequently underwent trabeculectomy, two others had IOP greater than 21 mm Hg in spite of resuming topical medications, and the rest of the patients either refused to resume medications or were still in the 1-month postoperative period without medications (total failure rate including trabeculectomies, 16/101 = 16%). Intraoperative reflux bleeding occurred in 100% of cases. Complications have been minimal and not vision-threatening. Conclusions The Trabectome facilitates minimally invasive and effective glaucoma surgery, which spares the conjunctiva and does not preclude subsequent standard filtering procedures. PMID:17471324

  20. A follow-up study of cleft children treated with vomer flap as part of a three-stage soft tissue surgical procedure. Facial morphology and dental occlusion.

    PubMed

    Friede, H; Johanson, B

    1977-01-01

    The development of the face and jaws in cleft patients, treated with a three-stage surgical procedure including a single layer vomer flap, was studied by analysing cephalometric radiographs and dental casts. The material consisted of 13 patients with complete bilateral cleft lip and palate and 50 cases with complete unilateral cleft lip and palate, operated on 1964--1970. At the follow-up the average patient in both cleft categories demonstrated a maxillary retrognathia and in the unilateral cleft sample also a facial skeletal profile straighter than normal, though not as pronounced as we had found in cases where the vomer flap procedure was accompanied by bone grafting. However, the mean profile for the bilateral as well as the unilateral cleft group was straighter than reported for patients subjected to neither vomer flap nor bone grafting. The occlusal findings confirmed the maxillary growth retardation and similarly placed the present patients at a level between the results of the other two types of surgical regimes. As a side-effect cleft-bridging bone was formed in some part of the hard palate in every second case, though without importance for facial development. In an effort to reduce the restricted mid-facial growth found in the present patients, we have changed our surgical technique and since 1975 excluded the use of vomer flaps. PMID:333561

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

    MedlinePLUS

    ... the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off ... vessels. These cells can block arteries to the brain, causing a stroke. Family ... in the carotid artery in the neck, can lead to ischemic stroke. Plaque in the ...

  2. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    PubMed

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ? .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ? .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ? .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3 radical prostatectomy modalities. Preoperative prostate-specific antigen density and number of positive surgical margin foci were the only independent predictors of biochemical recurrence. PMID:21820147

  3. Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

    PubMed Central

    Sivasubramaniam, Vinothan; Patel, Hitesh C; Ozdemir, Baris A; Papadopoulos, Marios C

    2015-01-01

    Objectives Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Design Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends. Outcome measures Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100?000, respectively, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60–74 and ?75?years, respectively, and a 2.8-fold increase in procedures for those aged ?60?years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100?000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearson's correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100?000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group. PMID:26671956

  4. Outcomes of Traumatic Aortic Injury in a Primary Open Surgical Approach Paradigm

    PubMed Central

    Forcillo, Jessica; Philie, Michel; Ojanguren, Andrea; Le Guillan, Soazig; Verdant, Alain; Demers, Philippe; Lamarche, Yoan

    2015-01-01

    Background: Multiple classifications can be used to define the magnitude of aortic injury. The Vancouver Classification (VC) is a new and simplified computed tomography-based Blunt Aortic Injury (BAI) grading system correlating with clinical outcomes. Objectives: The objectives of this study are: 1) to describe the severity of aortic injury in a center with a predominantly surgical approach to BAI; 2) to correlate the severity of aortic trauma to hospital survival rate and rate of adverse events according to the type of interventions performed during the hospital stay; and 3) to evaluate VC. Patients and Methods: All patients referring to the Sacre-Coeur Hospital of Montreal between August 1998 and April 2011 for management of BAI were studied. Two radiologists reviewed all CT scan images individually and classified the aortic injuries using VC. Results: Among the 112 patients presenting with BAI, 39 cases had local CT scans available for reconstruction. Seven patients were identified as suffering from grade I injuries (flap or thrombus of less than 1 cm), 6 from grade II injuries (flap or thrombus of more than 1 cm), and 26 from grade III injuries (pseudoaneurysm). Among the patients with grade I injuries, 57% were treated surgically and 43% medically with a survival rate of 100%. Among the patients with grade II injuries (67% treated surgically and 33% treated medically) survival was also 100%. Among patients with grade III injuries (85% treated surgically, 7% had Thoracic Endovascular Aortic Repair (TEVAR) and 8% treated medically) survival was 95%, 95% and 50%, respectively. There were no significant differences between groups as to clinical outcome. Inter-rater reliability was 0.81. Conclusions: VC is easy to use and has low inter-observer variability. Low grades of injury were associated with low mortality related to medical treatment. PMID:26290856

  5. 21 CFR 878.4040 - Surgical apparel.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...surgical procedures to protect both the surgical patient and the operating room personnel from transfer of microorganisms, body fluids, and particulate material. Examples include surgical caps, hoods, masks, gowns, operating room shoes and...

  6. Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma

    PubMed Central

    Kudo, Yohei; Maeda, Michihiro; Tochiki, Aito; Ichimura, Haruto; Uesugi, Masafumi; Jikuya, Tomoaki

    2015-01-01

    Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuum-assisted closure therapy was used to prevent graft infection. Surgical bypasses using saphenous veins are approved treatments for arterial occlusions from blunt trauma if the grafts go through contaminated wounds. PMID:26421079

  7. Open Surgical Bypass for Superficial Femoral Artery Occlusion Caused by Blunt Trauma.

    PubMed

    Ikeda, Akihiko; Kudo, Yohei; Maeda, Michihiro; Tochiki, Aito; Ichimura, Haruto; Uesugi, Masafumi; Jikuya, Tomoaki

    2015-01-01

    Blunt vascular trauma of the lower extremities brings about a high amputation rate, because other organ injuries disturb revascularization. We experienced a case of a superficial femoral artery occlusion caused by blunt trauma. The patient also had a femoral bone fracture and a large skin defect with deep muscular injuries of the thigh. We performed a femoropopliteal (FP) bypass using a saphenous vein which was routed through the contaminated wound. Postoperative vacuum-assisted closure therapy was used to prevent graft infection. Surgical bypasses using saphenous veins are approved treatments for arterial occlusions from blunt trauma if the grafts go through contaminated wounds. PMID:26421079

  8. 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.

  9. Surgical Treatment of Perianal Fistulizing Crohn's Disease: From Lay-Open to Cell-Based Therapy—An Overview

    PubMed Central

    2014-01-01

    Background. Perianal Crohn's disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons. PMID:25431776

  10. Using Surgical Microscope for Sclera Buckling and Transscleral Cryopexy: An Alternative Procedure of Treatment for Rhegmatogenous Retinal Detachment

    PubMed Central

    Zhong, Liu-xue-ying; Liu, Wen; Huang, Su-Ying; Zhang, Shao-chong

    2014-01-01

    Purpose. To observe the long-term effectiveness of scleral buckling and transscleral cryopexy conducted under a surgical microscope in the treatment of uncomplicated rhegmatogenous retinal detachment. Methods. This was a retrospective analysis in a total of 227 consecutive patients (244 eyes) with uncomplicated rhegmatogenous retinal detachment (proliferative vitreoretinopathy ? C2). All patients underwent scleral buckling and transscleral cryopexy under a surgical microscope without using a binocular indirect ophthalmoscope or a contact lens. Results. After initial surgery, complete retinal reattachment was achieved in 226 eyes (92.6%), and retinal redetachment developed in 18 eyes (7.4%). The causes of retinal redetachment included presence of new breaks in eight eyes (44%), failure to completely seal the breaks in five eyes (28%), missed retinal breaks in four eyes (22%), and iatrogenic retinal breaks in one eye (6%). Scleral buckling surgery was performed again in 12 eyes (66%). Four eyes (22%) developed proliferative vitreoretinopathy and then were treated by vitrectomy. The sealing of retinal breaks and complete retinal reattachment were achieved in 241 eyes (98.8%). Conclusion. Probably because of clear visualization of retinal breaks and being controllable under a surgical microscope, the microsurgery of scleral buckling and transscleral cryopexy for uncomplicated retinal detachment exhibits advisable effectiveness. PMID:24790997

  11. 78 FR 24347 - Approval and Promulgation of Implementation Plans; Oregon: Open Burning and Enforcement Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-25

    ...The EPA is approving State Implementation Plan (SIP) revisions submitted by the State of Oregon on February 16, 2001, July 14, 2005, August 28, 2006, and May 20, 2008 that relate to open burning rules, enforcement procedures, civil penalties, and procedures in contested cases (appeals). These revisions were made to the Oregon Administrative Rules (OAR) Chapter 340, Division 264 (OAR 340-264),......

  12. 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

  13. A simple sheath removal after open trans-femoral catheterization procedure: the ZIP technique.

    PubMed

    Du Cailar, Claude; Gandet, Thomas; Du Cailar, Marie; Albat, Bernard

    2014-04-01

    The ZIP technique, a surgical equivalent of the 'Preclose' technique, useful for transcatheter aortic valve implantation or endovascular aortic aneurysm repair is described. While percutaneous closure devices are expensive, need a long learning curve and are associated with primary failure, the ZIP technique is easy and allows a quick, safe and anatomical closure of the artery. This procedure avoids arterial cross-clamping and no purse-string effect was demonstrated using Doppler ultrasound examination. PMID:23886993

  14. Simultaneous colorectal and hepatic procedures for colorectal cancer result in increased morbidity but equivalent mortality compared with colorectal or hepatic procedures alone: outcomes from the National Surgical Quality Improvement Program

    PubMed Central

    Hamed, Osama H; Bhayani, Neil H; Ortenzi, Gail; Kaifi, Jussuf T; Kimchi, Eric T; Staveley-O'Carroll, Kevin F; Gusani, Niraj J

    2013-01-01

    Background: Simultaneous colorectal and hepatic surgery for colorectal cancer (CRC) is increasing as surgery becomes safer and less invasive. There is controversy regarding the morbidity associated with simultaneous, compared with separate or staged, resections. Methods: Data for 2005–2008 from the National Surgical Quality Improvement Program (NSQIP) were used to compare morbidity after 19?925 colorectal procedures for CRC (CR group), 2295 hepatic resections for metastatic CRC (HEP group), and 314 simultaneous colorectal and hepatic resections (SIM group). Results: An increasing number of simultaneous resections were performed per year. Fewer major colorectal and liver resections were performed in the SIM than in the CR and HEP groups. Patients in the SIM group had a longer operative time and postoperative length of stay compared with those in either the CR or HEP groups. Simultaneous procedures resulted in higher rates of postoperative morbidity and major morbidity than CR procedures, but not HEP procedures. This difference was driven by higher rates of wound and organ space infections, and a greater incidence of septic shock. Mortality rates did not differ among the groups. Conclusions: Hospitals in the NSQIP are performing more simultaneous colonic and hepatic resections for CRC. These procedures are associated with increases in operative time, length of stay and rate of perioperative complications. Simultaneous procedures do not, however, increase perioperative mortality. PMID:23458152

  15. Guide to Surgical Specialists

    MedlinePLUS

    ... also deal with the liver, urinary, and female reproductive systems if they are involved with primary intestinal disease. ... focus for this specialty is on the female reproductive system, including performing surgical procedures, managing the care of ...

  16. Surgical Technologists

    MedlinePLUS

    ... site or suture a wound. <- Summary Work Environment -> Work Environment About this section Surgical technologists are trained ... communicable diseases and unpleasant sights, odors, and materials. Work Schedules Most surgical technologists work full time. Surgical ...

  17. Preventing Surgical Site Infections: A Randomized, Open-label Trial of Nasal Mupirocin Ointment and Nasal Povidone Iodine Solution

    PubMed Central

    Phillips, Michael; Rosenberg, A.; Shopsin, B.; Cuff, G.; Skeete, F.; Foti, A.; Kraemer, K.; Inglima, K.; Press, B.; Bosco, J.

    2015-01-01

    Background Treatment of Staphylococcus aureus colonization prior to surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone iodine solution may provide an alternative to mupirocin. Methods We conducted an investigator initiated, open label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical 2% chlorhexidine gluconate (CHG) wipes with either twice daily application of mupirocin 2% ointment for the 5 days prior to surgery or two 30 second applications of povidone iodine 5% solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery caused by any pathogen or S. aureus. Results In the intent-to-treat analysis, a deep SSI developed after 14 of 855 surgeries in the mupirocin group and 6 of 842 surgeries in the povidone iodine group; S. aureus deep SSI developed after 5 surgeries in the mupirocin group and 1 surgery in the povidone iodine group. In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgeries in the mupirocin group and 0 of 776 surgeries in the povidone iodine group. Patients found to be S. aureus colonized before surgery were more likely to have a S. aureus deep SSI (OR 6.79; 95% CI 1.1–41.2; p=0.02). Conclusions Nasal povidone iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI. PMID:24915210

  18. 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

  19. Management of residual mucogingival defect resulting from the excision of recurrent peripheral ossifying fibroma by periodontal plastic surgical procedure

    PubMed Central

    Salaria, Sanjeev Kumar; Gupta, Neha; Bhatia, Vineet; Nayar, Amit

    2015-01-01

    Peripheral ossifying fibroma (POF) is a local gingival reactive lesion, thought to be originating from the superficial periodontal ligament. It is found most often in the anterior maxilla with predilection for females and high recurrence rate. Clinically, the lesion is observed in gingiva or interdental papilla and manifested either as sessile or pedunculated mass which may appear ulcerated or erythematous or exhibit no color difference from the adjacent healthy gingival tissue. The present case report describes the diagnosis, treatment of POF, and immediate management of residual functional and cosmetic mucogingival defect which originated as a sequel of excisional biopsy of recurrent POF by utilizing modification of Grupe and Warren technique (modified laterally displaced flap). Clinical healing was uneventful at 2 weeks, and excellent coverage of residual mucogingival defect without any evidence of recession and or recurrence of POF was observed at surgical site 9 months postoperatively. PMID:26604587

  20. "The opening of the mouth"--a new perspective for an ancient Egyptian mummification procedure.

    PubMed

    Seiler, Roger; Rühli, Frank

    2015-06-01

    "The opening of the mouth ritual" (OMR) is a central and well-documented component of the Ancient Egyptian mortuary ceremony. In the scientific literature, we find various references that indicate that parts of this ritual correspond to physical opening of the deceased's mouth during its mummification. We denote this physical treatment of the dead the "opening of the mouth procedure," to underline the distinction against the "opening of the mouth ritual," which is performed ceremonially later on the mummy or even the statue. The mummifying procedure itself however is known only from rare pictorial representations and the later summary descriptions of Greek authors. Nevertheless, recently some authors tried, on the basis of paleopathological findings, to demonstrate that the mouth of the deceased had to be opened physically before mummifying. Careful examination of the mummies of the Swiss Mummy Project and other cases reported in the literature showed frequent dental pathologies including fractured and totally luxated teeth, which were up to now not sufficiently taken into consideration. The detailed report of the preliminary procedures of mummifying the Apis bull-as appropriate detailed descriptions for humans are missing-gives us insight into the treatment of the oral cavity. Our results, when combined with the available historical literature, indicate that the OMR can be regarded as a ritualized counterpart of a real "opening of mouth procedure" during mummification. PMID:25998653

  1. Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration.

    PubMed

    Kawamoto, Ai; Katori, Yukio; Honkura, Yohei; Kakuta, Risako; Higashi, Kenjiro; Ogura, Masaki; Miyazaki, Makiko; Arakawa, Kazuya; Kashima, Kazutaka; Asada, Yukinori; Matsuura, Kazuto

    2014-05-01

    A novel narrow-field laryngectomy procedure known as central-part laryngectomy (CPL) for less invasive laryngeal diversion in patients with intractable aspiration is introduced. We conducted retrospective case reviews of 15 patients who underwent CPL. In this procedure, an area of the glottis including the mid-part of the thyroid cartilage and cricoid cartilage is removed to separate the digestive tract from the air way. The lateral part of the thyroid cartilage, the entire hypopharyngeal mucosa and epiglottis are preserved. The superior laryngeal vessels and nerve are not invaded. All fifteen patients were relieved of aspiration without major complications. In good accordance with cutting of the cricopharyngeal muscles and removal of the cricoid cartilage, postoperative videofluoroscopy demonstrated smooth passages of barium. Ten of 12 patients who had hoped to resume oral food intake became able to do so after CPL and two others also achieved partial oral deglutition. CPL is a useful procedure for treatment of intractable aspiration and offers considerable advantages over other laryngotracheal diversion procedures from the view point of oral food intake. PMID:24136476

  2. 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

  3. Management of localized gingival recession by two-stage surgical procedure - Double pedicle flap with CTG and coronally advanced flap: A novel technique

    PubMed Central

    Prasanth, T.

    2009-01-01

    Cosmetic treatments have become an integral part of periodontal treatment. One of the commonly used esthetic periodontal procedures is coverage of denuded root surface. While considering the elimination of these defects two criteria should be considered, the esthetic aspects and the functional aspects. This case report has describes a two stage surgical technique using double pedicle flap with connective tissue graft followed by coronally advanced flap for the treatment of a severe localized gingival recession measuring 15 mm. The recession measurement at the end of 12 months was 1 mm. It showed a predictable result at the end of one year. The advantages of this technique are excellent colour matching, dual blood supply to graft and very predictable results. The promising result suggest that this technique can be used in severe gingival recession cases with minimum amount of keratinized tissue. PMID:20376241

  4. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ? 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ? 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  5. 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

  6. Impact of the Biliary Diversion Procedure on Carcinogenesis in Barrett's Esophagus Surgically Induced by Duodenoesophageal Reflux in Rats

    PubMed Central

    Nishijima, Koji; Miwa, Koichi; Miyashita, Tomoharu; Kinami, Shinichi; Ninomiya, Itasu; Fushida, Sachio; Fujimura, Takashi; Hattori, Takanori

    2004-01-01

    Objective: To determine whether the elimination of bile reflux in the established esophagojejunostomy model of Barrett's esophagus (BE) will reduce or eliminate the risk of developing esophageal adenocarcinoma. Summary Background Data: Reflux of duodenal juice as well as gastric acid plays an important role in the pathogenesis of BE and adenocarcinoma. Duodenoesophageal reflux (DER) per se induces these diseases without carcinogen. However, it is unclear whether antireflux surgery induces regression of BE and prevents adenocarcinoma. Methods: Two hundred F344 male rats underwent one of following 3 operations: (1) total gastrectomy and esophagojejunostomy to induce DER, followed by killing after 20 (n = 13), 30 (n = 12), and 50 weeks (n = 30); (2) biliary diversion procedure, converted to Roux-en-Y method, to avoid bile regurgitation into the esophagus at 20 (n = 29) and 30 weeks (n = 32) after the operation to induce DER, followed by killing 50 weeks after initial operation; or (3) total gastrectomy and Roux-en-Y esophagojejunostomy followed by killing after 50 weeks served as controls (n = 28). Results: BE developed in more than half of the animals exposed to DER for 20 weeks, in more than 90% of rats with DER for 30 weeks, and in 100% of animals exposed to DER for 50 weeks. In the incidence and the length of BE, there is no difference between the animals that underwent biliary diversion at 20 (62%) and 30 weeks (94%) and those that had DER for 20 (54%) and 30 weeks (92%), respectively. Incidence of adenocarcinoma was significantly lower in the rats that underwent the biliary diversion procedure after 30 (19%) and 20 weeks (3%) than in the rats that had DER for 50 weeks (60%) (P < 0.005). None of the control animals that underwent Roux-en-Y esophagojejunostomy developed BE and carcinoma. Conclusions: It is likely that the converting procedure from the esophagojejunostomy to induce DER to biliary diversion does not lead to regression of BE but prevents the development of esophageal adenocarcinoma in the rats. PMID:15213619

  7. Time Savings and Surgery Task Load Reduction in Open Intraperitoneal Onlay Mesh Fixation Procedure

    PubMed Central

    Roy, Sanjoy; Hammond, Jeffrey; Panish, Jessica; Shnoda, Pullen; Savidge, Sandy; Wilson, Mark

    2015-01-01

    Background. This study assessed the reduction in surgeon stress associated with savings in procedure time for mechanical fixation of an intraperitoneal onlay mesh (IPOM) compared to a traditional suture fixation in open ventral hernia repair. Study Design. Nine general surgeons performed 36 open IPOM fixation procedures in porcine model. Each surgeon conducted two mechanical (using ETHICON SECURESTRAPTM Open) and two suture fixation procedures. Fixation time was measured using a stopwatch, and related surgeon stress was assessed using the validated SURG-TLX questionnaire. T-tests were used to compare between-group differences, and a two-sided 95% confidence interval for the difference in stress levels was established using nonparametric methodology. Results. The mechanical fixation group demonstrated an 89.1% mean reduction in fixation time, as compared to the suture group (p < 0.00001). Surgeon stress scores measured using SURG-TLX were 55.5% lower in the mechanical compared to the suture fixation group (p < 0.001). Scores in five of the six sources of stress were significantly lower for mechanical fixation. Conclusions. Mechanical fixation with ETHICON SECURESTRAPTM Open demonstrated a significant reduction in fixation time and surgeon stress, which may translate into improved operating efficiency, improved performance, improved surgeon quality of life, and reduced overall costs of the procedure. PMID:26240834

  8. Comparative clinical study of the effect of LLLT in the immediate and late treatments of hypoesthesia due to surgical procedures

    NASA Astrophysics Data System (ADS)

    Ladalardo, Thereza C.; Brugnera, Aldo, Jr.; Pinheiro, Antonio L. B.; Castanho Garrini, Ana E.; Bologna, Elisangela D.; Takamoto, Marcia; Siqueira, Jose T.; Dias, Pedro; Campos, Roberto A. d. C.

    2002-06-01

    We evaluated the effect of LLLT in 68 patients who presented hypoesthesia due to odontological surgery procedures: dental implant surgeries (N=51); extraction of impacted lower third molars (N=10); endodontics in lower first molars (N=7). Lesions treated within 30 days after the nerve injury had occurred were part of the immediate group, and lesions with more than 30 days from the occurrence of the injury were part of the late group. Treatments were carried out with an infrared diode laser of 40 mW-830nm, continuous wave emission, spot size 3 mm2, and a total dosage of 18 joules per session in a contact mode of application, 20 sessions altogether. The efficacy of laser therapy in peripheral nerve regeneration is also related to the degree of the peripheral nerve lesion, and not only to the lesion duration. LLLT resulted in neurosensory functional improvement in both immediate and late treatments of hypoesthesia.

  9. Open-label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of post-operative surgical wounds.

    PubMed

    Arroyo, Ana Abejón; Casanova, Pabló López; Soriano, José Verdú; Torra I Bou, Joan-Enric

    2015-06-01

    Surgical site infection (SSI) is a common postoperative complication and can cause avoidable morbidity and excessive costs for the health service. Novel dressings, designed specifically for postoperative wounds, can help to reduce the risk of SSI and other complications such as blistering. This study compared the use of a new polyurethane film surgical dressing (Opsite Post-Op Visible, Smith & Nephew, Hull, UK) with gauze and tape in the management of postoperative wounds. The results show that the polyurethane film dressing results in a significant reduction in SSI (1·4% versus 6·6%, P = 0·006) as well as a reduction in other postoperative wound complications (e.g. blistering and erythema). Economic analysis conducted alongside the study suggests that these improved outcomes can be achieved at a lower treatment cost than gauze and tape dressings. The modest incremental cost of the polyurethane film surgical dressing is easily offset by the reduction in the costs related to treating SSI and other wound complications associated with gauze and tape dressings. PMID:23742125

  10. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  11. Laying open (deroofing) and curettage under local anesthesia for pilonidal disease: An outpatient procedure

    PubMed Central

    Garg, Pankaj; Garg, Mahak; Gupta, Vikas; Mehta, Sudhir Kumar; Lakhtaria, Paryush

    2015-01-01

    AIM: To test the efficacy of lay open (deroofing, not excision) with curettage under local anesthesia (LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate. RESULTS: Thirty-three (M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo (6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty (93.8%) patients had complete resolution of the disease and two (6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%. CONCLUSION: Lay open (deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate (up to 97%), doesn’t require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease. PMID:26425271

  12. Surgically inverting an incidentally detected Meckel's diverticulum – Wrong method

    PubMed Central

    Shah, Ketul; Khiria, Lakhsman; Desai, Premal; Vora, Hasmukh; Bhavsar, Mehendra

    2014-01-01

    INTRODUCTION Intusussception leading to intestinal obstruction is a known complication of Meckel's diverticulum. Inverting of Meckel's acts as a lead point for intussusception. Causes of inversion are many but surgical inversion leading to intusussception is extremely rare. PRESENTATION OF CASE We hereby report a case of a 14 year adolescent boy operated previously for open appendicetomy presenting to us with intestinal obstruction who on exploration was found to have an surgically inverted Meckel's diverticulum acting as a lead point for ileo-colic intusussception. DISCUSSION To the best of our knowledge, surgically inverting any Meckel's diverticulum is never a treatment option even when the diverticulum is incidentally detected. Diverticulectomy or segmental resection is the procedure of choice for Meckel's diverticulum. CONCLUSION Meckel's divereticulum should never be inverted surgically. Not only it is a wrong method but also increases the risk of complications. PMID:25560057

  13. Surgical Risks Associated with Winter Sport Tourism

    PubMed Central

    Sanchez, Stéphane; Payet, Cécile; Lifante, Jean-Christophe; Polazzi, Stéphanie; Chollet, François; Carty, Matthew J; Duclos, Antoine

    2015-01-01

    Background Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context. Methods We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics. Results A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists’ influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716). Conclusion Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies. PMID:25970625

  14. A lagged implicit segregated data reconstruction procedure to treat open boundaries

    NASA Astrophysics Data System (ADS)

    Sani, M.; Saidi, M. S.

    2010-08-01

    The problem of treating open boundaries is still a challenging one. Applying fully developed condition is constrained to long enough domains. Without having enough physical evidence about what happens on boundaries, the domain extent could not be shortened and computational costs could not be reduced. From the advent of free (open) boundary conditions, they were confined to mixed finite element procedures. Recent works have extended their application to coupled finite volume solvers based on the shape function data reconstruction. A wider class of flow solvers available, however, rely on the segregated procedure where the velocity components and pressure are solved in succession. Moreover, many finite volume algorithms do not use the shape function reconstruction. In this work, by proposing a lagged implicit procedure, we have extended the application of the open boundary condition to these wider classes of flow solvers. The proposed extension is a combination of lagged implicit data reconstruction and overall mass conservation enforcement, which is easily applicable to any segregated and coupled flow solver. To validate the compatibility of this extension, benchmark problem of backward facing step is solved on successively truncated domains, where open boundary may pass through recirculation zones. Results show that the proposed extension works fine. For that problem, it reduced the computational domain length (and hence memory) by a factor of 4.6 and the required computational time by a factor of 21. Flow passing a cylinder is also solved which proves that the method could be applied to external flow problems as well.

  15. In Situ and Home Care Nasopharyngeal Intubation Improves Respiratory Condition and Prevents Surgical Procedures in Early Infancy of Severe Cases of Robin Sequence

    PubMed Central

    Drago Marquezini Salmen, Isabel Cristina; Lazarini Marques, Ilza

    2015-01-01

    Aim. To evaluate the clinical outcome of infants with Robin Sequence (RS) and severe respiratory obstruction managed with nasopharyngeal intubation (NPI). Methods. This prospective study was conducted with 107 infants with RS admitted to the Hospital for Craniofacial Anomalies of the University of São Paulo (HRAC-USP), from July 2003 to June 2010, diagnosed with severe RS and treated with NPI. The infants were followed up for the first year of life. Clinical findings, morbidity, and mortality were recorded. Results. Of the 223 infants with RS admitted to the hospital in the period studied, 149 were diagnosed with severe respiratory distress and 107 (71.81%) matched all the inclusion criteria. Of those, 78 (73%) presented Isolated Robin Sequence and 29 (27%) presented other syndromes or anomalies associated with RS. NPI treatment lasted an average of 57 days and the mean hospitalization time was 18 days. Although all infants presented feeding difficulties, 85% were fed orally and only 15% underwent gastrostomy. Morbidity was 14% and no deaths occurred. Conclusions. The children treated with the RS treatment protocol adopted at the HRAC-USP had improved respiratory and feeding difficulties, required a shorter hospitalization time, and presented low morbidity and mortality during the first year of life. The general outcome prevented surgical procedures in early infancy. PMID:26273635

  16. Surgical wound care - open

    MedlinePLUS

    ... off dry. Put the old dressing in a plastic bag and set it aside. Clean your hands again ... dressing and other used supplies in a waterproof plastic bag. Close it tightly, then double it before putting ...

  17. 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

  18. Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique.

    PubMed

    Marchini, Giovanni Scala; Torricelli, Fábio César Miranda; Mazzucchi, Eduardo; Srougi, Miguel; Monga, Manoj

    2015-01-01

    The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy, cystolithopaxy, rigid or flexible ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy, open surgery, and a combination of those methods. In this study we describe the management of severe forgotten encrusted ureteral stents in 3 female patients using a prone split-leg position. This position allows us to effectively treat any site and degree of stent encrustation in a single-session approach with the patient in the same position during the whole procedure. All patients were rendered stent and stone free. No complications occurred. PMID:26279723

  19. Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

    PubMed Central

    Marchini, Giovanni Scala; Torricelli, Fábio César Miranda; Mazzucchi, Eduardo; Srougi, Miguel; Monga, Manoj

    2015-01-01

    The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy, cystolithopaxy, rigid or flexible ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy, open surgery, and a combination of those methods. In this study we describe the management of severe forgotten encrusted ureteral stents in 3 female patients using a prone split-leg position. This position allows us to effectively treat any site and degree of stent encrustation in a single-session approach with the patient in the same position during the whole procedure. All patients were rendered stent and stone free. No complications occurred. PMID:26279723

  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. Minimally invasive procedures.

