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1

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

PubMed Central

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

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

2014-01-01

2

Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree  

PubMed Central

Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure with open surgical procedure for outpatient treatment of symptomatic hemorrhoids. Material and method: A comparison trial between hemorrhoid laser procedure or open surgical hemorrhoidectomy was made. This study was conducted at Aloka hospital in Kosovo. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 20 patients treated with the laser hemorrhoidoplasty, and 20 patients–with open surgery hemorrhoidectomy. Operative time and postoperative pain with visual analog scale, were evaluated. Results: A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty and open surgical procedure were observed in operative time and early postoperative pain. There was a statistically significant difference between the two groups regarding the early postoperative period: 1 week, 2 weeks, 3 weeks and 1 month after respective procedure (p<0.01). The procedure time for LHP was 15.94 min vs. 26.76 min for open surgery (p<0.01). Conclusion: The laser hemorrhoidoplasty procedure was more effective than open surgical hemorrhoidectomy. Postoperative pain and duration time are only two indicators for this difference between there procedures. PMID:25684841

Maloku, Halit; Gashi, Zaim; Lazovic, Ranko; Islami, Hilmi; Juniku-Shkololli, Argjira

2014-01-01

3

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

E-print Network

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

Dupont, Pierre

4

Subjective versus statistical model assessment of mortality risk in open heart surgical procedures  

Microsoft Academic Search

Background. The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons’ subjective risk assessment.Methods. Predictive discrimination of both risk assessments (surgeons’ and model) was compared through the area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the

Joan M. V Pons; Josep M Borras; Josep A Espinas; Victor Moreno; Maria Cardona; Al??cia Granados

1999-01-01

5

Surgical Procedures. Second Edition. Teacher Edition.  

ERIC Educational Resources Information Center

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;…

Baker, Beverly; And Others

6

Costs of surgical procedures in Indian hospitals  

PubMed Central

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

Chatterjee, Susmita; Laxminarayan, Ramanan

2013-01-01

7

Surgical procedures in pinniped and cetacean species.  

PubMed

Significant advances in veterinary diagnostic and surgical techniques have been made over the past several decades. Many of these advances, however, have not reached the field of marine mammal medicine. A number of limitations exist: risks of anesthesia, anatomical challenges, difficulties with wound closure, environmental constraints, equipment limitations, and perceived risks. Despite these limitations, surgical treatments have been successfully utilized in marine mammals. While surgery is performed in pinnipeds more frequently than in cetaceans, studies conducted in the 1960s and 1970s on dolphin sleep and hearing demonstrated that general anesthesia can be successfully induced in cetaceans. Since this pioneering work, a small number of successful surgeries have been performed in dolphins under both general anesthesia and heavy sedation. While these surgical procedures in pinnipeds and cetaceans have typically been limited to wound management, dentistry, ophthalmic procedures, fracture repair, and superficial biopsy, a number of abdominal surgeries have also been performed. Recently there have been pioneering successes in the application of minimally invasive surgery in marine mammals. Many of the anatomical challenges that almost prohibit traditional laparotomies in cetacean species and present challenges in pinnipeds can be overcome through the use of laparoscopic techniques. Due to the limited number of pinnipeds and cetaceans in captivity and, thus, the limited case load for veterinarians serving marine mammal species, it is vital for knowledge of surgical procedures to be shared among those in the field. This paper reviews case reports of surgical procedures, both traditional and laparoscopic, in pinnipeds and cetaceans. Limitations to performing surgical procedures in marine mammals are discussed and surgical case reports analyzed in an effort to determine challenges that must be overcome in order to make surgery a more feasible diagnostic and treatment option in the field of marine mammal medicine. PMID:24450040

Higgins, Jennifer L; Hendrickson, Dean A

2013-12-01

8

Characterization of aerosols produced by surgical procedures  

SciTech Connect

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.

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

1994-07-01

9

Surgical Procedures in Predoctoral Periodontics Programs.  

ERIC Educational Resources Information Center

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…

Radentz, William H.; Caffesse, Raul G.

1991-01-01

10

Elective plastic surgical procedures in adolescence.  

PubMed

Adolescent patients are seeking plastic surgery to correct deformities or perceived deformities in increasing numbers. It is essential for the physician to understand the influence of perceived body image irregularity that motivates patients of all ages to request plastic surgery. The increased demand for plastic surgical procedures among young patients is caused partially to increased media exposure to the available procedures offered by plastic surgeons. A successful aesthetic procedure can have a positive influence on a mature, well-motivated teenager, while surgery on a psychologically unstable adolescent can be damaging to the patient. The American Society for Aesthetic Plastic Surgery has developed guidelines for the appropriate selection of teenagers for aesthetic plastic surgery [26]. First, the physician must "assess physical maturity, because operating on a feature that has not yet fully developed could interfere with growth or negate the benefits of surgery in later years." Second, the physician should explore emotional maturity and expectations of the teenager. The teenager should understand the goals and limitations of the proposed surgery and have realistic expectations. Third, only board certified plastic surgeons who operate in accredited facilities should perform these procedures, to ensure the safety of the teenager and the quality of the procedure. Finally, teenagers and their parents should understand the risks of surgery, postoperative restrictions on activity, and typical recovery times. The referring physician and surgeon must be aware of the positive or negative effects that plastic surgery can have on the life of a teenager and be able to select patients who have the motivation, maturity, psychosocial, and emotional attributes that will lead to patient satisfaction. PMID:15625989

McGrath, Mary H; Schooler, Wesley G

2004-10-01

11

Allocation of surgical procedures to operating rooms.  

PubMed

Reduction of health care costs is of paramount importance in our time. This paper is a part of the research which proposes an expert hospital decision support system for resource scheduling. The proposed system combines mathematical programming, knowledge base, and database technologies, and what is more, its friendly interface is suitable for any novice user. Operating rooms in hospitals represent big investments and must be utilized efficiently. In this paper, first a mathematical model similar to job shop scheduling models is developed. The model loads surgical cases to operating rooms by maximizing room utilization and minimizing overtime in a multiple operating room setting. Then a prototype expert system which replaces the expertise of the operations research analyst for the model, drives the modelbase, database, and manages the user dialog is developed. Finally, an overview of the sequencing procedures for operations within an operating room is also presented. PMID:8522909

Ozkarahan, I

1995-08-01

12

New surgical procedure for correction of club hand.  

PubMed

Two cases of radial club hand were treated by a new surgical procedure. This procedure consisted of correction of the wrist deviation and pollicization. The metacarpal of the pollicized digit was used for radial osseous support. PMID:3998614

Tsuge, K; Watari, S

1985-02-01

13

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2013 CFR

...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...

2013-10-01

14

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2010 CFR

...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...

2010-10-01

15

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2014 CFR

...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...

2014-10-01

16

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2012 CFR

...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...

2012-10-01

17

42 CFR 416.65 - Covered surgical procedures.  

Code of Federal Regulations, 2011 CFR

...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...

2011-10-01

18

Anatomical characterisation of surgical procedures in the Read Thesaurus.  

PubMed

Each concept in the surgical operations chapter of the Read Thesaurus has been analysed to determine its anatomical site component. The underlying structure of this chapter and its relationship to the anatomy chapter are explored. The defined anatomical sites have been included as atomic maps in the Read Code template table, one of the key component files of the Thesaurus, relevant features of which are described. The analysis methodology is outlined and the value of an anatomically characterised surgical procedure terminology is discussed together with the implications of semantically defining a wider range of characteristics of surgical procedures. PMID:8947638

Price, C; Bentley, T E; Brown, P J; Schulz, E B; O'Neil, M

1996-01-01

19

Randomised Trial Support for Orthopaedic Surgical Procedures  

PubMed Central

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

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

2014-01-01

20

[Surgical procedures on the external carotid artery].  

PubMed

A clinical series of five patients operated on for symptomatic cerebral blood flow deterioration is discussed. They presented with either hemispheral symptoms (hemiparesis, amaurosis fugax) or signs of diffuse cerebral hypoxia. In the presence of unilateral or bilateral internal carotid artery (ICA) occlusion a critical stenosis of the external carotid artery (ECA) was confirmed either by duplex ultrasound or angiography. In all these cases ECA was reconstructed by means of common vascular surgical techniques. The use of intraluminal (i.l.) shunt was mandatory. There were neither early nor late deaths in this group. In one patient a transient stroke occurred three days following standard carotid endarterectomy performed after ECA surgery on the contralateral side. After the mean follow-up of 46 months all patients remain neurologically asymptomatic. In selected cases the ECA reconstruction offers an effective and beneficial tool for surgical management of critical cerebral perfusion impairment. PMID:11210609

Sebesta, P; Zdráhal, P; Bor?vka, V; Weiss, K

2000-11-01

21

A Method to Detect the Microshock Risk During a Surgical Procedure  

Microsoft Academic Search

During a surgical procedure, the patient is exposed to a risk that is inherent in the use of medical electric equipment. The situations involved in this study presume that, in open thorax surgery, 60-Hz currents with milliampere units can pass through the myocardium. A current as small as 50 or 70 muA crossing the heart can cause cardiac arrest. This

Luiz Eduardo Schardong Spalding; Nelson Jhoe Batistela

2009-01-01

22

Valve-in-valve procedure: importance of the anatomy of surgical bioprostheses.  

PubMed

Transcatheter aortic valve implantation is an accepted and established alternative to surgical aortic valve replacement for patients with severe symptomatic aortic valve stenosis and multiple comorbidities that would make open surgery a high-risk option. It has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. To enable a successful procedure, avoiding malposition, valve embolization and coronary obstruction, clinicians should be familiar with the design, fluoroscopic appearances and implantation technique of the degenerated surgical bioprosthetic valve in situ, as well as its compatibility with currently available transcatheter valves. PMID:25355944

Noorani, Alia; Attia, Rizwan; Bapat, Vinayak

2014-01-01

23

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

PubMed Central

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

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

2014-01-01

24

The evolution of surgical procedures in the management of duodenal and gastric ulcers.  

PubMed

Surgical procedures for the surgical management of duodenal ulcer had evolved through many stages, over the years. It started with gastroenterostomy alone, then followed by subtotal gastrectomy, vagotomy alone, vagotomy and gastro-jejunostomy, vagotomy and pyloroplasty, and highly selective vagotomy - all which started as open surgical procedures. Now unless there are complications the treatment is essentially medical following the work of Marshall and Warren. Currently, even when surgery is indicated, minimal invasive procedures are preferred. Four main types of pyloroplasties are well known. They are Weinberg, Heinecke-Mikulicz, Finney and Jaboulay. Vagotomy can be truncal, selective, and highly selective. Accepted surgical treatment for gastric ulcer is the distal gastric resection to include the ulcerated area, but not resecting more than 50-60% of the stomach. In the uncommon cases of Zollinger-Ellison syndrome, aggressive gastric surgery, the use of drugs, and the resection of the tumour have all been recommended in appropriate cases. With the discovery of Helicobacter pylori and its effective medical treatment, surgery has little role in the initial management of peptic ulcer disease. The place of the history of the surgical procedures employed earlier in the treatment of this disease would remain relevant. PMID:24122679

Ajao, O G; Ugwu, B T

2013-01-01

25

Functional separation of septic and aseptic surgical procedures  

PubMed Central

Current evidence does not favour constructional over functional separation of septic and aseptic surgical procedures in terms of overall hygiene maintenance and incidence of skin and soft tissue infections. In both laminar and turbulent flow air operating theatres, air is not a relevant source of pathogens if surface disinfection is carried out properly. Final cleaning after a septic procedure includes a thorough wipe-disinfection of all potentially contaminated near and distant surfaces, including maintaining the necessary and effective exposure time of the chosen surface disinfectant. Cleaning utensils and clothes of all team members must be disposed of before leaving the theatre, and a complete change of gowns is mandatory before re-entering the operating room area. Strict adherence to this code of behaviour will allow for efficient functional separation of clean and contaminated surgical procedures without compromising patient safety. PMID:22242093

Kramer, Axel; Assadian, Ojan; Wendt, Michael; Stengel, Dirk; Seifert, Julia

2011-01-01

26

Posterior approach (Kraske procedure) for surgical treatment of presacral tumors  

PubMed Central

Presacral tumors are rare, but can comprise a great variety of histological types. Congenital tumors are the most common. Once the diagnosis is established, surgical resection is essential because of the potential for malignancy or infection. Previous biopsy is not necessary or may be even harmful. To decide the best surgical approach (abdominal, sacral or combined) an individual and multidisciplinary analysis must be carried out. We report three cases of cystic presacral masses in which a posterior approach (Kraske procedure) enabled complete resection, the only way to decrease local recurrence. All patients had a satisfactory recovery. A brief overview of retrorectal tumors is presented, focusing on classification, clinical presentation, diagnosis and surgical management. PMID:22655127

Aranda-Narváez, José Manuel; González-Sánchez, Antonio Jesús; Montiel-Casado, Custodia; Sánchez-Pérez, Belinda; Jiménez-Mazure, Carolina; Valle-Carbajo, Marta; Santoyo-Santoyo, Julio

2012-01-01

27

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

Microsoft Academic Search

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

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

1999-01-01

28

Effect of Surgical Training Course on Performance of Minor Surgical Procedures in Family Medicine Physicians’ Offices: an Observational Study  

PubMed Central

Aim To examine the influence of a practical surgical course on the number of minor surgical procedures performed by family physicians. Methods We compared the number of minor surgical procedures performed by family physicians in 59 offices in the city of Osijek and surrounding rural area, Croatia, during 12 months before and after the 40-hour practical surgical course held in September 2006 by surgeons and family medicine specialists. Minor surgical procedures taught in the course included management of ingrown toenails, abscesses/comedones, and minor wounds, anesthesia application, disinfection, use and sterilization of surgical instruments, and antibiotic treatment. Results The number of minor surgical procedures performed in family medicine offices almost doubled (503 vs 906 after the course, P<0.001, Wilcoxon test). The median number of abscesses/comedones treatments per physician increased from 1 to 6 (P<0.001, Wilcoxon test), the number of managed wounds increased from 111 to 217 (P<0.001, Wilcoxon test), while the number of ingrown toenail resections increased from 120 to 186 (P?=?0.004, Wilcoxon test). Fifty percent of physicians did not treat patients surgically, irrespective of the training. We found no association between the number of performed procedures and age, length of employment, or location of the physician’s office (urban vs rural). However, we found that male physicians performed more surgical treatments both before and after the course (abscesses/comedones: P<0.001 and P?=?0.108 respectively; ingrown toenail resections: P?=?0.008 and P?=?0.008 respectively; minor wounds: P?=?0.030 and P<0.001; respectively). Conclusion Practical courses can encourage practitioners to treat the patients surgically in their offices and, thus, increase the number of services offered in primary care. Female physicians should be more encouraged to perform minor surgical procedures in their offices. PMID:18581614

Gmajni?, Rudika; Pribi?, Sanda; Luki?, Anita; Ebling, Barbara; ?upi?, Nikola; Markovi?, Ivana

2008-01-01

29

Surgical procedure and long-term survival of hilar cholangiocarcinoma  

PubMed Central

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

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

2015-01-01

30

Surgical procedure in immunoglobulin G4-related ascending aortitis?  