    PubMed

    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; Zarogoulidis, Paul

    2015-03-01

    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

  2. Surgical Procedures for Vestibular Dysfunction

    MedlinePLUS

    ... using only the opposite ear to maintain balance. Chemical labyrinthectomy A chemical labyrinthectomy is also known as transtympanic or intratympanic ... ear by filling the scala tympani with a chemical solution. Click here to download the "Surgery for ...

  3. 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 ... M. Intravenous anesthetics. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

  4. Combined Lacrimal Passage Probing and Tobramycin/Dexamethasone Ophthalmic Ointment Infiltration: A Minimally Invasive Surgical Procedure for Incomplete Nasolacrimal Duct Obstruction.

    PubMed

    Xu, Jianjiang; Hong, Jiaxu; Sun, Xinghuai; Liu, Zuguo; Mashaghi, Alireza; Inomata, Takenori; Lu, Yi; Li, Yimin; Wu, Dan; Yang, Yujing; Wei, Anji; Zhao, Yujin; Lu, Chun

    2015-09-01

    The optimal treatment strategy for an incomplete nasolacrimal duct obstruction (INDO) is still being debated. The aim of this study is to evaluate the treatment results of combined lacrimal passage probing and tobramycin/dexamethasone ophthalmic ointment infiltration (PIO, Probing and Injection) for INDO.In this retrospective, noncomparative case series, 397 consecutive adult patients with INDO treated at Shanghai Eye, Ear, Nose and Throat Hospital were enrolled. Records of the patients were reviewed. With the help of a modified 23-gauge lacrimal cannula, the PIO surgery was performed for the INDO-identified patients. The main outcome measures were resolution of tearing and complications. The relationship between successful outcome and clinical characteristics was analyzed.The surgery was performed successfully in all of the enrolled cases. No intraoperative complications were found in the procedure. The average follow-up time was 7.9 months. Three hundred patients (75.6%) experienced complete resolution of their symptoms after the surgery. Ninety-seven patients (24.4%) showed a partial improvement (1.8%), no improvement (18.4%), or a worsening of symptoms (4.3%). Of the 97 surgical-failure patients, 90 required silicone intubation or external dacryocystorhinostomy, and 94% were finally resolved. The most common postoperative complications were mild nasal bleeding in 41 patients, drug residues in 12 patients (6 developed the complete obstruction), and a slit punctum in 8 patients. Multivariate logistic regression analysis revealed that unilateral eye onset, not having a discharge at baseline, and not having postoperative drug residues were significant factors determining successful outcome.The PIO surgery is an effective, safe, timesaving, easy-to-perform, and minimally invasive technique for treating INDO. PMID:26356711

  5. 78 FR 24347 - Approval and Promulgation of Implementation Plans; Oregon: Open Burning and Enforcement Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-25

    ...burning rules, enforcement procedures, civil penalties, and procedures...burning rules, enforcement procedures, civil penalties, and procedures...submittals relate to enforcement procedures, civil penalties, and...

  6. [Robotic surgery -- the modern surgical treatment of prostate cancer].

    PubMed

    Szabó, Ferenc János; Alexander, de la Taille

    2014-09-01

    Minimally invasive laparoscopic surgery replaces many open surgery procedures in urology due to its advantages concerning post-operative morbidity. However, the technical challenges and need of learning have limited the application of this method to the work of highly qualified surgeons. The introduction of da Vinci surgical system has offered important technical advantages compared to the laparoscopic surgical procedure. Robot-assisted radical prostatectomy became a largely accepted procedure. It has paved the way for urologists to start other, more complex operations, decreasing this way the operative morbidity. The purpose of this article is to overview the history of robotic surgery, its current and future states in the treatment of the cancer. We present our robot-assisted radical prostatectomy and the results. PMID:25260081

  7. [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

  8. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Mixed Open Biological Treatment Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS..., App. E Appendix E to Part 63—Monitoring Procedure for Nonthoroughly Mixed Open Biological...

  9. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Mixed Open Biological Treatment Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS..., App. E Appendix E to Part 63—Monitoring Procedure for Nonthoroughly Mixed Open Biological...

  10. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Mixed Open Biological Treatment Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS..., App. E Appendix E to Part 63—Monitoring Procedure for Nonthoroughly Mixed Open Biological...

  11. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Mixed Open Biological Treatment Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS..., App. E Appendix E to Part 63—Monitoring Procedure for Nonthoroughly Mixed Open Biological...

  12. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Mixed Open Biological Treatment Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS..., App. E Appendix E to Part 63—Monitoring Procedure for Nonthoroughly Mixed Open Biological...

  13. Deriving DICOM surgical extensions from surgical workflows

    NASA Astrophysics Data System (ADS)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  14. Rationale, scope, and 20-year experience of vascular surgical training with lifelike pulsatile flow models.

    PubMed

    Eckstein, Hans-Henning; Schmidli, Jürg; Schumacher, Hardy; Gürke, Lorenz; Klemm, Klaus; Duschek, Nikolaus; Meile, Toni; Assadian, Afshin

    2013-05-01

    Vascular surgical training currently has to cope with various challenges, including restrictions on work hours, significant reduction of open surgical training cases in many countries, an increasing diversity of open and endovascular procedures, and distinct expectations by trainees. Even more important, patients and the public no longer accept a "learning by doing" training philosophy that leaves the learning curve on the patient's side. The Vascular International (VI) Foundation and School aims to overcome these obstacles by training conventional vascular and endovascular techniques before they are applied on patients. To achieve largely realistic training conditions, lifelike pulsatile models with exchangeable synthetic arterial inlays were created to practice carotid endarterectomy and patch plasty, open abdominal aortic aneurysm surgery, and peripheral bypass surgery, as well as for endovascular procedures, including endovascular aneurysm repair, thoracic endovascular aortic repair, peripheral balloon dilatation, and stenting. All models are equipped with a small pressure pump inside to create pulsatile flow conditions with variable peak pressures of ~90 mm Hg. The VI course schedule consists of a series of 2-hour modules teaching different open or endovascular procedures step-by-step in a standardized fashion. Trainees practice in pairs with continuous supervision and intensive advice provided by highly experienced vascular surgical trainers (trainer-to-trainee ratio is 1:4). Several evaluations of these courses show that tutor-assisted training on lifelike models in an educational-centered and motivated environment is associated with a significant increase of general and specific vascular surgical technical competence within a short period of time. Future studies should evaluate whether these benefits positively influence the future learning curve of vascular surgical trainees and clarify to what extent sophisticated models are useful to assess the level of technical skills of vascular surgical residents at national or international board examinations. This article gives an overview of our experiences of >20 years of practical training of beginners and advanced vascular surgeons using lifelike pulsatile vascular surgical training models. PMID:23601597

  15. Risk Factors for Survival following Open Surgical Repair of Ruptured Abdominal Aortic Aneurysms: A 13-Year Experience

    PubMed Central

    Ozen, Anil; Hanedan, Muhammet Onur; Songur, Çetin Murat; Boysan, Emre; Unal, Ertekin Utku; Mola, Serkan; Erkengel, Halil Ibrahim; Kubat, Emre; Iscan, Zafer; Tutun, Ufuk; Sar?tas, Ahmet; Birincioglu, Cemal Levent

    2015-01-01

    Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs.

  16. Are the surgeon's movements repeatable? An analysis of the feasibility and expediency of implementing support procedures guiding the surgical tools and increasing motion accuracy during the performance of stereotypical movements by the surgeon

    PubMed Central

    Pods?dkowski, Leszek Robert; Moll, Jacek; Moll, Maciej

    2014-01-01

    The developments in surgical robotics suggest that it will be possible to entrust surgical robots with a wider range of tasks. So far, it has not been possible to automate the surgery procedures related to soft tissue. Thus, the objective of the conducted studies was to confirm the hypothesis that the surgery telemanipulator can be equipped with certain routines supporting the surgeon in leading the surgical tools and increasing motion accuracy during stereotypical movements. As the first step in facilitating the surgery, an algorithm will be developed which will concurrently provide automation and allow the surgeon to maintain full control over the slave robot. The algorithm will assist the surgeon in performing typical movement sequences. This kind of support must, however, be preceded by determining the reference points for accurately defining the position of the stitched tissue. It is in relation to these points that the tool's trajectory will be created, along which the master manipulator will guide the surgeon's hand. The paper presents the first stage, concerning the selection of movements for which the support algorithm will be used. The work also contains an analysis of surgical movement repeatability. The suturing movement was investigated in detail by experimental research in order to determine motion repeatability and verify the position of the stitched tissue. Tool trajectory was determined by a motion capture stereovision system. The study has demonstrated that the suturing movement could be considered as repeatable; however, the trajectories performed by different surgeons exhibit some individual characteristics. PMID:26336404

  17. A qualitative analysis of health professionals’ job descriptions for surgical service delivery in Uganda

    PubMed Central

    2014-01-01

    Background The ever increasing demand for surgical services in sub-Saharan Africa is creating a need to increase the number of health workers able to provide surgical care. This calls for the optimisation of all available human resources to provide universal access to essential and emergency surgical services. One way of optimising already scarce human resources for health is by clarifying job descriptions to guide the scope of practice, measuring rewards/benefits for the health workers providing surgical care, and informing education and training for health professionals. This study set out to determine the scope of the mandate to perform surgical procedures in current job descriptions of surgical care health professionals in Uganda. Methods A document review was conducted of job descriptions for the health professionals responsible for surgical service delivery in the Ugandan Health care system. The job descriptions were extracted and subjected to a qualitative content data analysis approach using a text based RQDA package of the open source R statistical computing software. Results It was observed that there was no explicit mention of assignment of delivery of surgical services to a particular cadre. Instead the bulk of direct patient related care, including surgical attention, was assigned to the lower cadres, in particular the medical officer. Senior cadres were assigned to perform predominantly advisory and managerial roles in the health care system. In addition, a no cost opportunity to task shift surgical service delivery to the senior clinical officers was identified. Conclusions There is a need to specifically assign the mandate to provide surgical care tasks, according to degree of complexity, to adequately trained cadres of health workers. Health professionals’ current job descriptions are not explicit, and therefore do not adequately support proper training, deployment, defined scope of practice, and remuneration for equitable surgical service delivery in Uganda. Such deliberate assignment of mandates will provide a means of increasing surgical service delivery through further optimisation of the available human resources for health. PMID:25859744

  18. Surgical Assisting

    MedlinePLUS

    ... years Military medical training with surgical assistant experience Proof of liability insurance Current CPR/BLS certification Acceptable ... literacy Students also must be able to show proof of successful completion of basic science (college level) ...

  19. Surgical Mesh

    MedlinePLUS

    ... Device Safety Safety Communications Surgical Mesh: FDA Safety Communication Share Tweet Linkedin Pin it More sharing options ... Prolapse and Stress Urinary Incontinence More in Safety Communications Information About Heparin Preventing Tubing and Luer Misconnections ...

  20. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  1. Laparoscopic vs open partial colectomy in elderly patients: Insights from the American College of Surgeons - National Surgical Quality Improvement Program database

    PubMed Central

    Kannan, Umashankkar; Reddy, Vemuru Sunil K; Mukerji, Amar N; Parithivel, Vellore S; Shah, Ajay K; Gilchrist, Brian F; Farkas, Daniel T

    2015-01-01

    AIM: To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons - National Surgical Quality Improvement Program (ACS NSQIP) database. METHODS: The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar pre-operative comorbidities. Outcomes including post-operative complications, length of stay and mortality were compared between the laparoscopic and open groups. ?2 and Fisher’s exact test were used for discrete variables and Student’s t-test for continuous variables. P < 0.05 was considered significant and odds ratios with 95%CI were reported when applicable. RESULTS: The total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009 (43%) of the cases were done laparoscopically and 15595 (57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic (LC) and open colectomy (OC) cohorts. The laparoscopic approach had lower post-operative complications (LC 15.2%, OC 23.8%, P < 0.001), shorter length of stay (LC 6.61 d, OC 9.62 d, P < 0.001) and lower mortality (LC 1.6%, OC 2.9%, P < 0.001). CONCLUSION: Even after propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach. PMID:26668508

  2. The Surgical Treatment for Atrial Fibrillation: Ablation Technology and Surgical Approaches

    PubMed Central

    Henry, Linda; Ad, Niv

    2013-01-01

    The Cox maze procedure developed originally in 1987 by Dr James Cox has evolved from a “cut and sew” surgical procedure, where the maze was applied using multiple surgical cuts, to an extensive use of surgical ablation technology where ablation lesions are placed with alternative energy sources (radiofrequency, cryothermy, microwave, and high-frequency ultrasound). Furthermore, the procedure has changed from a median sternotomy approach only to one that can be performed minimally invasively and robotically. The purpose of this paper is to review the current available technology for the ablation of atrial fibrillation as well as the different procedural approaches for the surgical ablation of atrial fibrillation. PMID:23908871

  3. Surgical Skills Beyond Scientific Management

    PubMed Central

    Whitfield, Nicholas

    2015-01-01

    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

  4. Surgical Skills Beyond Scientific Management.

    PubMed

    Whitfield, Nicholas

    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

  5. 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

  6. Surgical Derotation Technique: A Novel Approach in the Management of Rotated Immature Permanent Incisor

    PubMed Central

    Krishnapriya, V; Sriram, CH; Reddy, Maheshwar KR

    2015-01-01

    ABSTRACT Surgical derotation is a method of placing a rotated tooth in normal alignment in a dental arch; surgically, immediately and permanently. It is a potentially convenient and cost-effective treatment modality as compared to conventional orthodontic procedure for rotated maxillary incisor with open apex. Here is a presentation of a severely rotated maxillary left permanent central incisor in a nine and half years old girl, with a radiographic evidence of immature root apex which was surgically derotated, orthodontically retroclined and intruded to its normal position. Postsurgical clinical and radiographic evaluation was done for a period of one and half years to confirm the vitality and continued physiological root formation of the affected tooth. How to cite this article: Dutta B, Krishnapriya V, Sriram CH, Reddy MKR. Surgical Derotation Technique: A Novel Approach in the Management of Rotated Immature Permanent Incisor. Int J Clin Pediatr Dent 2015;8(3):220-223. PMID:26604541

  7. 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

  8. 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

  9. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 15 2012-07-01 2012-07-01 false Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS...

  10. EACTS expert consensus statement for surgical management of pleural empyema.

    PubMed

    Scarci, Marco; Abah, Udo; Solli, Piergiorgio; Page, Aravinda; Waller, David; van Schil, Paul; Melfi, Franca; Schmid, Ralph A; Athanassiadi, Kalliopi; Sousa Uva, Miguel; Cardillo, Giuseppe

    2015-11-01

    Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference. PMID:26254467

  11. Surgical staplers: a review.

    PubMed

    McGuire, J; Wright, I C; Leverment, J N

    1997-02-01

    For almost two centuries, surgeons have been using mechanical devices to join tissue. One of the most successful methods is that of stapling, which has become very common in more recent times. The range of staplers consists of five established stapler categories (circular, linear, linear cutting, ligating and skin staplers), along with recent variations which lend themselves to minimally invasive surgery. Within each category, several commercial models are available, many of which have their own unique features. The procedures which are enhanced by these instruments are many and varied. Applications have been further expanded and improved by the instrument design developments seen in recent years. This review attempts to present a rationalized overview of the array of stapling instruments, with relevant procedures. The authors believe that surgical stapling may be greatly enhanced by further research and development, taking the instrument designs and procedures further into the realm of minimally invasive surgery. PMID:9046134

  12. 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

  13. Surgical access to separate branches of the cat vestibular nerve

    NASA Technical Reports Server (NTRS)

    Radkevich, L. A.; Ayzikov, G. S.

    1981-01-01

    A posteroventral approach for access to separate branches of the cat vestibular nerve is presented which permits simultaneous surgical access to the ampullary and otolithic nerves. Surgical procedures are discussed.

  14. Laparoscopic pancreatic resection: some benefits of evolving surgical techniques.

    PubMed

    Nakamura, Yoshiharu; Uchida, Eiji; Nomura, Tsutomu; Aimoto, Takayuki; Matsumoto, Satoshi; Tajiri, Takashi

    2009-01-01

    Laparoscopic pancreatic resection began to be reported in the first half of the 1990s, with subsequent reports focusing primarily on the safety and usefulness of laparoscopic distal pancreatectomy (Lap-DP) for benign and low-malignancy lesions of the pancreatic body and tail (such as chronic pancreatitis, neuroendocrine tumor, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm). Recently we have also begun to see retrospective case-control studies comparing these techniques with open surgery, with Lap-DP showing advantages not only in terms of esthetics related to the surgical wound, but also with regard to reduced intraoperative bleeding, postoperative recovery time, and days of postoperative hospitalization. Prospective randomized controlled trials are still needed for confirmation, but it appears likely that this technique will become a standard surgical procedure for the treatment of diseases of the pancreatic body and tail. In contrast, laparoscopic pancreatoduodenectomy (Lap-PD) remains controversial in the minds of many pancreatic surgeons. This is primarily due to the difficulty of laparoscopic reconstruction following resection. However, there have recently been a number of single-center reports on the use of this procedure in at least 20 patients per center, showing that Lap-PD is associated with considerable reduction in intraoperative bleeding. Our own experience has been similar. In carefully selected patients, we find Lap-PD to be a useful surgical procedure. PMID:19585074

  15. Comparative Efficacy of Pulse-Spray Thrombolysis and Angioplasty Versus Surgical Salvage Procedures for Treatment of Recurrent Occlusion of PTFE Dialysis Access Grafts

    SciTech Connect

    Polak, Joseph F.; Berger, Markus F.; Pagan-Marin, Heriberto; Aruny, John E.; Meyerovitz, Michael F.

    1998-07-15

    Purpose: To compare the efficacy of surgery versus pulse-spray thrombolysis and angioplasty in patients with recurrent thrombosis of polytetrafluoroethylene (PTFE) dialysis access grafts. Methods: We analyzed 96 consecutive interventions for thrombosed PTFE dialysis access grafts in 18 patients. Primary patency after thrombolysis and angioplasty (n= 25) was compared with primary patency following thrombectomy alone (n= 50) or thrombectomy followed by graft revision (n= 21) using life-table analysis. A Cox proportional hazards model that accounted for graft age and number of previous interventions was used to generate the relative risk for recurrent occlusion following therapy. Results: Life-table analysis showed that patency after thrombolysis and angioplasty was greater than that following thrombectomy alone (p= 0.02). After accounting for the age of the graft and the number of previous interventions (average six per patient), the relative risk for recurrent occlusion [3.0; 95% confidence intervals (CI): 1.5, 6.4] was greater for thrombectomy alone than for thrombolysis/angioplasty [0.6; CI = 0.3, 1.3]. The relative risks of repeat occlusion following thrombolysis/angioplasty [0.6; CI = 0.3, 1.3] and thrombectomy/surgical revision [1.0; CI = 0.5, 1.7] were similar. Conclusion: Outcome data from our retrospective study on recurrent thrombosis of PTFE dialysis access grafts suggest that thrombolysis/angioplasty is superior to thrombectomy alone, and equivalent to thrombectomy/surgical revision.

  16. 78 FR 918 - Approval and Promulgation of Implementation Plans; Oregon: Open Burning and Enforcement Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-07

    ...May 2008 submittals relate to enforcement procedures, civil penalties, and procedures in contested cases (appeals). DATES...2006. Division 12 contains enforcement procedures and civil penalty provisions that apply across...

  17. 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

  18. [A Case of Foix-Alajouanine Syndrome due to Perimedullary AVF: Remission and Aggravation Mechanism Considered by an Open Surgical Biopsy and Intraoperative ICG Angiography].

    PubMed

    Maruyama, Fumiaki; Akasaki, Yasuharu; Watanabe, Mitsuyoshi; Arai, Takao; Isoshima, Akira; Nagashima, Hiroyasu; Murayama, Yuichi

    2015-08-01

    Foix-Alajouanine syndrome (FAS), also known as congestive myelopathy due to spinal vascular malformations, presents with paraplegia, sensory disturbance of lower limbs, and dysfunction of the bladder and rectum. Although FAS is characterized by a subacute onset of neurological symptoms that may wax and wane over a few years, the progression mechanism remains unclear. We report a case of FAS due to an angiographically occult arteriovenous fistula (AVF) that was diagnosed by an open surgical biopsy and intraoperative indocyanine green (ICG) angiography. The patient was a 74-year-old female who presented with a one-year history of gradually progressive gait disturbance, weakness, and decreased sensation in her legs associated with bladder and rectum dysfunction. MRI showed intramedullary T1 hypointensity, T2 hyperintensity at level Th4-12, and intramedullary enhancing with a Gd-DTPA lesion at level Th8-12. A true-FISP image of the MRI revealed an abnormal tortuous vessel in the dorsal spinal subarachnoid space, but digital subtraction angiography of the spine at the C1-L5 level showed no abnormality. The patient also underwent Th8-12 laminectomy for open biopsy. ICG angiography revealed blood flow stagnation in an abnormally enlarged posterior spinal vein. Histological findings indicated necrotizing myelopathy and stenosis with wall thickening of the posterior spinal vein. We hypothesized that the progression mechanism in the present case may have resulted from histological changes in the draining veins of an AVF. Intraoperative ICG angiography may be a valuable method, not only for diagnosing AVFs but also for determining the existence and pathological characteristics of FAS. PMID:26224468

  19. Oncological and surgical outcomes of minimally invasive versus open esophagectomy for esophageal squamous cell carcinoma: a matched-pair comparative study

    PubMed Central

    Wang, Wenli; Zhou, Yongxin; Feng, Jing; Mei, Yunqing

    2015-01-01

    Only a few series have demonstrated the safety and efficacy of minimally invasive esophagectomy (MIE) for esophageal squamous cell carcinoma and the benefits of this approach. This report describes the results of a pair-matched comparative study between minimally invasive and open esophagectomy (OE) for esophageal squamous cell carcinoma. Patients were retrospectively matched in pairs for the following criteria: age, sex, American Society of Anesthesiology (ASA) score, clinical TNM stage, tumor location, and type of resection. A total of 97 patients undergoing MIE were compared with patients undergoing OE during the same period. Operative, postoperative, and oncologic outcomes were compared. Significantly less bleeding was observed in the MIE group (P = 0.001). Transfusion was required for three patients in the MIE group and ten patients in the OE group (P = 0.044). Overall morbidity was similar in the two groups. The hospital stay was significantly shorter for the patients undergoing MIE (P = 0.027). The surgical margin and tumor stage were not affected by MIE. The overall survival rates in the MIE group were 54% at 5 years and 46% in the OE group (P = 0.631). The disease-free survival rates in the MIE group were 45% at 5 years, 41% in the OE group (P = 0.704). In summary, MIE for esophageal squamous cell carcinoma for selected patients gave a better postoperative outcome without oncologic consequences.

  20. Infection prevention: the surgical care continuum.

    PubMed

    Barnes, Sue

    2015-05-01

    Lack of careful attention to the increasing complexity of surgical procedures, instrument cleaning and processing, and the transition of surgical and other invasive procedures from the OR to areas outside the traditional hospital OR can contribute to surgical site infection (SSI) risk. Regardless of the location of an intervention, when basic infection prevention measures are applied reliably, even low infection rates can be reduced. To address infection prevention challenges, infection preventionists (IPs) must be well informed regarding infection risk and prevention during surgical and other invasive procedures and the effect a facility type may have on patients' infection risk. The IP must have a solid understanding of surgical asepsis, instrument disinfection, and sterilization to educate and support clinical teams in identifying opportunities for improvement relative to infection prevention. PMID:25946177

  1. 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. PMID:26069523

  2. On surgical intervention in the temporomandibular joint.

    PubMed

    Widmark, G

    1997-01-01

    The aim of this thesis was to evaluate the indications for and the results of temporomandibular joint (TMJ) surgery in patients with long-standing severe orofacial pain and dysfunction as well as in patients with fractures of the condylar neck. The patients with long-standing pain and dysfunction had had symptoms for a mean time of 4 years, had been treated conservatively for a mean time of 2.5 years, and had undergone numerous conservative treatment methods without improvement except for a minor increase in mouth opening capacity. The indications for surgery were strict; only 1% or less of all the patients referred to the departments with a diagnosis of temporomandibular disorder (TMD) were prescribed surgery, which was considered to be the only remaining option. The TMJ surgery reduced pain, sleeping problems, and analgesic consumption and improved mouth opening capacity. The procedure showed low morbidity except for a facial nerve disturbance in three patients. Postoperatively, the bite force was observed to be normalised, and the radiographic examination showed moderate to severe osteoarthrotic changes. These changes, though extensive, were considered to be the normal outcome of diskectomy and without clinical significance, even though they resembled degenerative joint disease. In study V, surgery was performed on patients with a clear diagnosis of anterior disk displacement (ADD) with or without reduction. The preoperative pain and mouth opening capacity were markedly improved as well as other subjective symptoms. Although surgical morbidity was low, some radiographic changes were clearly detectable. In agreement with earlier reports, patients with a distinct diagnosis of ADD with or without reduction were clearly helped by diskectomy. In cases of ADD with or without reduction, it can be concluded that unsuccessful conservative treatment should not exceed 3-6 months but be discontinued in favour of the documented advantages of surgery in these cases. Patients with ankylosis should be treated surgically without delay. Unclear diagnoses such as arthralgia and osteoarthrosis with symptoms should be excluded from surgery unless overlapping muscular hyperactivity has been excluded as a major cause of the patients problem. Diskectomy is a useful surgical procedure for patients with severe long-standing TMD. It was shown in study VI that patients with dislocated fractures of the condylar neck can be successfully treated with open surgical reduction when the dislocation is large and associated with symptoms and limited function. When cognitive-behavioural profiles were measured psychometrically in study VII, a dysfunctional profile was more common in patients with myofascial pain and pain with an obscure origin than in other patients diagnosed with TMD. The dysfunctional profile was also common in patients in whom treatment of a conservative or surgical nature had failed. Among TMD patients with disk displacement, adaptive copers were most common in successfully diskectomized patients and least common in patients about to undergo invasive treatment. PMID:9352617

  3. Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm.

    PubMed

    Zhang, Chang-Lie; Song, Zhi-Hong; Wang, Fan

    2016-01-01

    To explore the efficacy of endovascular aneurysm repair (EVAR) compared with traditional open surgical repair (OSR) in the treatment of middle/high-risk patients with abdominal aortic aneurysm (AAA). With a retrospective method, we analyzed the clinical data of 57 patients with middle/high-risk AAA admitted to Linyi People's Hospital Affiliated to Shandong University from January 2010 to January 2014. Twenty-eight of the 57 patients received EVAR and 29 others received OSR. Statistical analysis was conducted by the design of spreadsheet according to preoperative, intraoperative, perioperative, and postoperative follow-up relevant information. Our study showed that the difference in baseline characteristics of different therapies in middle/high-risk AAA patients was not statistically significant in preoperative period (P > 0.05). In intraoperative period, the efficacy of middle/high-risk AAA patients in EVAR group was significantly superior to OSR group in terms of blood loss, blood transfusion, and general anesthesia rate (all P < 0.01). In perioperative period, the ICU observation time and the average fasting time of middle/high-risk AAA patients in EVAR group were remarkably lower than OSR group (all P < 0.01), but the average hospital stay and the operation cost of middle/high-risk AAA patients in EVAR group were notably higher than OSR group. In postoperative follow-up period, OSR group was identified with a lower incidence of surgery-related complications than EVAR group (P < 0.05), but EVAR group was demonstrated with a higher survival rate than OSR group (P < 0.05); after 12 months of follow-up, SF-36 scale scores in OSR group were higher than EVAR group (P < 0.05). In conclusion, EVAR may have a better short-term effect, whereas OSR may have a better long-term effect in the treatment of middle/high-risk AAA patients. PMID:26295612

  4. Surgical video systems.

    PubMed

    1995-11-01

    Surgical video systems (SVSs), which typically consist of a video camera attached to an optical endoscope, a video processor, a light source, and a video monitor, are now being used to perform a significant number of minimally invasive surgical procedures. SVSs offer several advantages (e.g., multiple viewer visualization of the surgical site, increased clinician comfort) over nonvideo systems and have increased the practicality and convenience of minimally invasive surgery (MIS). Currently, SVSs are used by hospitals in their general, obstetric/gynecologic, orthopedic, thoracic, and urologic procedures, as well as in other specialties for which MIS is feasible. In this study, we evaluated 19 SVSs from 10 manufacturers, focusing on their use in laparoscopic applications in general surgery. We based our ratings on the usefulness of each system's video performance and features in helping clinicians provide safe and efficacious laparoscopic surgery. We rated 18 of the systems Acceptable because of their overall good performance and features. We rated 1 system Conditionally Acceptable because, compared with the other evaluated systems, this SVS presents a greater risk of thermal injury resulting from excessive heating at the distal tip of the laparoscope. Readers should be aware that our test results, conclusions, and ratings apply only to the specific systems and components tested in this Evaluation. In addition, although our discussion focuses on the laparoscopic application of SVSs, much of the information in this study also applies to other MIS applications, and the evaluated devices can be used in a variety of surgical procedures. To help hospitals gain the perspectives necessary to assess the appropriateness of specific SVSs to ensure that the needs of their patients, as well as the expectations of their clinicians, will be satisfied, we have included a Selection and Purchasing Guide that can be used as a supplement to our Evaluation findings. We have also included a Glossary of relevant terminology and the supplementary article, "Fiberoptic Illumination Systems and the Risk of Burns or Fire during Endoscopic Procedures," which addresses a safety concern with the use of these devices. While we made every effort to present the most current information, readers should recognize that this is a rapidly evolving technology, and developments occurring after our study was complete may not be reflected in the text. For additional information on topics related to this study, refer to the following Health Devices articles: (1) our Guidance Article, "Surgical Video Systems Used in Laparoscopy," 24(1), January 1995, which serves as an introduction to SVS terminology and includes a discussion of the significance of many SVS specifications; (2) our Evaluation, "Video Colonoscope Systems," 23(5), May 1994, which includes a detailed overview of video endoscopic applications and technology; and (3) our Evaluations of laparoscopic insufflators (21[5], May 1992, and 24[7], July 1995), which address issues related to the creation of a viewing and working space inside the peritoneal cavity to facilitate visualization in laparoscopic procedures. PMID:8750067

  5. Teleoperation in surgical robotics--network latency effects on surgical performance.

    PubMed

    Lum, Mitchell J H; Rosen, Jacob; King, Hawkeye; Friedman, Diana C W; Lendvay, Thomas S; Wright, Andrew S; Sinanan, Mika N; Hannaford, Blake

    2009-01-01

    A teleoperated surgical robotic system allows surgical procedures to be conducted across long distances while utilizing wired and wireless communication with a wide spectrum of performance that may affect the outcome. An open architecture portable surgical robotic system (Raven) was developed for both open and minimally invasive surgery. The system has been the subject of an intensive telesurgical experimental protocol aimed at exploring the boundaries of the system and surgeon performance during a series of field experiments in extreme environments (desert and underwater) teleportation between US, Europe, and Japan as well as lab experiments under synthetic fixed time delay. One standard task (block transfer emulating tissue manipulation) of the Fundamentals of Laparoscopic Surgery (FLS) training kit was used for the experimental protocol. Network characterization indicated a typical time delay in the range of 16-172 ms in field experiments. The results of the lab experiments showed that the completion time of the task as well as the length of the tool tip trajectory significantly increased (alpha< 0.02) as time delay increased in the range of 0-0.5 sec increased. For teleoperation with a time delay of 0.25s and 0.5s the task completion time was lengthened by a factor of 1.45 and 2.04 with respect to no time delay, whereas the length of the tools' trajectory was increased by a factor of 1.28 and 1.53 with respect to no time delay. There were no statistical differences between experienced surgeons and non-surgeons in the number of errors (block drooping) as well as the completion time and the tool tip path length at different time delays. PMID:19964184

  6. Surgical management for fecal incontinence.

    PubMed

    Anandam, Joselin L

    2014-09-01

    Fecal incontinence is a socially debilitating condition that can lead to social isolation, loss of self-esteem and self-confidence, and depression in an otherwise healthy person. After the appropriate clinical evaluation and diagnostic testing, medical management is initially instituted to treat fecal incontinence. Once medical management fails, there are a few surgical procedures that can be considered. This article is devoted to the various surgical options for fecal incontinence including the history, technical details, and studies demonstrating the complication and success rate. PMID:25320569

  7. Elec 331 -Surgical Instruments Surgical Instruments

    E-print Network

    Pulfrey, David L.

    Elec 331 - Surgical Instruments 1 Surgical Instruments Iron (Fe) · Crystalline Structure ­ Atoms 331 - Surgical Instruments 2 Atomic Structure of Iron Crystal Body Centered Ferrite ( iron) Face · Iron Alloy ­ Fe + Other atoms ­ At least 50% Fe · Stainless steel ­ 11% to 30% Cr ­ Up to 2% C #12;Elec

  8. Fibular Head-Based Posterolateral Reconstruction of the Knee: Surgical Technique and Outcomes.

    PubMed

    Fanelli, Gregory C

    2015-12-01

    The purpose of this article is to present the author's experience with fibular head-based surgical procedures for the treatment of posterolateral instability of the knee. The surgical techniques presented are the biceps tendon transfer procedures and the fibular head-based figure of eight posterolateral reconstruction using free grafts. Each of these techniques is combined with capsular repair and/or posterolateral capsular shift procedures in all cases. The decision points for surgical technique selection, the surgical technique itself, the postoperative rehabilitation, and the outcomes of these surgical procedures are presented, including a comparison of the biceps tendon procedures with the free graft procedure. PMID:26408995

  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. The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy

    PubMed Central

    Sivarajan, Ganesh; Borofsky, Michael S; Shah, Ojas; Lingeman, James E; Lepor, Herbert

    2015-01-01

    Lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) are among the most common medical issues for aging men. Population-based studies suggest that 13.8% of men in their 40s and more than 40% of men over age 60 have BPH. When LUTS are refractory to medical therapy and bothersome enough to warrant surgical intervention, transurethral resection of the prostate and open simple prostatectomy have been the historical reference-standard procedures for decades. Both procedures are highly effective and offer durable improvements in urinary functional outcomes. However, they also have the potential for considerable perioperative complications and morbidity. In an effort to limit surgical morbidity, a variety of minimally invasive surgical techniques to treat BPH have been introduced. Herein we present a comprehensive, evidence-based review of the efficacy and safety profile of modern minimally invasive treatments for large-gland BPH. PMID:26543428

  11. Volumetric assessment of results of treatment of vascular malformations of the head and neck regions treated with a minimally invasive surgical technique after embolization procedure.

    PubMed

    Konas, Ersoy; Canter, Halil Ibrahim; Cil, Barbaros; Peynircioglu, Bora; Karabulut, Erdem; Tuncbilek, Gokhan; Kayikcioglu, Aycan; Erk, Yucel

    2009-03-01

    Treatment of large soft tissue vascular lesions, one of the greatest challenges facing plastic surgeons, is patient specific in almost all cases, and preoperative angiographic evaluation and embolization of these lesions are standards of care. The aim of this study was to evaluate the usefulness of 3-dimensional demonstration and volumetric assessment of soft tissue vascular lesions both in the treatment of these lesions with curettage and in the participation of the patients to the decision-making process of the disease. Five patients with vascular malformation of the head and neck regions were included to this prospective trial. All patients were evaluated with preoperative angiography, and selective embolizations of the soft tissue vascular lesions were done in the same session by the same interventional radiologists. The amount of embolic agent injected was determined according to the size and vascularization of the lesions. Surgery was done by curettage of the embolized lesions 7 to 10 days after the embolization procedure. The raw data obtained from preoperative and postoperative high-resolution computed tomographic scans of the patients were processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Leuven, Belgium). Volume and surface area of the injected embolic agent were assessed. Statistical analysis was performed using the software package SPSS 10.0 for Windows (SPSS Inc, Chicago, IL). Wilcoxon signed rank test was used to compare the measurements of the volume and the surface area of injected sclerosing agent preoperatively and postoperatively. There were no complications related to either the preoperative angiography or embolization procedure. All the patients emphasized (assessed) that the 3-dimensional demonstration of the lesions and their relation with other anatomic structures helped them to understand the extent of their pathology and aim of the proposed treatment. The difference between the volumetric measurements before and after the treatment was found statistically significant. Treatment of large soft tissue vascular lesions with curettage after embolization has acceptable cosmetic results. Although it is not possible to remove all of the sclerosing agent from its injection site with this technique, a significant amount of it can be removed, and the 3-dimensional vascular architecture of the lesion is disturbed. Reactive chronic inflammation against the remaining sclerosing agent and the intralesional scarring caused by curettage lead to further improvement. Using 3-dimensional imaging modalities helps patients and/or their relatives to understand their disease and participate in the decision-making process. PMID:19258907

  12. 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

  13. Techniques and Results for Open Hip Preservation

    PubMed Central

    Levy, David M.; Hellman, Michael D.; Haughom, Bryan; Stover, Michael D.; Nho, Shane J.

    2015-01-01

    While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg–Calve–Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum. Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy. PMID:26649292

  14. 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

  15. 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

  16. 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

  17. Simulation in Surgical Education

    PubMed Central

    de Montbrun, Sandra L.; MacRae, Helen

    2012-01-01

    The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills. PMID:23997671

  18. [GERD: surgical therapy].

    PubMed

    Obermaier, R; Hopt, U T

    2006-08-01

    Proton pump inhibitors (PPIs) are generally accepted as gold standard for treatment of gastro-esophageal reflux disease (GERD). Nevertheless, there are clear indications for surgical anti-reflux therapy. Principally, laparoscopic anti-reflux therapy is an excellent therapeutic alternative in all patients, who have objective or subjective problems with long-term PPI therapy. Clear cut proof of the symptomatic gastro esophageal reflux (endoscopy, 24 h pH-testing) is an absolute prerequisite for surgery. Partial or total laparoscopic fundoplication has replaced completely open operative techniques. Treatment of the hiatal hernia and the hiatoplasty are integral parts of the operation. Perioperative complication rate is low. The long-term results are good. Proper patient selection and correct indication for operation are most important in this respect. PMID:16909688

  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. 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

  1. [Results of open arthrolysis for extrinsic elbow stiffness via radial access. Indications and limits of the procedure].

    PubMed

    Schorn, D; Steinbeck, J

    2011-04-01

    Open release of elbow stiffness via the lateral approach has proven to be a reliable option in the treatment of elbow stiffness over the last years. For evaluation of patient outcome after this procedure the current literature and studies were reviewed and analyzed with special reference to the increase in range of motion and patient satisfaction. It appears that particularly posttraumatic elbow stiffness with contracture of the capsule and minor alterations of the joint surface can achieve improvement in mobility and patient satisfaction. Therefore careful selection of patients is important for successful therapy. PMID:21347860

  2. 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...

  3. Duplication of surgical site marking.

    PubMed

    Davis, James S; Karmacharya, Jagajan; Schulman, Carl I

    2012-12-01

    Wrong-site surgery is a devastating complication, and its avoidance requires uncompromising vigilance. The Joint Commission on Accreditation of Healthcare Organizations has labeled wrong-site surgery as a sentinel event and requires marking the surgical site before initiating an operation. We present a case involving the duplication of a preprocedure mark. A complete review of the patient's medical record averted disaster, but the case emphasizes the need for constant attentiveness by all members of the procedural team. PMID:22935604

  4. Surgical Force-Measuring Probe

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Roberts, Paul W.; Scott, Charles E.

    1993-01-01

    Aerodynamic balance adapted to medical use. Electromechanical probe measures forces and moments applied to human tissue during surgery. Measurements used to document optimum forces and moments for surgical research and training. In neurosurgical research, measurements correlated with monitored responses of nerves. In training, students learn procedures by emulating forces used by experienced surgeons. Lightweight, pen-shaped probe easily held by surgeon. Cable feeds output signals to processing circuitry.

  5. Surgical Robotics Research in Cardiovascular Disease

    SciTech Connect

    Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles

    2008-02-29

    This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ({sup 31}P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery devices utilizes an open-loop configuration involving a team consisting of neurosurgeon, neurologist and neurophysiologist all present and participating in the decision process of delivery. We propose the development of an integrated system which provides for distributed decision making and tele-manipulation of the instrument delivery system.

  6. Minimally invasive esophagectomy for esophageal cancer – results of surgical therapy

    PubMed Central

    Vrba, Radek; Vomá?ková, Katherine; Bohanes, Tomáš; Stašek, Martin; Neoral, ?estmír

    2015-01-01

    Introduction The indication for minimally invasive esophagectomy (MIE) in esophageal cancer has an increasing tendency. Aim To present our cohort of patients operated on between 2006 and 2012. Material and methods: A single centre study of 106 consecutive esophagectomies performed for esophageal cancer by a minimally invasive approach in 79 patients was performed. Transhiatal laparoscopic esophagectomy (THLE) was performed in 66 patients, transthoracic esophagectomy (TTE) in 13 patients, with histological findings of squamous cell carcinoma in 28 and adenocarcinoma in 51 patients. Results The MIE was completed in 76 (96.2%) patients. In cases of TTE, the operation was converted to an open procedure in 3 cases. Operation time ranged from 225 to 370 min (average 256 min). The number of lymph nodes removed was 7–16 (11 on average). The postoperative course was without any complications in 54 (68.3%) patients. Respiratory complications were observed in 14 (17.7%) patients (9 following THLE, 5 following TTE). Other serious complications included acute myocardial infarction (1 patient) and necrosis of the gastroplasty (1 patient). Anastomotic dehiscence was observed in 8 patients, left recurrent laryngeal nerve paralysis in 8 patients, intra-abdominal abscesses in 2 patients, and pleural empyema in 1 case. The overall morbidity of patients operated on by MIE was 31.6%. Thirty-day mortality was 10.1%. Conclusions The MIE belongs to the therapeutic portfolio of surgical procedures performed for esophageal cancer. Successful performance requires erudition of the surgical team in both minimally invasive procedures as well as in classical surgical treatment of esophageal cancer; therefore centralization of patients is imperative. PMID:26240618

  7. Restoring accommodation: surgical technique and preliminary evaluation in rabbits

    NASA Astrophysics Data System (ADS)

    Tahi, Hassan; Chapon, Pascal F.; Hamaoui, Marie; Lee, William E.; Holden, Brien; Parel, Jean-Marie A.

    1999-06-01

    Purpose. To evaluate an innovative surgical technique for phaco-ersatz, a cataract surgery designed to restore accommodation. Techniques for very small capsulorhexis as well as the refilling procedure were developed. This study evaluates the feasibility and reproducibility of the surgical technique. Methods. The right eye of 8 NZW rabbits (~ 2 Kg) were operated following the ARVO Statements for the Use of Animals in Ophthalmic and Vision Research. The surgery is begun by making a small peripheral capsulorhexis of about 1 mm using. The lens content is then removed. The lens is then refilled with a novel in situ polymerizable gel and the corneal incision is closed using one 10/0 Nylon interrupted stitch. Results. The capsulorhexis technique was succesfully performed and reproducible in all animals. The average size of the capsulorhexis opening was 1. 2 mm (+/-0.14). Lens material removal and refilling of the capsular bag with an in situ polymerizable material was also performed in each trial study. Conclusion. This surgical technique seemed feasible and reproducible.

  8. High and low surgical rates: risk factors for area residents.

    PubMed Central

    Roos, N P; Roos, L L

    1981-01-01

    Patterns of surgical practice, the type of operations performed, and risk characteristics of elderly patients brought to surgery are examined in areas with differing surgical rates. This population-based analysis covering Manitoba's 56 rural hospital areas uses discharge claims filed routinely with the provincial Health Services Commission. One and a half times as much surgery was performed in high rate areas (115.2 procedures per 1,000 elderly) as in low rate areas (74.7 procedures/1,000). Since surgical case mix varied little between high and low rate areas, the rate variation means that place of residence strongly influences exposure to major surgical procedures. In similar fashion, the proportion of surgical cases classified as high-risk does not vary with the surgical rate. High risk patients resident in high surgical rate areas are more likely to come to surgery than are their counterparts in low rate areas. Further analyses of nonsurgical hospitalization, of three common elective procedures, and of area characteristics were carried out. The surgical selection process, not characteristics of the population residing in the area, appears to determine the rate at which high and low risk patients come to surgery. Our research clearly suggests that high surgical rates carry with them the risk of excess surgical deaths. PMID:7235097

  9. Reducing Surgical Site Infections: A Review

    PubMed Central

    Reichman, David E; Greenberg, James A

    2009-01-01

    Infection at or near surgical incisions within 30 days of an operative procedure contributes substantially to surgical morbidity and mortality each year. The prevention of surgical site infections encompasses meticulous operative technique, timely administration of appropriate preoperative antibiotics, and a variety of preventive measures aimed at neutralizing the threat of bacterial, viral, and fungal contamination posed by operative staff, the operating room environment, and the patient’s endogenous skin flora. It is the latter aspect of contamination, and specifically mechanical methods of prevention, on which this review focuses. PMID:20111657

  10. Incorporating music into the surgical environment.

    PubMed

    Reilly, M

    1999-01-01

    Responsibility for patient comfort has always been the concern of the nurse. Conscious sedation and or local anesthesia are commonly becoming the primary method of anesthesia for a variety of outpatient plastic surgical procedures. These surgical methods require the nurse to become aware of nonchemical adjuncts that can assist in providing a safe comfortable atmosphere for the patients. Furthermore, many patients now request nonchemical adjuncts for anxiolysis and sedation as well as for analgesia in the surgical suite. This article will provide the nurse with a basic overview of one such alternative, music, including a brief historical review, relevant research, and guidelines for use of music with the operative client. PMID:10478129

  11. Endoscopic Plantar Fasciotomy: A Minimally Traumatic Procedure for Chronic Plantar Fasciitis

    PubMed Central

    Hake, Daniel H.

    2000-01-01

    Endoscopic plantar fasciotomy (EPF) is a minimally invasive and minimally traumatic surgical treatment for the common problem of chronic plantar fasciitis. This procedure is indicated only for the release of the proximal medial aspect of the fascia in cases that do not respond to aggressive conservative, nonsurgical treatment. In the literature, an overall 87% success rate has been reported in 1228 procedures, in addition to an 83% success rate reported by Burke at the Northwest Podiatric Foundation Surgical Seminar in January 2000. The author's personal experience with 41 procedures over 5 years is consistent with an overall average success of 90%. EPF complications are reduced in comparison with traditional open procedures and can be avoided in many cases when identified early and treated properly. EPF is recommended as the procedure of choice when conservative treatment measures have been exhausted. PMID:21765689

  12. Three-piece Inflatable Penile Prosthesis: Surgical Techniques and Pitfalls

    PubMed Central

    Al-Enezi, Ahmad; Al-Khadhari, Sulaiman; Al-Shaiji, Tariq F.

    2011-01-01

    Penile prosthesis surgery plays a vital role in the treatment of erectile dysfunction (ED). As far as outcome is concerned, it is one of the most rewarding procedures for both patients and surgeons. We describe our surgical technique for implantation of the three-piece inflatable penile prosthesis and point out the major surgical pitfalls accompanying this procedure and their specific management. The psychological outcome of penile prosthesis surgery is also discussed. Different surgical approaches are available when performing the procedure. A number of procedure-related problems can be encountered and a thorough knowledge of these is of paramount importance. Penile prosthesis surgery has a favorable psychological outcome. Surgery for implantation of an inflatable penile prosthesis is a rewarding procedure, with a high yield of patient satisfaction. Urologists should have thorough understanding of the surgical pitfalls peculiar to this procedure and their management. PMID:22413049

  13. Prepubertal gonadectomy in cats: different surgical techniques and comparison with gonadectomy at traditional age.

    PubMed

    Porters, N; Polis, I; Moons, C; Duchateau, L; Goethals, K; Huyghe, S; de Rooster, H

    2014-09-01

    Feasibility, surgical time and complications of different surgical techniques for prepubertal gonadectomy (PPG; 8-12?weeks of age) in cats were studied and compared to gonadectomy at traditional age (TAG; 6-8?months of age). Kittens were randomly assigned to PPG or TAG. Ovarian pedicle haemostasis for PPG was achieved by ligatures (n=47), vascular clips (n=50), bipolar electrocoagulation (n=50), or pedicle tie (n=50); for TAG (n=34) ligatures were used. In male cats, PPG consisted of closed castration by spermatic cord knot (n=92) or ligature (n=91) while TAG (n=34) was an open castration by spermatic cord knot. A linear (surgical time) and a logistic regression (complications) model were designed. Significance was set at 0.05. For female PPG, clips and coagulation were the fastest procedures; placement of ligatures was most time-consuming. In male PPG, knot placement was significantly faster than ligation. In both sexes, very few intraoperative or wound complications were observed, irrespective of the surgical technique used. Surgical times in females (ligatures) as well as in males (knot) were significantly shorter for PPG than for TAG. PPG was as safe as TAG, yet took less time to perform and did not result in a greater rate of postoperative complications. PMID:24821860

  14. Surgical rehearsal platform: potential uses in microsurgery.

    PubMed

    Bambakidis, Nicholas C; Selman, Warren R; Sloan, Andrew E

    2013-10-01

    Surgical training has remained remarkably similar in many respects since the early days of halstedian training. Neurosurgery is a demanding field that requires extensive cognitive, perceptive, and technical training. Surgical simulation is a promising approach to facilitate acquiring proficiency in neurosurgical procedures. Simulation can permit mentoring trainees in a "safe" environment. By incorporating images that depict specific abnormalities in actual patients, simulation can provide realistic rehearsal for any given case for both novice and experienced surgeons in much the same way that data acquired from drones can be used to allow pilots to rehearse mission-critical maneuvers in a simulator before taking flight. Most neurosurgical simulators to date have focused on endovascular procedures, spinal procedures, temporal bone dissection, and stereotactic procedures. The use of simulator technology for microsurgery is in its infancy. This article describes a novel simulator technology developed by Surgical Theater LLC (http://www.surgicaltheater.net/home.html) called the Selman Surgical Rehearsal Platform. The platform shows promise for use in intracranial microvascular procedures, which require experience that is becoming increasingly limited for trainees who have to become proficient in more procedures in much less time than ever before. PMID:24051875

  15. Surgical Materials: Current Challenges and Nano-enabled Solutions

    PubMed Central

    Annabi, Nasim; Tamayol, Ali; Shin, Su Ryon; Ghaemmaghami, Amir M.; Peppas, Nicholas A.; Khademhosseini, Ali

    2014-01-01

    Surgical adhesive biomaterials have emerged as substitutes to sutures and staples in many clinical applications. Nano-enabled materials containing nanoparticles or having a distinct nanotopography have been utilized for generation of a new class of surgical materials with enhanced functionality. In this review, the state of the art in the development of conventional surgical adhesive biomaterials is critically reviewed and their shortcomings are outlined. Recent advancements in generation of nano-enabled surgical materials with their potential future applications are discussed. This review will open new avenues for the innovative development of the next generation of tissue adhesives, hemostats, and sealants with enhanced functionality for various surgical applications. PMID:25530795

  16. Current Surgical Options for the Management of Pediatric Glaucoma

    PubMed Central

    Morales, Jose; Al Shahwan, Sami; Al Odhayb, Sami; Al Jadaan, Ibrahim; Edward, Deepak P.

    2013-01-01

    Currently, there are numerous choices for the treatment of pediatric glaucoma depending on the type of glaucoma, the age of the patient, and other particularities of the condition discussed in this review. Traditionally, goniotomy and trabeculotomy ab externo have been the preferred choices of treatment for congenital glaucoma, and a variety of adult procedures adapted to children have been utilized for other types of pediatric glaucoma with variable results and complications. More recently, seton implantations of different types have become more popular to use in children, and newer techniques have become available including visualized cannulation and opening of Schlemm's canal, deep sclerectomy, trabectome, and milder more directed cyclodestructive procedures such as endolaser and transcleral diode laser cyclophotocoagulation. This paper reviews the different surgical techniques currently available, their indications, results, and most common complications to allow the surgeon treating these conditions to make a more informed choice in each particular case. Although the outcome of surgical treatment in pediatric glaucoma has improved significantly, its treatment remains challenging. PMID:23738051

  17. Characterizing electroactive polymers for use in robotic surgical instruments

    NASA Astrophysics Data System (ADS)

    Snyder, Alan J.; Cohen, Adam L.; Cheng, Zhong-Yang; Zhang, Qi Ming; Runt, James P.

    2002-07-01

    The popularity of minimally invasive surgical procedures over traditional open procedures motivates us to develop new instruments that address the limits of existing technology and enable more widespread use of minimally invasive approaches. Robotic surgical instruments have the potential to provide improved dexterity and range of motion within the confines of the human body when compared with manually actuated instruments. The high strain response and elastic energy density of electron-irradiated P(VDF-TrFE) make it a candidate actuator material for robotic instruments that provide electronic mediation and multiple degrees of freedom of tip movement. We are currently studying both active and passive properties of P(VDF-TrFE) with the goal of constructing a mathematical model of the material's behavior. Studies have been conducted on 15 micron thick film samples in rolled and rolled-flattened configurations. Passive properties can be represented by a 5 parameter viscoelastic model with two time constants on the order of ten and 200 seconds. Active responses were found to have strong dependence upon field and modest dependence upon load. We suggest means by which the active and passive responses can be combined in a model of steady-state response that would be of value in positioning tasks. The time course of the active response appears to contain components on two time scales, but further studies are required to characterized it in more detail.

  18. [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

  19. 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

  20. Optimal surgical options for descending necrotizing mediastinitis of the anterior mediastinum.

    PubMed

    Guan, Xin; Zhang, Wei Jie; Liang, Xi; Liang, Xiang; Wang, Feng; Guo, Xiang; Zhou, Yaodong

    2014-09-01

    The mortality rates from descending necrotizing mediastinitis (DNM) are between 25 and 40 % mainly because of delayed diagnosis and inappropriate surgical treatment. This study was undertaken to examine two surgical options for DNM and determine the optimal surgical option for DNM of the anterior mediastinum. Fifteen cases of DNM of the anterior mediastinum, January 2001 and October 2010, were retrospectively reviewed. Eleven were anterosuperior mediastinitis, with infection located above the tracheal bifurcation and four had infections involving the entire anterior mediastinum. Depending on the location of mediastinitis, open drainage of the submandibular and neck abscesses, in addition to other surgical treatments, was performed. If the infection was anterosuperior, transcervical mediastinal drainage or thoracotomy was performed. If the entire anterior mediastinum was involved, necrotic tissue was removed with thoracoscopic via subxiphoid incision, the bilateral pleurae were opened for drainage, and a tunnel connecting the neck incision and the subxiphoid incision through the whole anterior mediastinum was made for drainage. The anterosuperior mediastinitis cases were treated with either transcervical mediastinal drainage (n = 8) or thoracotomy (n = 3). Patients healed after an average of 24.5 and 20.0 days in the hospital, respectively. For the four other cases, one patient died of septic shock, while the other three patients were healed after and an average of 43.3 days in the hospital. Mortality rate was 6.7 %. The surgical procedure used to treat DNM should be selected according to the location of the infection. DNM involving the anterosuperior mediastinum can be treated by transcervical mediastinal drainage. If anterosuperior mediastinitis spreads to the side of the trachea, open thoracotomy is a suitable therapy. If the entire anterior mediastinum is involved, debridement and drainage of the anterior mediastinum should be performed with a thoracoscope via the subxiphoid incision. PMID:24696071

  1. Standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC): a prospective, observational, multicenter study [NCT01283893

    PubMed Central

    2014-01-01

    Background Extended systemic lymphadenectomy (D2) is standard procedure for surgical treatment of advanced gastric cancer (AGC) although less extensive lymphadenectomy (D1) can be applied to early gastric cancer. Complete D2 lymphadenectomy is the mandatory procedure for studies that evaluate surgical treatment results of AGC. However, the actual extent of D2 lymphadenectomy varies among surgeons because of a lacking consensus on the anatomical definition of each lymph node station. This study is aimed to develop a consensus for D2 lymphadenectomy and also to qualify surgeons that can perform both laparoscopic and open D2 gastrectomy. Methods/Design This (KLASS-02-QC) is a prospective, observational, multicenter study to qualify the surgeons that will participate in the KLASS-02-RCT, which is a prospective, randomized, clinical trial comparing laparoscopic and open gastrectomy for AGC. Surgeons and reviewers participating in the study will be required to complete a questionnaire detailing their professional experience and specific gastrectomy surgical background/training, and the gastrectomy metrics of their primary hospitals. All surgeons must submit three laparoscopic and three open D2 gastrectomy videos, respectively. Each video will be allocated to five peer reviewers; thus each surgeon’s operations will be assessed by a total of 30 reviews. Based on blinded assessment of unedited videos by experts’ review, a separate review evaluation committee will decide whether or not the evaluated surgeon will participate in the KLASS-02-RCT. The primary outcome measure is each surgeon’s proficiency, as assessed by the reviewers based on evaluation criteria for completeness of D2 lymphadenectomy. Discussion We believe that our study for standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC) will guarantee successful implementation of the subsequent KLASS-02-RCT study. After making consensus on D2 lymphadenectomy, we developed evaluation criteria for completeness of D2 lymphadenectomy. We also developed a unique surgical standardization and quality control system that consists of recording unedited surgical videos, and expert review according to evaluation criteria for completeness of D2 lymphadenectomy. We hope our systematic approach will set a milestone in surgical standardization that is essential for surgical clinical trials. Additionally, our methods will serve as a novel system for educating surgeons and assessing surgical proficiency. Trial registration NCT01283893. PMID:24646327

  2. Surgical time outs in a combat zone.

    PubMed

    Harrington, Jason W

    2009-03-01

    AORN supports the Joint Commission's requirements and guidelines to promote correct site surgery, including preoperative verification, site marking, and conducting and documenting a surgical time out. This article highlights the success of a well-implemented surgical time out policy and procedure at a two-bed combat support hospital in northern Iraq. Policy implementation, training, documentation, and quality management chart checks prevented any incidence of wrong site surgery through the completion of more than 900 procedures on more than 400 patients during a 15-month period. PMID:19269378

  3. Surgical Treatment of the Twisted Nose.

    PubMed

    Menger, Dirk Jan

    2016-01-01

    The twisted nose is a challenging procedure in rhinoplasty. The goal of surgery is to realign the nasal skeleton to create symmetry in the face and restore nasal patency. Key in the surgical procedure is that all structures of the nasal skeleton be dissected free, mobilized, repositioned, and stabilized. Important surgical steps are intermediate osteotomies on the contralateral side of the deviation for the upper nasal third; for the mid nasal third, a unilateral spreader graft or splint on the nondeviated side, and for the lower nasal third, fixation of the caudal septum to the anterior nasal spine. PMID:26616698

  4. Surgical Management for Peyronie's Disease

    PubMed Central

    Segal, Robert L.