PubMed

Immunoglobulin G4 (IgG4)-related fibroinflammatory systemic disease accounts for 7% of all noninfectious aneurysms of the thoracic aorta. A patient was admitted with a symptomatic ascending aortic aneurysm and thickened aortic wall (outer/inner diameter 55/45 mm), which was replaced. Probes revealed IgG4-related aortitis associated with a primary tuberculosis infection. Corticosteroid and antituberculosis therapies were used, and the patient's clinical evolution was favorable. The optimal treatment strategy of IgG4-related aortitis, a new entity, remains vague. Inner aortic diameter alone does not justify aortic replacement, but wall thickening may mimic intramural hematoma. In this particular case of IgG4-related aortitis, immunosuppressive treatment alone, as an alternative to a surgical procedure, may be debatable. PMID:24694451

Colombier, Sébastien; Ruchat, Patrick; Gronchi, Fabrizio; Prêtre, René; Niclauss, Lars

2014-04-01

31

Nonconcordance with Surgical Site Infection Prevention Guidelines and Rates of Surgical Site Infections for General Surgical, Neurological, and Orthopedic Procedures?‡  

PubMed Central

Surgical site infection (SSI) is a common and preventable complication of surgery, but the relative importance of individual measures recommended by guidelines has not been determined. Elective general surgical, neurological, and orthopedic procedures requiring antibiotic prophylaxis from a 3-month period were retrospectively studied to determine concordance with SSI prevention guidelines and to identify factors which predicted the development of SSIs. A total of 216 surgeries were reviewed, with 18 SSIs (8.3%). A mean of 1.4 antibiotic prophylaxis errors per surgery were identified, with correct antibiotic type identified for 64%, antibiotic timing for 83%, supplemental antibiotic dosing for 34%, and antibiotic duration of less than 24 h for 44%. Normothermia was present in 79% of surgeries, and normoglycemia was present in 17%. Univariate analysis of the SSI rate identified four significant factors. Antibiotic prophylaxis for less than 24 h postoperatively (odds ratio [OR], 0.213; 95% confidence interval [95% CI]0.060 to 0.757) and neurosurgery (OR, 0.118; 95% CI, 0.15 to 0.903) correlated with a reduced risk of SSI. The mean number of prophylaxis errors (OR, 1.6; 95% CI, 1.02 to 2.4) and a duration of surgical drainage for more than 3 days (OR, 2.679; 95% CI, 1.009 to 7.113) predicted SSI. By multivariate analysis, errors in individual antibiotic prophylaxis measures were not significantly associated with SSI; however, the presence of more than two errors was significant (OR, 4.030; 95% CI, 1.018 to 15.96). A strong correlation was identified between the degree of concordance to SSI prevention guidelines and the SSI rate (P = 0.001, Mantel-Haenszel linear-by-linear association chi-square test). PMID:21825293

Young, Barnaby; Ng, Tat Ming; Teng, Christine; Ang, Brenda; Tai, Hwei Yee; Lye, David C.

2011-01-01

32

Nonconcordance with surgical site infection prevention guidelines and rates of surgical site infections for general surgical, neurological, and orthopedic procedures.  

PubMed

Surgical site infection (SSI) is a common and preventable complication of surgery, but the relative importance of individual measures recommended by guidelines has not been determined. Elective general surgical, neurological, and orthopedic procedures requiring antibiotic prophylaxis from a 3-month period were retrospectively studied to determine concordance with SSI prevention guidelines and to identify factors which predicted the development of SSIs. A total of 216 surgeries were reviewed, with 18 SSIs (8.3%). A mean of 1.4 antibiotic prophylaxis errors per surgery were identified, with correct antibiotic type identified for 64%, antibiotic timing for 83%, supplemental antibiotic dosing for 34%, and antibiotic duration of less than 24 h for 44%. Normothermia was present in 79% of surgeries, and normoglycemia was present in 17%. Univariate analysis of the SSI rate identified four significant factors. Antibiotic prophylaxis for less than 24 h postoperatively (odds ratio [OR], 0.213; 95% confidence interval [95% CI]0.060 to 0.757) and neurosurgery (OR, 0.118; 95% CI, 0.15 to 0.903) correlated with a reduced risk of SSI. The mean number of prophylaxis errors (OR, 1.6; 95% CI, 1.02 to 2.4) and a duration of surgical drainage for more than 3 days (OR, 2.679; 95% CI, 1.009 to 7.113) predicted SSI. By multivariate analysis, errors in individual antibiotic prophylaxis measures were not significantly associated with SSI; however, the presence of more than two errors was significant (OR, 4.030; 95% CI, 1.018 to 15.96). A strong correlation was identified between the degree of concordance to SSI prevention guidelines and the SSI rate (P = 0.001, Mantel-Haenszel linear-by-linear association chi-square test). PMID:21825293

Young, Barnaby; Ng, Tat Ming; Teng, Christine; Ang, Brenda; Tai, Hwei Yee; Lye, David C

2011-10-01

33

The importance of surgeon volume and training in outcomes for vascular surgical procedures  

Microsoft Academic Search

Purpose: Mortality and morbidity rates after vascular surgical procedures have been related to hospital volume. Hospitals in which greater volumes of vascular surgical procedures are performed tend to have statistically lower mortality rates than those hospitals in which fewer procedures are performed. Only a few studies have directly assessed the impact of the surgeon's volume on outcome. Therefore, the purpose

William H. Pearce; Michele A. Parker; Joe Feinglass; Michael Ujiki; Larry M. Manheim

1999-01-01

34

Femoroacetabular Impingement in Professional Ice Hockey PlayersA Case Series of 5 Athletes After Open Surgical Decompression of the Hip  

Microsoft Academic Search

Background: Femoroacetabular impingement of the hip joint has been identified as a major cause for hip pain in athletes. Surgical open decompression of the hip has historically been proposed as the first treatment of choice. Functional outcomes in athletes after this procedure are unknown.Purpose: To describe the functional and sport-related outcome 2 years after open surgical hip decompression in a

Mario Bizzini; Hubert P. Notzli; Nicola A. Maffiuletti

2007-01-01

35

Early Surgical Outcome of a New Modification for Senning Procedure.  

PubMed

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

Ozkan, Suleyman; Kuserli, Yusuf

2014-06-24

36

Semiquantitative Culture of Open Surgical Wounds for Diagnosis of Surgical Site Infection  

Microsoft Academic Search

The aim of this study was to assess the performance of a semiquantitative culture method and traditional qualitative culture for the diagnosis of surgical site infections resulting in an open wound. Results were correlated with the definitions for the diagnosis of SSI proposed by the Centers for Disease Control and Prevention, Atlanta, Ga., USA. The sensitivity, specificity, positive and negative

E. Bouza; A. Burillo; P. Munoz; E. Cercenado; M. Rodríguez-Créixems

2004-01-01

37

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

PubMed Central

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

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

2013-01-01

38

Robotic-assisted thymectomy: surgical procedure and results.  

PubMed

Background?Thymectomy is an essential component in the treatment of myasthenia gravis (MG) and the best treatment for localized thymoma. Minimally invasive thymectomy has advanced to include robotic-assisted techniques. The acceptance of this approach is growing rapidly, while the debate on the adequate technique for thymectomy remains open. Methods?We describe the technique of robotic-assisted thymectomy and its modifications. The worldwide registries and the literature are reviewed. The experience from the largest single-center database is analyzed. Results?The unilateral three-trocar approach for robotic thymectomy from either left or right side has been standardized. More than 100 centers worldwide perform robotic thymectomy. The annual number of this procedure increased steadily and reached 1,000 in 2012, while the largest single-center experiences comprise almost 500 cases. The end points improvement of MG and recurrence of thymoma are comparable to open procedures. There are special advantages of robotic assistance for complete mediastinal dissection. The perioperative complication rate is below 2%. Conclusion?Robotic thymectomy combines minimal incisional discomfort with extensive mediastinal dissection. As its use expands, robotic thymectomy may become the standard for all indications of thymectomy. PMID:25806663

Rueckert, Jens; Swierzy, Marc; Badakhshi, Harun; Meisel, Andreas; Ismail, Mahmoud

2015-04-01

39

Open and Arthroscopic Surgical Anatomy of the Ankle  

PubMed Central

Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

Frank, Rachel M.; Hsu, Andrew R.; Gross, Christopher E.; Walton, David M.

2013-01-01

40

Endoscopic goniotomy: a potential surgical procedure for primary infantile glaucoma  

NASA Astrophysics Data System (ADS)

Goniotomy is an effective treatment for primary infantile glaucoma. Unlike trabeculotomy, goniotomy facilitates the visualization of the trabecular meshwork and does not disturb the conjunctiva. Because a cloudy cornea may prevent a clear view of the anterior chamber angle through the operating microscope, we investigated whether an endoscope would improve visualization during goniotomy in pig cadaver eyes. We deepened the anterior chamber of each pig eye with viscoelastic material. A modified 23-gauge needle attached to an Olympus 0.8 mm diameter flexible fiberoptic endoscope entered the anterior chamber through a 3 mm limbal incision. The angle was clearly seen on a videoscreen as the needle approached and incised the trabecular pillars for 120 degree(s); the iris immediately fell back. Following the procedure, the eyes were fixed in formalin and sectioned for light microscopy, or fixed in 2% glutaraldehyde for scanning electron microscopy. Trabecular pillars were present from the iris root to Schwalbe's line in the untreated region of the anterior chamber angle. The treated area demonstrated incision of the trabecular pillars with opening of the underlying trabecular meshwork.

Joos, Karen M.; Alward, Wallace L. M.; Folberg, Robert

1993-06-01

41

An Intelligent Mechatronics Solution for Automated Tool Guidance in the Epidural Surgical Procedure  

Microsoft Academic Search

This work reports results regarding the recognition of soft tissues in the Epidural surgical procedure by a novel scheme implementable on a surgical mechatronics tool. The data employed are Raman spectra of soft tissues. A whole Raman spectrum is treated here as a single datum. Soft tissue recognition is achieved using the novel \\

Vassilios Petridis; Vassilis G. Kaburlasos

2000-01-01

42

Learning to See the Body: Supporting Instructional Practices in Laparoscopic Surgical Procedures  

E-print Network

Learning to See the Body: Supporting Instructional Practices in Laparoscopic Surgical Procedures-rays or, as in this paper, a laparoscope. This method of visualizing the body is referred to as `indirect

Paris-Sud XI, Université de

43

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

E-print Network

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

Begg, Nikolai David Michael

2009-01-01

44

Surgical Closure of the Left Atrial Appendage – A Beneficial Procedure?  

Microsoft Academic Search

Background: Closure of the fibrillating left atrial appendage (LAA) has been recommended during valve surgery to decrease the risk of arterial embolism. However, patients undergoing surgical LAA closure have not systematically been reevaluated for complete LAA obliteration. Methods and Results: During a 12-month period, we studied 6 consecutive patients with paroxysmal (n = 3) or permanent (n = 3) atrial

Birke Schneider; Claudia Stöllberger; Hans H. Sievers

2005-01-01

45

Transscleral diode laser cyclophotocoagulation as primary and secondary surgical treatment in primary open-angle and pseudoexfoliatve glaucoma  

Microsoft Academic Search

Background  Transscleral diode laser cyclophotocoagulation (TDLC) has been used successfully in the treatment of refractive glaucoma. However, little is known about TDLC as a primary or secondary surgical procedure in primary open-angle and pseudoexfoliative glaucoma.Methods  In a retrospective chart review we analyzed 90 eyes (48 OD\\/42 OS) in 90 patients (mean age 75 years, range 60–92 years; 51 men\\/39 woman) with primary open-angle glaucoma

Matthias Grueb; Jens Martin Rohrbach; Karl Ulrich Bartz-Schmidt; Torsten Schlote

2006-01-01

46

Femoral lengthening during hip resurfacing arthroplasty: A new surgical procedure.  

PubMed

Correction of leg length discrepancy during hip arthroplasty is a technical challenge. Although resurfacing proposed to young subjects presents a number of advantages (stability, bone stock, etc.), it does not correct leg length discrepancy. We propose an original femoral lengthening technique concomitant to resurfacing performed through the same approach, consisting in a Z-shaped subtrochanteric osteotomy. Resurfacing was performed first and the femoral and acetabular reaming material was used for autografting. The series comprised five cases followed for a mean 42.2 months (range, 33-64 months). The mean surgical time was 100min (range, 76-124min). Weightbearing was authorized in all cases at the 8th week. The mean lengthening was 32mm (range, 25-40mm). Healing was observed in all cases. This surgical technique, reserved for very young subjects who accept an 8-week postoperative period without weightbearing, can be proposed in cases with substantial preoperative leg length discrepancy. PMID:25755066

Vasseur, L; Ayoub, B; Mesnil, P; Pasquier, G; Migaud, H; Girard, J

2015-04-01

47

A critical investigation of some of the procedures employed in the surgical use of titanium  

Microsoft Academic Search

Rigorous and exhaustive procedures are employed when titanium (Ti) is surgically implanted, whether for orthopaedic or dental applications. Many of these are adopted because it is thought that surface cleanliness is paramount for clinical success. This paper critically examines the necessity for some of these procedures, concentrating on the surface chemistry of Ti plates. Radio frequency plasma treatments are used

A. P. Ameen; R. D. Short; C. W. I. Douglas; R. Johns; B. Ballet

1996-01-01

48

Use of Articaine in loco-regional anesthesia for day care surgical procedures  

PubMed Central

The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures. PMID:23225921

Bajwa, Sukhminder Jit Singh; Jindal, Ravi

2012-01-01

49

A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure  

PubMed Central

Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent sites: Plaque and Gingival Indices (PI) & (GI), Position of Gingival Margin from reference Stent (PGMRS), Probing depth (PD), and Biologic Width (BW). Statistical Analysis Used. Student “t” Test. Results. Initial baseline values of biologic width were 2.55?mm (Gingivectomy procedure B1 Group) and 1.95?mm (Ostectomy procedure B2 Group) and after surgical procedure the values were 1.15?mm and 1.25?mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening. PMID:22969804

Ganji, Kiran Kumar; Patil, Veena Ashok; John, Jiji

2012-01-01

50

A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure.  

PubMed

Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent sites: Plaque and Gingival Indices (PI) & (GI), Position of Gingival Margin from reference Stent (PGMRS), Probing depth (PD), and Biologic Width (BW). Statistical Analysis Used. Student "t" Test. Results. Initial baseline values of biologic width were 2.55?mm (Gingivectomy procedure B1 Group) and 1.95?mm (Ostectomy procedure B2 Group) and after surgical procedure the values were 1.15?mm and 1.25?mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening. PMID:22969804

Ganji, Kiran Kumar; Patil, Veena Ashok; John, Jiji

2012-01-01

51

Field immobilization of muskrats (Ondatra zibethicus) for minor surgical procedures.  

PubMed

A combination of ketamine hydrochloride and xylazine hydrochloride at doses of 50 mg/kg and 5 mg/kg, respectively, was used to immobilize 48 muskrats (Ondatra zibethicus) from October 1993 to November 1994 in Tennessee (USA). Mean (+/-SD) time for induction was 2.97 +/- 1.1 min. After a mean (+/-SD) duration of 27.2 +/- 3.5 min intramuscular yohimbine hydrochloride at a dose of 0.125 mg/kg was administered. Mean (+/-SD) recovery time was 48.1 +/- 21.6 min. All anesthetic inductions were smooth and sufficient depth of anesthesia was achieved to allow surgical collection of adipose tissue. Recovery times were more variable than expected. There was a significant (P < or = 0.05) drop in heart rate, respiratory rate, and body temperature during anesthesia. One animal died during recovery. PMID:9027708

Sleeman, J; Stevens, R; Ramsay, E

1997-01-01

52

Office-Based Surgical and Medical Procedures: Educational Gaps  

PubMed Central

Over the past decade, the number of procedures performed in office-based settings by a variety of practitioners—including surgeons, gastroenterologists, ophthalmologists, radiologists, dermatologists, and others—has grown significantly. At the same time, patient safety concerns have intensified and include issues such as proper patient selection, safe sedation practices, maintenance of facilities and resuscitation equipment, facility accreditation and practitioner licensing, and the office staff's ability to deal with emergencies and complications. An urgent need exists to educate practitioners about safety concerns in the office-based setting and to develop various educational strategies that can meet the continued growth of these procedures. This review outlines educational needs and possible solutions such as simulation exercises and education during residency training. PMID:23267269

Urman, Richard D.; Punwani, Nathan; Shapiro, Fred E.