    2013-01-01

    Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations. PMID:23658860

  5. 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

  6. Hip pain in the young, active patient: surgical strategies.

    PubMed

    Bloomfield, Michael R; Erickson, Jill A; McCarthy, Joseph C; Mont, Michael A; Mulkey, Patrick; Peters, Christopher L; Pivec, Robert; Austin, Matthew S

    2014-01-01

    Hip disorders in young patients likely exist as a spectrum of prearthritic and arthritic conditions. With the increasing recognition of these disorders, surgical options are being popularized and more patients are being treated at a younger age. Hip surgeons must develop a careful set of evidenced-based indications and follow surgical outcomes in a rigorous, scientific manner. Hip arthroscopy can be used to successfully treat some hip disorders, including labral tears, with or without femoroacetabular impingement, resulting in mechanical symptoms. Long-term outcomes after arthroscopy are determined by the condition of the cartilage at the time of surgery. Patients with preoperative radiographic evidence of moderate to severe arthritis have poor outcomes when treated with arthroscopy. Open joint preservation procedures (including periacetabular osteotomy and surgical hip dislocation with osteochondroplasty) can be done in the absence of substantial arthritis to treat hip dysplasia, femoroacetabular impingement, and related conditions. The results of these procedures are good in appropriately selected patients at short-term to midterm follow-ups. In the presence of severe arthritis, joint replacement is the treatment of choice. Total hip arthroplasty using uncemented acetabular and femoral fixation provides reliable osseointegration; however, long-term results in young patients have historically been compromised by bearing surface wear, osteolysis, and component loosening. Contemporary, highly cross-linked polyethylene and ceramic-on-ceramic bearings have durable results, low complication rates, and offer the potential of long-term survivorship in this high-demand population. In general, metal-on-metal implants have higher complication rates versus other bearing surface options and should be avoided. The best results of hip resurfacing are seen in men younger than 55 years with large femoral head sizes. Although implant survivorship is comparable to that of total hip arthroplasty, the sequelae of metal wear debris continue to cause concern. PMID:24720303

  7. Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion.

    PubMed

    Abla, Adib A; Zaidi, Hasan A; Crowley, R Webster; Britz, Gavin W; McDougall, Cameron G; Albuquerque, Felipe C; Spetzler, Robert F

    2014-07-01

    Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery-middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED. PMID:24835048

  8. In vivo measurement of surgical gestures.

    PubMed

    Dubois, Patrick; Thommen, Quentin; Jambon, Anne Claire

    2002-01-01

    Virtual reality techniques are now more and more widely used in the field of surgical training. However, the realism of the simulation devices requires a good knowledge of the mechanical behavior of the living organs. To provide perioperative measurement of laparoscopic surgical operations, we equipped a conventional operating grasper with a force sensor and a position sensor. The entire apparatus was connected to a PC that controlled the real-time data acquisition. After calibrating the sensors, we conducted three series of in vivo measurements on animals under video control. A standardized protocol was set up to perform various surgical gestures in a reproducible manner. Under these conditions, we can assess an original tool for a quantitative approach of surgical gestures' mechanics. The preliminary results will be extended by measurements during other operations and with other surgical instruments. The in vivo quantification of the mechanical interactions between operating instruments and anatomical structures is of great interest for the introduction of the force feedback in virtual surgery, for the modeling of the mechanical behavior of living organs, and for the design of new surgical instruments. This quantification of manipulations opens new prospects in the evaluation of surgical practices. PMID:11794771

  9. Surgical Results of the Carotid Occlusion Surgery Study

    PubMed Central

    Grubb, Robert L.; Powers, William J.; Clarke, William R.; Videen, Tom O.; Adams, Harold P.; Derdeyn, Colin P.

    2014-01-01

    Object The Carotid Occlusion Surgery Study (COSS) was conducted to determine if STA-MCA bypass, when added to best medical therapy, would reduce subsequent ipsilateral stroke in patients with complete ICA occlusion and an elevated OEF in the cerebral hemisphere distal to the carotid occlusion. A recent publication reported the methodology of COSS in detail and briefly outlined the major findings of the trial.29 The surgical results of COSS are described in detail in this report. Methods The Carotid Occlusion Surgery Study (COSS) was a parallel group, prospective, 1:1 randomized, open-label, blinded-adjudication treatment trial. Participants with angiographic confirmed complete occlusion of the ICA causing either a transient ischemic attack (TIA) or ischemic stroke within 120 days and hemodynamic cerebral ischemia demonstrated by an increased oxygen extraction fraction (OEF) measured by positron emission tomography (PET) were randomized to either surgical or medical treatment. The surgical patients underwent a STA-MCA cortical branch anastomosis. One hundred and ninety-five patients were randomized: 97 to the surgical group and 98 to the medical group. Results In the intention-to-treat analysis, the two-year rates of the primary endpoint were 0.210 for the surgical group and 0.227 for the medical group (p=0.78, log rank). Fourteen (15%) of the 93 patients who had an STA-MCA arterial bypass had an endpoint ipsilateral hemispheric stroke in the 30 day peri-operative period, 12 within two days. The STA-MCA arterial bypass patency rate was 98% at the 30 day post-operative visit and 96% at the last follow-up examination. STA-MCA arterial bypass markedly improved, although it did not normalize, the level of elevated OEF in the symptomatic cerebral hemisphere. Five operated patients and one non-operated patient in the surgical group had an endpoint ipsilateral hemispheric stroke after the 30 day peri-operative period. No baseline characteristics or intra-operative variables were identified that permitted the identification of those who would experience a procedure related stroke. Conclusions In spite of excellent bypass graft patency and improved cerebral hemodynamics, STA-MCA anastomosis did not provide an overall benefit on ipsilateral two-year stroke recurrence, mainly due to a much better than expected stroke recurrence rate (22.7%) in the medical group in the trial, but also because of a significant peri-operative stroke rate (15%). PMID:23101451

  10. Surgical Ablation of Atrial Fibrillation.

    PubMed

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to obtain optimal long-term sinus rhythm control. This article provides an overview of current surgical strategies for patients with atrial fibrillation and addresses the two main goals in its management. PMID:26306128

  11. Surgical Management of Patellar Fractures.

    PubMed

    Kakazu, Rafael; Archdeacon, Michael T

    2016-01-01

    The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement, comminution, and fracture pattern, which often guide treatment. Modern treatment options include internal fixation using tension bands with Kirschner wires or cannulated screws, lag screw fixation, partial patellectomy, and rarely total patellectomy. Nondisplaced, closed patellar fractures or fractures with less than 2-mm articular steps can be successfully treated conservatively. Open fractures, articular step of 2 mm or greater, and loss of knee extension are indications for surgical intervention. PMID:26614923

  12. [Pathways for surgical antibiotic prophylaxis].

    PubMed

    Maio, Patrizia

    2003-09-01

    Surgical site infections (SSIs) are a notable cause of hospital morbidity and mortality. Antibiotic prophylaxis has demonstrated a significant reduction in infection rate in clean-contaminated surgery and in clean surgery to a limited extent. To make antibiotic prophylaxis effective it is necessary to choose the right antibiotic, to administer it preoperatively and maintain sufficient serum and tissue levels through the operation. Open issues remain: antibiotic prophylaxis duration in prosthetic surgery, its use in hernia repair, breast surgery and mini-invasive surgery. PMID:14985643

  13. Choosing the right surgical glove: an overview and update.

    PubMed

    Tanner, Judith

    Sterile surgical gloves are routinely worn during all invasive procedures to prevent the two-way transmission of pathogens between the surgical team and the patient. This reduces the risk of surgical-site infections and blood-borne diseases. Since their introduction to the operating room over 100 years ago, surgical gloves, and the materials used to make them, have continued to evolve in line with ever-changing healthcare demands. Following recent developments in surgical glove technologies, including de-proteinized natural rubber latex and newer gloving methods such as triple gloving, it is timely that an overview and update of surgical gloves is given. By providing information on latex-associated allergies, glove materials, gloving methods and glove protection, this article will enable practitioners to choose the most appropriate surgical glove. PMID:18825848

  14. Multimodal augmented reality system for surgical microscopy

    NASA Astrophysics Data System (ADS)

    Garcia Giraldez, Jaime; Talib, Haydar; Caversaccio, Marco; Gonzalez Ballester, Miguel A.

    2006-03-01

    Image-guided, computer-assisted neurosurgery has emerged to improve localization and targeting, to provide a better anatomic definition of the surgical field, and to decrease invasiveness. Usually, in image-guided surgery, a computer displays the surgical field in a CT/MR environment, using axial, coronal or sagittal views, or even a 3D representation of the patient. Such a system forces the surgeon to look away from the surgical scene to the computer screen. Moreover, this kind of information, being pre-operative imaging, can not be modified during the operation, so it remains valid for guidance in the first stage of the surgical procedure, and mainly for rigid structures like bones. In order to solve the two constraints mentioned before, we are developing an ultrasoundguided surgical microscope. Such a system takes the advantage that surgical microscopy and ultrasound systems are already used in neurosurgery, so it does not add more complexity to the surgical procedure. We have integrated an optical tracking device in the microscope and an augmented reality overlay system with which we avoid the need to look away from the scene, providing correctly aligned surgical images with sub-millimeter accuracy. In addition to the standard CT and 3D views, we are able to track an ultrasound probe, and using a previous calibration and registration of the imaging, the image obtained is correctly projected to the overlay system, so the surgeon can always localize the target and verify the effects of the intervention. Several tests of the system have been already performed to evaluate the accuracy, and clinical experiments are currently in progress in order to validate the clinical usefulness of the system.

  15. American Pediatric Surgical Association

    MedlinePLUS

    ... Curricula Membership + Members Join APSA Careers Surgical Practice Management In Memoriam About APSA + APSA Mission Awards APSA Leadership Committees Alliances APSA Foundation Third-Party Advertising Disclaimer ...

  16. Contribution of intestinal flora to surgical infections.

    PubMed

    Mandal, A K; Thadepalli, H

    1988-07-01

    Postoperative septic complications related to intestinal injury are regulated by a complex group of factors, including intestinal microflora, site of injury, surgical procedures used, and the type of antimicrobial therapy; however, a large number of yet-to-be understood factors also exist that influence septic morbidity associated with intestinal surgery. The authors present an overview of this serious complication of surgery. PMID:3404556

  17. 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

  18. 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,...

  19. 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,...

  20. 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,...

  1. 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,...

  2. 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,...

  3. Laparoscopic approach for inflammatory bowel disease surgical managment.

    PubMed

    Maggiori, Léon; Panis, Yves

    2012-01-01

    For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach. PMID:23373362

  4. Are costs of robot-assisted surgery warranted for gynecological procedures?

    PubMed

    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

  5. 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

  6. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    PubMed Central

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  7. 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.

  8. Medical & Surgical Management of Pelvic Floor Disorders Affecting Defecation

    PubMed Central

    Schey, Ron; Cromwell, John; Rao, Satish S.C.

    2014-01-01

    Pelvic floor disorders that affect stool evacuation include structural (example: rectocele) and functional disorders (example: dyssynergic defecation). Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion and imaging studies such as anal ultrasound, defecography, and static and dynamic MRI can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and lastly surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation. Because dyssynergic defecation may co-exist with conditions such as solitary rectal ulcer syndrome (SRUS), and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic and trans-abdominal approach, stapled transanal rectal resection (STARR), and robotic colon and rectal resections. However, there is lack of well controlled randomized studies and efficacy of these surgical procedures remains to be established. PMID:22907620

  9. 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

  10. 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.

  11. Preferences in surgical waiting area amenities.

    PubMed

    Carmichael, Julie M; Agre, Patricia

    2002-06-01

    The purpose of this needs assessment was to determine which waiting area amenities family members deem important to make them comfortable when waiting for news about surgical patients. A literature review was conducted, perioperative staff members were interviewed and surveyed, and family members were interviewed and surveyed. The findings indicate that family members have preferences for specific amenities. Items of highest importance include the service of a surgical nurse coordinator and a private room for consulting with physicians. Items of average importance include beepers and educational materials about the procedure. Items of least importance include a food cart and soft music. PMID:12085400

  12. Surgical Treatment of Canine Glaucoma: Cyclodestructive Techniques.

    PubMed

    Bras, Dineli; Maggio, Federica

    2015-11-01

    Medical and surgical management of canine glaucoma can be challenging. The goal of surgical treatment is to manipulate the inflow and/or outflow of aqueous humor. This article describes the inflow-reducing, cyclodestructive techniques. Diode cyclophotocoagulation is the most common cyclodestructive procedure performed in humans and animals. Diode laser energy can be applied via a transscleral (transscleral cyclophotocoagulation [TSCP]) or an endoscopic (endoscopic cyclophotocoagulation [ECP]) approach. ECP provides direct visualization of the targeted ciliary body, allowing safer and more titratable treatment than TSCP techniques, offering a better long-term prognosis for vision and intraocular pressure control. Advancements in diode laser therapy seem promising. PMID:26342764

  13. Surgical treatment of radiation enteritis

    SciTech Connect

    Cross, M.J.; Frazee, R.C. )

    1992-02-01

    Radiation enteritis is a progressive, disease process that causes intestinal fibrosis and obliterative endarteritis, which results in significant morbidity and mortality. The authors' clinical experience involving 20 patients over a 22-year period from 1967 through 1989 who underwent various surgical procedures to alleviate chronic symptoms secondary to radiation enteritis is described. Eight men and 12 women with a mean age of 52 years (24 to 81 years) underwent a total of 27 procedures for complications of radiation enteritis. Radiation therapy was delivered for treatment of gynecologic malignancies (55%), colorectal cancer (20%), prostate malignancies (10%), and others (15%). The mean average dose of radiation delivered was 5,514 rads with a range of 2,613 to 7,000 rads. The interval from radiation treatment to time of surgery averaged 9 years. Operative procedures consisted of 12 resection and primary anastomosis procedures and 15 resections with stoma creation. Formation of a stoma was used in patients with more severe disease. The 30-day operative mortality was 0% and morbidity was 55%. There were no anastomotic leaks or intra-abdominal abscesses. The authors conclude that resection and primary anastomosis can safely be performed in selected patients but that judicious use of stoma formation can avoid major mortality and morbidity associated with surgery in this setting.

  14. Percutaneous versus surgical management of lower extremity peripheral artery disease.

    PubMed

    Kakkar, Amit M; Abbott, J Dawn

    2015-01-01

    Lower extremity peripheral artery disease (PAD) is highly prevalent and can manifest as intermittent claudication or, in the most advanced form, critical limb ischemia. Revascularization, which can be accomplished by an endovascular or surgical approach, is performed to improve quality of life or, in severe cases, for limb salvage. Over the past decade, percutaneous catheter-based techniques have improved such that acute procedural success is high even in complex anatomy. Patency rates have also increased with the use of atherectomy devices and drug-eluting stents. Often, patients with PAD have comorbidities that increase the risk of cardiovascular complications with surgical procedures. These factors have led to the adoption of an endovascular first strategy with surgical management reserved for selected patients. This review focuses on the most current clinical trials of endovascular therapy for PAD. In addition, older but relevant studies comparing endovascular and surgical approaches and contemporary surgical trials are presented for reference. PMID:25612856

  15. Interdisciplinary Approach to a Tooth with Open Apex and Persistent Sinus

    PubMed Central

    Das, Anoop N.; Geetha, Krishnamohan; Varghese Kurian, Ajay; Nair, Radhakrishnan; Nandakumar, K.

    2015-01-01

    Traumatic injuries in childhood may disrupt root development leading to a tooth with open apex. Apexification procedures in such cases aim at root end closure after reasonable period of time. In some chronic cases, complete healing of the periapical area does not occur resulting in development of a nonhealing sinus. Failure of nonsurgical approach in such cases needs surgical intervention permitting thorough periapical curettage. In the present case, apexification procedure with MTA achieved root end closure but failed to heal the sinus for which surgical treatment was completed with thorough periapical curettage and application of platelet rich fibrin (PRF) and a combination of ?-tricalcium phosphate and hydroxyapatite resulted in healing. PMID:26425373

  16. Performance improvement initiative: prevention of surgical site infection (SSI)

    PubMed Central

    Ng, Wai Khuan; Awad, Nawal

    2015-01-01

    Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable. Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen. A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care.

  17. Early and late residual renal function and surgical complications in living donors: a 15-year experience at a single institution.

    PubMed

    Sansalone, C V; Maione, G; Aseni, P; Rossetti, O; Mangoni, I; Soldano, S; De Roberto, A; Minetti, M E; Perrino, M L; Civati, G

    2006-05-01

    Living donation in the field of renal transplantation has increased over time as well as the use of laparoscopic nephrectomy. We present a 15-year experience on 162 living donors (105 women, 57 men; mean age, 46.7 years; range, 31-74 years) who underwent nephrectomy using different surgical approaches as open lombotomic nephrectomy (OLN), open transperitoneal nephrectomy (OTN), and laparoscopic hand-assisted nephrectomy (LHAN). We collected data on residual donor and recipient renal function, as well as early versus late medical and surgical complications. With a mean follow-up of about 8 years, we observed normal residual renal function in all donors and similar results of early and late graft function independent of the surgical procedure. Long-term incidence of hypertension and noninsulin-dependent diabetes in living donors was similar to the general population. OLN and OTN donors showed higher incidences of early and late complications, readmissions, and reoperations than LHAN donors. Our results confirmed that living donor nephrectomy is a safe procedure without serious side effects in terms of renal function and long-term quality of life. LHAN should be the preferred technique because of a lower incidence of early and late complications. PMID:16757241

  18. 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

  19. Loop Electrosurgical Excision Procedure (LEEP)

    MedlinePLUS

    ... that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away ... A procedure in which an instrument works with electric current to destroy tissue. Local Anesthesia: The use of ...

  20. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.

  1. Urogynecologic Surgical Mesh Implants

    MedlinePLUS

    ... Repair UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse: FDA ... Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse (July 2011) (PDF - 243KB) ...

  2. Standardising fast-track surgical nursing care in Denmark.

    PubMed

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik; Egerod, Ingrid

    Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care. PMID:24820811

  3. [DIN-oriented tensile strength evaluation of surgical tissue sutures].

    PubMed

    Bücheler, M

    1999-03-01

    Methods to determine the mechanical properties of surgical wounds and sutures are valuable tools in wound healing research. So far standardized testing procedures have not been defined in the surgical literature, which reduces the comparability of results from different authors. Therefore we suggest a modified tensile testing procedure which follows German industrial standards (DIN 53455). The experimental set-up includes an universal testing machine and special clamps. The dumbbell-shaped specimen consist of freshly prepared pig skin and the suture which is to be tested. Well-known mechanical properties of surgical sutures and wounds were used to approve the precision of the experimental set-up. Reproducible analysis of all tested sutures and wounds (n = 120) was possible. We recommend testing procedures adapted to industrial standards to obtain comparable results in determination of mechanical properties of surgical wounds and sutures. PMID:10230549

  4. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    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.

  5. Microcomputer database management for surgical residents.

    PubMed

    Johnson, P C; Hendricks, D; White, M J; Futrell, J W

    1989-01-01

    Surgical residents must record procedures performed and may choose to keep files of photographic slides, bibliographic references, and a curriculum vitae. Four databases that store this information are produced with an inexpensive and easily obtained microcomputer software program. A surgical procedure database is modeled after the procedure list recommended by surgical boards. This list can be viewed while one enters data, thereby enabling production of accurate and complete records. In the second database, photographic slides are assigned sequence numbers and slide content is designated using both procedure codes and key words, allowing structured and personal recall of data. Data can be printed in many report formats, including that used by the boards of surgery for final submission of reports of residents' operations at the completion of residency. The bibliographic and CV databases contain highly segmented citation data. This structure enables manipulation of data to satisfy the sequence requirements of journals or institutions to which articles or CV are submitted. Database maintenance consumes a few minutes daily and requires a minimum of experience with computers. By providing ease of access to organized data, these databases enhance the potential for critical review of clinical experience by both residents and program directors. PMID:2805774

  6. 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

  7. Unusual Open Surgical Repair of a Type IB Endoleak and a Giant Symptomatic Aortic Aneurysm following Stent Grafting for Type B Aortic Dissection.

    PubMed

    Mihály, Zsuzsanna; Csobay-Novák, Csaba; Entz, László; Szeberin, Zoltán

    2016-01-01

    Treatment of type IB endoleak after thoracic endovascular aortic repair (TEVAR) for post-dissection aortic aneurysm usually includes attempts of endovascular interventions using coils or plugs to occlude the false lumen or placement of a distal fenestrated endograft. Open conversion usually requires deep hypothermia and circulatory arrest with the associated increased mortality and complications. We present a case of a young patient with a 90 mm descending thoracic aneurysm caused by a chronic type B aortic dissection. A type II endoleak after TEVAR was successfully treated with left subclavian artery transposition. The patient had a rapidly increasing aortic aneurysm with a persistent type IB endoleak in spite of placement of an Amplatzer plug into the false lumen of the dissection. He developed progressive acute compression of the main stem bronchi by the aneurysm sac and his dyspnea worsened by an acute pulmonary embolism treated with anticoagulation. Adequate oxygenation could only be achieved with mechanical ventilation using a double-lumen endobronchial tube. A left thoracotomy was performed and the type IB endoleak was treated with bending of the distal aorta around the stent graft with a Dacron graft sleeve. Aortic clamping and circulatory support devices were avoided. The sac of the aneurysm was opened, a giant hematoma was evacuated, and aneurysmorrhaphy was performed to cover the stent graft. There was no residual endoleak and the bronchi were decompressed. The patient recovered after prolonged hospitalization and he was discharged home in good condition 24 days after admission. He returned to his normal activities and is asymptomatic 5 months later. Computed tomographic angiography showed decreased aneurysm sac, no evidence of endoleak, no residual pulmonary embolus, and no bronchial compression. PMID:26520424

  8. Low Back Pain: Current Surgical Approaches

    PubMed Central

    Treon, Katrina; Craig, Niall John Angus

    2015-01-01

    Low back pain (LBP) is a worldwide phenomenon. The UK studies place LBP as the largest single cause of absence from work; up to 80% of the population will experience LBP at least once in their lifetime. Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures. However, around 10% of patients go on to develop chronic pain. This review outlines the basics of the traditional approach to spinal surgery for chronic LBP secondary to osteoarthritis of the lumbar spine as well as explains the novel concepts and terminology of back pain surgery. Traditionally, the stepwise approach to surgery starts with local anaesthetic and steroid injection followed by spinal fusion. Fusion aims to alleviate pain by preventing movement between affected spinal segments; this commonly involves open surgery, which requires large soft tissue dissection and there is a possibility of blood loss and prolonged recovery time. Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods. Newer MISS techniques include extreme lateral interbody fusion and axial interbody fusion. The main problem of fusion is the disruption of the biomechanics of the rest of the spine; leading to adjacent level disease. Theoretically, this can be prevented by performing motion-preserving surgeries such as total disc replacement, facet arthroplasty, and non fusion stabilisation. We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP. PMID:26240729

  9. [Surgical treatments of erectile impotence].

    PubMed

    Sarramon, J P; Bertrand, N; Malavaud, B; Rischmann, P; Chamssudin, A

    1997-01-01

    Impotence affects 10 to 15% of the male population. Organic factors are recognized in 80% of cases. Intracavernosal injections of vasoactive agents (Virag) have provided advances in the physiopathologic understanding of impotence and provide new ways of treating this incapacity. However this option is inaffective in most organic cases: arteriogenic, venogenic or disorders of smooth cavernous muscle. Vasoactive injections for many reasons are abandoned in about 40% of the cases. Two kinds of surgical management can be performed: microrevascularization in order to restore the arterial penile flow or to reduce penile venous flow during erection; implantation of penile prosthesis when other therapeutic possibilities are exhausted. Arterialization of the deep dorsal vein (DDV) appears to be the best procedure in arteriogenic and principally venous impotence. Erectile function in theses case is restored in 60% of our patients. Two types of prostheses can be implanted: semi-rigid with an axial permanent rigidity and inflatable or hydraulic devices with a flaccid aspect after intercourse. These prostheses are technically successful in 75 to 90% of cases, but partner satisfaction does not match surgical success rates. PMID:9183461

  10. Surgical Reconstruction of Radiation Injuries

    PubMed Central

    Fujioka, Masaki

    2014-01-01

    Significance: Patients with cancer receive benefits from radiation therapy; however, it may have adverse effects on normal tissue such as causing radiation-induced ulcer and osteoradionecrosis. The most reliable method to treat a radiation ulcer is wide excision of the affected tissue, followed by coverage with well-vascularized tissue. As usual, radiation-induced skin ulcers are due to therapeutic irradiation for residual cancer or lymph nodes; the locations of radiation ulcers are relatively limited, including the head, neck, chest wall, lumbar, groin, and sacral areas. Thus, suitable reconstructive methods vary according to functional and aesthetic conditions. I reviewed the practices and surgical results for radiation ulcers over the past 30 years, and present the recommended surgical methods for these hard-to-heal ulcers. Recent Advances: At a minimum, flaps are required to treat radiation ulcers. Surgeons can recommend earlier debridement, followed by immediate coverage with axial-pattern musculocutaneous and fasciocutaneous flaps. Free flaps are also a useful soft tissue coverage option. The choice of flap varies with the location and size of the wounds. Critical Issues: The most crucial procedure is the complete resection of the radiation-affected area, followed by coverage with well-vascularized tissue. Future Directions: Recent developments in perforator flap techniques, which are defined as flaps with a blood supply from isolated perforating vessels of a stem artery, have allowed the surgeons to successfully resurface these difficult wounds with reduced morbidity. PMID:24761342

  11. 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

  12. Modified arthroscopic Brostrom procedure.

    PubMed

    Lui, Tun Hing

    2015-09-01

    The open modified Brostrom anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. However, there is high incidence of intra-articular pathologies associated with chronic lateral ankle instability which may not be addressed by an isolated open Brostrom procedure. Arthroscopic Brostrom procedure with suture anchor has been described for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. However, the complication rates seemed to be higher than open Brostrom procedure. Modification of the arthroscopic Brostrom procedure with the use of bone tunnel may reduce the risk of certain complications. PMID:26235865

  13. AUTOMATED SYSTEM FOR SURGICAL INSTRUMENT AND SPONGE TRACKING (ASSIST). Nilo Rivera, Rosemary Mountain, Lia Assumpcao,

    E-print Network

    Amir, Yair

    AUTOMATED SYSTEM FOR SURGICAL INSTRUMENT AND SPONGE TRACKING (ASSIST). Nilo Rivera¹, Rosemary procedures is the unintentional retention of an instrument or sponge within a patient. This error can lead and Sponge Tracking to increase the safety of surgical procedures. In ASSIST, RFID (Radio Frequency

  14. Factors influencing the surgical process during shoulder joint replacement: Time-action analysis

    E-print Network

    van Vliet, Lucas J.

    , time-action analysis can be used. Material/Methods: Forty procedures performed by 7 surgeons used. The surgical procedure was influenced by several factors, such as the prosthesis used surgical outcome. key words: joint replacement · guiding instruments · shoulder prosthesis · time

  15. [Innovative concepts for surgical treatment of the carcinoma of the breast].

    PubMed

    Gauwerky, J F; Dieterich, H; Schmidt-Rhode, P

    2003-09-01

    Breast conserving therapy is a stable element in primary breast cancer treatment. Conservation and also restoration of the breast improve the outcome concerning psychological aspects. Surgical interventions include techniques for classical breast conservation as well as oncoplastic procedures like reduction mammaplasties and different types of flaps. Theses modern surgical procedures should be realised in a breast center. PMID:14569513

  16. [Stress urinary incontinence. Its surgical management].

    PubMed

    Neri Ruz, E S; Azcona Arteaga, F J

    1991-10-01

    Ninety eight patients with stress urinary incontinence treated surgically at Central Military Hospital, were studied. We analyzed the risk factors as age, weight, height, parity, menopause age, and previous medical and surgical procedures. They were divided in two groups. The Group I, vaginal approach, with 35 patients and Group II, retropubic surgery, with 63 patients. There were no differences both groups regarding age, weight, height, parity and menopausal age. The most frequent illness associated with stress urinary incontinence, was pelvic floor relaxation. The complications were 17.1% and 33.3%, respectively. The efficacy of Burch is procedure for the management of stress urinary incontinence, with a success rate of 84.1% versus 62.1% in the vaginal approach, was confirmed. PMID:1752448

  17. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.

    PubMed

    Mangram, A J; Horan, T C; Pearson, M L; Silver, L C; Jarvis, W R

    1999-04-01

    EXECUTIVE SUMMARY The "Guideline for Prevention of Surgical Site Infection, 1999" presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, "Surgical Site Infection: An Overview," describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, "Recommendations for Prevention of Surgical Site Infection," represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge.It has been estimated that approximately 75% of all operations in the United States will be performed in "ambulatory," "same-day," or "outpatient" operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not: Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care. Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures. Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6-11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy). Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activitie PMID:10196487

  18. Corrosion and fatigue of surgical implants

    NASA Technical Reports Server (NTRS)

    Lisagor, W. B.

    1975-01-01

    Implants for the treatment of femoral fractures, mechanisms leading to the failure or degradation of such structures, and current perspectives on surgical implants are discussed. Under the first heading, general usage, materials and procedures, environmental conditions, and laboratory analyses of implants after service are considered. Corrosion, crevice corrosion, stress corrosion cracking, intergranular corrosion, pitting corrosion, fatigue, and corrosion fatigue are the principal degradation mechanisms described. The need for improvement in the reliability of implants is emphasized.

  19. Upside-down stomach – results of mini-invasive surgical therapy

    PubMed Central

    Vrba, Radek; Aujesky, Rene; Vomackova, Katherine; Zbrozkova, Lenka

    2011-01-01

    Aim The authors evaluate the results of mini-invasive therapy in patients diagnosed with upside-down stomach. Material and methods From 1998 to 2008, a total of 27 patients diagnosed with upside-down stomach were surgically treated at the 1st Department of Surgery, University Hospital Olomouc. Before the operation, patients were examined endoscopically and a barium swallow was performed. In all 27 patients (100%), the operation was performed electively laparoscopically. The principle of the operation in all cases was reposition of the stomach into the abdominal cavity, resection of the hernial sac and hiatoplasty. In addition, in 15 patients (56%) with reflux symptoms or endoscopic findings of reflux oesophagitis, fundoplication in Nissen's modification was also performed. Fundopexy was indicated in 12 patients (44%). Results In all patients (100%), the operation was performed mini-invasively; conversion to an open procedure was never necessary. In 3 cases (11%), the left pleural cavity was opened during the operation; this was treated by introducing a chest drain. The operation mortality in the patient set was zero; morbidity was 11%. A year after the operation, patients were re-examined, and follow-up endoscopy and barium swallow were performed. Conclusions In all patients diagnosed with upside-down stomach, surgical treatment is indicated due to the risk of developing severe complications. Mini-invasive surgical therapy in the hands of an experienced surgeon is a safe procedure which offers patients all the benefits of mini-invasive therapy with promising short- and long-term results. PMID:23255985

  20. 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

  1. [Pulmonary Echinococcosis: Surgical Aspects].

    PubMed

    Eichhorn, M E; Hoffmann, H; Dienemann, H

    2015-10-01

    Pulmonary cystic echinococcosis is a very rare disease in Germany. It is caused by the larvae of the dog tapeworm (echinococcus granulosus). The liver is the most affected organ, followed by the lungs. Surgery remains the main therapeutic approach for pulmonary CE. Whenever possible, parenchyma-preserving lung surgery should be preferred over anatomic lung resections. To ensure best therapeutic results, surgery needs to be performed under precise consideration of important infectiological aspects and patients should be treated in specialised centres based on interdisciplinary consensus. In addition to surgical aspects, this review summarises special infectiological features of this disease, which are crucial to the surgical approach. PMID:26351761

  2. Surgical resection for hepatoportal bile duct cancer

    PubMed Central

    He, Xiao-Shun; Huang, Jie-Fu; Liang, Li-Jian; Lu, Ming-De; Cao, Xiu-Hu

    1999-01-01

    AIM To discuss the effect of surgical procedures on the prognosis of patients of bile duct cancer and their indications. METHODS A retrospective analysis was made for 52 cases of hepat oportal bile duct cancer treated from January 1991 to December 1996. All the cases were classified according to the modified Bismuth-Corlettle sys tem and received appropriate operation. Therapeutic effects were evaluated on the basis of their survival rates, jaundice elimination, comfort index, operative mortality and complications. RESULTS Seventeen cases received surgical resection (32.7%). The survival rate was 71.4%, 35.7% and 10.4% for one, two and three years respectively, and was 30%, 16.8% and 0% for those with drainage (P < 0.05). The mortality rate was 6.0% for the drainage group and 5.9% for the resection group (P > 0.05). Of the 17 resected patients, 8 (47.1%) had curative resection and 9 (52.9%) noncurative resection. Their mean survival time was 21.1 months and 7.5 months respectively (P < 0.05). CONCLUSION Proper surgical procedure should be used on the basis of the local and general conditions of the patients, and aggressive resection with or without liver resection is a valid procedure for the treatment of hepato portal bile duct cancer and can significantly improve the prognosis of patients. PMID:11819410

  3. [Thiel's method of embalming and its usefulness in surgical assessments].

    PubMed

    Okada, Ryuhei; Tsunoda, Atsunobu; Momiyama, Naoko; Kishine, Naomi; Kitamura, Ken; Kishimoto, Seiji; Akita, Keiichi

    2012-08-01

    When we assess anatomical problems and the safety and effectiveness for performing a difficult surgical procedure or planning novel surgical approaches, preoperative human dissections are very helpful. However, embalming with the conventional formaldehyde method makes the soft tissue of the cadaver harder than that of a living body. Therefore, the cadaver embalmed with conventional formaldehyde is not appropriate for dissections when assess surgical approaches. Thiel's method is a novel embalming technique, first reported by W. Theil in 1992. This method can preserve color and softness of the cadaver without risk of infections. We have used cadavers embalmed with Thiel's method for preoperative assessments and have confirmed the usefulness of this method especially for the prevention of complications or in assessing surgical approaches. The cadaver embalmed with this method has several advantages over other embalming methods and it might be also useful for the developments of new surgical devices or evaluation of a surgeon's skill. PMID:23016272

  4. Surgical Ventricular Reconstruction

    MedlinePLUS Videos and Cool Tools

    ... We use very, very fine suture for this work. In fact, it's barely perceptible to the television ... Batista procedure, viable myocardium which can perform useful work is removed. In this procedure we really perform ...

  5. Surgical repair of rectocele. Comparison of transvaginal and transanal approach and personal technique

    PubMed Central

    LEANZA, V.; INTAGLIATA, E.; LEANZA, G.; CANNIZZARO, M.A.; ZANGHÌ, 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

  6. 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).

  7. Improving surgical weekend handover

    PubMed Central

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting.

  8. Surgical approaches for liver metastases in carcinoid tumors

    PubMed Central

    Saeed, Ahmad; Buell, Joseph

    2015-01-01

    Liver is the commonest site for metastasis in patients with neuroendocrine tumors (NETs); it occurs in 45-95% of patients. Available treatment options include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy. Typically, a multidisciplinary approach is a cornerstone for decision making while dealing with this aggressive disease. This review will focus on the performance and safety of open, laparoscopic, and liver transplant surgical approaches in NETs patients with liver metastases. PMID:26425458

  9. Percutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture.

    PubMed

    Figueiredo, Nicandro; Barra, Filipe; Moraes, Laryssa; Rotta, Roger; Casulari, Luiz Augusto

    2009-06-01

    A total of 47 percutaneous vertebroplasties (PVs) were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening cannula (FOC) and 22 using the new side-opening cannula (SOC), randomly distributed. The incidence of cement extrusion was 27% with the SOC, and 68% with the FOC, all asymptomatic (p<0.01). The pain control was similar for both groups, with good improvement of pain in most of the patients, and there were no clinical relevant complications. The cement leakage can be significantly reduced with this new SOC, which allows for a better cement injection toward the center of the vertebral body, increasing the safety of the procedure, with no increase in cost. PMID:19623429

  10. Surgical smoke evacuation systems.

    PubMed

    1997-04-01

    Surgical smoke evacuation systems are high-flow vacuum sources used to capture, at the surgical site, the smoke aerosols and gases generated during the use of lasers and electrosurgical units (ESUs). In this study, we evaluated 16 evacuation systems, from 10 suppliers, designed and marketed for use in the operating room for general surgery. For our testing, we focused on the performance of the systems (particularly their ability to capture smoke particles under simulated surgical conditions) and their ease of use and quality of construction. We also examined the projected costs of each system over a seven-year life cycle. We rated the systems separately for two different evacuation applications (1) general-purpose applications, for which the system would, in many cases, be used with a handheld nozzle (the traditional capture device used with these systems), and (2) ESU-pencil-based evacuation applications only, for which the system would always be used with a pencil-based wand. (We report on ESU-pencil-based smoke evacuation wands in a separate Evaluation in this issue.) While we found most units to be Acceptable, we did rate two units Acceptable-Not Recommended for both applications and one unit Unacceptable for general-purpose applications. In addition to our findings for the evaluated models, this study features several sections providing generic information and guidance about smoke evacuation technology. The Technology Overview describes the basics: what these systems do and how they do it. The Technology Management Guide, "Clearing the Air-Should Surgical Smoke Be Evacuated?," discusses the issues healthcare facilities should consider when determining whether, when, and how surgical smoke should be evacuated. Finally, the Selection, Purchasing, and Use Guide offers guidance on how facilities can most effectively implement this technology, from identifying models that will meet their needs to ensuring that the systems are used properly to provide adequate staff protection. PMID:9134439

  11. Interpretive Diagnostic Error Reduction in Surgical Pathology and Cytology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the Association of Directors of Anatomic and Surgical Pathology.

    PubMed

    Nakhleh, Raouf E; Nosé, Vania; Colasacco, Carol; Fatheree, Lisa A; Lillemoe, Tamera J; McCrory, Douglas C; Meier, Frederick A; Otis, Christopher N; Owens, Scott R; Raab, Stephen S; Turner, Roderick R; Ventura, Christina B; Renshaw, Andrew A

    2016-01-01

    Context .- Additional reviews of diagnostic surgical and cytology cases have been shown to detect diagnostic discrepancies. Objective .- To develop, through a systematic review of the literature, recommendations for the review of pathology cases to detect or prevent interpretive diagnostic errors. Design .- The College of American Pathologists Pathology and Laboratory Quality Center in association with the Association of Directors of Anatomic and Surgical Pathology convened an expert panel to develop an evidence-based guideline to help define the role of case reviews in surgical pathology and cytology. A literature search was conducted to gather data on the review of cases in surgical pathology and cytology. Results .- The panel drafted 5 recommendations, with strong agreement from open comment period participants ranging from 87% to 93%. The recommendations are: (1) anatomic pathologists should develop procedures for the review of selected pathology cases to detect disagreements and potential interpretive errors; (2) anatomic pathologists should perform case reviews in a timely manner to avoid having a negative impact on patient care; (3) anatomic pathologists should have documented case review procedures that are relevant to their practice setting; (4) anatomic pathologists should continuously monitor and document the results of case reviews; and (5) if pathology case reviews show poor agreement within a defined case type, anatomic pathologists should take steps to improve agreement. Conclusions .- Evidence exists that case reviews detect errors; therefore, the expert panel recommends that anatomic pathologists develop procedures for the review of pathology cases to detect disagreements and potential interpretive errors, in order to improve the quality of patient care. PMID:25965939

  12. Deep space neck infection: principles of surgical management.

    PubMed

    Osborn, Timothy M; Assael, Leon A; Bell, R Bryan

    2008-08-01

    Knowledge of the management of infections of the deep spaces of the neck is essential to the daily practice of oral and maxillofacial surgery. Timely decisions must be made through the acute course of the disease. Interventions must be performed with the appropriate surgical skill. The surgeon must decide on medical and surgical management, including antibiotic selection, how to employ supportive resuscitative care, when to operate, what procedures to perform, and how to secure the airway. To make these decisions the surgeon must understand the anatomy of the region and the etiology of infection, appropriate diagnostic workup, and medical and surgical management. This article provides a review of these pertinent topics. PMID:18603196

  13. Surgical treatments to restore function control in spinal cord injury.

    PubMed

    Keith, Michael W; Peljovich, Allan

    2012-01-01

    People with spinal cord injury (SCI) have a profound loss of control of their lives and abilities. Surgical procedures are of significant benefit in improving autonomy, self-care, and body function. Functional electrical stimulation (FES) is useful at higher levels of paralysis such as ASIA C5 or C6 where there are no remaining voluntary muscles for tendon transfer and can partially replace respiration, balance, and ambulation. Outcomes studies show that surgical care improves independence, strength of grasp, and measured quality of life. Those with tetraplegia should be referred for consultation for surgical reconstruction, release of contractures, consideration for neuroprostheses, and reconstruction. PMID:23098712

  14. Toward fluorescence detection of protein residues on surgical instruments

    NASA Astrophysics Data System (ADS)

    Richardson, Patricia R.; Jones, Anita C.; Baxter, Robert L.; Baxter, Helen C.; Whittaker, A. Gavin; Campbell, Gaynor A.

    2004-06-01

    Prion proteins are the infectious agents that cause Creutzfeldt-Jakob Disease (CJD) in humans. These proteins are particularly resistant to normal sterilization procedures, and the theoretical risk of prion transmission via surgical instruments is of current public and professional concern. We are currently investigating fluorescence methods for the detection of proteins on surfaces, with a view to developing an optical-fiber-based system for routine, online monitoring of residual protein contamination on surgical instruments, in hospital sterilization departments. This paper presents preliminary results on the detection of femtomole amounts of fluorescently labelled protein on surgical steel and discusses some of the problems involved in the detection of fluorescence from metal samples.

  15. The surgically altered breast: imaging technique and findings

    PubMed Central

    2014-01-01

    Early diagnosis of breast cancer is the most importance factor that improve patient prognosis. Mammography has been proven in various randomized control trial as an effective screening tool for breast cancer. However, with the increasing of various breast surgical procedures such as breast augmentation, reduction mammoplasty and reconstruction, it may result in more challenging in surveillance and screening of the breast cancer. Imaging appearances of breast augmentation and other surgical altered breast are diverse. Understanding and familiar with the spectrum of imaging findings in the surgical altered breast may require to prevent image misinterpretation and which can result in delay diagnosis of malignancy and detection of locoregional recurrence. PMID:25083494

  16. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions E Appendix E to Part 63...Systems at Kraft Pulp Mills Under Unsafe Sampling Conditions I. Purpose This procedure...3) to be followed during unsafe sampling conditions when it is not...

  17. Toward Developing a Relative Value Scale for Medical and Surgical Services

    PubMed Central

    Hsiao, William C.; Stason, William B.

    1979-01-01

    A methodology has been developed to determine the relative values of surgical procedures and medical office visits on the basis of resource costs. The time taken to perform the service and the complexity of that service are the most critical variables. Interspecialty differences in the opportunity costs of training and overhead expenses are also considered. Results indicate some important differences between the relative values based on resource costs and existing standards, prevailing Medicare charges, and California Relative Value Study values. Most dramatic are discrepancies between existing reimbursement levels and resource cost values for office visits compared to surgical procedures. These vary from procedure to procedure and specialty to specialty but indicate that, on the average, office visits are undervalued (or surgical procedures overvalued) by four- to five-fold. After standardizing the variations in the complexity of different procedures, the hourly reimbursement rate in 1978 ranged from $40 for a general practitioner to $200 for surgical specialists. PMID:10309112

  18. Surgical Treatment of Atrial Fibrillation: A Review

    PubMed Central

    Hiari, Nadine

    2011-01-01

    Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1) reduce embolic complications, particularly stroke, (2) alleviate symptoms, and (3) prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources. PMID:21738854

  19. Raplixa™: A Review in Improving Surgical Haemostasis.

    PubMed

    McKeage, Kate

    2015-08-01

    Raplixa™ is a novel fibrin sealant containing a blend of human fibrinogen and thrombin in powder form. It is approved in adults to help control bleeding when standard surgical techniques have been insufficient. This article summarizes the product characteristics of Raplixa and provides a narrative review of its clinical use and tolerability. Unlike other available fibrin sealants, including liquid agents and lyophilized powders, the dry-powder, ready-to-use formulation of Raplixa provides potential advantages, including ease of storage and use. In the randomized, phase III FINISH-3 study, Raplixa plus gelatin sponge was superior to gelatin sponge alone in reducing the time to haemostasis in adults who developed mild or moderate bleeding uncontrolled by conventional surgical techniques while undergoing spinal, vascular, hepatic or soft-tissue surgical procedures. Raplixa was well tolerated, with a similar safety profile to that observed in the gelatin-sponge-alone group. Thus, Raplixa provides an easy to store and use option for improving haemostasis in adults when standard surgical techniques are ineffective or impractical. PMID:26142085

  20. 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.

  1. An introduction to the practical and ethical perspectives on the need to advance and standardize the intracoelomic surgical implantation of electronic tags in fish

    SciTech Connect

    Brown, Richard S.; Eppard, M. B.; Murchie, Karen J.; Nielsen, Jennifer L.; Cooke, Steven 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.

  2. Minimally invasive surgical options for ureteropelvic junction obstruction: A significant step in the right direction

    PubMed Central

    Symons, Stephanie J.; Palit, Victor; Biyani, Chandra Shekhar; Cartledge, Jon J.; Browning, Anthony J.; Joyce, Adrian D.

    2009-01-01

    Open pyeloplasty is the gold standard treatment for adult ureteropelvic junction obstruction (UPJO) with published success rates consistently over 90%. In recent years, the management of UPJO has been revolutionized by the introduction of endoscopic procedures and laparoscopic techniques. We analyzed the long-term results of endoscopic and other minimal access approaches for the treatment of UPJO. Early results for endopyelotomy were promising but long-term results were not encouraging. Laparoscopic pyeloplasty technique is well defined and duplicates the surgical principles of conventional open pyeloplasty. With such a large variety of minimally invasive procedures for the treatment of UPJO available, the treatment choice for UPJO must be based on the success and morbidity of the procedures, the surgeon’s experience, the cost of the treatment, and the patient’s choice. We feel that with the technological advances in instrumentation coupled with a decrease in cost and improved training of urological surgeons, laparoscopic pyeloplasty may evolve to be the new “gold” standard for the treatment of UPJO. PMID:19468425

  3. 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

  4. Mentoring in surgical training.

    PubMed

    Rashid, Prem; Narra, Maruthi; Woo, Henry

    2015-04-01

    Surgical mentors have helped trainees develop fulfilling and academically productive careers, while supervisors are formally assigned to impart skills and oversee training. This paper reviews the comparative roles of the supervisor and mentor and how they overlap, while exploring the impact of the 'unknown' mentor. While the supervisor's role in directing the student is formally recognized, the mentee will personally select a mentor who successfully models the career and life balance to which the mentee aspires. The unknown mentor is known only to the mentee. The mentee's commitment to communicating with both mentor and supervisor is crucial to success. Better processes can be used to guide the mentor relationship. Confusion between the two roles - mentor and supervisor - is due to their complementary nature as well as an overlap in roles. Both remain essential to the growth and development of the surgical trainee. The unknown mentor could give detached advice and guidance to the student, while acting as a positive role model. PMID:25649003

  5. Surgical Approach to Splenic Hydatid Cyst: Single Center Experience

    PubMed Central

    Eris, Cengiz; Akbulut, Sami; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Odabasi, Mehmet; Ozkan, Erkan; Atalay, Suleyman; Gunay, Emre

    2013-01-01

    The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy. PMID:24229022

  6. Allergy to Surgical Implants.

    PubMed

    Pacheco, Karin A

    2015-01-01

    Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care. PMID:26362550

  7. 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

  8. Prevention of surgical site infections.

    PubMed

    Hedrick, Traci L; Anastacio, Melissa M; Sawyer, Robert G

    2006-04-01

    In the current era of pay-for-performance standards, the incidence of surgical site infections is increasingly becoming an institutional marker of quality assurance. Surgical site infections lead to increased morbidity and mortality in the surgical population and contribute to an already rising healthcare cost. As a result, the surgical community goes to great lengths to prevent this costly and occasionally lethal complication. Many practices are evidence based, however, many are not. In this article, the most commonly used preventive strategies in practice today and the evidence behind each are reviewed. In addition, an overview of the epidemiology, pathophysiology and microbiology of surgical site infections will be provided. PMID:16597204

  9. [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

  10. Surgical management of glaucoma: a review.

    PubMed

    Morgan, William H; Yu, Dao-Yi

    2012-01-01

    This review will briefly describe the history of surgical glaucoma treatment and concentrate on the current surgical strategies for managing glaucoma. A discussion of treatments for angle closure, open-angle glaucoma and paediatric glaucoma with an emphasis on drainage surgery are included. The role of cataract surgery is also briefly described. Drainage surgery evolved from peripheral iridectomy and sclerotomy with an increasing understanding of aqueous flow within the eye and the production of a functioning bleb. The current mainstays include trabeculectomy, glaucoma drainage devices as well as goniotomy and trabeculotomy, which have all been in existence for more than 40 years. Their various advantages as well as methods used to minimize their disadvantages, including the antimitotics and case selection are discussed. We finish by discussing the preliminary results of some newer forms of drainage surgery illustrating the energetic search for methods to minimize the problems of hypotony and bleb failure. PMID:22339885

  11. Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication

    PubMed Central

    Kriegmair, M. C.; Mandel, P.; Rathmann, N.; Diehl, S. J.; Pfalzgraf, D.; Ritter, M.

    2015-01-01

    Objectives. A symptomatic renal pseudoaneurysm (RPA) is a severe complication after open partial nephrectomy (OPN). The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6%) patients, on average 14 (4–42) days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p = 0.004). There was a significant correlation between RPAs and transfusion and the duration of stay (p < 0.001 and p = 0.021). Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment. PMID:26539549

  12. 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

  13. 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.

  14. Clinical experience with a multifunctional, flexible surgery system for endolumenal, single-port, and NOTES procedures

    PubMed Central

    Thompson, Kari; Talamini, Mark; Ferreres, Alberto; Jacobsen, Garth; Spaun, Georg; Cullen, John; Swanstrom, Lee

    2010-01-01

    Background Single-port and incisionless surgical approaches hold the promise of fewer complications, reduced pain, faster recovery, and improved cosmesis compared with traditional open or laparoscopic approaches. The ability to select an access approach (i.e., endolumenal, single-port, transvaginal, or transgastric) with one platform may be important to optimization of individual patient results. The authors report their results using these four separate surgical approaches tailored to three different therapeutic procedures, all with the use of a single flexible platform, the Incisionless Operating Platform (IOP). Methods After institutional review board approval, the IOP was used to perform nine cholecystectomies via transvaginal (TV) (n = 4), transgastric (TG) (n = 4), and single-port transumbilical (TU) (n = 1) access. Two appendectomies were performed via TG access. Endolumenal access was used for 18 gastric pouch and stoma reductions after Roux-en-Y gastric bypass. The TG and TV procedures involved the use of one to three trocars. The recorded data included safety, procedural success, operative time, patient pain assessment (on a 0–10 scale) at discharge, and length of hospital stay. Results Procedural success was achieved for 16 of 18 endolumenal procedures, 1 of 1 single-port procedure, and 10 of 10 NOTES procedures. For 5 of 10 NOTES procedures, only one small trocar was required. The mean operative times were 79 min for pouch with stoma reduction, 171 min for cholecystectomy, and 274 min for appendectomy. Of 29 patients, 27 were discharged in 24 h or less. The average pain scores were 0.44 for pouch with stoma reduction, 1.3 for cholecystectomy, and 2.5 for appendectomy. No significant complications occurred. The ergonomics of IOP allowed the surgeon to interface with the system using an endoscopic or laparoscopic orientation. Conclusion Availability of a multifunctional, flexible surgery platform provides a choice of a single-port or incisionless surgical approach with the potential to reduce complications, pain, and recovery time while improving cosmesis. PMID:20734085

  15. Cardiac surgical theatre traffic: time for traffic calming measures?

    PubMed

    Young, Richard S; O'Regan, David J

    2010-04-01

    Surgical site infections (SSIs) remain a significant cause of postoperative complications. The risk of death from a medical error in a UK hospital remains one in 300. Increased theatre traffic has been identified as a modifiable determinant of SSI and surgical error. This cross-sectional study for the first time describes the pattern of theatre traffic in a UK cardiac centre. An electronic door counter and galaxy theatre management software (v3.4, iSOFT Banbury, UK) were used to calculate frequencies and rates of door opening during operations. Forty-six cases were analysed with 4273 door openings recorded. The median age of patients was 65 (range 43-75) with a median EuroSCORE of 5 (1-14). The mean frequency of door openings per case was 92.9 (45-205), with 19.2 (6.4-38.2) openings per hour. The theatre door was open for 10.7% of each hour of operating. Prolonged, acute and cases involving patients with higher EuroSCOREs demonstrated a trend towards increased opening. Door opening disturbs theatre airflow and results in increased air and wound contamination. It is also described as a contributor to surgical mistakes. Current levels of traffic are unacceptably high and represent a modifiable risk factor for SSI and error. PMID:20100706

  16. Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases

    PubMed Central

    Shin, Sung Jin; Kwak, Hong-Seok; Park, Moon Seok; Yoo, Won Joon; Chung, Chin Youb; Choi, In Ho

    2009-01-01

    Background Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases. Methods Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calvé-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications. Results Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7° to a mean of 115.0° at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons. Conclusions Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications. PMID:19885048

  17. Surgical interventions for gastric cancer: a review of systematic reviews

    PubMed Central

    He, Weiling; Tu, Jian; Huo, Zijun; Li, Yuhuang; Peng, Jintao; Qiu, Zhenwen; Luo, Dandong; Ke, Zunfu; Chen, Xinlin

    2015-01-01

    Aim: To evaluate methodological quality and the extent of concordance among meta-analysis and/or systematic reviews on surgical interventions for gastric cancer (GC). Methods: A comprehensive search of PubMed, Medline, EMBASE, the Cochrane library and the DARE database was conducted to identify the reviews comparing different surgical interventions for GC prior to April 2014. After applying included criteria, available data were summarized and appraised by the Oxman and Guyatt scale. Results: Fifty six reviews were included. Forty five reviews (80.4%) were well conducted, with scores of adapted Oxman and Guyatt scale ? 14. The reviews differed in criteria for avoiding bias and assessing the validity of the primary studies. Many primary studies displayed major methodological flaws, such as randomization, allocation concealment, and dropouts and withdrawals. According to the concordance assessment, laparoscopy-assisted gastrectomy (LAG) was superior to open gastrectomy, and laparoscopy-assisted distal gastrectomy was superior to open distal gastrectomy in short-term outcomes. However, the concordance regarding other surgical interventions, such as D1 vs. D2 lymphadenectomy, and robotic gastrectomy vs. LAG were absent. Conclusion: Systematic reviews on surgical interventions for GC displayed relatively high methodological quality. The improvement of methodological quality and reporting was necessary for primary studies. The superiority of laparoscopic over open surgery was demonstrated. But concordance on other surgical interventions was rare, which needed more well-designed RCTs and systematic reviews. PMID:26550311

  18. 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

  19. The frontal sinus rescue procedure: early experience and three-year follow-up.

    PubMed

    Kuhn, F A; Javer, A R; Nagpal, K; Citardi, M J

    2000-01-01

    The frontal sinus rescue (FSR), first described in 1997, has now been performed on 24 patients (32 sides) over a period of three years. It is a functional endoscopic surgical approach to correct an iatrogenically scarred and obstructed frontal recess, which cannot be successfully opened via a normal endoscopic frontal sinusotomy approach. It is utilized primarily for patients whose only remaining option is either a Draf-type drill-out (modified intranasal Lothrop) procedure or frontal sinus obliteration. The FSR is a technically challenging procedure, but faster, less difficult, and less destructive for the patient than a "drill-out" or frontal sinus obliteration. Once learned, it can save the patient from undergoing the more radical drill-out or obliterative procedure. The early experience and three-year follow-up with this new endoscopic procedure is presented in our first 24 patients (32 sides). PMID:10979492

  20. 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.

  1. The Hidden Costs of Reconciling Surgical Sponge Counts.

    PubMed

    Steelman, Victoria M; Schaapveld, Ann G; Perkhounkova, Yelena; Storm, Hillary E; Mathias, Michelle

    2015-11-01

    Retained surgical sponges are serious adverse events that can result in negative patient outcomes. The primary method of prevention is the sponge count. Searching for sponges to reconcile counts can result in inefficient use of OR time. The purpose of this descriptive study was to estimate the cost of nonproductive OR time (ie, time spent not moving forward with the surgical procedure) spent reconciling surgical sponge counts and the cost of using radiography to rule out the presence of retained sponges. We included 13,322 patient surgeries during a nine-month period. Perioperative personnel required from one to 90 minutes of additional time to reconcile each of 212 incorrect/unresolved counts. The total annualized cost of OR time spent searching for sponges and ruling out the presence of potentially retained sponges using radiography was $219,056. These costs should be included in comprehensive cost analyses when considering alternatives to supplement the surgical count. PMID:26514707

  2. Surgical complications of carotid body tumors surgery: a review.

    PubMed

    Amato, B; Serra, R; Fappiano, F; Rossi, R; Danzi, M; Milone, M; Quarto, G; Benassai, G; Bianco, T; Amato, M; Furino, E; Compagna, R

    2015-12-01

    Carotid body tumor (CBT) is a rare neoplasm, although it represents about 65% of head and neck paragangliomas. Surgical excision is considered the appropriate therapy for CBTs. The aim of this study was to evaluate surgical outcomes on a large scale. We reviewed 19 studies between 2004 to 2014 with a total of 625 procedures. We observed a higher number of cases in women (62%). Only 3 (0,48%) deaths were reported as surgical complication. Total cranial nerve injuries were 302 (48,32%) of which 194 (31,04%) were transient and 108 (17,28%) were permanent. We found a total of 174 (27,84%) arterial injuries, most of which are external carotid artery (ECA) injuries. Cerebrovascular accident due to surgery were 15 (2,4%). We concluded that surgical resection remains the treatment of choice for these disease despite the related morbidity. PMID:26498887

  3. Trials and tribulations: the professional development of surgical trialists

    PubMed Central

    Jarman, Anna F.; Wray, Nelda P.; Wenner, Danielle M.; Ashton, Carol M.

    2013-01-01

    BACKGROUND Regulatory and professional bodies issue an ever-increasing number of guidance documents on the ethics and methods of clinical trials, but the quality of clinical trials of invasive therapeutic procedures continues to be a concern. We interviewed aspiring and accomplished surgical trialists to understand how they use guidance documents and other resources in their work. METHODS We performed a qualitative research study involving semistructured interviews of a diverse sample of 15 surgical trialists. RESULTS Professional development as a surgical trialist was haphazard, inefficient, and marked by avoidable mistakes. Four types of resources played constructive roles: formal education; written materials on clinical trials; experience with actual trials; and interpersonal interactions with peers, experts, collaborators, and mentors. Recommendations for improvement centered on education, mentoring, networking, participating in trials, and facilitation by department chairs. CONCLUSIONS The haphazard and unstructured nature of the current system is adding unnecessarily to the numerous challenges faced by surgical trialists. PMID:22920404

  4. Surgical Treatments for Fibroids

    MedlinePLUS

    ... this procedure, the surgeon inserts a long, thin telescope with a light through the vagina and cervix ( ... skoh-pee ). The surgeon uses a long, thin telescope to see inside the pelvic area, and then ...

  5. [The surgical treatment of pressure ulcers].