2012-01-01

53

The role of shortening procedures for the surgical therapy of Peyronie's disease.  

PubMed

In this article we briefly review the current surgical treatment options for Peyronie's disease (PD) in its stable phase. We emphasize the important role of tunical shortening procedures which account for the major share of operations for PD. Shortening procedures provide excellent curvature correction combined with a very low risk of new erectile dysfunction. Since erectile function is already heavily impaired by the disease and its comorbidities in many patients with PD, tunical shortening procedures often are the treatment of choice for the correction of penile curvature. While there is no hard evidence for the superiority of a specific shortening procedure, several authors prefer the classical Nesbit technique over simple plication techniques. We also present our experiences with the Tunica albuginea underlap technique (TAU-technique), a new modification of the Nesbit procedure, that might add further surgical advantages while preserving the strength of the classical Nesbit technique. PMID:23703100

Schwarzer, J U; Steinfatt, H

2013-06-01

54

Impact of Robotic Assistance on Precision of Vitreoretinal Surgical Procedures  

PubMed Central

Purpose To elucidate the merits of robotic application for vitreoretinal maneuver in comparison to conventional manual performance using an in-vitro eye model constructed for the present study. Methods Capability to accurately approach the target on the fundus, to stabilize the manipulator tip just above the fundus, and to perceive the contact of the manipulator tip with the fundus were tested. The accuracies were compared between the robotic and manual control, as well as between ophthalmologists and engineering students. Results In case of manual control, ophthalmologists were superior to engineering students in all the 3 test procedures. Robotic assistance significantly improved accuracy of all the test procedures performed by engineering students. For the ophthalmologists including a specialist of vitreoretinal surgery, robotic assistance enhanced the accuracy in the stabilization of manipulator tip (from 90.9 µm to 14.9 µm, P?=?0.0006) and the perception of contact with the fundus (from 20.0 mN to 7.84 mN, P?=?0.046), while robotic assistance did not improve pointing accuracy. Conclusions It was confirmed that telerobotic assistance has a potential to significantly improve precision in vitreoretinal procedures in both experienced and inexperienced hands. PMID:23335991

Noda, Yasuo; Ida, Yoshiki; Tanaka, Shinichi; Toyama, Taku; Roggia, Murilo Felix; Tamaki, Yasuhiro; Sugita, Naohiko; Mitsuishi, Mamoru; Ueta, Takashi

2013-01-01

55

[Minimally invasive approach and surgical procedures in the lumbar spine].  

PubMed

The history of minimally invasive lumbar spine surgery began in 1963 with the introduction of chemonucleolysis. Like this technique, the later development of mechanical nucleotomy and lasernucleotomy aimed primarily at reduction of the disc pressure. Miniature optical systems offered the opportunity for more specific decompression by discoscopy or, more recently, by transforaminal epiduroscopy. Initially, nucleotomy was the only feasible minimally invasive procedure. In recent years, however, minimally invasive spinal fusion became possible due to the development of new devices (Cages) and advanced transperitoneal (laparoscopic) and retroperitoneal approaches. PMID:9333744

Ogon, M; Maurer, H; Wimmer, C; Landauer, F; Sterzinger, W; Krismer, M

1997-06-01

56

[Neuropsychiatric complication after surgical procedures--literature review].  

PubMed

2-3% of patients after cardiac procedures with the use of cardiopulmonary by-pass develop neurological complications with focal symptoms. Also to there may be mental, emotional and intellectual disturbances. This kind of complications occurs in 33-83% of patients. The post-cardiopulmonary by-pass delirium is a syndrome with diverse symptoms. Confusion, hallucinations, paranoid illusions, psycho-motoric excitation, fear may also occur. A high level of serotonin and overstimulation of 5-HT2 receptors in the central nervous system are the reason of delirium. The relief of symptoms may be achieved by intravenous administration of Ondansetron, an antagonist of 5-HT2 receptors. PMID:15058164

Czech, Bronis?aw; Kucewicz, Ewa; Frank, Marek

2003-01-01

57

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

PubMed Central

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

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

2014-01-01

58

The Kiricuta procedure in reconstructive surgical treatment of the breast  

SciTech Connect

A series of 50 patients with carcinoma of the breast underwent omental transposition. This palliative procedure is indicated for recurrences after conservative treatment, radiation necrosis and Stage III or IV ulcerated tumors. The operative technique is described in detail. Omentoplasties were performed upon 33 right and 17 left mammary areas. Forty-five right pedicled flaps and only four left areas were used. One patient died on the fourth postoperative day because of massive pulmonary embolus. Local repair was satisfactory in 76 per cent of the patients. Four patients presented with herniation of the abdominal wall at the site of omental tunneling. In three, the treatment consisted of sectioning the vascular pedicle and reinforcing the parietal closure with Dacron (polyester fiber) mesh.

Lopez, J.F.; Bouchet, Y.; Dupre, A. (Centre Hospitalier Regional Universitaire, Grenoble (France))

1990-03-01

59

Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures  

PubMed Central

Background Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. Methods Data were retrospectively collected for patients (n?=?240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n?=?103) or without (n?=?137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48 hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality. Results 240 patients (176 M: 64 F) underwent 240 cardiothoracic procedures including heart transplantation (n?=?53), cardiac assist devices (n?=?113), coronary artery bypass grafts (n?=?20), valve procedures (n?=?19), lung transplantation (n?=?17), aortic dissection (n?=?8), and other (n?=?10). Application of Arista® AH led to significant reduction in hemostasis time versus the untreated control group (Arista® AH: 93.4?±?41 min. vs. Control: 107.6?±?56 min., p?=?0.02). Postoperative chest tube output in the first 48 hours was also significantly reduced (Arista® AH: 1594?±?949 mL vs. Control: 2112?±?1437 mL, p?

2014-01-01

60

Abortion - surgical  

MedlinePLUS

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

61

Changes in surgical procedures for acromioclavicular joint dislocation over the past 30 years.  

PubMed

Generally, surgical treatment is recommended for Rockwood type 5 traumatic acromioclavicular joint dislocations. Since 1980, the authors have performed the modified Dewar procedure, the modified Cadenat procedure, and anatomical reconstruction of the coracoclavicular ligaments for this injury. The goal of this study was to determine the ideal surgical procedure for acromioclavicular joint dislocations by comparing these 3 procedures. The modified Dewar procedure was performed on 55 patients (Dewar group), the modified Cadenat procedure was performed on 73 patients (Cadenat group), and anatomical reconstruction of the coracoclavicular ligaments was performed on 11 patients (reconstruction group). According to the UCLA scoring system, therapeutic results averaged 27.3 points in the Dewar group, 28.2 in the Cadenat group, and 28.4 in the reconstruction group. The incidence of residual subluxation or dislocation in the acromioclavicular joint was evaluated at final radiographic follow-up. Subluxation occurred in 21 patients in the Dewar group, 18 in the Cadenat group, and 3 in the reconstruction group. Dislocation occurred in 3 patients in the Dewar group. Osteoarthritic changes in the acromioclavicular joint occurred in 20 patients in the Dewar group, 9 in the Cadenat group, and 1 in the reconstruction group. The modified Cadenat procedure can provide satisfactory therapeutic results and avoid postoperative failure or loss of reduction compared with the modified Dewar procedure. However, the modified Cadenat procedure does not anatomically restore the coracoclavicular ligaments. Anatomic restoration of both coracoclavicular ligaments can best restore acromioclavicular joint function. PMID:24093704

Takase, Katsumi; Yamamoto, Kengo

2013-10-01

62

An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence  

Microsoft Academic Search

The object was to study prospectively the results of a modified intravaginal slingplasty for the surgical treatment of female stress incontinence, carried out under local anesthesia as a day procedure. Seventy five patients with genuine stress incontinence were operated upon and followed for a 2-year period. All patients were diagnosed urodynamically to have genuine stress incontinence. Pad tests and quality

U. Ulmsten; L. Henriksson; P. Johnson; G. Varhos

1996-01-01

63

Iontophoresis: A needle-free, electrical system of local anesthesia delivery for pediatric surgical office procedures  

Microsoft Academic Search

Background\\/Purpose: Delivery of local anesthesia for surgical office procedures for pediatric patients can be difficult. Injections are painful and often lead to patient anxiety, and topical anesthetics frequently provide incomplete anesthesia. The authors prospectively studied the efficacy of iontophoresis, a needle-free technique in which positively charged lidocaine and epinephrine molecules are drawn into the tissue by an electrical current as

James M DeCou; Randel S Abrams; Julie H Hammond; Leslee R Lowder; Michael W. L Gauderer

1999-01-01

64

Positive Nitrogen Balance in Hypercatabolic States: Results Obtained with Parenteral Feeding after Major Surgical Procedures  

Microsoft Academic Search

Conclusive evidence that positive nitrogen balance can regularly be achieved during hypercatabolic states has not yet been established. Nitrogen balance has been measured in 15 patients over the first ten days following major surgical procedures whilst they were receiving parenteral alimentation with constant high caloric intake. A linear correlation was found between daily nitrogen intake and balance. The slope of

Ph. Loirat; J. E. Rohan; A Chapman; F. Beaufils; R. David; R. Nedey

1975-01-01

65

Surgical Site Infection and Validity of Staged Surgical Procedure in Emergent/Urgent Surgery for Ulcerative Colitis  

PubMed Central

Although restorative proctocolectomy is recognized as a standard procedure for ulcerative colitis, infectious complications after surgery cannot be disregarded. The aim of this study was to define predictors of surgical site infection (SSI) in urgent/emergent surgery for ulcerative colitis. We performed prospective SSI surveillance for 90 consecutive patients. Possible risk factors were analyzed by logistic regression analyses. Incidences of incisional SSI (i-SSI) and organ/space SSI were 31.1% and 6.9%, respectively, and increased significantly with higher wound class (P < 0.01). Multivariate analysis showed wound class ?3 as an independent risk factor for i-SSI. In univariate analysis, although the mucous fistula procedure was a risk factor for i-SSI (odds ratio, 3.45; P < 0.01), Hartmann procedure also represented a risk factor for o-SSI (odds ratio, 12.8; P < 0.01). Urgent restorative proctocolectomy for patients without high wound class and emergent total colectomy with mucous fistula for patients with high wound class appear to represent feasible options. PMID:23438273

Uchino, Motoi; Ikeuchi, Hiroki; Matsuoka, Hiroki; Takahashi, Yoshiko; Tomita, Naohiro; Takesue, Yoshio

2013-01-01

66

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

PubMed

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

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

67

Horizontal augmentation through the ridge-split procedure: a predictable surgical modality in implant reconstruction.  

PubMed

Among alveolar ridge augmentation techniques, the ridge-split procedure demonstrates many benefits, including no need for a second (donor) surgical site, rare risk of inferior alveolar nerve injury, and less pain and swelling, and others. Lateral bone augmentation through the ridge-split works best in a localized lateral bony defect intended for 1 or 2 implants and where the ridge is vertically intact. In this article, the authors present a detailed description of the implant-driven technique of alveolar ridge-split procedure in small and large bone deficiencies, in maxilla and mandible, supplemented by multiple photographs. The authors emphasize the need for careful manipulation of the thin ridge based on knowledge of precise surgical principles and stress that a practitioner needs specialized training and experience to perform this type of alveolar bone augmentation. PMID:23402358

Tolstunov, Len; Hicke, Bruce

2013-02-01

68

The Clinical Outcomes of Damus-Kaye-Stansel Procedure According to Surgical Technique  

PubMed Central

Background The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used. Methods We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed. Results There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up. Conclusion The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used. PMID:25207242

Yang, Chan Kyu; Jang, Woo Sung; Choi, Eun-Suk; Cho, Sungkyu; Choi, Kwangho; Nam, Jinhae; Kim, Woong-Han

2014-01-01

69

290 Surgical Procedures for Ulnar Nerve Entrapment at the Elbow: Physiopathology, Clinical Experience and Results  

Microsoft Academic Search

Summary  ??Ulnar nerve entrapment at the elbow is an important and relatively frequent pathological condition that may be related to\\u000a diffent causes depending on individual or external factors. The cause of the nerve lesion is also idiopathic in about one-quarter\\u000a to one-third of cases. This variable aetiopathogenetic presentation has often suggested different diagnostic and clinical\\u000a approaches and, moreover, various surgical procedures.

M. Artico; F. S. Pastore; F. Nucci; R. Giuffre

2000-01-01

70

Phaeochromocytoma Crisis: Two Cases of Undiagnosed Phaeochromocytoma Presenting after Elective Nonrelated Surgical Procedures  

PubMed Central

Phaeochromocytoma is a catecholamine producing tumour and an uncommon cause of hypertension. We present two cases of relatively asymptomatic individuals, in which previously undiagnosed phaeochromocytoma was unmasked by elective nonadrenal surgical procedures, manifesting as postoperative hypertensive crisis and subsequent cardiogenic shock. The initial management in intensive care is discussed, in addition to the clinical and biochemical diagnostic challenges present. Successful adrenalectomy was performed in each case. PMID:24288628

Johnston, P. C.; Silversides, J. A.; Wallace, H.; Farling, P. A.; Hutchinson, A.; Hunter, S. J.; Eatock, F.; Mullan, K. R.

2013-01-01

71

Raven IITM: Open Platform for Surgical Robotics Research H. Hawkeye King1  

E-print Network

Raven IITM: Open Platform for Surgical Robotics Research H. Hawkeye King1 , Lei Cheng1 , Philip In this paper we present a new platform for surgical robotics research: the Raven IITM. The goal of this work the hardware and software to meet their needs. The first generation RAVEN[1] was designed for experiments

Rosen, Jacob

72

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

PubMed Central

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

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

2012-01-01

73

The pros and cons of endovascular and open surgical treatments for patients with acute limb ischemia.  

PubMed

The present review addresses the pros and cons of the current, wide variety of therapeutic options available for the treatment of acute limb ischemia (ALI). Despite five prospective randomized controlled trials comparing catheter directed thrombolysis and open surgical revascularization, no single treatment strategy can yet be considered optimal for patients with ALI. This report includes 20 years of published data to evaluate the efficacy and safety profile of thrombolytic agents and adjunctive endovascular techniques when compared to open surgical revascularization. PMID:25573443

Branco, B C; Montero-Baker, M F; Mills, J L

2015-06-01

74

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

PubMed

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

Yin, Jian; Hou, Xuhui

2014-11-01

75

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

PubMed Central

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

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

76

Open re-rupture of the Achilles tendon after surgical treatment  

PubMed Central

The rate of re-rupture of Achilles tendon after surgical treatment were reported to 1.7–5.6% previously. Re-rupture of Achilles tendon generally occurs subcutaneously. We experienced two rare cases of the open re-ruptures of Achilles tendon with a transverse wound perpendicular to the primary surgical incision. Re-rupture occurred 4 and 13 weeks after surgical treatment. We suggest that open re-rupture correlates more closely with skin scaring and shortening. Another factor may be adhesion between the subcutaneous scar and the suture of the paratenon and Achilles tendon with post-operative immobilization. PMID:24765375

Hanada, Mitsuru; Takahashi, Masaaki; Matsuyama, Yukihiro

2011-01-01

77

Report of 2,087,915 Surgical Admissions in U.S. Children: Inpatient Mortality Rates by Procedure and Specialty  

Microsoft Academic Search

Background  Mortality rates for eight surgical procedures have been endorsed by the Agency for Healthcare Research and Quality as part\\u000a of the Inpatient Quality Indicators developed to assist hospitals in identifying potential problem areas and as an indirect\\u000a measure of quality for inpatient adult surgical care. Little to no broad information relating to the overall mortality relating\\u000a to the surgical care

Fizan Abdullah; Alodia Gabre-Kidan; Yiyi Zhang; Leilani Sharpe; David C. Chang

2009-01-01

78

Waiting times for surgical and diagnostic procedures in public hospitals in Mexico.  