    PubMed

    Gaucher, Sonia; Rochet, Jean-Michel

    2013-01-01

    The whole context of the treatment must be taken into account. The aim is to treat the patient and avoid a recurrence. Not all pressure ulcers are suitable for surgery and patients must be rigorously assessed, which requires a coherent approach by all the medical and allied health care teams in order to harmonise practices. This coordination must lead to the acceptance of the surgical procedure and the implementation of a care approach which will ensure its success both with regard to the preoperative preparation and the immediate post-operative period as well as the long-term. PMID:23785861

  6. Using improvement science methods to increase accuracy of surgical consents.

    PubMed

    Mercurio, Patti; Shaffer Ellis, Andrea; Schoettker, Pamela J; Stone, Raymond; Lenk, Mary Anne; Ryckman, Frederick C

    2014-07-01

    The surgical consent serves as a key link in preventing breakdowns in communication that could lead to wrong-patient, wrong-site, or wrong-procedure events. We conducted a quality improvement initiative at a large, urban pediatric academic medical center to reliably increase the percentage of informed consents for surgical and medical procedures with accurate safety data information at the first point of perioperative contact. Improvement activities focused on awareness, education, standardization, real-time feedback and failure identification, and transparency. A total of 54,082 consent forms from 13 surgical divisions were reviewed between May 18, 2011, and November 30, 2012. Between May 2011 and June 2012, the percentage of consents without safety errors increased from a median of 95.4% to 99.7%. Since July 2012, the median has decreased slightly but has remained stable at 99.4%. Our results suggest that effective safety checks allow discovery and prevention of errors. PMID:24973184

  7. Minimally invasive surgical treatment of valvular heart disease.

    PubMed

    Goldstone, Andrew B; Joseph Woo, Y

    2014-01-01

    Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease. PMID:24952756

  8. The Apprenticeship Model for Surgical Training Is Inferior.

    PubMed

    Lubowitz, James H; Provencher, Matthew T; Brand, Jefferson C; Rossi, Michael J

    2015-10-01

    While the apprenticeship model for surgical training is a long-standing gold standard worldwide, proficiency-based progression (PBP) training proves significantly superior. The combination of a metrics tool describing procedural steps and errors with a simulator model or cadaveric training, results in a measurement tool that not only judges but serves to improve surgeon skill. PMID:26433232

  9. Improving the accuracy of operation coding in surgical discharge summaries

    PubMed Central

    Martinou, Eirini; Shouls, Genevieve; Betambeau, Nadine

    2014-01-01

    Procedural coding in surgical discharge summaries is extremely important; as well as communicating to healthcare staff which procedures have been performed, it also provides information that is used by the hospital's coding department. The OPCS code (Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedures) is used to generate the tariff that allows the hospital to be reimbursed for the procedure. We felt that the OPCS coding on discharge summaries was often incorrect within our breast and endocrine surgery department. A baseline measurement over two months demonstrated that 32% of operations had been incorrectly coded, resulting in an incorrect tariff being applied and an estimated loss to the Trust of £17,000. We developed a simple but specific OPCS coding table in collaboration with the clinical coding team and breast surgeons that summarised all operations performed within our department. This table was disseminated across the team, specifically to the junior doctors who most frequently complete the discharge summaries. Re-audit showed 100% of operations were accurately coded, demonstrating the effectiveness of the coding table. We suggest that specifically designed coding tables be introduced across each surgical department to ensure accurate OPCS codes are used to produce better quality surgical discharge summaries and to ensure correct reimbursement to the Trust.

  10. Automatic Detection and Segmentation of Robot-Assisted Surgical Motions

    E-print Network

    Shafran, Izhak

    's da Vinci system provide a rich source of motion and video data from surgical procedures. In principle Surgi- cal's da Vinci, introduce new challenges to this paradigm due to its steep learning curve]. Verner et al. [19] collected da Vinci motion data during performance of a training task by several

  11. Electrical Bioimpedance-Controlled Surgical Instrumentation.

    PubMed

    Brendle, Christian; Rein, Benjamin; Niesche, Annegret; Korff, Alexander; Radermacher, Klaus; Misgeld, Berno; Leonhardt, Steffen

    2015-10-01

    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

  12. Advanced Procedure for the Monitoring of Settlement and Open Space Development on Basis of Topographical Geodata Sets in the Ioer-Monitor

    NASA Astrophysics Data System (ADS)

    Meinel, G.

    2011-08-01

    Concept, Procedures and Results of the Monitor of settlement and open space development are presented. The monitoring system will describe the state and the development of land use especially in regard to its sustainability for the entire Federal Republic of Germany. To this end, for the first time ever it makes use of topographical geobasis data (digital landscape model of the Authoritative Topographic-Cartographic Information System, short ATKIS). These data allow for a more precise spatial and contentwise description of land use than that of the land register data, which serve as the basis for the official land use statistics. On the basis of the geobasis data an automatic calculation of indicators from the fields of settlement, open space, nature reserves, population, traffic occurs and landscape fragmentation. The indicators are depicted in thematic maps, thus allowing for spatial and chronological comparisons. In addition to administrative spatial units (federal state, region, district, municipality), the indicator values are also presented in scales of various cell widths. For calculating building-based settlement indicators, the patented program SEMENTA® is used, which is based on an automated evaluation of analogue maps.

  13. Synthesis of tunable-band-gap "Open-Box" halide perovskites by use of anion exchange and internal dissolution procedures.

    PubMed

    Wu, Zhengcui; Wang, Baohua; He, Jian; Chen, Tao

    2016-01-01

    We demonstrate the synthesis of cuboid MAPbBr3 (MA=CH3NH3) microcrystals and subsequent conversion into open-box-like MAPb(Br1-xIx)3 (0?x?1) microcrystals by anion exchange in MAI solution. During the substitution of Br(-) with I(-), the initial cuboid framework of MAPbBr3 crystals is retained. The preferential internal dissolution of MAPbBr3 due to the surface coverage and protection of MAPb(Br1-xIx)3 induces voids inside the cuboid crystals, finally leading to open-box-like iodide-rich MAPb(Br1-xIx)3. By controlling the degree of anion exchange, the intense light absorption of the product is able to be tuned in specific wavelengths throughout the visible range. This solution-phase anion exchange approach provides a synthetic strategy in designing sophisticated organolead halide perovskites structures as well as tuning the band gaps for further applications across a range of possible domains. PMID:26397923

  14. Surgical Management of Melanoma.

    PubMed

    Koshenkov, Vadim P; Broucek, Joe; Kaufman, Howard L

    2016-01-01

    The surgical management of melanoma has undergone considerable changes over the past several decades, as new strategies and treatments have become available. Surgeons play a pivotal role in all aspects of melanoma care: diagnostic, curative, and palliative. There is a high potential for cure in patients with early-stage melanoma and the selection of an appropriate operation is very important for this reason. Staging the nodal basin has become widespread since the adoption of sentinel lymph node biopsy (SLNB) for the management of melanoma. This operation provides the best prognostic information that is currently available for patients with melanoma. The surgeon plays a central role in the palliation of symptoms resulting from nodal disease and metastases, as melanoma has a propensity to spread to almost any site in the body. PMID:26601862

  15. Surgical management of ruptured small cerebral aneurysm: Outcome and surgical notes

    PubMed Central

    Grasso, Giovanni; Perra, Giancarlo

    2015-01-01

    Background: Management of small aneurysms often poses a therapeutic dilemma and surgical treatment or coiling can be considered as therapeutic choices. In the present study, we reviewed our series of ruptured small cerebral aneurysm treated surgically. Methods: A total of 53 consecutive patients with ruptured small aneurysm were surgically treated between January 2008 and July 2014. Data were retrospectively collected. Procedure-related death and complications were systematically reviewed. Clinical outcomes were assessed using the Modified Ranking Scale. Neuroradiological follow-up was performed to assess aneurysmal occlusion and recanalization rate. Results: The mean aneurysm size was 2 mm ± 0.8 mm. All the patients were operated and the aneurysm clipped. Clinical outcomes were as expected on the basis of the presenting Hunt and Hess grade. Overall, major and minor neurological deficit related to clipping were 5.2% and 2.2%, respectively. At the time of discharge, 84.9% of the patients presented with a favorable outcome, while 15.1% had poor clinical outcome. Aneurysm occlusion was achieved in all the cases. Neither recanalization nor re-aneurysmal rupture was observed in the clinical follow-up. Conclusion: Aneurysms, 3 mm in diameter or smaller, represent a therapeutic challenge. Given the proven role of microsurgery in small aneurysms and the perceived challenges with endovascular therapy, surgical clipping still can be considered an effective treatment modality in this setting. PMID:26677419

  16. Some historical aspects of the surgical treatment of the infected maxillary sinus.

    PubMed

    Tange, R A

    1991-06-01

    Sinus surgery probably originates from the time of the New Kingdom of ancient Egypt. Instruments were used to remove the brain through the nose as a part of the mummification process. The interest in the pathology of the maxillary sinus started to rise in the 17th century. Antral trephination for suppuration was the most common maxillary sinus operation in that period. An oro-antral fistula was often created by the extraction of a molar to drain the infected maxillary sinus daily. Later on the anterior wall of the maxillary sinus was opened through the canine fossa and was kept open for irrigation. Caldwell (1893), Scanes Spicer (1894) and later Luc in 1897 closed the canine fossa incision after an intranasal antrostomy and the removal of the infected mucosa. This so-called Caldwell-Luc procedure is still the most commonly used maxillary sinus operation today. After the introduction of the endoscopy in the beginning of this century endonasal surgery has been developed in the last decades into one of the important surgical procedures for maxillary sinus infections today. PMID:1891683

  17. Classification of Surgical Complications

    PubMed Central

    Dindo, Daniel; Demartines, Nicolas; Clavien, Pierre-Alain

    2004-01-01

    Objective: Although quality assessment is gaining increasing attention, there is still no consensus on how to define and grade postoperative complications. This shortcoming hampers comparison of outcome data among different centers and therapies and over time. Patients and Methods: A classification of complications published by one of the authors in 1992 was critically re-evaluated and modified to increase its accuracy and its acceptability in the surgical community. Modifications mainly focused on the manner of reporting life-threatening and permanently disabling complications. The new grading system still mostly relies on the therapy used to treat the complication. The classification was tested in a cohort of 6336 patients who underwent elective general surgery at our institution. The reproducibility and personal judgment of the classification were evaluated through an international survey with 2 questionnaires sent to 10 surgical centers worldwide. Results: The new ranking system significantly correlated with complexity of surgery (P < 0.0001) as well as with the length of the hospital stay (P < 0.0001). A total of 144 surgeons from 10 different centers around the world and at different levels of training returned the survey. Ninety percent of the case presentations were correctly graded. The classification was considered to be simple (92% of the respondents), reproducible (91%), logical (92%), useful (90%), and comprehensive (89%). The answers of both questionnaires were not dependent on the origin of the reply and the level of training of the surgeons. Conclusions: The new complication classification appears reliable and may represent a compelling tool for quality assessment in surgery in all parts of the world. PMID:15273542

  18. Mini-Bentall procedure

    PubMed Central

    2015-01-01

    An important goal in cardiovascular and thoracic surgery is reducing surgical trauma to achieve faster recovery for our patients. Mini-Bentall procedure encompasses aortic root and ascending aortic replacement with re-implantation of coronary buttons, performed via a mini-sternotomy. The skin incision extends from the angle of Louis to the third intercostal space, usually measuring 5-7 cm in length. Through this incision, it is possible to perform isolated aortic root surgery and/or hemi-arch replacement. The present illustrated article describes the technical details on how I perform a Mini-Bentall procedure with hemi-arch replacement. PMID:25870816

  19. 21 CFR 874.4420 - Ear, nose, and throat manual surgical instrument.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator;...

  20. 21 CFR 874.4420 - Ear, nose, and throat manual surgical instrument.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator;...

  1. 21 CFR 874.4420 - Ear, nose, and throat manual surgical instrument.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator;...

  2. 21 CFR 874.4420 - Ear, nose, and throat manual surgical instrument.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator;...

  3. 21 CFR 874.4420 - Ear, nose, and throat manual surgical instrument.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...is one of a variety of devices intended for use in surgical procedures to examine or treat the bronchus, esophagus, trachea, larynx, pharynx, nasal and paranasal sinus, or ear. This generic type of device includes the esophageal dilator;...

  4. 21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY...surgical procedures. The device may be nonpowered, hand-held, or hand-manipulated. Manual...

  5. 21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY...surgical procedures. The device may be nonpowered, hand-held, or hand-manipulated. Manual...

  6. 21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY...surgical procedures. The device may be nonpowered, hand-held, or hand-manipulated. Manual...

  7. 21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY...surgical procedures. The device may be nonpowered, hand-held, or hand-manipulated. Manual...

  8. 21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY...surgical procedures. The device may be nonpowered, hand-held, or hand-manipulated. Manual...

  9. Higher risk of incomplete mesorectal excision and positive circumferential margin in low rectal cancer regardless of surgical technique

    PubMed Central

    Ferko, Alexander; Orhalmi, Julius; Chobola, Milan; Hovorkova, Eva; Nikolov, Dimitar Hadzi

    2014-01-01

    Introduction Currently, the predominant question is whether a laparoscopic approach is comparatively radical in comparison with an open access approach, especially in the circumferential resection margin and quality of the completeness of total mesorectal excision. These factors are important in determining the quality of surgical care as well as long-term results of the treatment. Aim This article focuses on the evaluation of circumferential resection margins and on the quality of mesorectal excision of middle and lower rectum tumors. In addition, laparoscopic and open techniques are compared. Material and methods Data were collected prospectively and stored in a rectal cancer registry over a 3-year period. The parameters studied were age, sex, body mass index, localization and topography of the tumor, clinical stage, neoadjuvant chemotherapy and its response, the type of surgery, character of the circumferential and distal margins, quality of the mesorectal excision, pT and pN. Results One hundred and twenty-five patients were chosen for our study. Laparoscopy was performed in 53 operations and a conventional approach was performed in 72 operations. Complete mesorectal excision was achieved in 54.7% of laparoscopic operations versus 44.4% in the conventional technique; partially complete excision was performed in 20.8 and 12.5%, respectively. Incomplete excisions were described in 24.5 and 43.1% (p = 0.085). Positive circumferential margin occurred during laparoscopic surgery in 11 (20.8%) patients, and in the case of conventional resection in 27 (37.5%) patients (p = 0.044). Conclusions Our study showed comparable results between laparoscopic and open access procedures during rectal resection. The results achieved, in particular in the quality of the mesorectal excision and negative circumferential resection margin, show that the laparoscopic approach is comparable to conventional surgical techniques, with an adequate surgical outcome, in the treatment of rectal cancer. PMID:25561995

  10. Standardizing the Handling of Surgical Specimens.

    PubMed

    Shirey, Cheryl; Perrego, Kristen

    2015-11-01

    To standardize the handling of surgical specimens, the OR clinical educators in a community hospital setting devised a series of departmental changes as a quality improvement project. A newly created skill validation was reviewed in an hour-long educational meeting with all OR staff members. In addition to creating a new annual skill validation, discussions about specimens were included in the hand over, the time out, and a newly instituted debriefing tool to be used toward the end of a procedure. This interdisciplinary group devised interventions to improve the process of handling specimens such as standardizing the labeling process and changing the transparency of the specimen container. The goal was to assure standardization of specimen handling, specifically to assist novice staff members, and to harmonize inconsistencies between specialties within the practice of existing staff members. These combined methods helped to ensure accurate communication and procurement of specimens for all procedures. PMID:26514715

  11. Endovascular Treatment of Anastomotic Pseudoaneurysms after Aorto-iliac Surgical Reconstruction

    SciTech Connect

    Lagana, Domenico Carrafiello, Gianpaolo; Mangini, Monica Recaldini, Chiara; Lumia, Domenico; Cuffari, Salvatore; Caronno, Roberto; Castelli, Patrizio; Fugazzola, Carlo

    2007-11-15

    Purpose. To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction. Materials. We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter. Results. Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1-72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%. Conclusion. Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach.

  12. [SURGICAL TREATMENT OF PATIENTS WITH URETERAL RUPTURES].

    PubMed

    Komjakov, B K; Guliev, B G

    2015-01-01

    The aim of the study was to analyze the causes of ureteral ruptures and the types surgical procedures used for their management. Over the period from 2006 to 2014, 7 patients with ureteral ruptures underwent surgical treatment in the Mechnikov N-WSMU clinic. All of them were males aged 50 to 71 years. In all cases, the ureter was injured during ureteroscopy and contact lithotripsy. In two patients the right ureter was cut off at the border of the upper and middle third, in four--at 3-4 cm below pyeloureteral segment, one patient diagnosed with a complete separation of the ureter from the kidney pelvis. Patients, who have suffered a detachment of the ureter in other hospitals, previously underwent surgical exploration of the retroperitoneal space, drainage of the kidney by pyelonephrostomy (5) and ureterocutaneostomy (1). In a case of a patient with an injury that occurred in our clinic, laparoscopic nephrectomy with autologous renal transplantation was carried out. Five patients with extended ureter defects underwent ileo-ureteroplasty. The patient with left ureterocutaneostomy underwent nephrovesical bypass. Patency of the upper urinary tract and kidney function were restored in all patients, all of them were relieved from external drains. The duration of the intestinal plastic averaged 160 minutes, laparoscopic nephrectomy with autologous transplantation--210 min and nephrovesical bypass--110 min. Blood transfusion was required only in autologous graft patient. The ureteral rupture is a serious complication of ureteral endourological procedures in upper urinary tract. It requires such complicated reconstructive operations as autologous transplantation of the kidney or intestinal ureteroplasty. PMID:26390553

  13. 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

  14. From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve

    PubMed Central

    Zweemer, R. P.; van Baal, W. M.; van de Lande, J.; Dijkstra, J. C.; Verheijen, R. H. M.

    2010-01-01

    We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery. PMID:20700514

  15. Systematic Review: What Surgical Technique Provides the Best Outcome for Symptomatic Partial Articular-Sided Rotator Cuff Tears?

    PubMed Central

    Bollier, Matthew; Shea, Kevin

    2012-01-01

    Purpose There is no consensus in the literature regarding the optimal surgical treatment of symptomatic partial rotator cuff tears. We attempted to determine the optimal surgical treatment for partial articular-sided rotator cuff tears through a systematic review of appropriate studies. Methods Medline®, PubMed, Ovid, and the cochrane register of controlled trials were searched for all studies published between January 1991 to March 2010 that used the key words “shoulder”, “partial rotator cuff tear”, “PASTA”, “articularsided rotator cuff tear”, “incomplete rotator cuff tear”, “arthroscopic” and “repair”. Inclusion criteria were studies (Level I to IV) that reported clinical outcomes in patients who had arthroscopic evaluation and arthroscopic or mini-open treatment of a symptomatic partial articular-sided rotator cuff tear. One of three surgical treatments was used: debridement with or without acromioplasty; transtendon arthroscopic repair; or tear completion with repair. Exclusion criteria included studies with over 50% overhead throwers or athletes, studies that involved an open approach to the rotator cuff without arthroscopy, and data presented in technical notes or review papers. Data abstracted from the studies included patient demographics, tear characteristics, surgical procedure(s), and clinical outcomes. Results Of 588 studies involving partial rotator cuff tears, 14 studies were identified which met our inclusion and exclusion criteria. All studies were Level IV retrospective case-series studies. Seven studies reported outcomes after rotator cuff debridement. Tear completion and repair was performed in three studies. Transtendon repair of a partial articular-sided rotator cuff tear was performed in three studies. Although different outcome measures were used, each study reported subjective and objective improvement postoperatively. One study compared outcomes in patients who underwent arthroscopic debridement versus another group where patients had tear completion and mini-open repair. Improved long-term results and decreased reoperation rates were reported in the tear completion and repair group. Conclusion On the basis of the available evidence, no single technique provides superior clinical outcomes. Level I and II comparison studies are needed to determine the optimal treatment of partial articular-sided rotator cuff tears. PMID:23576937

  16. [Surgical versus non-surgical treatment of unilateral dislocated fractures of the lower mandibular condyle].

    PubMed

    Worsaae, N; Thorn, J J

    1995-06-12

    To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive patients were treated either by closed reduction with a median of four weeks of maxillomandibular fixation or by a median of six weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were observed for a median of two years after treatment. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were significantly more frequent in patients treated with closed reduction (39%) compared with those treated surgically (4%)(p = 0.005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results. PMID:7792975

  17. 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

  18. Congenital lung lesions: classification and concordance of radiological appearance and surgical pathology.

    PubMed

    Farrugia, M K; Raza, S A; Gould, S; Lakhoo, K

    2008-09-01

    Congenital lung lesions are diagnosed antenatally in the majority of cases. Postnatal management includes chest radiography and CT-scanning, followed by either surgical resection or CT surveillance. Pre-operatively, lesions are often "labelled" as CCAM (and the Stocker classification incorrectly applied), sequestration, or lobar emphysema, and their frequent "hybrid" nature sometimes missed. The aim of our study was to correlate antenatal and postnatal radiological diagnoses and classification of congenital lung lesions with surgical and pathological outcome. Twenty-six consecutive cases of antenatally-diagnosed cystic lung lesions managed at our centre between January 2003 and April 2007 were reviewed. Diagnoses were: cystic adenomatoid malformations (CCAM) in 13 cases (50.0%), three bronchopulmonary sequestrations (11.5%), "hybrid" lesions in eight cases (30.8%), one isolated lobar emphysema (3.8%) and a normal lung segment with anomalous systemic supply (3.8%). Overall concordance rate between prenatal ultrasound and resection pathology was 61.5%, whereas CT findings correlated with pathology in 65.4% of cases. Incorrect radiological classification resulted in one morbidity, when an attempted thoracoscopic resection of a presumed CCAM had to be converted to an open procedure due to bleeding from an unsuspected anomalous vessel. The common embryological origin of these lesions, and the need for standardisation of reporting is discussed. We propose that lesions should be classified anatomically according to their nature, arterial supply and venous drainage in order to reduce discrepancies between radiological, intra-operative and pathological reporting. PMID:18665370

  19. Vision and Task Assistance using Modular Wireless In Vivo Surgical Robots

    PubMed Central

    Platt, Stephen R.; Hawks, Jeff A.; Rentschler, Mark E.

    2009-01-01

    Minimally invasive abdominal surgery (laparoscopy) results in superior patient outcomes compared to conventional open surgery. However, the difficulty of manipulating traditional laparoscopic tools from outside the body of the patient generally limits these benefits to patients undergoing relatively low complexity procedures. The use of tools that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Our previous work demonstrated that miniature mobile and fixed-based in vivo robots using tethers for power and data transmission can successfully operate within the abdominal cavity. This paper describes the development of a modular wireless mobile platform for in vivo sensing and manipulation applications. Design details and results of ex vivo and in vivo tests of robots with biopsy grasper, staple/clamp, video, and physiological sensor payloads are presented. These types of self-contained surgical devices are significantly more transportable and lower in cost than current robotic surgical assistants. They could ultimately be carried and deployed by non-medical personnel at the site of an injury to allow a remotely located surgeon to provide critical first response medical intervention irrespective of the location of the patient. PMID:19237337

  20. 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

  1. Postgraduate cadaver surgery: An educational course which aims at improving surgical skills

    PubMed Central

    Tjalma, W.A.A.; Degueldre, M.; Van Herendael, B.; D’Herde, K.; Weyers, S.

    2013-01-01

    Objective: To describe the postgraduate surgical skills training programme of the Flemish Society of Obstetrics and Gynaecology (VVOG*). Laparoscopic surgical techniques and indications have increased substantially during the past two decades. From surgeons it is expected that they keep up with all techniques and should be able to perform all relevant procedures. Learning new procedures in daily practice is hazardous and difficult to achieve. A training experience with cadaver surgery could improve the course and outcome of surgery on patients. We present the objective, structure, and outcome of the endoscopic postgraduate training course. Structure: The overall objective of the endoscopic postgraduate training course is to refresh anatomical knowledge and improve general gynaecological laparoscopic surgical skills. The VVOG endoscopic training programme is based on black box training, followed by pig surgery. New is the possibility to perform surgical procedures on specifically prepared human cadavers. The course consists of an anatomical teaching session followed by lectures with videotaped procedures on the anatomical exploration of the pelvis, laparoscopic hysterectomy and pelvic lymphadenectomy. During the hands-on session the participant performs the surgical procedures in a controlled, nonthreatening and interactive way under the guidance of an experienced trainer. Conclusions: All participants provided feedback on their experiences. The evaluation of the workshop revealed that this course is an opportunity to practise and improve clinical laparoscopic skills of gynaecological procedures and anatomy. Attending the course was regarded as of genuine additional value for surgical practice. PMID:24753929

  2. Surgical Management of Stone Disease in Patient with Primary Hyperoxaluria

    PubMed Central

    Carrasco, Alonso; Granberg, Candace F.; Gettman, Matthew T.; Milliner, Dawn S.; Krambeck, Amy E.

    2015-01-01

    Objectives To present our experience with surgical management of nephrolithiasis in patients with primary hyperoxaluria (PH). Methods A retrospective chart review from 1994–2012 was perform to identify patients with diagnosis of PH. Results A total of 14 patients with PH were identified with median follow-up of 18.6 years (range: 0.9–51). Median age at initial symptom and subsequent diagnosis were 6.7 years (range: 1.1–35.5) and 0.42 years (range: 0–33.25), respectively. Patients underwent a total of 54 procedures at our institution including: ureteroscopy 27 (50%), percutaneous nephrolithotomy 15 (28%), shock wave lithotripsy 8 (15%), and combined procedures 4 (7%). Overall non-intraparenchymal stone free rate after first, second, and third procedure(s) were 59%, 76%, and 78%, respectively. On average 1.6 procedures (range: 1–4) were required to rid patients of symptomatic stones, which subsequently afforded them a mean of 3.62 years (range: 0.25–21.5) without the need of additional intervention. There were 6 Clavien grade ? III complications in 4 patients, including immediate postoperative ESRD in 3. Conclusions Despite optimal medical and surgical management, patients experience recurrent acute stone events requiring multiple urologic interventions. Significant complications such as ESRD can occur secondary to surgical intervention. PMID:25733260

  3. Standardization of surgical techniques used in facial bone contouring.

    PubMed

    Lee, Tae Sung

    2015-12-01

    Since the introduction of facial bone contouring surgery for cosmetic purposes, various surgical methods have been used to improve the aesthetics of facial contours. In general, by standardizing the surgical techniques, it is possible to decrease complication rates and achieve more predictable surgical outcomes, thereby increasing patient satisfaction. The technical strategies used by the author to standardize facial bone contouring procedures are introduced here. The author uses various pre-manufactured surgical tools and hardware for facial bone contouring. During a reduction malarplasty or genioplasty procedure, double-bladed reciprocating saws and pre-bent titanium plates customized for the zygomatic body, arch and chin are used. Various guarded oscillating saws are used for mandibular angloplasty. The use of double-bladed saws and pre-bent plates to perform reduction malarplasty reduces the chances of post-operative asymmetry or under- or overcorrection of the zygoma contours due to technical faults. Inferior alveolar nerve injury and post-operative jawline asymmetry or irregularity can be reduced by using a guarded saw during mandibular angloplasty. For genioplasty, final placement of the chin in accordance with preoperative quantitative analysis can be easily performed with pre-bent plates, and a double-bladed saw allows more procedural accuracy during osteotomies. Efforts by the surgeon to avoid unintentional faults are key to achieving satisfactory results and reducing the incidence of complications. The surgical techniques described in this study in conjunction with various in-house surgical tools and modified hardware can be used to standardize techniques to achieve aesthetically gratifying outcomes. PMID:26346781

  4. 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

  5. Design and application of compliant mechanisms for surgical tools.

    PubMed

    Kota, S; Lu, K-J; Kreiner, K; Trease, B; Arenas, J; Geiger, J

    2005-11-01

    This paper introduces the benefits of exploiting elasticity in the engineering design of surgical tools, in general, and of minimally invasive procedures, in particular. Compliant mechanisms are jointless mechanisms that rely on elastic deformation to transmit forces and motion. The lack of traditional joints in these single-piece flexible structures offers many benefits, including the absence of wear debris, pinch points, crevices, and lubrication. Such systems are particularly amenable to embedded sensing for haptic feedback and embedded actuation with active-material actuators. The paper provides an overview of design synthesis methods developed at the Compliant Systems Design Laboratory and focuses specifically on surgical applications. Compliant systems have potential to integrate. well within the constraints of laparoscopic procedures and telerobotic surgery. A load-path representation is used within a genetic algorithm to solve two gripper example problems. In addition, the paper illustrates the design and construction of an organ (kidney) manipulator for use in minimally invasive procedures. PMID:16438236

  6. 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

  7. Surgical consent: the world's largest Chinese Whisper? A review of current surgical consent practices.

    PubMed

    Loughran, Dafydd

    2015-02-01

    As the law around surgical consent continues to evolve, surgeons and those in training risk being caught red-faced and defenceless. Despite repeated concerns regarding surgical consent being raised by the General Medical Council of the UK, how much is changing on the National Health Service shop floor? This report investigates the variation between consenting practices for six common general surgical operations in 123 individual operations. Results showed that only 20% of mentioned operative complications for each operation were being documented on >75% of consent forms. The vast majority of mentioned complications were mentioned inconsistently, leading to patients being given grossly varying information preoperatively. Reassuringly, only 4.1% of consent procedures were done by those not in core surgical training (junior resident) or above, but nonetheless significant omissions were observed. When consenting a patient for an emergency exploratory laparotomy, an operation carrying a 14% chance of death, a risk of death was only documented in 28% of cases. Trainees failed to document the possibility of an orchidectomy in 30% of scrotal exploration cases. Data showed that complication incidences were only documented for 0.004% of the 721 complications mentioned in total, and a consent process was documented in the chronological notes in only 38% of cases. Seventy-seven per cent of surgical trainees surveyed across four UK deaneries stated that they would strongly support an online and mobile consenting resource detailing the recommended mentionable risks and incidences. Is it time for the traditional consenting approach to give way to an evidence-based gold standard? PMID:25205390

  8. Surgical force detection probe

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Roberts, Paul; Scott, Charles; Prass, Richard

    1991-01-01

    The development progress of a precision electro-mechanical instrument which allows the detection and documentation of the forces and moment applied to human tissue during surgery (under actual operation room conditions), is reported. The pen-shaped prototype probe which measures 1/2 inch in diameter and 7 inches in length was fabricated using an aerodynamic balance. The aerodynamic balance, a standard wind tunnel force and moment sensing transducer, measures the forces and the moments transmitted through the surgeon's hand to the human tissue during surgery. The prototype probe which was fabricated as a development tool was tested successfully. The final version of the surgical force detection probe will be designed based on additional laboratory tests in order to establish the full scale loads. It is expected that the final product will require a simplified aerodynamic balance with two or three force components and one moment component with lighter full scale loads. A signal conditioner was fabricated to process and display the outputs from the prototype probe. This unit will be interfaced with a PC-based data system to provide automatic data acquisition, data processing, and graphics display. The expected overall accuracy of the probe is better than one percent full scale.