PubMed

Objective. A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. Materials and methods. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Results. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). Conclusion. Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction. PMID:25629277

Contreras-Loya, David; Gómez-Dantés, Octavio; Puentes, Esteban; Garrido-Latorre, Francisco; Castro-Tinoco, Manuel; Fajardo-Dolci, Germán

2015-02-01

79

Surgical and transcatheter aortic valve procedures. The limits of risk scores.  

PubMed

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in very high-risk patients with severe aortic stenosis. The present multicenter, retrospective study investigates the accuracy and calibration properties of the EuroSCORE and the age, serum creatinine, and ejection fraction (ACEF) score in selecting a population of patients to be referred to TAVI. The study includes 1053 surgical and 211 transcatheter procedures. The operative mortality rate within the surgical group was 2%. The EuroSCORE and the ACEF score had similar levels of accuracy; the ACEF score was well calibrated and the EuroSCORE overestimated the mortality risk. The observed mortality rate within the transcatheter group was 10.4%. Cut-off values corresponding to a mortality rate of 10% were 26 for the logistic EuroSCORE and 2.5 for the ACEF score: both the EuroSCORE and the ACEF score may be used to refer patients to TAVI. However, they do not consider a number of 'extreme' risk conditions that may justify a transcatheter procedure even in absence of an overall elevated risk score. These risk conditions should be included in a specific risk model for referring patients for TAVI. PMID:20484408

Ranucci, Marco; Guarracino, Fabio; Castelvecchio, Serenella; Baldassarri, Rubia; Covello, Remo Daniel; Landoni, Giovanni

2010-08-01

80

Results of the open surgery after endoscopic basket impaction during ERCP procedure  

PubMed Central

AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure. METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively. RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases. PMID:25722797

Yilmaz, Sezgin; Ersen, Ogun; Ozkececi, Taner; Turel, Kadir S; Kokulu, Serdar; Kacar, Emre; Akici, Murat; Cilekar, Murat; Kavak, Ozgur; Arikan, Yuksel

2015-01-01

81

The increasing number of surgical procedures for female genital fistula in England: analysis of Hospital Episode Statistics (HES) data.  

PubMed

The aim of this study was to describe the number and trend of surgical procedures for female genital fistula in England. An online search of Hospital Episode Statistics (HES) data was carried out. Data were available for the 4-year period from 2002-03 until 2005-06. The total number of surgical procedures carried out for female genital fistula steadily increased by 28.7% from 616 in 2002-03 to 793 in 2005-06. The number of surgical procedures performed for rectovaginal fistula exceeded the total number of surgical procedures carried out for vesicovaginal and urethrovaginal fistula in each year of the study period. This pattern needs to be monitored and investigated further. PMID:25020114

Ismail, S I M F

2015-01-01

82

Cost differences between academic and nonacademic hospitals: a case study of surgical procedures.  

PubMed

Decreased public funding, a competitive healthcare market, and higher patient care costs have been blamed for the present financial challenges that confront academic health centers. The authors examined the costs associated with graduate medical education, particularly, indirect medical education expenses in the operating room. The results indicate that it is more costly for teaching hospitals to provide surgical care to patients in the operating room. The academic health center's indirect graduate medical expenses only covered a portion of the increased costs. If the missions of academic health centers are perceived as a public good, policy makers must design a system that more appropriately compensates academic health centers for the additional costs associated with surgical procedures in graduate medical education. PMID:17405419

Williams, Joe R; Matthews, Michael C; Hassan, Mahmud

2007-01-01

83

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

PubMed Central

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

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

2015-01-01

84

A Modified Surgical Procedure for Endoscopic Optic Nerve Decompression for the Treatment of Traumatic Optic Neuropathy  

PubMed Central

Background: Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored. Aims: The aim of our study is to develop a less invasive procedure for endoscopic optic nerve decompression. Materials and Methods: We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic nerve decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae. Results: After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic nerve canal and the apex using a 45° angled endoscope. Successful decompression of the canal optic nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage. Conclusions: The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae. PMID:25006562

Chen, Fenghong; Zuo, Kejun; Feng, Shaoyan; Guo, Jiebo; Fan, Yunping; Shi, Jianbo; Li, Huabin

2014-01-01

85

1 External Graduate Open Day Nov 2012 Application Procedures  

E-print Network

1 External Graduate Open Day Nov 2012 Application Procedures and a DPhil at Oxford Dr Nick Green Director of Studies Organic Chemistry External Graduate Open Day 2012 Thursday 8th November #12;2 External training, thesis submission, and VIVA · Year 4+? What afterwards? #12;3 External Graduate Open Day Nov 2012

Wallace, Mark

86

1 External Graduate Open Day Nov 2013 Application Procedures  

E-print Network

1 External Graduate Open Day Nov 2013 Application Procedures and a DPhil at Oxford Dr Rob Adlington Director of Graduate Studies Organic Chemistry & Chemical Biology External Graduate Open Day 2013 Monday 11th November #12;2 External Graduate Open Day Nov 2013 OVERVIEW : A DPHIL IN ORGANIC CHEMISTRY

Wallace, Mark

87

Transmission of hepatitis C virus associated with surgical procedures - new jersey 2010 and wisconsin 2011.  

PubMed

Incidents of health care-associated hepatitis C virus (HCV) transmission that resulted from breaches in injection safety and infection prevention practices have been previously documented. During 2010 and 2011, separate, unrelated, occurrences of HCV infections in New Jersey and Wisconsin associated with surgical procedures were investigated to determine sources of HCV and mechanisms of HCV transmission. Molecular analyses of HCV strains and epidemiologic investigations indicated that transmission likely resulted from breaches of infection prevention practices. Health care and public health professionals should consider health care-associated transmission when evaluating acute HCV infections. PMID:25719676

Apostolou, Andria; Bartholomew, Michael L; Greeley, Rebecca; Guilfoyle, Sheila M; Gordon, Marcia; Genese, Carol; Davis, Jeffrey P; Montana, Barbara; Borlaug, Gwen

2015-02-27

88

Essential emergency surgical, procedures in resource-limited facilities: a WHO workshop in Mongolia.  

PubMed

A WHO 'Training of Trainers' workshop on essential emergency surgical procedures was organised in collaboration with the Ministry of Health, Mongolia. The participants included doctors and nurses from the six selected aimags (provinces). Facilitators of the workshop included experts from the Faculty of Health Science University, Mongolian Surgeon's Association and Mongolian Association of Anaesthesiologists association with the Swiss Surgical Team of the International College of Surgeons, Surgical Department of Nurse's College, Trauma Orthopaedic Clinical Hospital, the Department of Quality Assurance of the Directorate of Medical Services, Ministry of Health. Facilitators from the Hospital University of Geneva, Geneva Foundation of Medical Education and Research (RHR) and Evidence and Information for Policy in Geneva, Switzerland participated via video link. The workshop included lectures, discussions, role playing and 'hands on' basic skills training. Videoconference and e-learning sessions using the WHO e-learning tools were conducted at the Global Development Learning Centre. The topics covered during this training workshop included team responsibility and organisation in a health care facility; patient safety; disaster planning; appropriate use of oxygen; management of bleeding, burns and trauma; basic anaesthetic and resuscitation techniques; prevention of HIV transmission; sterilisation of equipment; waste disposal; hygiene; record keeping, monitoring and evaluation of quality of care and checklists prior to surgery to assure that the correct patient gets the correct surgery on the correct side at the correct time. Recommendations were made by the participants on the next steps after this training. PMID:15751550

Cherian, Meena Nathan; Noel, Luc; Buyanjargal, Ya; Salik, Govind

2004-01-01

89

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

PubMed Central

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.

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

2014-01-01

90

Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence.  

PubMed

A new ambulatory procedure for treatment of female urinary incontinence (intravaginal slingplasty, IVS) was performed on 50 patients. In all patients the surgical procedure was carried out under local anaesthesia and without postoperative urinary catheterization. The technique has been elaborated from previous experimental and clinical studies and aims at restoration of the pubourethral ligament and the suburethral vaginal hammock. Thirty-eight patients suffered from genuine stress incontinence as objectively verified and 12 patients had symptoms and signs of both urge and stress incontinence. Thirty-nine (78%) patients were completely cured from their stress incontinence symptoms. Another six patients (12%) reported a considerable improvement of their urinary incontinence leaking only occasionally. Concerning urge incontinence symptoms a significant relief of the symptoms was obtained in 6 of 12 patients. No intra- or post-operative complications occurred. PMID:7618052

Ulmsten, U; Petros, P

1995-03-01

91

J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.  

PubMed

Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures. PMID:24915184

Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

2014-11-01

92

Open Surgical Repair for a Ruptured Abdominal Aortic Aneurysm with a Horseshoe Kidney  

PubMed Central

Horseshoe kidney is a congenital anomaly characterized by medial fusion of the bilateral kidneys. Treatment for an abdominal aortic aneurysm (AAA) with a horseshoe kidney is a technical challenge because of the complex anatomy. We report a successful open surgical repair for a ruptured AAA with a horseshoe kidney. An aortic grafting was performed with division of the renal isthmus through a transperitoneal approach. In the case of a ruptured AAA, quick open surgery is the most reliable treatment. If a horseshoe kidney coexists, transperitoneal approach with division of the renal isthmus provides good surgical field for an aortic grafting. PMID:25848435

Tsukada, Toru; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki; Hiramatsu, Yuji

2015-01-01

93

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

PubMed

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

Mancini, P F

2001-01-01

94

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

PubMed

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

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

2014-01-01

95

Surgical procedure of extracting teeth for obtaining dental pulp for regenerative medicine in swine.  

PubMed

Dental pulp is a potential source of cells that can be used in cell replacement therapy for various nerve disorders, including stroke, spinal cord injury, and peripheral nerve defect. However, the validation of an animal model closely related to humans is needed in translational research. The miniature pig is a suitable experimental model in maxillofacial surgery, because its anatomical structure and size are similar to those of humans. However, the swine tooth is extremely long. The routine closed extraction procedure for harvesting dental pulp tissue causes root fracture. This report describes the details of a surgical procedure for tooth extraction. Four healthy 7-8-month-old male NIBS miniature pigs were used. Two mandibular deciduous right incisors (Di1 and Di2) were extracted in order to obtain dental pulp tissue. Gingival envelope incision with vertical-releasing incision was performed, and a full-thickness mucoperiosteal flap was made. The buccal alveolar bone was exposed and removed by osteotomy. Di1 and Di2 were extracted. Dental pulp tissue was obtained from these extracted teeth by splitting hard tissue. In this procedure, 9.8?±?2.5?×?10(5) cells were obtained from the mandibular Di1 and Di2 (n?=?4). PMID:25448868

Sasaki, R; Matsumine, H; Watanabe, Y; Yamato, M; Ando, T

2015-04-01

96

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

PubMed

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

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

97

AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical trial  

Microsoft Academic Search

The results of a prospective, nonrandomized, multicenter clinical trial that compared endovascular stent graft exclusion of abdominal aortic aneurysms with open surgical repair are presented. During an 18-month period, 250 patients with infrarenal aneurysms underwent treatment at 12 study sites—190 patients underwent endovascular repair using the Medtronic AneuRx stent graft (Sunnyvale, Calif), and 60 underwent open surgical repair. There was

Christopher K. Zarins; Rodney A. White; Donald Schwarten; Edward Kinney; Edward B. Diethrich; Kim J. Hodgson; Thomas J. Fogarty

1999-01-01

98

Balanced anesthesia with sevoflurane does not alter redox status in patients undergoing surgical procedures.  

PubMed

Despite the effectiveness and safety of anesthetics, some unanswered questions remain concerning their toxicity and effects on cellular redox balance. To test for possible toxic effects of balanced anesthesia maintained with the volatile anesthetic sevoflurane, we evaluated oxidative stress during and after general anesthesia in 15 adult patients without comorbidities who underwent elective minor surgical procedures. Venous blood samples were collected at baseline, before anesthesia (t0); after anesthesia induction and immediately before surgery (t1); 2h after the beginning of anesthesia (t2); and on the day following surgery (t3). Antioxidant defense was determined by fluorometry. Oxidative stress markers included oxidative DNA damage, evaluated by the alkaline comet assay, and plasma malondialdehyde (MDA), assessed by high performance liquid chromatography (HPLC). No increase in oxidized DNA damage or antioxidant defense was observed. Plasma MDA increased only at t3 compared with t2. Balanced sevoflurane-maintained anesthesia appears neither to damage DNA nor to alter redox status. PMID:25308703

Orosz, José Eduardo B; Braz, Leandro G; Ferreira, Ana Lucia A; Amorim, Rosa Beatriz; Salvadori, Daisy Maria F; Yeum, Kyung-Jin; Braz, José Reinaldo C; Braz, Mariana G

2014-10-01

99

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

PubMed

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

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

2015-06-01

100

An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence.  

PubMed

The object was to study prospectively the results of a modified intravaginal slingplasty for the surgical treatment of female stress incontinence, carried out under local anesthesia as a day procedure. Seventy five patients with genuine stress incontinence were operated upon and followed for a 2-year period. All patients were diagnosed urodynamically to have genuine stress incontinence. Pad tests and quality of life assessments were carried out in all patients both pre- and postoperatively. There were no intra- or postoperative complications and 63 patients (84%) were completely cured throughout the 2-year follow-up period. Six patients (8%) were significantly improved, i.e. they did not loose urine apart from an occasional leakage during severe cold etc. In the remaining 6 patients (8%) no improvement was seen. These failures were obvious at the first postoperative check-up after 2 months. Thus, there were no relapses after 2 months. All but 5 patients were able to void properly directly after surgery. These 5 needed an indwelling catheter during the night directly after the operation. All 75 patients were released from the hospital the same day or the day after surgery without catheterization. Mean sick leave was 10 days and mean operation time 22 minutes. No defect healing or rejection of the sling occurred. It is concluded that the procedure described is a promising new technique for the surgical treatment of female stress incontinence. Prospective long-term studies including more patients are in progress to establish the definitive place of this technique in the clinical routine. PMID:8798092

Ulmsten, U; Henriksson, L; Johnson, P; Varhos, G

1996-01-01

101

Open anterior acromioplasty with preservation of the coracoacromial ligament: A modified surgical technique  

Microsoft Academic Search

The importance of the preservation of the subacromial arch has been stressed recently, especially in irreparable lesions of the rotator cuff to prevent anterosuperior migration of the humeral head. The purpose of this article is to describe the surgical technique of a modified open anterior acromioplasty performed through an intra-acromial osteotomy that increases the subacromial space and preserves the insertion

Carlos Torrens; Joan Miquel López; Enrique Verdier; Manuel Mar??n

2003-01-01

102

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

NASA Astrophysics Data System (ADS)

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.

Zheng, Guoyan

2007-03-01

103

Outcomes of Open Surgical Repair of Descending Thoracic Aortic Disease  

PubMed Central

Background To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. Methods We identified 103 patients (23 females; mean age, 64.1±12.3 years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). Results The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was 80.9%±4.3% and 71.7%±5.9%, respectively. Reoperation-free survival at 5 and 10 years was 77.3%±4.8% and 70.2%±5.8%. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). Conclusion Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy. PMID:25207223

Lee, Won-Young; Yoo, Jae Suk; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

2014-01-01

104

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

USGS Publications Warehouse

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.

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

2012-01-01

105

Risk factors for conversion from laparoscopic to open surgery: analysis of 2138 converted operations in the American College of Surgeons National Surgical Quality Improvement Program.  

PubMed

Minimal access procedures have influenced surgical practice and patient expectations. Risk of laparoscopic conversion to open surgery is frequently cited but vaguely quantified. The present study examines three common procedures to identify risk factors for laparoscopic conversion to open (LCO) events. Cross-sectional analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2005 to 2009) identified cases with laparoscopic procedure codes for appendectomy, cholecystectomy, and bariatric procedures. The primary outcome was conversion of a laparoscopic procedure to its open equivalent. Summary statistics for laparoscopic and LCO groups were compared and logistic regression analysis was used to estimate patient and operative risk factors for conversion. Of 176,014 selected laparoscopic operations, 2,138 (1.2%) were converted. Most patients were female (68%) and white (71.2%); mean age was 45.1 years. LCO cholecystectomy was significantly more likely (n = 1526 [1.9%]) and LCO bariatric procedures were less likely (n = 121 [0.3%]); appendectomy was intermediate (n = 491 [1.0%], P < 0.001). Patient factors associated with LCO included male sex (P < 0.001), age 30 years or older (P < 0.025), American Society of Anesthesiologists Class 2 to 4 (P < 0.001), obesity (P < 0.01), history of bleeding disorder (P = 0.036), or preoperative systemic inflammatory response syndrome or sepsis (P < 0.001). LCO was associated with greater incidence of postoperative complications, including death, organ space surgical site infection, sepsis, wound dehiscence, and return to the operating room (P < 0.001). Overall LCO incidence is low in hospitals participating in ACS-NSQIP. Conversion risk factors include patient age, sex, obesity, and preoperative comorbidity as well as the procedure performed. This information should be valuable to clinicians in discussing conversion risk with patients. PMID:24069991

Papandria, Dominic; Lardaro, Thomas; Rhee, Daniel; Ortega, Gezzer; Gorgy, Amany; Makary, Martin A; Abdullah, Fizan

2013-09-01

106

Submental/Transmylohyoid route for endotracheal intubation in maxillofacial surgical procedures: a review.  

PubMed

Patients with severe panfacial injuries usually require long-term airway management. Nasal intubation may be contraindicated in case of nasoorbitoethmoidal fractures and also there may be a need for intraoperative and short-term postoperative intermaxillary fixation to achieve optimum reduction of fractures. The need for unobstructed access to the perinasal area during bimaxillary orthognathic procedures is felt many a time and to avoid a tracheostomy with its attending morbidity, many techniques have evolved that involve a submandibular/transmylohyoid or submental approach for temporary oroendotracheal intubation. In this article, we present our experience of patients by using submental/transmylohyoid route for endotracheal intubation. technique gives the surgeon and the anesthetist comfortable control over their respective domains, is easy to learn and implement in the operating protocol with no added costs. How to cite the article: Prakash VJ, Chakravarthy C, Attar AH. Submental/transmylohyoid route for endotracheal intubation in maxillofacial surgical procedures: A review. J Int Oral Health 2014;6(3):125-8. PMID:25083048

Prakash, V Jeevan; Chakravarthy, Chitra; Attar, Abdul Hameed

2014-06-01

107

Submental/Transmylohyoid Route for Endotracheal Intubation in Maxillofacial Surgical Procedures: A Review  

PubMed Central

Patients with severe panfacial injuries usually require long-term airway management. Nasal intubation may be contraindicated in case of nasoorbitoethmoidal fractures and also there may be a need for intraoperative and short-term postoperative intermaxillary fixation to achieve optimum reduction of fractures. The need for unobstructed access to the perinasal area during bimaxillary orthognathic procedures is felt many a time and to avoid a tracheostomy with its attending morbidity, many techniques have evolved that involve a submandibular/transmylohyoid or submental approach for temporary oroendotracheal intubation. In this article, we present our experience of patients by using submental/transmylohyoid route for endotracheal intubation. technique gives the surgeon and the anesthetist comfortable control over their respective domains, is easy to learn and implement in the operating protocol with no added costs. How to cite the article: Prakash VJ, Chakravarthy C, Attar AH. Submental/transmylohyoid route for endotracheal intubation in maxillofacial surgical procedures: A review. J Int Oral Health 2014;6(3):125-8. PMID:25083048

Prakash, V Jeevan; Chakravarthy, Chitra; Attar, Abdul Hameed

2014-01-01

108

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

PubMed

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

Ernst, Christian M

2003-03-01

109

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.

110

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

PubMed

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

Barouk, L S

2000-09-01

111

Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965–2002  

Microsoft Academic Search

To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN,\\u000a we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December\\u000a 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic\\u000a floor repair (PFR) procedures and

Ebenezer O. Babalola; Adil E. Bharucha; L. Joseph Melton; Cathy D. Schleck; Alan R. Zinsmeister; Christopher J. Klingele; John B. Gebhart

2008-01-01

112

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

PubMed Central

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

2014-01-01

113

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

ERIC Educational Resources Information Center

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…

Cuming, Richard G.

2009-01-01

114

[Total thyroidectomy as the most frequent surgical procedure on the thyroid gland].  

PubMed

In 1997 and 1999 at the Second Surgical Clinic 35 patients with thyroid disease were operated. The authors reflect on the increasing radicality of operations from the aspect of the endocrinologist and surgeon. Extended surgical operations in relation to the original endocrinological indications are explained by the surgical finding and results of the histological examination. PMID:11505693

Stupka, Z; Hrubý, I; Kyjas, P; Gladis, P; Jandousová, E

2001-07-01

115

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

PubMed

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

Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

2007-06-01

116

Surgical Procedures for a Rat Model of Partial Orthotopic Liver Transplantation with Hepatic Arterial Reconstruction  

PubMed Central

Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as studies on graft preservation and ischemia-reperfusion injury 1,2, immunological responses 3,4, hemodynamics 5,6, and small-for-size syndrome 7. The rat OLT is among the most difficult animal models in experimental surgery and demands advanced microsurgical skills that take a long time to learn. Consequently, the use of this model has been limited. Since the reliability and reproducibility of results are key components of the experiments in which such complex animal models are used, it is essential for surgeons who are involved in rat OLT to be trained in well-standardized and sophisticated procedures for this model. While various techniques and modifications of OLT in rats have been reported 8 since the first model was described by Lee et al. 9 in 1973, the elimination of the hepatic arterial reconstruction 10 and the introduction of the cuff anastomosis technique by Kamada et al. 11 were a major advancement in this model, because they simplified the reconstruction procedures to a great degree. In the model by Kamada et al., the hepatic rearterialization was also eliminated. Since rats could survive without hepatic arterial flow after liver transplantation, there was considerable controversy over the value of hepatic arterialization. However, the physiological superiority of the arterialized model has been increasingly acknowledged, especially in terms of preserving the bile duct system 8,12 and the liver integrity 8,13,14. In this article, we present detailed surgical procedures for a rat model of OLT with hepatic arterial reconstruction using a 50% partial graft after ex vivo liver resection. The reconstruction procedures for each vessel and the bile duct are performed by the following methods: a 7-0 polypropylene continuous suture for the supra- and infrahepatic vena cava; a cuff technique for the portal vein; and a stent technique for the hepatic artery and the bile duct. PMID:23524839

Nagai, Kazuyuki; Yagi, Shintaro; Uemoto, Shinji; Tolba, Rene H.

2013-01-01

117

Locoregional versus general anesthesia for open inguinal herniorrhaphy: a National Surgical Quality Improvement Program analysis.  

PubMed

Our objective was to study outcomes associated with open inguinal herniorrhaphy performed under locoregional (LR) versus general anesthesia (GA). National Surgical Quality Improvement Program (NSQIP) data from 2005 to 2009 was queried to capture patients undergoing initial unilateral inguinal herniorrhaphy. We excluded patients with incarcerated/strangulated hernia or those undergoing a concomitant procedure. Outcomes were anesthesia and operative times, postoperative admission, and 30-day morbidity. Using the entire NSQIP sample, forward stepwise multivariate regression analysis was used to compare outcomes between patients receiving LR versus GA after adjustment for patient demographics and comorbid diagnoses. Outcomes were also compared for a smaller subgroup of patients propensity-matched for receiving LR anesthesia. A total of 25,213 patients were analyzed (16,282 GA and 8,931 LR). Patients in the LR group had a higher incidence of comorbid illnesses and were more likely to have an American Society of Anesthesiologists classification ? 3. Multivariate analyses demonstrated that LR anesthetic is associated with shorter anesthetic and operative times and a lower hospital admission rate. Comparison using a propensity-matched cohort for undergoing LR anesthesia confirms that these patients had significantly shorter anesthesia (32 vs 38 min, P < 0.0001) and operative times (53.3 vs 57.2 min, P < 0.0001), as well as a significantly reduced rate of postoperative admission (5.9% vs 10.9%, P < 0.0001) and 30-day morbidity (0.9% vs 1.3%, P < 0.05). Our analysis of NSQIP suggests that, compared with general anesthesia, the locoregional technique is associated with shorter anesthesia and operative times, reduced need for postoperative hospital admission, and a small but significant reduction in postoperative morbidity. PMID:22748541

Bhattacharya, Syamal D; Vaslef, Steven N; Pappas, Theodore N; Scarborough, John E

2012-07-01

118

Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer  

PubMed Central

Objective Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. Methods This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. Results Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. Conclusion Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity. PMID:25872893

Bleu, Géraldine; Merlot, Benjamin; Boulanger, Loïc; Vinatier, Denis; Kerdraon, Olivier; Collinet, Pierre

2015-01-01

119

Development of a Mass Spectrometry Sampling Probe for Chemical Analysis in Surgical and Endoscopic Procedures  

PubMed Central

A sampling probe based on ambient desorption ionization was designed for in-vivo chemical analysis by mass spectrometry in surgical and endoscopic procedures. Sampling ionization of analytes directly from tissue was achieved by sealing the sampling tip against the tissue surface without allowing leakage of the auxiliary gas used for desorption ionization. The desorbed charged species were transferred over a long distance (up to 4 m) through a flexible tube of internal diameter as small as 1/16 inch to the inlet of the mass spectrometer used for analysis. The conditions used for desorption electrospray ionization (DESI) were optimized to achieve biocompatibility for clinical applications while obtaining adequate efficiency for the analysis. This optimization involved removal of high voltage and use of pure water as spray solvent instead of the organic solvents or aqueous mixtures normally used. Improved sensitivity was achieved under these conditions by increasing the gas flow rate in the transfer tube. The destructive effect on tissue surfaces associated with typical desorption ionization was avoided by altering the local gas dynamics in the sample area without compromising the overall analysis efficiency. PMID:24251679

Chen, Chien-Hsun; Lin, Ziqing; Garimella, Sandilya; Zheng, Lingxing; Shi, Riyi; Cooks, R. Graham; Ouyang, Zheng

2014-01-01

120

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

PubMed Central

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

Kinaci, Ahmet; Neuhaus, Valentin; Ring, David

2015-01-01

121

Complications of Liver Resection: Laparoscopic Versus Open Procedures  

PubMed Central

Background and Objective: Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection. Methods: We performed a single-center retrospective chart review. Results: We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 ± 1450 mL in open cases versus 47.8 ± 89 mL in laparoscopic cases (P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral (P < .085) and posterosuperior (P < .002) resection subgroups. Conclusion: In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver. PMID:23743371

Simms, Eric; Drew, Barbara; Yazdi, Farshid; Roberts, Brett

2013-01-01

122

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

PubMed Central

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

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

2014-01-01

123

Early implant placement following single-tooth extraction in the esthetic zone: biologic rationale and surgical procedures.  

PubMed

Early implant placement is one treatment option for implant therapy following single-tooth extraction in the anterior maxilla. The surgical technique presented here is characterized by tooth extraction without flap elevation, a 4- to 8-week soft tissue healing period, implant placement in a correct three-dimensional position, simultaneous contour augmentation on the facial aspect with guided bone regeneration using a bioabsorbable collagen membrane combined with autogenous bone chips and a low-substitution bone filler, and tension-free primary wound closure. The surgical step-by-step procedure is presented with a case report. In addition, the biologic rationale is discussed. PMID:18990995

Buser, Daniel; Chen, Stephen T; Weber, Hans Peter; Belser, Urs C

2008-10-01

124

Urogynecologic Surgical Mesh Implants  

MedlinePLUS

... Medical Devices Products and Medical Procedures Implants and Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants ... More in Products and Medical Procedures Implants and Prosthetics Urogynecologic Surgical Mesh Implants Pelvic Organ Prolapse (POP) ...

125

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

PubMed Central

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

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

126

MD Anderson study finds African American women with breast cancer less likely to have newer, recommended surgical procedure  

Cancer.gov

African American women with early stage, invasive breast cancer were 12 percent less likely than Caucasian women with the same diagnosis to receive a minimally invasive technique, axillary sentinel lymph node (SLN) biopsy, years after the procedure had become the standard of surgical practice, according to research from The University of Texas MD Anderson Cancer Center. The study, presented at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium, also found that those African American women who underwent the older, more invasive procedure, axillary lymph node (ALN) dissection, had higher rates of lymphedema.

127

The surgical treatment of children with congenital convex foot (vertical talus): evaluation of midtarsal surgical release and open reduction.  

PubMed

In this study we evaluated the results of midtarsal release and open reduction for the treatment of children with convex congenital foot (CCF) (vertical talus) and compared them with the published results of peritalar release. Between 1977 and 2009, a total of 22 children (31 feet) underwent this procedure. In 15 children (48%) the CCF was isolated and in the remainder it was not (seven with arthrogryposis, two with spinal dysraphism, one with a polymalformative syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to 175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°). The procedure included talonavicular and calcaneocuboid joint capsulotomies, lengthening of tendons of tibialis anterior and the extensors of the toes, allowing reduction of the midtarsal joints. Lengthening of the Achilles tendon was necessary in 23 feet (74%). The mean follow-up was 11 years (2 to 21). The results, as assessed by the Adelaar score, were good in 24 feet (77.4%), fair in six (19.3%) and poor in one foot (3.3%), with no difference between those with isolated CCF and those without. The mean American Orthopaedic Foot and Ankle Society midfoot score was 89.9 (54 to 100) and 77.8 (36 to 93) for those with isolated CCF and those without, respectively. At the final follow-up, the mean tibiotalar (120°; 90 to 152) and calcaneal pitch angles (4°; -13 to 22) had improved significantly (p < 0.0001). Dislocation of the talonavicular and calcaneocuboid joints was completely reduced in 22 (70.9%) and 29 (93.6%) of feet, respectively. Three children (five feet) underwent further surgery at a mean of 8.5 years post-operatively, three with pes planovalgus and two in whom the deformity had been undercorrected. No child developed avascular necrosis of the talus. Midtarsal joint release and open reduction is a satisfactory procedure, which may provide better results than peritalar release. Complications include the development of pes planovalgus and persistent dorsal subluxation of the talonavicular joint. PMID:24891587

Ramanoudjame, M; Loriaut, P; Seringe, R; Glorion, C; Wicart, P

2014-06-01

128

[Penetrating gunshot wounds of the chest: the surgical procedure and treatment times and outcomes].  

PubMed

On the basis of data obtained during the war in Afghanistan the article analyses surgical management and the results of treatment in three groups of patients with chest wounds. The authors consider that the efficiency of treatment could be improved by gaining time during evacuation period and providing the earliest surgical care to the wounded. Indications and peculiarities for various surgical interventions were ascertained depending on the character of trauma and subsequent pathological disorders. The article proves the necessity of preventive sanitation of pleural cavity, gives the data concerning the period and outcome of treatment. PMID:1570690

Chepcheruk, G S; Shalaev, S A; Barinov, V S; Sorvari, Sh M

1992-01-01

129

[Open fractures of the tibia in the adult: surgical treatment and complications].  