  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 wound sepsis

    PubMed Central

    Cruse, P. J. E.

    1970-01-01

    With the help of a surgical nurse and using data-processing techniques, a prospective clinical study was conducted to determine the wound infection rate in two hospitals in Calgary. The overall sepsis rate was 5.2% and the clean wound rate 3.5%. The latter is the more meaningful figure as it allows for comparison between hospitals, specialties and individuals and is a good guide for hospital morbidity reviews. The groundwork for succeeding wound infection is laid in the operating theatre, and it is believed that wound infection would be reduced more by attention to Halsted's principles than by more rigid aseptic techniques. It is estimated that wound sepsis costs the Province of Alberta 1.5 million dollars per year for hospitalization alone. This amounts to roughly $1 per person per year. The annual cost of a prospective study such as the present one is approximately $7000. This is equivalent to the cost of hospitalizing 24 patients with infected wounds for one week (at $300 per week). One dividend of a prospective study is an associated reduction in infection rate. This reduction more than pays for the cost of the program. PMID:5414538

  11. Surgical management of endometriosis.

    PubMed

    Donnez, Jacques; Pirard, Céline; Smets, Mireille; Jadoul, Pascale; Squifflet, Jean

    2004-04-01

    The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain is a source of ongoing controversy. Complete resolution of endometriosis is not yet possible and current therapy has three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; and (3) to delay recurrence for as long as possible. It is possible that a consensus will never be reached on the optimal treatment of minimal and mild endometriosis. In case of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with a gonadotropin-releasing hormone (GnRH) agonist) should be considered as 'first-line' treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should first be undertaken to give our patients the best chance of conceiving naturally. In case of rectovaginal adenomyotic nodules, surgery must be considered as first-line therapy, medical therapy being relatively in-efficacious. PMID:15157646

  12. Percentage of Surgical Patients Receiving Recommended Care

    MedlinePLUS

    ... Surgical Patients Receiving Recommended Care Percentage of Surgical Patients Receiving Recommended Care This is a composite measure ... Clinical Data Warehouse. Age Group Percentage of Surgical Patients Receiving Recommended Care by Age Group uzrc-9bvr ...

  13. 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 ...

  14. Pediatric Glaucoma: A Literature's Review and Analysis of Surgical Results

    PubMed Central

    Scuderi, Gianluca; Iacovello, Daniela; Pranno, Federica; Plateroti, Pasquale; Scuderi, Luca

    2015-01-01

    The purpose of this paper is to review the surgical options available for the management of pediatric glaucoma, to evaluate their advantages and disadvantages together with their long-term efficacy, all with the intent to give guidelines to physicians on which elements are to be considered when taking a surgical decision. Currently there is a range of surgical procedures that are being used for the management of pediatric glaucoma. Within these, some are completely new approaches, while others are improvements of the more traditional procedures. Throughout this vast range of surgical options, angle surgery remains the first choice in mild cases and both goniotomy and trabeculotomy have good success rates. Trabeculectomy with or without mitomycin C (MMC) is preferred in refractory cases, in aphakic eyes, and in older children. GDIs have a good success rate in aphakic eyes. Nonpenetrating deep sclerectomy is still rarely used; nevertheless the results of ongoing studies are encouraging. The different clinical situations should always be weighed against the risks associated with the procedures for the individual patients. Glaucomatous progression can occur many years after its stabilization and at any time during the follow-up period; for this reason life-long assessment is necessary. PMID:26451368

  15. Open Achilles tendon lacerations.

    PubMed

    Said, M Nader; Al Ateeq Al Dosari, Mohamed; Al Subaii, Nasser; Kawas, Alaa; Al Mas, Ali; Al Ser, Yaser; Abuodeh, Yousef; Shakil, Malik; Habash, Ali; Mukhter, Khalid

    2015-04-01

    In contrast to closed Achilles tendon ruptures, open injuries are rarely reported in the literature. This paper provides information about open Achilles tendon wounds that are eventually seen in the Middle East. The reporting unit, Hamad Medical Corporation, is one of the biggest trauma centers in the Gulf area and the major health provider in Qatar. This is a retrospective study including patients admitted and operated for open Achilles tendon injuries between January 2011 and December 2013. Two hundred and five cases of open Achilles tendon lacerations were operated in Hamad General Hospital in this period. Forty-eight cases showed partial injuries, and the remaining are complete tendons cut. In the same period, fifty-one closed ruptured Achilles tendons were operated in the same trauma unit. In the majority of cases, the open injury resulted from a slip in the floor-leveled traditional toilette seats. Local damage to the toilette seats resulted in sharp edges causing the laceration of the heel if the patient was slipping over the wet floor. This occurrence is the cause in the vast majority of the cases. Wounds were located 1-5 cm proximal to tendon insertion. Standard treatment principles were applied. This included thorough irrigation in the emergency room, intravenous antibiotics, surgical debridement and primary repair within 24 h. Patients were kept in the hospital 1-7 days for intravenous antibiotics and possible dressing changes. Postoperatively below knee slabs were applied in the majority of patients and were kept for about 4 weeks followed by gradual weight bearing and range of motion exercises. Outpatients follow up in 1-2 weeks. Further follow-up visits at around 2-, 4-, 8- and 12-week intervals until complete wound healing and satisfactory rehabilitation outcome. Sixteen cases needed a second procedure. A high incidence of Achilles tendon open injuries is reported. This seems to be related to partially damaged floor-level toilettes in the typical Middle-East lavatory. The surgical treatment resulted in excellent outcome in the vast majority of the cases. Low incidence of complications resulted despite dramatic injury pattern. PMID:25337957

  16. The Koebner phenomenon and breast reconstruction: Psoriasis eruption along the surgical incision.

    PubMed

    Alolabi, Noor; White, Colin P; Cin, Arianna Dal

    2011-01-01

    The present report describes a recent case of recurrent infection in a breast reconstruction patient with a history of psoriasis. Following surgery, the patient developed psoriatic plaques along the incision scars. This phenomenon is known as Koebnerization, and has been found to affect surgical incisions. Cases of psoriatic patients being denied surgical procedures because of their inherent risk to Koebnerize have been previously reported. Similarly, such patients have been denied surgical procedures because of their increased risk of infection. The present case and literature review on this subject is described. PMID:23204886

  17. Committee opinion no. 464: patient safety in the surgical environment.

    PubMed

    2010-09-01

    Ensuring patient safety in the operating room begins before the patient enters the operative suite and includes attention to all applicable types of preventable medical errors (including, for example, medication errors), but surgical errors are unique to this environment. Steps to prevent wrong-site, wrong-person, wrong-procedure errors, or retained foreign objects have been recommended, starting with structured communication between the patient, the surgeon(s), and other members of the health care team. Prevention of surgical errors requires the attention of all personnel involved in the patient's care. PMID:20733473

  18. The Zollinger-Ellison syndrome. A collective surgical experience.

    PubMed Central

    Farley, D R; van Heerden, J A; Grant, C S; Miller, L J; Ilstrup, D M

    1992-01-01

    A retrospective study of 90 surgically treated patients with the Zollinger-Ellison syndrome seen from 1958 through 1990 was performed. Fifteen patients had Zollinger-Ellison syndrome as a manifestation of multiple endocrine neoplasia type I. Preoperative tumor localization was positive in 46% of 54 patients studied. Gastrinomas were identified in 66% of patients, 38% of the tumors being malignant. Postoperative eugastrinemia was achieved in 11% of patients after a variety of surgical procedures. Exploratory laparotomy provides the only chance for cure and identifies the significant prognostic factors associated with long-term patient survival: small tumor size, extrapancreatic primary, and absence of tumor metastases. PMID:1352963

  19. Psychological outcomes of medical versus surgical elective first trimester abortion.

    PubMed

    Crandell, Lena

    2012-01-01

    This article reviews the most recent studies that compare psychological outcomes after either a medical or a surgical abortion to pre-procedure findings. Some studies demonstrated slightly higher levels of anxiety and depression following surgical versus medical methods. Studies that evaluated post-traumatic stress showed conflicting results. Overall, the majority of the studies demonstrated that psychological outcomes, specifically quality of life, anxiety and depression, are markedly improved following either method. Finally, the studies reviewed suggest that having a choice of method may improve women's psychological outcomes following abortion. PMID:22900806

  20. Surgical and anaesthetic capacity of hospitals in Malawi: key insights

    PubMed Central

    Henry, Jaymie Ang; Frenkel, Erica; Borgstein, Eric; Mkandawire, Nyengo; Goddia, Cyril

    2015-01-01

    Background Surgery is increasingly recognized as an important driver for health systems strengthening, especially in developing countries. To facilitate quality improvement initiatives, baseline knowledge of capacity for surgical, anaesthetic, emergency and obstetric care is critical. In partnership with the Malawi Ministry of Health, we quantified government hospitals’ surgical capacity through workforce, infrastructure and health service delivery components. Methods From November 2012 to January 2013, we surveyed district and mission hospital administrators and clinical staff onsite using a modified version of the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) tool from Surgeons OverSeas. We calculated percentage of facilities demonstrating adequacy of the assessed components, surgical case rates, operating theatre density and surgical workforce density. Results Twenty-seven government hospitals were surveyed (90% of the district hospitals, all central hospitals). Of the surgical workforce surveyed (n = 370), 92.7% were non-surgeons and 77% were clinical officers (COs). Of the 109 anaesthesia providers, 95.4% were non-physician anaesthetists (anaesthesia COs or ACOs). Non-surgeons and ACOs were the only providers of surgical services and anaesthetic services in 85% and 88.9% of hospitals, respectively. No specialists served the district hospitals. All of the hospitals experienced periods without external electricity. Most did not always have a functioning generator (78.3% district, 25% central) or running water (82.6%, 50%). None of the district hospitals had an Intensive Care Unit (ICU). Cricothyroidotomy, bowel resection and cholecystectomy were not done in over two-thirds of hospitals. Every hospital provided general anaesthesia but some did not always have a functioning anaesthesia machine (52.2%, 50%). Surgical rate, operating theatre density and surgical workforce density per 100 000 population was 289.48–747.38 procedures, 0.98 and 5.41 and 3.68 surgical providers, respectively. Conclusion COs form the backbone of Malawi’s surgical and anaesthetic workforce and should be supported with improvements in infrastructure as well as training and mentorship by specialist surgeons and anaesthetists. PMID:25261799

  1. 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.

  2. Posterior surgical approaches to the rectum.

    PubMed

    Westbrook, K C; Lang, N P; Broadwater, J R; Thompson, B W

    1982-06-01

    This report summarizes experience with 19 posterior approaches to the rectum including nine trans-sacral (Kraske) and ten trans-sphincteric (Mason) procedures. This study included 12 men and 7 women, ranging in age from 18 to 89 years. Surgical indications included villous tumors in nine patients, various benign problems in four patients, primary carcinomas in three patients, and recurrent cancer in three patients. Eight complications developed in the 19 patients including: four fecal fistulae, two wound dehiscences, one rectal stricture, and one sacrococcygeal hernia. Spontaneous closure of the fecal fistulae occurred in two patients, and two patients required proximal colostomies. Fecal continence was achieved in 18 of the 19 patients. No patient died as a complication of the procedure. No recurrent tumors have developed. The conclusion is that a posterior approach to the rectum is a safe and effective procedure for various benign and for selected malignant conditions. It is particularly suitable for villous tumors that are too high for transanal resection and too low for transabdominal resection. It is an effective procedure for small, exophytic, mobile carcinomas of the lower 10 cm of the rectum in selected patients. PMID:7082059

  3. 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.

  4. Changing patterns in the surgical treatment of perforated duodenal ulcer – single centre experience

    PubMed Central

    Budzy?ski, Piotr; Grzesiak-Kuik, Agata; Natkaniec, Micha?; Major, Piotr; Mat?ok, Maciej; Stanek, Maciej; Wierdak, Mateusz; Migaczewski, Marcin; Pisarska, Magdalena; Budzy?ski, Andrzej

    2015-01-01

    Introduction Although the surgical treatment of patients with perforated duodenal ulcer is the method of choice, the introduction of effective pharmacotherapy has changed the surgical strategy. Nowadays less extensive procedures are chosen more frequently. The introduction of laparoscopic procedures had a significant impact on treatment results. Aim To present our experience in the treatment of perforated duodenal ulcer in two periods, by comparing open radical anti-ulcer procedures with laparoscopic ulcer repair. Material and methods The analysis covered patients operated on for perforated duodenal ulcer. Two groups of patients were compared. Group 1 included 245 patients operated on in the period 1980–1994 with a traditional method (pyloroplasty + vagotomy) before introduction of proton pump inhibitors (PPI). Group 2 included 106 patients treated in the period 2000–2014 with the laparoscopic technique supplemented with PPI therapy. Groups were compared in terms of patients’ demographic structure, operative time, complication rate and mortality. Results The mean operative time in group 1 was shorter than in group 2 (p < 0.0001). Complications were noted in 57 (23.3%) patients in group 1 and 14 (13.5%) patients in group 2 (p = 0.0312). Reoperation was necessary in 13 (5.3%) cases in group 1 and in 5 cases in group 2 (p = 0.8179). The mortality rate in group 1 was significantly higher than in group 2 (10.2% vs. 2.8%, p = 0.0192). In group 1, median length of hospital stay was 9 days and differed significantly from group 2 (6 days, p < 0.0001). Conclusions Within the last 30 years, significant changes in treatment of perforated peptic ulcer (PPU) have occurred, mainly related to abandoning routine radical anti-ulcer procedures and replacing the open technique with minimally invasive surgery. Thus it was possible to improve treatment results by reducing complication and mortality rates, and shortening the length of hospital stay. Although the laparoscopic operation is longer, it improves outcomes. In the authors’ opinion, in each patient with suspected peptic ulcer perforation, laparoscopy should be the method of choice.

  5. Perioperative Surgical Home: Perspective II.

    PubMed

    Vetter, Thomas R; Jones, Keith A

    2015-12-01

    Healthcare delivery and payment systems in the United States must continue to be reformed to address currently untenably increasing healthcare expenditures, while increasing the quality of care. The Perioperative Surgical Home is a highly patient-centered approach to care, focusing on the standardization, coordination, transitions, and value of care, throughout the perioperative continuum, including after hospital discharge. To increase the value of surgical care, any Perioperative Surgical Home model must translate, implement, and sustain improvements in quality, safety, and satisfaction, plus cost reduction strategies, throughout the perioperative continuum. Healthcare informatics, analytics, decision support, and practice change are central to this effort. PMID:26610629

  6. [Thoracopagus. Possibilities of surgical separation].

    PubMed

    Leguerrier, A; Latouche, X; Scarabin, J M; Milon, J; Almange, C; Babut, J M

    1978-09-01

    A new case of thoracopagus twins is reported. Radiological, hemodynamical and surgical explorations showed a communication between the two hearts, situated at the atrial level and associated with digestive and cardiovascular malformations. These abnormalities were definned by the anatomical study realized after vascular injection:hypoplastic pulmonary artery (associated with a persistent atrio-ventricular canal in one case, with a tricuspid atresia in the other case), a large fused liver, common pancreas and ileum. A bibliographic study allows the authors to define surgical separation possibilities. The prognosis depends essentially on cardiovascular abnormalities associating abnormal connections between the twins' hearts with malformations often too severe for surgical repair. PMID:753409

  7. 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

  8. Comparison of Actual Surgical Outcomes and 3D Surgical Simulations

    PubMed Central

    Tucker, Scott; Cevidanes, Lucia; Styner, Martin; Kim, Hyungmin; Reyes, Mauricio; Proffit, William; Turvey, Timothy

    2009-01-01

    Purpose The advent of imaging software programs have proved to be useful for diagnosis, treatment planning, and outcome measurement, but precision of 3D surgical simulation still needs to be tested. This study was conducted to determine if the virtual surgery performed on 3D models constructed from Cone-beam CT (CBCT) can correctly simulate the actual surgical outcome and to validate the ability of this emerging technology to recreate the orthognathic surgery hard tissue movements in 3 translational and 3 rotational planes of space. Methods Construction of pre- and post-surgery 3D models from CBCTs of 14 patients who had combined maxillary advancement and mandibular setback surgery and 6 patients who had one-piece maxillary advancement surgery was performed. The post-surgery and virtually simulated surgery 3D models were registered at the cranial base to quantify differences between simulated and actual surgery models. Hotelling T-test were used to assess the differences between simulated and actual surgical outcomes. Results For all anatomic regions of interest, there was no statistically significant difference between the simulated and the actual surgical models. The right lateral ramus was the only region that showed a statistically significant, but small difference when comparing two- and one-jaw surgeries. Conclusions Virtual surgical methods were reliably reproduced, oral surgery residents could benefit from virtual surgical training, and computer simulation has the potential to increase predictability in the operating room. PMID:20591553

  9. From passive tool holders to microsurgeons: safer, smaller, smarter surgical robots.

    PubMed

    Bergeles, Christos; Yang, Guang-Zhong

    2014-05-01

    Within only a few decades from its initial introduction, the field of surgical robotics has evolved into a dynamic and rapidly growing research area with increasing clinical uptake worldwide. Initially introduced for stereotaxic neurosurgery, surgical robots are now involved in an increasing number of procedures, demonstrating their practical clinical potential while propelling further advances in surgical innovations. Emerging platforms are also able to perform complex interventions through only a single-entry incision, and navigate through natural anatomical pathways in a tethered or wireless fashion. New devices facilitate superhuman dexterity and enable the performance of surgical steps that are otherwise impossible. They also allow seamless integration of microimaging techniques at the cellular level, significantly expanding the capabilities of surgeons. This paper provides an overview of the significant achievements in surgical robotics and identifies the current trends and future research directions of the field in making surgical robots safer, smaller, and smarter. PMID:24723622

  10. Three dimensional model for surgical planning in resection of thoracic tumors

    PubMed Central

    Kim, Min P.; Ta, Anderson H.; Ellsworth, Warren A.; Marco, Rex A.; Gaur, Puja; Miller?, Jordan S.

    2015-01-01

    Introduction The computed tomography scan provides vital information about the relationship of thoracic malignancies to the surrounding structures and aids in surgical planning. However, it can be difficult to visualize the images in a two-dimensional screen to interpret the full extent of the relationship between important structures in the surgical field. Presentation of case We report two cases where we used a three-dimensional printed model to aid in the surgical resection of thoracic malignancies. Discussion Careful planning is necessary to resect thoracic malignancies. Although two-dimensional images of the thoracic malignancies provide vital information about the tumor and its surrounding structures, the three-dimensional printed model can provide more accurate information about the tumor and assist in surgical planning. Conclusion Three-dimensional printed model provide better visualization of complex thoracic tumors, aid in counseling the patient about the surgical procedure and assisted in surgical resection of thoracic malignancy. PMID:26453940

  11. SELENA - An open-source tool for seismic risk and loss assessment using a logic tree computation procedure

    NASA Astrophysics Data System (ADS)

    Molina, S.; Lang, D. H.; Lindholm, C. D.

    2010-03-01

    The era of earthquake risk and loss estimation basically began with the seminal paper on hazard by Allin Cornell in 1968. Following the 1971 San Fernando earthquake, the first studies placed strong emphasis on the prediction of human losses (number of casualties and injured used to estimate the needs in terms of health care and shelters in the immediate aftermath of a strong event). In contrast to these early risk modeling efforts, later studies have focused on the disruption of the serviceability of roads, telecommunications and other important lifeline systems. In the 1990s, the National Institute of Building Sciences (NIBS) developed a tool (HAZUS ®99) for the Federal Emergency Management Agency (FEMA), where the goal was to incorporate the best quantitative methodology in earthquake loss estimates. Herein, the current version of the open-source risk and loss estimation software SELENA v4.1 is presented. While using the spectral displacement-based approach (capacity spectrum method), this fully self-contained tool analytically computes the degree of damage on specific building typologies as well as the associated economic losses and number of casualties. The earthquake ground shaking estimates for SELENA v4.1 can be calculated or provided in three different ways: deterministic, probabilistic or based on near-real-time data. The main distinguishing feature of SELENA compared to other risk estimation software tools is that it is implemented in a 'logic tree' computation scheme which accounts for uncertainties of any input (e.g., scenario earthquake parameters, ground-motion prediction equations, soil models) or inventory data (e.g., building typology, capacity curves and fragility functions). The data used in the analysis is assigned with a decimal weighting factor defining the weight of the respective branch of the logic tree. The weighting of the input parameters accounts for the epistemic and aleatoric uncertainties that will always follow the necessary parameterization of the different types of input data. Like previous SELENA versions, SELENA v4.1 is coded in MATLAB which allows for easy dissemination among the scientific-technical community. Furthermore, any user has access to the source code in order to adapt, improve or refine the tool according to his or her particular needs. The handling of SELENA's current version and the provision of input data is customized for an academic environment but which can then support decision-makers of local, state and regional governmental agencies in estimating possible losses from future earthquakes.

  12. Surgical repair of renal artery aneurysms

    PubMed Central

    Titze, Nicole; Ivanukoff, Victoria; Fisher, Tammy; Pearl, Gregory; Grimsley, Brad

    2015-01-01

    The pathogenesis of renal artery aneurysms (RAAs) is degenerative, which eventually leads to weakening of the vessel wall and, in extreme cases, rupture. RAAs are a rare occurrence. Patients generally are asymptomatic, with a small number presenting with uncontrollable hypertension or hematuria. Most RAAs are discovered incidentally on imaging and do not pose an immediate health threat. However, the risk of rupture is an indication for prophylactic repair in certain patients. Interest in interventional radiologic procedures in the management of RAAs has recently increased; however, open repair should still be considered in select instances. In this case series, we present three patients for whom an open approach was indicated and performed. PMID:26424954

  13. [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

  14. Essential Tremor (ET): Surgical Options

    MedlinePLUS

    ... no destruction of the brain. Rather, a wire (electrode or lead) is placed in the ventral intermediate ... rather than a surgical incision or use of electrodes. In a single outpatient treatment, the surgeon uses ...

  15. Intermittent exotropia: Surgical treatment strategies

    PubMed Central

    Kelkar, Jai Aditya; Gopal, Santhan; Shah, Rachana B; Kelkar, Aditya S

    2015-01-01

    Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered. PMID:26458472

  16. Surgical exposures of the hand.

    PubMed

    Watt, Andrew J; Chung, Kevin C

    2014-11-01

    Surgical approaches to the hand are commonly executed in the treatment of fractures, ligament injuries, and less commonly in the resection of bony tumors. Careful design and execution of these surgical approaches translates into superior functional and aesthetic outcomes. We have provided a thorough review of commonly used approaches to the hand by evaluating each of these approaches in the context of core principles including safety, versatility, preservation of stability, and aesthetic outcomes. PMID:25440073

  17. Treatment of a periorbital cyst in a dog by creation of a permanent drainage opening.

    PubMed

    Kaiser, S; Driesen, A; Malberg, S; Kramer, M; Thiel, C

    2015-12-01

    An inflammatory periorbital cyst with secondary pressure atrophy of the maxilla was treated by surgical creation of a drainage opening to the nasal cavity in a 4-year-old Yorkshire Terrier. Following treatment, clinical signs resolved and computed tomography 5 weeks after surgery confirmed the permanence of the drainage opening. Eight months later, the dog showed no clinical abnormalities. Therefore, the procedure described in this report may offer a suitable treatment option in cases where the cyst's size or localization prevents complete excision. PMID:26526863

  18. Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.

    PubMed

    Almpani, Konstantinia; Kantarci, Alpdogan

    2015-01-01

    Surgical techniques for the acceleration of the orthodontic tooth movement have been tested for more than 100 years in clinical practice. Since original methods have been extremely invasive and have been associated with increased tooth morbidity and various other gaps, the research in this field has always followed an episodic trend. Modern approaches represent a well-refined strategy where the concept of the bony block has been abandoned and only a cortical plate around the orthodontic tooth movement has been desired. Selective alveolar decortication has been a reproducible gold standard to this end. Its proposed mechanism has been the induction of rapid orthodontic tooth movement through the involvement of the periodontal ligament. More recent techniques included further refinement of this procedure through less invasive techniques such as the use of piezoelectricity and corticision. This chapter focuses on the evolution of the surgical approaches and the mechanistic concepts underlying the biological process during the surgically accelerated orthodontic tooth movement. PMID:26599122

  19. Congenital Upper Eyelid Coloboma: Clinical and Surgical Management

    PubMed Central

    Ortega Molina, José María; Mora Horna, Eduardo Ramón; Salgado Miranda, Andrés David; Rubio, Rosa; Solans Pérez de Larraya, Ana; Salcedo Casillas, Guillermo

    2015-01-01

    Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas. Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. “Dr. Luis Sánchez Bulnes” between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service. Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus. Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients. PMID:26366313

  20. Surgical time and motion: the intermediate equivalent revisited.

    PubMed Central

    Senapati, P. S. P.; Barry, J. D.; Edwards, P.; Hodzovic, I.; Shute, K.; Lewis, W. G.

    2003-01-01

    The relationship between operative time, the intermediate equivalent value (IEV) and the complexity of common general surgical operations was examined. Correlation was found between the BUPA schedule values for procedures categorized as intermediate and major, but complex major vascular reconstruction and oesophagogastric resection for cancer occupied significantly more theatre time than the four intermediate equivalents allocated by the Collins or BUPA schedule. Moreover, anaesthetic preparation time for complex major surgery in the latter surgical subspecialities contributed at least one further intermediate value. Re-evaluation of the ideal IEV weighting of all surgical operations including anaesthetic input from larger similar audits would allow more accurate audits of surgeons' work-load, and also facilitate transparent intensive management of operating theatre resource. PMID:12585631

  1. 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. PMID:26069886

  2. 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.; ZANGHÌ, 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

  3. The Use of Trazodone to Facilitate Post-Surgical Confinement in Dogs

    PubMed Central

    Gruen, Margaret E.; Roe, Simon C.; Griffith, Emily; Hamilton, Alexandra; Sherman, Barbara L.

    2015-01-01

    Objective To investigate the safety and efficacy of the oral serotonin antagonist/reuptake inhibitor trazodone hydrochloride to facilitate confinement and calming after orthopedic surgery in dogs. Design Prospective open-label trial. Animals 36 client-owned dogs. Procedures Healthy dogs were recruited when presented for pre-surgical evaluation for orthopedic procedures. Starting the day after surgery, dogs were administered trazodone (~3.5 mg/kg, per os (PO), q12h) with tramadol (4–6 mg/kg, PO, q8–12h) for pain management. After 3 days, tramadol was discontinued and trazodone was increased (~7 mg/kg, PO, q12h) and maintained for at least 4 weeks. If needed, trazodone dosage was increased to 7–10 mg/kg, PO, q8h. Clients completed electronic surveys rating their dogs’ confinement tolerance, calmness/hyperactivity level, and responses to specific provocative situations, prior to surgery and at 1, 2, 3, and 4 weeks and at the post-surgical evaluation (8–12 weeks). Results The majority of clients (~90%) reported that, when given trazodone during the 8–12 weeks following orthopedic surgery, their dogs improved moderately or extremely with regard to confinement tolerance and calmness. Trazodone was well tolerated, even in combination with non-steroidal drugs, antibiotics, and other medications; no dogs were withdrawn from the study due to adverse reactions. Client-reported median onset of action of trazodone was 31–45 minutes and median duration of action was four or more hours. Conclusions and Clinical Relevance The results suggest that oral trazodone is a safe and efficacious medication that may be used to facilitate confinement and enhance behavioral calmness of dogs during the critical recovery period following orthopedic surgery. PMID:25029308

  4. 42 CFR 416.166 - Covered surgical procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....166 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...) Generally result in extensive blood loss; (2) Require major or prolonged invasion of body cavities; (3... Payment System for ASC Services Furnished on or After January 1, 2008 § 416.166 Covered...