PubMed

Open tibial shaft fractures represent high-energy trauma and are associated with a substantial risk of complications. Management is an emergency, and the first steps in treatment include antibiotic prophylaxis, tetanus booster, surgical debridement, irrigation of the wound and stabilization of the fracture. The Gustilo and Anderson classification helps to guide definitive treatment. Intramedullary nailing is the surgical technique of choice. An indirect approach utilizing external fixation is recommended for Gustilo IIIB and IIIC fractures. The most prevalent complications are compartment syndrome (10%), infection (2%-40% without antibiotics according to Gustilo grading, most notably in the presence of vascular lesions), aseptic nonunion (23%), venous thromboembolism (60% without prevention) and anterior knee pain (>50%). PMID:22288287

Kohlprath, R; Assal, M; Uçkay, I; Holzer, N; Hoffmeyer, P; Suva, D

2011-12-21

130

Strategies for surgical approaches in open reduction internal fixation of pilon fractures.  

PubMed

Pilon or tibial plafond fractures usually result from high-energy injuries with rotation and/or axial compression. They occur in an area of relatively poor soft tissue coverage and frequently present a surgical challenge in deciding which incisions will be best for performing open reduction internal fixation. A variety of anterior and posterior approaches have been described based on the ease of fracture reduction and internal fixation with plates. Some of the incisions are fracture specific, that is, planned for a limited approach to the pilon. But in more complex cases, a wider exposure is indicated and thus more extensile approaches, both anterior and posterior, can be valuable. This review article will describe the different surgical approaches, focusing on their indication and technique. PMID:25072286

Assal, Mathieu; Ray, Adrien; Stern, Richard

2015-02-01

131

Simulation of carbon dioxide insufflation via a diffuser in an open surgical wound model.  

PubMed

Flow within a model surgical opening during insufflation with heated carbon dioxide was studied using computational fluid dynamics. A volume of fluid method was used to simulate the mixture of ambient air and carbon dioxide gas. The negative buoyancy of the carbon dioxide caused it to fill the wound and form a protective layer on the internal surfaces for a range of flow rates, temperatures, and angles of patient inclination. It was observed that the flow remained attached to the surface of the model due to the action of the Coanda effect. A flow rate of 10 L/min was sufficient to maintain a warm carbon dioxide barrier for a moderately sized surgical incision for all likely angles of inclination. PMID:25103346

Cater, John E; van der Linden, Jan

2015-01-01

132

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

PubMed Central

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

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

2013-01-01

133

Surgical Outcomes of 2041 Consecutive Laparoscopic Gastrectomy Procedures for Gastric Cancer: A Large-Scale Case Control Study  

PubMed Central

Background Laparoscopic gastrectomy (LG) for gastric cancer has increased in popularity due to advances in surgical techniques. The aim of this study is to validate the efficacy and safety of laparoscopic gastrectomy for gastric cancer compared with open gastrectomy (OG). Methods The study comprised 3,580 patients who were treated with curative intent either by laparoscopic gastrectomy (2,041 patients) or open gastrectomy (1,539 patents) between January 2005 and October 2013. The surgical outcomes were compared between the two groups. Results Laparoscopic gastrectomy was associated with significantly less blood loss, transfused patient number, time to ground activities, and post-operative hospital stay, but with similar operation time, time to first flatus, and time to resumption of diet, compared with the open gastrectomy. No significant difference in the number of lymph nodes dissected was observed between these two groups. The morbidity and mortality rates of the LG group were comparable to those of the OG group (13.6% vs. 14.4%, P = 0.526, and 0.3% vs. 0.2%, P = 0.740). The 3-year disease-free and overall survival rates between the two groups were statistically significant (P<0.05). According to the UICC TNM classification of gastric cancer, the 3-year disease-free and overall survival rates were not statistically different at each stage. Conclusions Our single-center study of a large patient series revealed that LG for gastric cancer yields comparable surgical outcomes. This result was also true of local advanced gastric cancer (AGC). A well-designed randomized controlled trial comparing surgical outcomes between LG and OG in a larger number of patients for AGC can be carried out. PMID:25642698

Lin, Jian-Xian; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi

2015-01-01

134

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

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

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

2014-01-01

135

AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical trial  

Microsoft Academic Search

The results of a prospective, nonrandomized, multicenter clinical trial that compared endovascular stent graft exclusion of abdominal aortic aneurysms with open surgical repair are presented. During an 18-month period, 250 patients with infrarenal aneurysms underwent treatment at 12 study sites—190 patients underwent endovascular repair using the Medtronic AneuRx stent graft (Sunnyvale, Calif), and 60 underwent open sur- gical repair. There

Christopher K. Zarins; Rodney A. White; Donald Schwarten; Edward Kinney; Edward B. Diethrich; Kim J. Hodgson; Thomas J. Fogarty

136

Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery  

Microsoft Academic Search

Background  Surgical-site infections (SSIs) are nosocomial infectious complications causing significant morbidity, mortality, and hospital\\u000a costs. Recently, the US Department of Human Health Services and the Centers for Medicare and Medicare Services outlined measures\\u000a intended to decrease and prevent hospital-acquired infections such as SSI. This study aimed to compare the incidence of SSI\\u000a after laparoscopic and open surgery.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective analysis of

J. Esteban Varela; Samuel E. Wilson; Ninh T. Nguyen

2010-01-01

137

[Peculiarities of surgical care in case of open injuries of limbs in emergency situations in peacetime].  

PubMed

It was done the comparative analysis of treatment results of casualties with open injuries of limbs in emergency situations in peacetime. It was determined that traditional approach of field surgery is unacceptable for this group of casualties. It is connected with limitations of evacuation and high frequency of complications. The developed modified surgical protocol permits not only to provide specialized care to casualties with soft tissue trauma and open fracture of limbs but also to reduce frequency of deep suppuration in 1.9 times. Also it allows to decrease number of dressings for one patient and period of the wound defect preparation to reconstructive plastic surgeries in 2.6 and 1.5 times respectively. PMID:24874226

Dubrov, V É; Mitish, V A; Kobritsov, G P; Shabanov, V É; Ba?ramov, Sh A; Khanin, M Iu

2014-01-01

138

Surgical Procedures and Clinical Results of Endoscopic Decompression for Lumbar Canal Stenosis  

Microsoft Academic Search

The purpose of this study was to evaluate the surgical indication and clinical outcomes of endoscopic decompression for lumbar spinal canal stenosis. From September 1998 to March 2002, 250 consecutive patients underwent posterior endoscopic surgery for lumbar radiculopathy. Among these patients, 27 were treated by posterior endoscopic decompression for lumbar canal stenosis. There were 19 men and 8 women, and

Munehito Yoshida; Akitaka Ueyoshi; Kazuhiro Maio; Masaki Kawai; Yukihiro Nakagawa

139

Minor oral surgical procedures in patients on oral anticoagulants — a controlled study  

Microsoft Academic Search

Background: Patients on therapeutic anticoagulation are at risk of bleeding from minor oral surgical sites. When the anticoagulant regime is modified to prevent the risk of bleeding, this at the same time predisposes the patient to risks of the medical condition for which they are being treated. Methods: A total of 70 patients who were on warfarin treatment requiring minor

PD Cannon; VT Dharmar

2003-01-01

140

Occlusion of surgical opening of the ventricular system with fibrinogen-coated collagen fleece: a case collection study  

Microsoft Academic Search

Background  Implantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafer for malignant glioma is not recommended in the case of\\u000a surgical opening of the ventricular system during microsurgical tumor resection because the wafer material may dislocate from\\u000a the resection cavity into the ventricular system and cause obstructive hydrocephalus. TachoSil is an adhesive collagen fleece\\u000a used in different surgical disciplines that provides an air- and

Hans Christoph Bock; Joseph Cohnen; Naureen Keric; Sven Rainer Kantelhardt; Alf Giese

2011-01-01

141

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

PubMed Central

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

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

2014-01-01

142

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

PubMed Central

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

2014-01-01

143

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

PubMed Central

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

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

2012-01-01

144

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

PubMed Central

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

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

145

Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures  

Microsoft Academic Search

The goals of any treatment of cervical spine injuries are: return to maximum functional ability, minimum of residual pain,\\u000a decrease of any neurological deficit, minimum of residual deformity and prevention of further disability. The advantages of\\u000a surgical treatment are the ability to reach optimal reduction, immediate stability, direct decompression of the cord and the\\u000a exiting roots, the need for only

Max Aebi

2010-01-01

146

Emergency surgical salvage for severe intracranial aneurysm rupture during endovascular coiling procedures not amenable to additional coiling  

PubMed Central

Background: We report the management and outcomes of six patients who underwent emergency surgical intervention in the setting of severe intraprocedural rupture during endovascular treatment of an intracranial aneurysm not amenable to additional coiling. Methods: From July 1997 through December 2010, our neurovascular service treated 1613 patients with coil embolization. During this time, we encountered six patients who suffered severe intraprocedural aneurysm rupture, defined by contrast extravasation during the coiling procedure, in whom additional attempted coiling failed to stop the ongoing extravasation. Hospital records, neuroimaging studies, operative reports, and follow-up clinic notes were complete and reviewed in all cases. The follow-up review in surviving patients ranged from 1.5 to 9 years (average 3.8 years), and no patient was lost to the follow-up review. Results: In all cases, persistent extravasation necessitated urgent surgical decompression and securing of the ruptured aneurysm. Of these six cases, three patients achieved a good functional status after prolonged rehabilitation, and one of these had only subtle cognitive changes on formal neuropsychological testing. Two patients died. Conclusion: Intraprocedural rupture during aneurysm coiling is a dangerous and potentially fatal event. Despite the seemingly hopeless nature of this situation, in our experience, aggressive management to control intracranial pressure combined with a rapid reversal of anticoagulation and early surgical intervention can result in reasonable outcomes in some patients. PMID:21748039

Nussbaum, Eric S; Defillo, Archie; Janjua, Tariq M; Zelensky, Andrea; Tatman, Penny; Stoller, Richard; Lowary, Jodi; Nussbaum, Leslie A

2011-01-01

147

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

PubMed Central

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

2014-01-01

148

A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures  

PubMed Central

Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS) has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the “pros” of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other) in various subspecialties, and correlated these with patients’ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors) contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery), preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection), along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS. PMID:24843814

Epstein, Nancy E.

2014-01-01

149

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

PubMed Central

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

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

2014-01-01

150

Medical Robots Surgical Assistants  

E-print Network

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

Pulfrey, David L.

151

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

PubMed

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

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

2014-06-01

152

Surgical treatment of odontogenic myxoma and facial deformity in the same procedure.  

PubMed

Odontogenic myxoma (OM) is an uncommon benign tumor with aggressive and invasive behavior. Predominant symptoms are usually slow and painless swelling, sometimes resulting in perforation of the cortical borders of the affected bone. In this paper, a case report of a patient with an OM on the right maxillary sinus and a vertical excess of maxilla will be presented. The treatment chosen was tumor resection in association with orthognathic surgery with biomodels assessment for surgical planning. A 3-year follow-up showed disease free and stability of the new position of maxilla. The international literature is evaluated to discuss this case report. PMID:24124313

Mayrink, Gabriela; Luna, Anibal Henrique Barbosa; Olate, Sergio; Asprino, Luciana; De Moraes, Marcio

2013-07-01

153

Expansive open-door laminoplasty secured with titanium miniplates is a good surgical method for multiple-level cervical stenosis  

PubMed Central

Background Laminoplasty is an effective procedure for treating cervical spondylotic myelopathy (CSM). Little information is available regarding the surgical outcomes of expansive open-door laminoplasty (EOLP) when securing with titanium miniplates without bone grafting. This study is aimed to elucidate the efficacy of and problems associated with EOLP secured with titanium miniplates without bone grafting, thereby enhancing future surgical outcomes. Methods This is a retrospective study. The study participants comprised 104 patients who underwent cervical EOLP secured with titanium miniplates without bone graft for CSM treatment between August 2005 and March 2011. The clinical results were evaluated based on the Japanese Orthopedic Association (JOA) and Nurick scores. The radiographic outcomes were determined based on plain film and magnetic resonance imaging findings, which were assessed and compared. Results Lateral cervical spine X-rays exhibited improvement in the Pavlov ratio of the spinal canal at 1 day postoperation, and this ratio did not change at 1 year postoperation. The mean cervical curvature from C2 to C7 decreased 0.21°?±?10.09° and the mean cervical range of motion was deteriorated by 35% at 12 months (P?surgical method for treating most patients with CSM. PMID:25142174

2014-01-01

154

[A combined surgical and interventional-radiologic procedure in bile duct obstructions].  

PubMed

Surgery for biliary obstruction may be complicated by the presence of intrahepatic stones and, in difficult anastomoses, by the possibility of recurrent stricture formation. In order to decrease the need for further operation, the first surgical repair in selected cases should allow access for later radiological intervention. Primary operation consists of biliary digestive anastomosis using established techniques with a Roux-en-Y-loop. A limb of the Roux-loop may be brought to the abdominal wall and secured to the anterior parietal peritoneum to allow access for later radiological intervention either by utilizing an established tubal tract into the Roux-loop or by later puncture of the loop under ultrasound guidance. Since October 1986 we have treated 11 patients utilizing this technique. Six patients had complex strictures following cholecystectomy and two patients had obstructions secondary to alveolar or cystic Echinococcosis. One stricture was due to a previous liver resection, one followed previous operation for congenital atresia of the biliary tract and one consisted of multiple strictures and stones associated with oriental recurrent pyogenic cholangitis. In all 11 patients, postoperative radiological imaging was possible. In 6 patients, 14 radiological manoeuvers were carried out for dilatation or for removal of stones and debris. There were no complications. During a median follow-up of 11 months no patient needed further surgical intervention. The indications and techniques are outlined. PMID:2715024

Schweizer, W; Baer, H U; Nudelmann, L I; Matthews, J; Thomas, P; Triller, J; Blumgart, L H

1989-01-01

155

Surgical Airway  

PubMed Central

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

Patel, Sapna A; Meyer, Tanya K

2014-01-01

156

[Endocavitary surgical procedures, an alternative to myomectomy in patients with symptomatic fibroids].  

PubMed

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure) can also be proposed, but for women with Essure placed before endometrial ablation, only Thermachoice and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet. PMID:22100862

De Jesus, I

2011-12-01

157

THE RENAL TUMOR MORPHOLOGICAL CHARACTERISTICS THAT AFFECT SURGICAL PLANNING FOR LAPAROSCOPIC OR OPEN PARTIAL NEPHRECTOMY  

PubMed Central

ABSTRACT The purpose of this study is to investigate the morphological characteristics of renal tumors which affect the surgeons’ decision-making for the selection of open or laparoscopic partial nephrectomy. We included 147 patients who underwent partial nephrectomy for renal masses with elective indications in this study. Laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) were performed in 72 and 75 patients, respectively. Preoperative trans-sectional images were used to assess tumor characteristics such as tumor size, endophyticity, distance from the sinus, distance from the kidney equator, hilar designation, inside designation, and R.E.N.A.L. nephrometry score. Univariate logistic regression analyses demonstrated that tumor size, endophyticity, distance from the sinus, hilar designation, inside designation, and R.E.N.A.L. nephrometry score were associated with decision of laparoscopic partial nephrectomy. Among these factors, multiple regression analyses showed that endophyticity (odds ratio = 0.92, p = 0.007) and distance from the sinus (odds ratio = 1.201, p < 0.001) had statistically significant associations with the type of operation performed. ROC analyses demonstrated cut-off values of 16 mm for endophyticity (sensitivity 69%, specificity 77%) and of 4 mm for distance from the sinus (sensitivity 79%, specificity 65%) for predicting the selection of laparoscopic surgery. In conclusion, this study revealed that endophyticity and distance from the sinus were important for the surgical planning of partial nephrectomy. PMID:25797988

FUNAHASHI, YASUHITO; MUROTANI, KENTA; YOSHINO, YASUSHI; SASSA, NAOTO; ISHIDA, SHOHEI; GOTOH, MOMOKAZU

2015-01-01

158

The Unreliability of the Intermetatarsal Angle in Choosing a Hallux Abducto Valgus Surgical Procedure  

Microsoft Academic Search

Conventional thinking holds that high intermetatarsal and hallux abductus angles (>15° and >25°, respectively) are associated with a hypermobile first ray and require a Lapidus procedure to achieve satisfactory correction for the treatment of hallux valgus. However, normal first ray motion may be misinterpreted as hypermobility, and it is possible to take advantage of this motion to correct some portion

Rahn A. Ravenell; Craig A. Camasta; Donald R. Powell

2011-01-01

159

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

USGS Publications Warehouse

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.

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

2011-01-01

160

Comparison Between Open Procedure and Tubular Retractor Assisted Procedure for Cervical Radiculopathy: Results of a Randomized Controlled Study  

PubMed Central

Posterior cervical foraminotomy is an effective surgical technique for the treatment of radicular pain caused by foraminal stenosis or posterolateral herniated discs. The present study was performed to compare the clinical parameters and surgical outcomes of open foraminotomy/discectomy (OF/OFD) and tubular retractor assisted foraminotomy/discectomy (TAF/TAFD) in the treatment of cervical radiculopathy. A total of 41 patients were divided into two groups: 19 patients in Group 1 underwent OF/OFD and 22 patients in Group 2 underwent TAF/TAFD. Among the various clinical parameters, skin incision size, length of hospital stay, analgesic using time, and postoperative neck pain (for the first 4 weeks after the operation) were favorable in Group 2. Surgical outcomes were not different between the two groups. In conclusion, TAF/TAFD should increase patient's compliance and is as clinically effective as much as the OF/OFD. PMID:19654947

Kim, Kyoung-Tae

2009-01-01

161

OA01.28. Management of post - axial polydactyly by ksharsutra - A minimally invasive Ayurvedic para surgical procedure  

PubMed Central

Purpose: Polydactyly is a most common congenital hand defect in which the hand has one or more extra fingers, commonly seen post axial i.e. on the small finger side, affecting about one out of every 1,000 babies. It is usually treated by surgically removing the extra finger typically, when the child is between 1 and 2 years old. Prognosis after removal of extra digit is good, though not devoid of complications like scar formation, instability and late deformity which may need additional reconstructive surgery to recover full function and improve the hand's appearance. The evidence of polydactyly is linked with superstitions related with divine phenomenon. Due to the myth and fear of complications, parents hesitate or are reluctant to opt for surgery. Method: In this study, Ksharsutra, an Ayurvedic medicated thread coated with herbal alkaline drugs having simultaneous cutting and healing property was used by free ligation technique to remove extra finger in a child, whose parents were not willing to undergo surgery. This was an observational single case design without controlled group. Result: After Ksharsutra ligation, the extra finger started necrosing within 24 hours. The finger turned bluish to black in next 3 days with minimal pain at the site of ligation and finally sloughed out in just nine days with minimal scar formation. Conclusion: Ksahrsutra Ligation showed excellent result in postaxial polydactyly. The results are encouraging enough to warrant more studies to establish and promote this unique para surgical procedure i.e. Ksharsutra in the management of postaxial Polydactyly.

Dwivedi, Amarprakash

2012-01-01

162

Open surgical inferior vena cava filter retrieval for caval perforation and a novel technique for minimal cavotomy filter extraction.  

PubMed

Late complications of retrievable inferior vena cava (IVC) filters resulting from IVC perforation and erosion into adjacent structures is an increasingly frequent phenomena. We describe six cases of open filter explantation for IVC penetration and offer a novel technique for open filter removal without the need for an extensive cavotomy. All patients had radiographic evidence of filter erosion into pericaval structures requiring open surgical filter explant. Four of the six patients underwent minimal cavatomy filter extraction, eliminating the need for caval reconstruction. PMID:22503185

Connolly, Peter H; Balachandran, Vinod P; Trost, David; Bush, Harry L

2012-07-01

163

Comparison between open and laparoscopic reversal of Hartmann’s procedure for diverticulitis  

PubMed Central

AIM: To compare the open and laparoscopic Hartmann’s reversal in patients first treated for complicated diverticulitis. METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann’s procedures for acute complicated diverticulitis. Other indications for Hartmann’s procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann’s reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups. RESULTS: The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimated blood loss were higher in the OHR group (235.8 ± 43.6 min vs 171.1 ± 27.4 min; and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively, P = 0.001). Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group, and 3 ± 1.3 d in the LHR group (P = 0.01). The length of hospital stay was significantly longer in the OHR group (11.2 ± 5.3 d vs 6.7 ± 1.9 d, P < 0.001). The 1 mo complication rate was 33.3% in the OHR (6 wound infections) and 3.6% in the LHR group (1 hemorrhage) (P = 0.004). At 12 mo, the complication rate remained significantly higher in the OHR group (27.8% vs 10.7%, P = 0.03). The anastomotic leak and mortality rates were nil. At 3 years, no patient required re-intervention for surgical complications. The OHR procedure had significantly higher costs (+56%) compared to the LHR procedure, when combining the surgery-related costs and the length of hospital stay. CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays, complication rates, and costs compared to OHR. PMID:23983906

de’Angelis, Nicola; Brunetti, Francesco; Memeo, Riccardo; Batista da Costa, Jose; Schneck, Anne Sophie; Carra, Maria Clotilde; Azoulay, Daniel

2013-01-01

164

The unreliability of the intermetatarsal angle in choosing a hallux abducto valgus surgical procedure.  

PubMed

Conventional thinking holds that high intermetatarsal and hallux abductus angles (>15° and >25°, respectively) are associated with a hypermobile first ray and require a Lapidus procedure to achieve satisfactory correction for the treatment of hallux valgus. However, normal first ray motion may be misinterpreted as hypermobility, and it is possible to take advantage of this motion to correct some portion of a large hallux abductovalgus deformity with distal procedures, such as the Austin or first metatarsophalangeal joint fusion. We retrospectively examined radiographs of 61 patients with first intermetatarsal and hallux abductus angles greater than 15° and greater than 25°, respectively, who had undergone hallux abductovalgus correction via Lapidus, Austin, or first metatarsophalangeal joint fusion. Preoperative and postoperative radiographic measurements of the intermetatarsal and hallux abductus angles were made. The results revealed no statistically significant differences in the amount of correction achieved by any of the 3 procedures in comparison with the others. We concluded that, given appropriate patient selection, an Austin or first MTPJ fusion could reliably correct large intermetatarsal and hallux abductus angles that, in the hands of many surgeons, are often treated by means of Lapidus arthrodesis. PMID:21435913

Ravenell, Rahn A; Camasta, Craig A; Powell, Donald R

2011-01-01

165

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

PubMed Central

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

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

2014-01-01

166

Postthrombotic Syndrome: Surgical Possibilities  

PubMed Central

Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves. PMID:22084674

Khanna, Ajay K.; Singh, Shivanshu

2012-01-01

167

Outcomes of skin closure with suture materials in clean paediatric surgical procedures.  

PubMed

Except through natural orifices, all surgical operations involve making skin incisions which are often closed with suture materials to which the skin may react. This is a five-year (2005-2009) retrospective study of postoperative outcomes of 998 clean skin incisions closed with continuous subcuticular suture materials in 796 children at two Nigerian centres. The children were aged between 1 day and 18 years (mean 6.5 +/- 3.4 years) with a male to female ratio of 2.5:1. The location of the incisions ranged from groin in 678 (67.9%) cases to lower limbs in 15 (1.5%), these were associated with 414 (61.1%) and 13 (86.7%) postoperative complications respectively. Sutures were not removed from the skin in 734 cases and were associated with 558 (76%) postoperative complications whereas sutures were removed between 5-7 postoperative days in 264 cases and were associated with 39(14.8%) postoperative complications (P < 0.0001). Whereas postoperative wound infection in 69 (6.9%) cases occurred before ten days, stitch abscess/sinus, 156 (15.6%), suture extrusion, 80 (8%), hyperpigmentation, 211 (21.1%), pruritus, 182 (18.2%), hypertrophied scars, 128 (12.8%), and keloid formation, 9 (0.9%), occurred after the tenth postoperative day among those whose sutures were not removed in direct proportion to patients' age/ suture size. These postoperative complications gave rise to 343 (34.3%) good, 245 (24.5%) fair, and 9 (0.9%) poor cosmetic outcomes, whereas 401 (40.2%) incisions without postoperative complication gave excellent cosmetic outcomes. It is suggested from this study that continuous subcuticular suture materials which should be removed not later than the tenth postoperative day be used for skin closure in children. PMID:22195383

Osifo, O D; Osagie, T O

2011-06-01

168

Surgical transposition of the atria: A new procedure for repairing transposition of the great vessels  

PubMed Central

The proposed procedure consists of interchanging the positions of the atria by means of an incision used in heart transplantation. After frontal sectioning of the atrial body, the heart is turned up on its pedicle, the interatrial septum is divided in its posterior part, and the vena cavae are extensively freed from their mediastinal and diaphragmatic attachments. The posterior parts of the atria can then be transposed: the right atrium and vena cava are repositioned to the left of the left atrium, and a new septum is constructed by joining the external atrial walls. The heart can then be replaced and the walls of the transposed atria repaired by edge-to-edge sutures. Cadaver experiments have indicated that this procedure is applicable in infants and young people. Casts and radiologic examinations have shown no strictures in the vena cavae, and the possibility of postoperative arrhythmias has been evaluated by means of electrocardiographic studies in dogs surviving for long periods after heart autotransplantation. Images PMID:15216279

Cachera, J.P.; Poulain, H.; Vouhé, P.; Laurent, F.; Vouron, J.; Léandri, J.

1980-01-01

169

New generation intraoperative three-dimensional imaging (O-arm) in 100 spine surgeries: does it change the surgical procedure?  

PubMed

The O-arm (Medtronic Sofamor Danek, Inc., Memphis, TN, USA), an intraoperative CT scan imaging system, may provide high-quality imaging information to the surgeon. To our knowledge, its impact on spine surgery has not been studied. We reviewed 100 consecutive spine surgical procedures which utilized the new generation mobile intraoperative CT imaging system (O-arm). The most common diagnoses were degenerative conditions (disk disease, spondylolisthesis, stenosis and acquired kyphosis), seen in 49 patients. The most common indication for imaging was spinal instrumentation in 81 patients (74 utilized pedicle screws). In 52 (70%) of these, the O-arm was used to assess screw position after placement; in 22 (30%), it was coupled with Stealth navigation (Medtronic Sofamor Danek, Inc.) to guide screw placement. Another indication was to assess adequacy of spinal decompression in 38 patients; in 19 (50%) of these, intrathecal contrast material was used to obtain an intraoperative CT myelogram. In 20 patients O-arm findings led to direct surgeon intervention in the form of screw removal/repositioning (n=13), further decompression (n=6), interbody spacer repositioning (n=1), and removal of kyphoplasty trocar (n=1). In 20% of spine surgeries, the procedure was changed based on O-arm imaging findings. We found the O-arm to be useful for assessment of instrumentation position, adequacy of spinal decompression, and confirmation of balloon containment and cement filling in kyphoplasty. When used with navigation for image-guided surgery, it obviated the need for registration. PMID:24120710

Sembrano, Jonathan N; Santos, Edward Rainier G; Polly, David W

2014-02-01

170

[Complicated postbulbar duodenal ulcers: the characteristics of the diagnosis and of the surgical procedure and management].  

PubMed

The paper reports on the authors' experience used on 164 patients with complicated postbulbar ulcers (12% of the duodenal ulcers) with hemorrhage (52 cases), perforation (9 cases), duodenal stenosis (13 cases), stenosis and penetration (36 cases) and pancreatic-biliary penetrations (36 cases). The frequency of hemorrhagic complication was of 31%. As the hemorrhage due to postbulbar ulcer is favoured by vascular fistula, the severe character of the hemorrhage and the frequency of the recurrence, mainly the cataclysmic one, impose the radical surgery as early as possible. The following were used: large Reichel-Polya's gastrectomy (26 cases with 7 deaths) Péan's gastro-duodenectomy (12 cases), Péan's hemigastrectomy+vagotomy (4 cases), gastrectomy for exclusion with hemostasis in situ and ligature of gastroduodenal artery (8 cases, of which 1 with vagotomy and 2 deaths) and pyloroplasty with vagotomy and hemostasis (2 cases). The postsurgical mortality was of 17%. In 9 cases with perforation: Reichel-Polya's gastrectomy in 5 patients (1 death), Péan's gastrectomy in 2 cases, excision pyloroplasty and suture of the perforation in one case, respectively, were used. In the postbulbar ulcers penetrating into the pancreas or into the hepatic pedicle associated with stenosis (36 cases) the following were performed: Reichel-Polya's gastrectomy (7 cases), Péan's gastrectomy (7 cases of which 2 with vagotomy) gastrectomy for exclusion of ulcer in 19 cases, of which 5 with vagotomy, Péan's hemigastrectomy+vagotomy (3 cases). The 36 cases of ulcers penetrating into pancreas were solved as follows: gastrectomy for exclusion (16 cases of which 5 with vagotomy), Reichel-Polya's gastrectomy (10 cases of which 1 with vagotomy), Péan's gastrectomy (10 cases of which 2 with vagotomy). In 13 patients with stenosed ulcers, Reichel's-Polya's gastric resection (10 cases), Péan's gastrectomy, gastrectomy for exclusion and gastrojejunostomy (in one case each) were performed. The conclusions may be drawn that the postbulbar ulcers are complicated ulcers that require differentiated surgical treatment, as early as possible, for diminishing the postsurgical morbidity and mortality (7.5% mortality). PMID:1688127

Gr?dinaru, V; Seicaru, T; Horeang?, D; Miron, A

1991-01-01

171

Efficacy of Rhizophora mangle aqueous bark extract in the healing of open surgical wounds.  

PubMed

Thirty-seven patients with open wounds from surgical intervention of pilonidal cyst (14; 37.8%) or pilonidal fistula (23; 62.2%) were enrolled on a voluntary basis in a comparative blinded clinical trial and randomly assigned to a topical treatment with a Rhizophora mangle aqueous bark extract once a day or twice a day or mercurocrome twice a day. The efficacy of the treatments was evaluated weekly from day 10 to 12 until 6 weeks after surgery by measuring the area of the wounds by image digital planimetry and the tolerability by recording adverse effects. The initial size of the wounds was taken in consideration as covariable in the Generalized Lineal Model used. A thin dark red colored film covering the wound was observed in all the cases treated with the extract. The wound areas of the groups treated with the extract once or twice per day showed a greater reduction (P < 0.05) compared to the group treated with mercurocrome. No differences between the two regimes of application of the extract of R. mangle were observed. No subject showed any sign of adverse effects and no secondary infections were observed. PMID:12490213

Fernandez, O; Capdevila, J Z; Dalla, G; Melchor, G

2002-12-01

172

Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure  

Microsoft Academic Search

Background. The maze procedure cures atrial fibrillation; however, it isolates the pulmonary vein area and results in discordant activation in certain adjacent left atrial segments, which affects left atrial function. To preserve a more physiologic atrial transport function, we developed a new concept of surgical treatment for atrial fibrillation—the radial approach. The atrial incisions radiate from the sinus node toward

Takashi Nitta; Richard Lee; Richard B Schuessler; John P Boineau; James L Cox

1999-01-01

173

Best surgical option for arch extension of type B aortic dissection: the open approach.  