  5. Minimal Invasive Surgical Procedure of Inducing Myocardial Infarction in Mice

    PubMed Central

    Curaj, Adelina; Simsekyilmaz, Sakine; Staudt, Mareike; Liehn, Elisa

    2015-01-01

    Myocardial infarction still remains the main cause of death in western countries, despite considerable progress in the stent development area in the last decades. For clarification of the underlying mechanisms and the development of new therapeutic strategies, the availability of valid animal models are mandatory. Since we need new insights into pathomechanisms of cardiovascular diseases under in vivo conditions to combat myocardial infarction, the validity of the animal model is a crucial aspect. However, protection of animals are highly relevant in this context. Therefore, we establish a minimally invasive and simple model of myocardial infarction in mice, which assures a high reproducibility and survival rate of animals. Thus, this models fulfils the requirements of the 3R principle (Replacement, Refinement and Reduction) for animal experiments and assure the scientific information needed for further developing of therapeutical strategies for cardiovascular diseases. PMID:25992740

  6. Differentiated surgical treatment of rectovaginal fistulae

    PubMed Central

    Kröpil, Feride; Raffel, Andreas M.; Schauer, Matthias; Rehders, Alexander; Eisenberger, Claus F.; Knoefel, Wolfram T.

    2012-01-01

    Objective: Rectovaginal fistulae (RVF) are a serious and debilitating problem for patients and a challenge for the treating surgeons. We present our experiences in the surgical treatment of these patients. Methods: Study population consisted of 22 consecutive patients (range 26–70 years) with RVF treated in our department between 2003 and 2009. 13 RVF were observed after colorectal or gynaecological surgery, 3 occurred after radiotherapy, 2 due to tumour infiltration, 4 because of local inflammation (3x diverticultis, 1x ulcus simplex recti). The RVF was classified in all patients before treatment as either ‘low’ or ‘high’. Results: Local procedures (transvaginal excision, preanal repair) as initial treatment were performed in 9 patients with low fistula. In 13 cases with high fistula an abdominal approach was performed to close the fistula. A recurrence was observed in 8/22 cases (36%), which were treated by a gracilis flap (n=2), a bulbospongiosus composite (n=1), a second abdominal approach (n=4), and a re-local excision (n=1). Ultimatively, in 19 cases the defect healed but in 3 patients the RVF persisted. Conclusions: Most important predictor of healing/failure is etiology followed by localization and recurrence of the RVF. Local (preanal, transvaginal) procedures are suitable for low RVF, whereas abdominal surgery is necessary in high RVF. In recurrent RVF, muscle flaps are promising procedures. PMID:26504694

  7. Surgical management of third nerve palsy.

    PubMed Central

    Noonan, C P; O'Connor, M

    1995-01-01

    AIMS--A surgical technique has been developed in order to obtain ocular alignment in the primary position in patients with third nerve palsy. METHODS--A method for surgically correcting the vertical deviation and the pseudoptosis is described in three patients with longstanding third nerve palsy. By decreasing the ability of the non-involved eye to elevate, a fixation duress was created which eliminated the secondary deviation that characteristically occurs in such patients when the involved eye fixates. As a result of this technique, both eyes in all patients on attempted fixation were under similar duress, therefore requiring equal amounts of stimulation to move into the primary position. When the fixation duress was sufficient, elimination of the hypotropia and ptosis was achieved. Additionally, in order to correct the exotropia, generous recession and resection procedures in the involved eye and recession of the lateral rectus in the noninvolved eye were performed. RESULTS--Between 8 and 10 prism dioptres of esotropia were achieved and maintained in two patients. One patient had 20 prism dioptres of exotropia. Two patients had no residual ptosis and one required an additional anterior levator resection to achieve a satisfactory result. CONCLUSION--Patients with a third nerve palsy and a pseudoptosis may be candidates for this approach. Images PMID:7612553

  8. Myocardial Sleeve Tissues in Surgical Lung Specimens.

    PubMed

    Yoshida, Akihiko; Kamata, Tsugumasa; Iwasa, Takeshi; Watanabe, Shun-ichi; Tsuta, Koji

    2015-10-01

    Left atrial myocardial extensions over the pulmonary veins (PVs), known as myocardial sleeves, are present in the physiological anatomy of most individuals. Although this structure has recently received clinical attention as a major origin of paroxysmal atrial fibrillation (AF), it has not been documented in surgical specimens. Here, we examine incidentally identified myocardial sleeve tissue in routinely processed lung resection specimens to determine its incidence and diagnostic implications. Among 694 lung resection specimens with evaluable PV margins, myocardial sleeve tissue was identified in 26 cases (3.7%). The tissue was located within the adventitia of the PVs, mostly in margin preparations, and existed outside the pericardium in the majority of cases. Carcinoma infiltration of the sleeves was evident in 6 cases. No heart injuries were observed, and no tumors invaded the heart. Preoperative electrocardiography showed sinus rhythm in all cases, whereas postoperative monitoring revealed sinus rhythm in all patients except one who showed AF and flutter. Myocardial sleeve tissue is an underrecognized incidental finding in lung resection specimens, and it is not indicative of heart injury. Cancer infiltration into this tissue indicates neither heart invasion nor, by itself, invasion into the pericardium. Although surgical transection of the myocardial sleeve did not evoke immediate arrhythmia in most cases, the overall influence of this procedure on the postsurgical risk of AF remains to be determined in further studies involving extensive rhythm assessment. PMID:26099012

  9. Surgical innovation and quality assurance: Can we have both?

    PubMed

    Georgeson, Keith

    2015-06-01

    Innovation is the major force for progress in pediatric surgery. Most of the progress in surgery has evolved secondary to novel approaches developed by surgeons confronted with difficult pathologic conditions. Up to the present time, most surgical innovation has been practiced with few rules for guidance. Innovation to make surgical procedures more effective and less morbid is highly desirable. However, the absence of oversight has the potential to lead to unbridled human experimentation. The quality improvement movement in medicine is attempting to improve outcomes using evidence-based clinical pathways. Quality improvement aims to decrease the variation in therapeutic approaches by scientifically defining best practices. There is a significant potential for autonomous surgical innovators to clash with well-meaning proponents of quality improvement. A suggested remedy to encourage surgical innovators while protecting patients from unintended harm is for institutions to develop Surgical Innovation Committees to evaluate and give oversight to the early application of new techniques and devices. Scientific evaluation under the auspices of an IRB should follow when feasible. PMID:25976145

  10. Surgically facilitated experimental movement of teeth: systematic review.

    PubMed

    Liem, A M L; Hoogeveen, E J; Jansma, J; Ren, Y

    2015-07-01

    Several surgical techniques based on corticotomy and dental distraction have been developed to improve the movement of teeth and reduce the duration of orthodontic treatment. In this systematic review we have critically assessed published studies on the experimental movement of teeth to find out whether operations such as corticotomy and dental distraction osteogenesis increase the rate of movement, and to find out which biological mechanisms are engaged during surgically facilitated orthodontics, and which complications may be seen. We searched PubMed and Embase for publications until January 2014 and screened the titles and abstracts. Articles that met the inclusion criteria were retrieved in full and assessed independently by 2 of the authors. A total of 22 studies were included, and corticotomy and distraction techniques were the main surgical methods. Generally, all studies reported that movement of teeth was faster after operation than with conventional orthodontics. The peak velocity was always at an early postoperative stage regardless of the surgical technique used. Immunohistological data showed simultaneous regional increases in catabolic and anabolic activity. Histomorphometric data showed more direct resorption of bone and less hyalinisation after operation, and a reduced bone volume density around the surgical site. When present, complications such as root resorption or periodontal problems were minimal. Current experimental animal studies show that procedures such as corticotomy and dental distraction can accelerate the movement of teeth without severe complications because of the regional increase in catabolic and anabolic remodelling. PMID:25911054

  11. Equipment and technology in surgical robotics.

    PubMed

    Sim, Hong Gee; Yip, Sidney Kam Hung; Cheng, Christopher Wai Sam

    2006-06-01

    Contemporary medical robotic systems used in urologic surgery usually consist of a computer and a mechanical device to carry out the designated task with an image acquisition module. These systems are typically from one of the two categories: offline or online robots. Offline robots, also known as fixed path robots, are completely automated with pre-programmed motion planning based on pre-operative imaging studies where precise movements within set confines are carried out. Online robotic systems rely on continuous input from the surgeons and change their movements and actions according to the input in real time. This class of robots is further divided into endoscopic manipulators and master-slave robotic systems. Current robotic surgical systems have resulted in a paradigm shift in the minimally invasive approach to complex laparoscopic urological procedures. Future developments will focus on refining haptic feedback, system miniaturization and improved augmented reality and telesurgical capabilities. PMID:16538515

  12. Artifacts in MR imaging after surgical intervention.

    PubMed

    Heindel, W; Friedmann, G; Bunke, J; Thomas, B; Firsching, R; Ernestus, R I

    1986-01-01

    Artifacts are encountered repeatedly in magnetic resonance (MR) imaging after neurological orthopedic surgery, although there is no evidence of metallic foreign bodies on radiography and CT. Experiments demonstrated that surgical filling materials, such as bone cement and bone transplants are not the cause of the artifacts. On the other hand, we have been able to show that short-term contact between a diamond drill and untempered operating instruments can cause abrasions and set free minute metallic fragments. Those particles are missed by X-ray procedures including CT but cause MR artifacts by local disturbance of the homogeneity of the magnetic field. Therefore, MR represents a highly sensitive method to trace extremely small amounts of magnetic substances. Postsurgical MR, however, may be of limited value because of the disturbing artifacts. PMID:3525623

  13. [Complex surgical techniques to control bleeding].

    PubMed

    Jover Navalón, José María; Carabias Hernández, Alberto; Ortega, Irene

    2009-06-01

    Massive bleeding is a major cause of intraoperative death or death in the immediate postoperative period as a result of surgery. The present article describes the basic principles for the control of surgical bleeding as well as temporary and definitive maneuvers. Temporary control of bleeding can often be achieved with simple maneuvers, which may not be definitive, in which case damage control or planned reoperation are required. The surgeon's aim should always be to control the bleeding. If simple maneuvers fail, more complex procedures are required. The present article also describes these maneuvers to control bleeding (Pringle's maneuver, total vascular exclusion, atrial caval shunt, Mattox's maneuver, Cattel Braasch maneuver, Kocher's maneuver and aortic control maneuvers). PMID:19589408

  14. Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study

    PubMed Central

    Wu, Wen-Xi; Sun, Yao-Min; Hua, Yi-Bin; Shen, Li-Zong

    2004-01-01

    AIM: To evaluate the feasibility of laparoscopic resection of rectal carcinoma and to compare the short-term outcome of laparoscopic procedure with conventional open surgery for rectal cancer. METHODS: Thirty-eight patients with rectal cancer were included in a prospective non-randomized study. The patients were assigned to laparoscopic (n = 18) or open (n = 18) colorectal resection. Case selection, surgical technique, and clinical and pathological results were reviewed. RESULTS: The operative time was longer in laparoscopic resection group (LAP) than in open resection group (189 ± 18 min vs 146 ± 22 min, P < 0.05). Intraoperative blood loss and postoperative complications were less in LAP resection group than in open resection group. An earlier return of bowel motility was observed after laparoscopic surgery. The overall postoperative morbidity was 5.6% in the LAP resection group and 27.8% in open resection group (P < 0.05). No anastomotic leakage was found in both groups. The pathologic examination showed that the length of the resected specimen, the mean number of harvested lymph nodes in laparoscopic resection group were comparable to those in open resection group. CONCLUSION: Laparoscopic total mesorectal excision (TME) for rectal cancer is a feasible but technically demanding procedure. The present study demonstrates the safety of the procedure, while oncologic results are comparable to the open surgery, with a favorable short-term outcome. PMID:15069719

  15. Protocol for a multicentre, prospective, population-based cohort study of variation in practice of cholecystectomy and surgical outcomes (The CholeS study)

    PubMed Central

    Vohra, Ravinder S; Spreadborough, Philip; Johnstone, Marianne; Marriott, Paul; Bhangu, Aneel; Alderson, Derek; Morton, Dion G; Griffiths, Ewen A

    2015-01-01

    Introduction Cholecystectomy is one of the most common general surgical operations performed. Despite level one evidence supporting the role of cholecystectomy in the management of specific gallbladder diseases, practice varies between surgeons and hospitals. It is unknown whether these variations account for the differences in surgical outcomes seen in population-level retrospective data sets. This study aims to investigate surgical outcomes following acute, elective and delayed cholecystectomies in a multicentre, contemporary, prospective, population-based cohort. Methods and analysis UK and Irish hospitals performing cholecystectomies will be recruited utilising trainee-led research collaboratives. Two months of consecutive, adult patient data will be included. The primary outcome measure of all-cause 30-day readmission rate will be used in this study. Thirty-day complication rates, bile leak rate, common bile duct injury, conversion to open surgery, duration of surgery and length of stay will be measured as secondary outcomes. Prospective data on over 8000 procedures is anticipated. Individual hospitals will be surveyed to determine local policies and service provision. Variations in outcomes will be investigated using regression modelling to adjust for confounders. Ethics and dissemination Research ethics approval is not required for this study and has been confirmed by the online National Research Ethics Service (NRES) decision tool. This novel study will investigate how hospital-level surgical provision can affect patient outcomes, using a cross-sectional methodology. The results are essential to inform commissioning groups and implement changes within the National Health Service (NHS). Dissemination of the study protocol is primarily through the trainee-led research collaboratives and the Association of Upper Gastrointestinal Surgeons (AUGIS). Individual centres will have access to their own results and the collective results of the study will be published in peer-reviewed journals and presented at relevant surgical conferences. PMID:25582453

  16. Multistep prediction of physiological tremor for surgical robotics applications.

    PubMed

    Veluvolu, Kalyana C; Tatinati, Sivanagaraja; Hong, Sun-Mog; Ang, Wei Tech

    2013-11-01

    Accurate canceling of physiological tremor is extremely important in robotics-assisted surgical instruments/procedures. The performance of robotics-based hand-held surgical devices degrades in real time due to the presence of phase delay in sensors (hardware) and filtering (software) processes. Effective tremor compensation requires zero-phase lag in filtering process so that the filtered tremor signal can be used to regenerate an opposing motion in real time. Delay as small as 20 ms degrades the performance of human-machine interference. To overcome this phase delay, we employ multistep prediction in this paper. Combined with the existing tremor estimation methods, the procedure improves the overall accuracy by 60% for tremor estimation compared to single-step prediction methods in the presence of phase delay. Experimental results with developed methods for 1-DOF tremor estimation highlight the improvement. PMID:23771303

  17. Designing Comparative Effectiveness Trials of Surgical Ablation for Atrial Fibrillation: Experience of the Cardiothoracic Surgical Trials Network

    PubMed Central

    Gillinov, A. Marc; Argenziano, Michael; Blackstone, Eugene H.; Iribarne, Alexander; DeRose, Joseph J.; Ailawadi, Gorav; Russo, Mark J.; Ascheim, Deborah D.; Parides, Michael K.; Rodriguez, Evelio; Bouchard, Denis; Taddei-Peters, Wendy C.; Geller, Nancy L.; Acker, Michael A.; Gelijns, Annetine C.

    2013-01-01

    Background Since the introduction of the cut-and-sew Cox-Maze procedure for atrial fibrillation (AF) there has been substantial innovation in techniques for ablation. Use of alternate energy sources for ablation simplified the procedure and has resulted in dramatic increase in the number of AF patients treated by surgical ablation. Despite its increasingly widespread adoption, there is lack of rigorous clinical evidence to establish this as an effective clinical therapy. Methods and Results This paper describes a comparative effectiveness randomized trial, supported by the Cardiothoracic Surgical Trials Network, of surgical ablation with left atrial appendage (LAA) closure versus LAA closure alone in patients with persistent and longstanding persistent AF undergoing mitral valve surgery. Nested within this trial, is a further randomized comparison of 2 different lesions sets: pulmonary vein isolation and full Maze lesion set. This paper addresses trial design challenges, including how to best characterize the target population, operationalize freedom from AF as a primary endpoint, account for the impact of anti-arrhythmic drugs, and measure and analyze secondary endpoints, such as post-operative AF load. Conclusions This paper concludes by discussing how insights that emerge from this trial may affect surgical practice and guide future research in this area. PMID:21616507

  18. Detection of the spatial accuracy of an O-arm in the region of surgical interest

    NASA Astrophysics Data System (ADS)

    Koivukangas, Tapani; Katisko, Jani P. A.; Koivukangsa, John P.

    2013-03-01

    Medical imaging is an essential component of a wide range of surgical procedures1. For image guided surgical (IGS) procedures, medical images are the main source of information2. The IGS procedures rely largely on obtained image data, so the data needs to provide differentiation between normal and abnormal tissues, especially when other surgical guidance devices are used in the procedures. The image data also needs to provide accurate spatial representation of the patient3. This research has concentrated on the concept of accuracy assessment of IGS devices to meet the needs of quality assurance in the hospital environment. For this purpose, two precision engineered accuracy assessment phantoms have been developed as advanced materials and methods for the community. The phantoms were designed to mimic the volume of a human head as the common region of surgical interest (ROSI). This paper introduces the utilization of the phantoms in spatial accuracy assessment of a commercial surgical 3D CT scanner, the O-Arm. The study presents methods and results of image quality detection of possible geometrical distortions in the region of surgical interest. The results show that in the pre-determined ROSI there are clear image distortion and artefacts using too high imaging parameters when scanning the objects. On the other hand, when using optimal parameters, the O-Arm causes minimal error in IGS accuracy. The detected spatial inaccuracy of the O-Arm with used parameters was in the range of less than 1.00 mm.

  19. The surgical sequence of combined total maxillary and mandibular osteotomies.

    PubMed

    Gross, B D; James, R B

    1978-07-01

    In many instances, orthognathic surgical cases require multiple osteotomies in the maxilla and mandible to achieve the most desirable result. When the entire maxilla and mandible are freed from their relationship with the remaining craniofacial complex, accurate repositioning and adequate stabilization can present problems. These problems can be minimized by operating in the proper sequence or by staging the procedure. Staging should be considered for the more complicated cases; in any instance, the maxilla should be operated on first. PMID:277635

  20. Postparalysis Facial Synkinesis: Clinical Classification and Surgical Strategies

    PubMed Central

    Chang, Tommy Nai-Jen; Lu, Johnny Chuieng-Yi

    2015-01-01

    Background: Postparalysis facial synkinesis (PPFS) can occur after any cause of facial palsy. Current treatments are still inadequate. Surgical intervention, instead of Botox and rehabilitation only, for different degrees of PPFS was proposed. Methods: Seventy patients (43 females and 27 males) with PPFS were enrolled since 1986. They were divided into 4 patterns based on quality of smile and severity of synkinesis. Data collection for clinically various presentations was made: pattern I (n = 14) with good smile but synkinesis, pattern II (n = 17) with acceptable smile but dominant synkinesis, pattern III (n = 34) unacceptable smile and dominant synkinesis, and pattern IV (n = 5) poor smile and synkinesis. Surgical interventions were based on patterns of PPFS. Selective myectomy and some cosmetic procedures were performed for pattern I and II patients. Extensive myectomy and neurectomy of the involved muscles and nerves followed by functioning free-muscle transplantation for facial reanimation in 1- or 2-stage procedure were performed for pattern III and many pattern II patients. A classic 2-stage procedure for facial reanimation was performed for pattern IV patients. Results: Minor aesthetic procedures provided some help to pattern I patients but did not cure the problem. They all had short follow-up. Most patients in patterns II (14/17, 82%) and III (34/34, 100%) showed a significant improvement of eye and smile appearance and significant decrease in synkinetic movements following the aggressively major surgical intervention. Nearly, all of the patients treated by the authors did not need repeated botulinum toxin A injection nor require a profound rehabilitation program in the follow-up period. Conclusions: Treatment of PPFS remains a challenging problem. Major surgical reconstruction showed more promising and long-lasting results than botulinum toxin A and/or rehabilitation on pattern III and II patients. PMID:25878931

  1. [Surgical management of pancreatic pseudocysts in children (author's transl)].

    PubMed

    Allouis, M; Bracq, H; Catier, P; Babut, J M

    1982-01-01

    The authors report eight new cases of pancreatic pseudocyst in children. Three principal operative procedures are generally performed with variable surgical indications. So, they emphasize the need of a precise pre and intra-operative evaluation of the pseudocyst. Thus, the internal drainage-cystogastrostomy or Roux-en-Y cystojejunostomy-appears to be the method of choice; however, external drainage and distal pancreatectomy have to be performed in some particular instances. PMID:7074715

  2. Surgical management of stage 2 adult acquired flatfoot.

    PubMed

    Maker, Jared M; Cottom, James M

    2014-07-01

    Adult acquired flatfoot deformity is a progressive disorder with multiple symptoms and degrees of deformity. Stage II adult acquired flatfoot can be divided into stage IIA and IIB based on severity of deformity. Surgical procedures should be chosen based on severity as well as location of the flatfoot deformity. Care must be taken not to overcorrect the flatfoot deformity so as to decrease the possibility of lateral column overload as well as stiffness. PMID:24980928

  3. Surgical management of anal cancer.

    PubMed

    Gilshtein, H; Khoury, W

    2015-04-01

    Squamous cell carcinoma (SCC) is the most common malignancy of the anal canal and anal region. The prevalence of transformation to SCC is much higher in patients with a concomitant human immundefficiency virus (HIV) infection. Historically, treatment of anal SCC consisted of surgical resection with wide local excision for small sized tumors and abdominoperineal resection (APR) for larger and locally invasive cancer. The introduction of chemoradiation by Nigro et al. revolutionized the treatment of SCC. It has improved local recurrence rates as well as survival and need for colostomy. Nowadays, primary surgical treatment is indicated for anal margin tumors that are smaller than 2 cm, and are not poorly differentiated. However, extensive surgery is reserved for those with persistent, progressing and recurrent disease after treatment with the Nigro protocol. Surgical approach for anal canal and margin cancer is to be discussed in this review. PMID:25690347

  4. Surgical smoke and infection control.

    PubMed

    Alp, E; Bijl, D; Bleichrodt, R P; Hansson, B; Voss, A

    2006-01-01

    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of infection (human immunodeficiency virus, hepatitis B virus, human papillomavirus) and causes irritation to the lungs leading to acute and chronic inflammatory changes. Furthermore, cytotoxic, genotoxic and mutagenic effects have been demonstrated. The American Occupational Safety and Health Administration have estimated that 500000 workers are exposed to laser and electrosurgical smoke each year. The use of standard surgical masks alone does not provide adequate protection from surgical smoke. While higher quality filter masks and/or double masking may increase the filtration capability, a smoke evacuation device or filter placed near (2-5 cm) the electrocautery blade or on endoscope valves offers additional (and necessary) safety for operating personnel and patients. PMID:16002179

  5. [The orthodontic surgical approach revisited].

    PubMed

    Ghoubril, Joseph; Kmeid, Roland; Nassar, Rania; Amm, Elie; Mansour, Marwan; Akl, Roula

    2015-03-01

    An adequate orthodontic preparation is a key to success of every orthognatic surgery. Therefore, the detection and the correction of the existing dentoalveolar compensation tend to favor the correction of the skeletal defects. The pre-surgical orthodontic goals have to be defined at the beginning of the treatment, thus, not always achieving a complete leveling of the arches, nor a final space closure and ideal intercuspation. The orthodontic preparation aims to guide the surgical skeletal displacements. Many dentoalveolar compensations can be identified as specific to different types of malocclusion. Accordingly, an adequate individualized planning and a good coordination between both orthodontist and surgeon, are of a major importance, in order to avoid unexpected traps during orthodontic pre-surgical preparation. PMID:25888040

  6. Fluid handling 2: Surgical applications

    NASA Technical Reports Server (NTRS)

    Billica, Roger; Young, John; Rushing, Doug; Kizzee, Victor D.

    1991-01-01

    The methods proposed for managing fluids and particulate debris during minor surgery on Space Station Freedom (SSF) were investigated and demonstrated. A KC-135 parabolic flight test was performed, in which the flight followed the standard 40 parabola profile with 20 to 25 seconds in near-zero gravity in each parabola. The equipment (suction and laminar flow device) was evaluated. While this equipment performed satisfactorily previously in the dental simulation, the purpose of the current flight was to reconfigure the equipment in support of a minor surgical situation in order to evaluate its efficacy and establish clear requirements for the actual flight hardware. To accomplish the study the Health Maintenance Facility medical restraint system was deployed as for surgical use and mannequin suture arm was restrained to its surface. The surgical area was established as for performing minor surgery with standard tray and suture instruments employed.

  7. [Arthroscopic versus open anterior shoulder stabilization. A systematic validation].

    PubMed

    Steinbeck, J; Witt, K-A; Marquardt, B

    2009-01-01

    The treatment of traumatic anterior glenohumeral instability has been a topic of debate over the last couple of decades. However, a consensus exists regarding the necessity of an individualized treatment plan based on the type and degree of instability and the patient's functional demands. Various open and arthroscopic techniques are among the currently used surgical procedures. Open reconstruction of the capsulolabral complex had been considered the treatment of choice for many years, but the latest results for arthroscopic anterior shoulder stabilization demonstrate its increasing use. The current literature suggests that with the introduction of suture anchors, it is possible to mirror the principles of open anterior shoulder stabilization and thus combine the general advantages of arthroscopic surgery with a low recurrence rate. PMID:19093098

  8. Surgical teams: role perspectives and role dynamics in the operating room.

    PubMed

    Leach, Linda Searle; Myrtle, Robert C; Weaver, Fred A

    2011-05-01

    Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance. PMID:21471578

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. Surgical management of fecal incontinence.

    PubMed

    Bleier, Joshua I S; Kann, Brian R

    2013-12-01

    The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches. PMID:24280402

  15. Surgical Correction of Rectal Prolapse in Laboratory Mice (Mus musculus).

    PubMed

    Uchihashi, Mayu; Wilding, Laura A; Nowland, Megan H

    2015-07-01

    Rectal prolapse is a common clinical problem in laboratory mice. This condition may occur spontaneously, develop after genetic manipulations, result from infections with pathogens such as Citrobacter species, or arise secondary to experimental design such as colitis models. The current standard of care at our institution is limited to monitoring mice until tissue becomes ulcerated or necrotic; this strategy often leads to premature euthanasia of valuable animals prior to the study endpoint. Surgical correction of rectal prolapse is performed routinely and with minimal complications in larger species by using manual reduction with placement of a pursestring suture. In this report, we investigated whether the use of a pursestring suture was an effective treatment for mice with rectal prolapse. The procedure includes anesthetizing mice with isoflurane, manually reducing prolapsed tissue, and placing a pursestring suture of 4-0 polydioxanone. We have performed this procedure successfully in 12 mice. Complications included self-trauma, fecal impaction due to lack of defecation, and mutilation of the surgical site by cage mates. Singly housing mice for 7 d postoperatively, applying multimodal analgesia, and releasing the pursestring when indicated eliminated these complications. The surgical repair of rectal prolapses in mice is a minimally invasive procedure that resolves the clinical symptoms of affected animals and reduces the number of mice that are euthanized prematurely prior to the study endpoint. PMID:26442289

  16. Arthroscopic Surgical Techniques for the Management of Proximal Biceps Injuries.

    PubMed

    Werner, Brian C; Holzgrefe, Russell E; Brockmeier, Stephen F

    2016-01-01

    Current arthroscopic surgical techniques for the management of proximal biceps tendon disorders encompass 3 commonly advocated procedures: proximal biceps anchor reattachment (superior labrum anterior to posterior or SLAP repair), biceps tenotomy, and arthroscopic biceps tenodesis. The indications for each procedure vary based on injury pattern, symptomatic presentation, concomitant pathologic abnormality, and most notably, patient factors, such as age, functional demand, and specific sport or activity participation. Outcomes after SLAP repair are generally favorable, although recent studies have found biceps tenodesis to be the preferred treatment for certain patient populations. PMID:26614472

  17. Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis

    PubMed Central

    García-Morales, Esther; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; Cecilia-Matilla, Almudena; García-Álvarez, Yolanda; Beneit-Montesinos, Juan Vicente

    2012-01-01

    Background The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot. PMID:23050062

  18. Event-free survival following CRT with surgically implanted LV leads versus standard transvenous approach

    PubMed Central

    Miller, Amy Leigh; Kramer, Daniel B.; Lewis, Eldrin F.; Koplan, Bruce; Epstein, Laurence M.; Tedrow, Usha

    2011-01-01

    Background While surgical epicardial lead placement is performed in a subset of CRT patients, data comparing survival following surgical vs. transvenous lead placement is limited. We hypothesized that surgical procedures would be associated with increased mortality risk. Methods Long-term event-free survival was assessed for 480 consecutive patients undergoing surgical (48) or percutaneous (432) LV lead placement at our institution from January 2000 to September 2008. Results Baseline clinical and demographic characteristics were similar between groups. While there was no statistically significant difference in overall event-free survival (p=0.13), when analysis was restricted to surgical patients with isolated surgical lead placement (n=28), event-free survival was significantly lower in surgical patients (p=0.015). There appeared to be an early risk (first ?3 months post-implantation) with surgical lead placement, primarily in LV-lead only patients. Event rates were significantly higher in LV-lead only surgical patients than in transvenous patients in the first 3 months (p=0.006). In proportional hazards analysis comparing isolated surgical LV lead placement to transvenous lead placement, adjusted hazard ratios were 1.8 ([1.1,2.7] p=0.02) and 1.3 ([1.0,1.7] p=0.07) for the first 3 months and for the full duration of follow-up, respectively. Conclusions Isolated surgical LV lead placement appears to carry a small but significant up-front mortality cost, with risk extending beyond the immediate postoperative period. Long-term survival is similar, suggesting those surviving beyond this period of early risk derive the same benefit as CS lead recipients. Further work is needed to identify risk factors associated with early mortality following surgical lead placement. PMID:21463344

  19. 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

  20. Journal of Surgical Oncology Quantitative Comparison of Surgical Margin Histology Following Excision

    E-print Network

    Kummel, Andrew C.

    Journal of Surgical Oncology Quantitative Comparison of Surgical Margin Histology Following, and histological effect were compared on the same breast tissue cut with each excision instrument. A probability