PubMed

Arch extension of aortic dissection (AD) is reported to occur in 4-25% of patients presenting with acute type B AD. The DeBakey and Stanford classifications do not specifically account for this subset, however, recent studies have demonstrated that the prognosis of patients with arch extension in acute type B AD is virtually identical to that of others with type B AD. In this sense, it seems reasonable to extend the general management principles that are applied to classic acute type B AD even to patients with arch extension. This may be because even in patients with arch extension, most complications occur at locations distal to the arch, and therefore treatment of these patients is similar to that of complicated type B AD, namely thoracic endovascular aortic repair (TEVAR). Conversely, 10% of patients with acute type B AD and arch extension develop complications that are directly related to the arch pathology. This clinical scenario generally necessitates surgical arch repair through a sternotomy approach. The frozen elephant trunk technique combined with arch repair is a very reasonable option to treat this unique clinical entity that involves relatively distal locations of the aortic diseases. Combined arch and descending aorta replacement through thoracotomy is an alternative option particularly when the anatomical features of the target lesions are not suitable for a sternotomy approach or TEVAR. Nonetheless, the reported mortality associated with this approach has been exceedingly high. Hybrid arch repair is another consideration in treating these patients to reduce the treatment-related mortality and morbidity, especially when the arch pathology is limited to the distal part. Nevertheless, the safety and efficacy of this procedure in cases with more extensive arch involvement needs to be assessed in further studies in comparison with other treatment modalities. PMID:25133105

Kim, Joon Bum; Sundt, Thoralf M

2014-07-01

174

Functional Outcome and Health-Related Quality of Life After Surgical Repair of Full-Thickness Rotator Cuff Tear Using a Mini-Open Technique  

Microsoft Academic Search

Background: Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss.Hypothesis: Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life.Study Design: Cohort study. Level of evidence, 2.Methods: Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1)

Deniz Baysal; Robert Balyk; David Otto; Charlene Luciak-Corea; Lauren Beaupre

2005-01-01

175

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

PubMed Central

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

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

2005-01-01

176

Incontinence Treatment: Surgical Treatments  

MedlinePLUS

... Treatment Lifestyle Changes Dietary Tips Medication Bowel Management Biofeedback Surgical Treatments Newer Treatment Options Tips on Finding ... changes Dietary changes Medication Bowel management/retraining program Biofeedback therapy Surgical treatments Newer procedures or devices Tips ...

177

Mastectomy -- The Surgical Procedure  

MedlinePLUS

... Radiation Therapy Breast Reconstruction Questions for Your Provider - Surgery Print | Share About Us Corporate Partners Grants Central FAQs Media Center Contact Us Message Boards Site Map Blog ShopKomen. ...

178

IC Treatment: Surgical Procedures  

MedlinePLUS

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

179

Open-loop recycling: Criteria for allocation procedures  

Microsoft Academic Search

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

Tomas Ekvall; Anne-Marie Tillman

1997-01-01

180

Preliminary Development of a Workstation for Craniomaxillofacial Surgical Procedures: Introducing a Computer-Assisted Planning and Execution System  

PubMed Central

Introduction Facial transplantation represents one of the most complicated scenarios in craniofacial surgery because of skeletal, aesthetic, and dental discrepancies between donor and recipient. However, standard off-the-shelf vendor computer-assisted surgery systems may not provide custom features to mitigate the increased complexity of this particular procedure. We propose to develop a computer-assisted surgery solution customized for preoperative planning, intraoperative navigation including cutting guides, and dynamic, instantaneous feedback of cephalometric measurements/angles as needed for facial transplantation. Methods We developed the Computer-Assisted Planning and Execution (CAPE) workstation to assist with planning and execution of facial transplantation. Preoperative maxillofacial computed tomography (CT) scans were obtained on 4 size-mismatched miniature swine encompassing 2 live face-jaw-teeth transplants. The system was tested in a laboratory setting using plastic models of mismatched swine, after which the system was used in 2 live swine transplants. Postoperative CT imaging was obtained and compared with the preoperative plan and intraoperative measures from the CAPE workstation for both transplants. Results Plastic model tests familiarized the team with the CAPE workstation and identified several defects in the workflow. Live swine surgeries demonstrated utility of the CAPE system in the operating room, showing submillimeter registration error of 0.6 ± 0.24 mm and promising qualitative comparisons between intraoperative data and postoperative CT imaging. Conclusions The initial development of the CAPE workstation demonstrated integration of computer planning and intraoperative navigation for facial transplantation are possible with submillimeter accuracy. This approach can potentially improve preoperative planning, allowing ideal donor-recipient matching despite significant size mismatch, and accurate surgical execution. PMID:24406592

Gordon, Chad R.; Murphy, Ryan J.; Coon, Devin; Basafa, Ehsan; Otake, Yoshito; Al Rakan, Mohammed; Rada, Erin; Susarla, Sriniras; Swanson, Edward; Fishman, Elliot; Santiago, Gabriel; Brandacher, Gerald; Liacouras, Peter; Grant, Gerald; Armand, Mehran

2014-01-01

181

A 1-minute hand wash does not impair the efficacy of a propanol-based hand rub in two consecutive surgical hand disinfection procedures  

Microsoft Academic Search

We studied the effect of a 1-min hand wash on the bacterial hand flora in two consecutive surgical hand disinfection procedures.\\u000a A propanol-based hand rub (PBHR; Sterillium®) and n-propanol (60%, v\\/v) were tested in a Latin-square design according to\\u000a EN 12791 in four variations. The reference alcohol was always applied for 3 min after a 1-min hand wash (variation 1). The

G. Kampf; C. Ostermeyer

2009-01-01

182

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 ...

183

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

PubMed Central

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

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

2006-01-01

184

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

PubMed Central

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

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

2015-01-01

185

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

PubMed

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

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

2014-04-01

186

Effect of surgical stress on endogenous morphine and cytokine levels in the plasma after laparoscopoic or open cholecystectomy  

Microsoft Academic Search

Background: Endogenous morphine in the brain leads to various biological responses after surgery. The aim of this study was to determine\\u000a whether morphine levels in the plasma would be enhanced by open laparotomy rather than by laparoscopic procedures.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: We compared 19 patients who underwent laparoscopic cholecystectomy with five patients who underwent resection of the gallbladder\\u000a by open laparotomy. Morphine

S. Yoshida; J. Ohta; K. Yamasaki; H. Kamei; Y. Harada; T. Yahara; A. Kaibara; K. Ozaki; T. Tajiri; K. Shirouzu

2000-01-01

187

42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...  

Code of Federal Regulations, 2011 CFR

...basis, that are related to covered ASC surgical...hospital's reasonable cost or customary charges...hospital's reasonable cost or customary charges...For the period of time beginning with the...of a hospital's cost reporting period...classified in diagnosis related groups 36...

2011-10-01

188

Relation of Surgical Volume to Outcome in Eight Common Operations  

PubMed Central

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

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

189

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

PubMed Central

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

2014-01-01

190

The Effects of Modeling on Learning a Simple Surgical Procedure: See One, Do One or See Many, Do One?  

Microsoft Academic Search

The effect of modeling a simple surgical task on the subsequent performance of pre-clinical medical students was investigated.\\u000a Groups of students read a verbal description of the excision of a skin lesion and closure of the resulting wound. Subsequently,\\u000a groups watched zero, one, or four videotapes in which expert surgeons demonstrated the task. Finally, students had to perform\\u000a the task

Eugène J. F. M. Custers; Glenn Regehr; Wendy McCulloch; Charles Peniston; Richard Reznick

1999-01-01

191

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

PubMed Central

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

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

2014-01-01

192

OCTYL2CYANOACRYLATE AS A ROUTINE DRESSING AFTER OPEN PEDIATRIC UROLOGICAL PROCEDURES  

Microsoft Academic Search

Purpose:Octyl-2-cyanoacrylate Dermabond, Ethicon, Inc., Sommerville, New Jersey is a synthetic tissue adhesive that has recently been used for skin closure in the treatment of minor lacerations. We assess its effectiveness as a sole dressing after open pediatric urological procedures.

ASHOK RAJIMWALE; BRIAN K. GOLDEN; SIAM OOTTOMASATHIEN; MINA KRISHNAMURTHY; NATHAN O. ULLRICH; MARTIN A. KOYLE

2004-01-01

193

Surgical Management of Aortic Root Dilatation with Advanced Aortic Regurgitation: Bentall Operation versus Valve-sparing Procedure  

PubMed Central

Background Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results The mean follow-up duration was 4.9±3.1 years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of 4.4±2.5 years of echocardiographic follow-up (p<0.001). Conclusion Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures. PMID:22708080

Lim, Ju Yong; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun

2012-01-01

194

An Evaluation of Use of Trans-Obturator Tape (TOT) Sling Procedure in the Current Surgical Management of Female Stress Urinary Incontinence  

PubMed Central

Objective: To assess the role of TOT sling procedure in current surgical management of female Stress Urinary Incontinence (SUI) in terms of post-operative results, cost effectivenss, pt acceptance and complications. Method: From June 2006 to September 2008, 30 patients of SUI were treated surgically by TOT-sling procedure. Pre-operatively the patients were evaluated by thorough history taking, clinical examination and different diagnostic test depending upon the individual clinical scenario. Patients were explained in their own language the nature of procedure and the principle behind it. Any complication(s) (intra/postoperative) were noted. After discharging the patients they were followed up by atleast 3 visits (follow-up visits) at 1, 3 & 6 month interval. Any complications of the procedure and patient acceptance were evaluated at each follow-up. Results: The mean age of the total patients (n=30) was 39.5 yrs and 28 (93.33%) were multiparous. Involuntary loss of urine on straining was the most common complaint present in 25 (83.33%) patients and 22 (73.33) patients were having duration of symptoms less than 3 yrs. 9 (30%) patients were having mild cystocele pre-operatively which resolved after surgery. All the 30 (100%) patients were continent post-operatively while 7 (23.33%) were having lower urinary tract symptoms (LUTS). No major intra/post-operative complication was seen but, urgency, dysuria, fever and haematuria was seen post-operatively which resolved after few days. The operative time was 24 ± 3.8 months and catheter was removed on 2.7 ± 1.7 days post-operatively. Hospital stay was 6 ± 2.4 days (3 – 11) and app. Cost of the treatment was Rs3253 ± 360 (2700,3900). Conclusion: TOT Sling procedure is currently the Gold Standard for management of female SUI. It is very important to diagnose SUI and rule out other causes of incontinence because only the former one (Genuine SUI) is improved by TOT sling and other types may be even worsened by this procedure. PMID:21475493

Khan, Farhat Nissar; Hamid, Arif; Wazir, Baldev Singh; Wani, Mohammed Saleem; Ahmad, Zahoor

2008-01-01

195

Metatarsalgia and Morton's Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up.  

PubMed

The present study compared the clinical results of open neurectomy versus a percutaneous procedure for Morton's disease. This was a retrospective study comparing the functional results after 2 surgical procedures: open neurectomy and a percutaneous procedure (with deep transverse metatarsal ligament release and distal metatarsal osteotomies). The present study included 52 patients (26 in each group), and the mean follow-up period was 4 (range 2 to 7) years. The patient evaluation criteria included the presence of painful symptoms of Morton's disease, American Orthopaedic Foot and Ankle Society (AOFAS) functional scale score, patient satisfaction, and delay for recovery. Percutaneous treatment of Morton's disease and open neurectomy produced complete relief of pain in 25 of 26 patients in each group. At the latest follow-up visit, the mean AOFAS score had significantly improved from 36 ± 11 preoperatively to a mean of 89 ± 18 (p < .001). After 2 years, the functional improvement obtained with the percutaneous procedure persisted, with a stable AOFAS score (96 ± 10). Persistent metatarsalgia was reported by patients who had undergone open neurectomy, with a significantly decreased AOFAS score (81 ± 21, p = .009). The percutaneous procedure for Morton's disease provided excellent functional outcomes (AOFAS score >90) significantly more often with a shorter delay than after open neurectomy (p = .03). At the latest follow-up visit, metatarsalgia due to plantar hyperpressure or bursitis and requiring plantar orthotics was present in 11 of 26 patients (44%) after open neurectomy and in 1 of 26 patients (4%) after the percutaneous procedure (p = .002). Percutaneous treatment of Morton's disease is a reliable procedure providing results as good as those after open neurectomy, with significantly better outcomes in the longer term and a lower rate of late metatarsalgia. PMID:25481724

Bauer, Thomas; Gaumetou, Elodie; Klouche, Shahnaz; Hardy, Philippe; Maffulli, Nicola

2015-01-01

196

Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures  

PubMed Central

Background Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively. Patients and methods We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003–2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006–2009 (group B). Results In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = < 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner. Interpretation Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center. PMID:24032521

2013-01-01

197

A Staged Surgical Treatment Outcome of Type 3 Open Tibial Fractures  

PubMed Central

Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport. PMID:24967129

Uysal, Emin; Özmeriç, Ahmet

2014-01-01

198

Comparison of surgical stress response to laparoscopic and open radical cystectomy  

Microsoft Academic Search

Objectives  To prospectively compare stress response to laparoscopic and open radical cystectomy by the measurement of humoral mediators\\u000a and the incidence of systemic inflammatory response syndrome (SIRS).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Thirty-eight patients undergoing radical cystectomy were prospectively assessed. Blood samples were obtained from all patients\\u000a before surgery, during surgery, 72 h after surgery. Serum levels of interleukin (IL)-6 and interferon (IFN)-? were measured\\u000a using an

Sheng-zheng Wang; Yu Chen; Huan-yi Lin; Ling-wu Chen

2010-01-01

199

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

PubMed Central

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

O'Malley, Sue P

2006-01-01

200

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

PubMed Central

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

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

201

Surgical Instrument Restraint in Weightlessness  

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

202

Orthodontic and surgical perspectives in management of a severe skeletal open bite.  

PubMed

In orthognathic correction of skeletal discrepancy, different treatment options should be considered to give optimum results to the patient with minimal postoperative problems caused by extensive bi-jaw surgery. In a case of severe vertical dysplasia with a large open bite, the orthodontist with the help of advanced diagnostic tools such as imaging software had planned bi-jaw surgery. However, there was a difference in opinion with the oral surgeon who considered only single jaw surgery to get adequate results. The possibility of only maxillary Le Fort I surgery creating autorotation of the mandible was considered, as 0.5° of autorotation results with 1° of maxillary posterior segment clockwise rotation thus avoiding bi-jaw surgery. After performing the Le Fort I superior repositioning of maxilla, the mandibular autorotation was not adequate, so a mandibular bilateral sagittal split osteotomy (BSSO) for mandibular advancement had to be performed to achieve favourable results. PMID:24835800

Vadgaonkar, Vaishali; Gangurde, Parag; Deshmukh, Vijay; Shah, Alok

2014-01-01

203

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

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

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

2012-01-01

204

One-Step Surgical Procedure for the Treatment of Osteochondral Defects with Adipose-Derived Stem Cells in a Caprine Knee Defect: A Pilot Study  

PubMed Central

Abstract Regenerative therapies offer attractive alternatives for the treatment of osteochondral defects. Adipose-derived stromal vascular fraction (SVF) cells allow the development of one-step surgical procedures by their abundant availability and high frequency. In this pilot study we evaluated the in vivo safety, feasibility, and efficacy of this concept using scaffolds seeded with freshly isolated (SVF) or cultured adipose stem cells (ASCs), and compared these to their acellular counterparts. Osteochondral defects were created in medial condyles and trochlear grooves in knees of eight goats. Defects were filled with acellular collagen I/III scaffolds or scaffolds seeded with SVF cells or cultured ASCs. Osteochondral regeneration was evaluated after 1 and 4 months by macroscopy, immunohistochemistry, biomechanical analysis, microCT analysis, and biochemistry. After 1 month, no adverse effects were noted. Microscopic, but not macroscopic evaluation showed considerable yet not significant differences, with cell-loaded constructs showing more extensive regeneration. After 4 months, acellular constructs displayed increased regeneration, however, to a lesser degree than cell-treated constructs. The latter exhibited more extensive collagen type II, hyaline-like cartilage, and higher elastic moduli, and their glycosaminoglycan content in the cartilaginous layer better approached native tissue values. Moreover, their defect regions contained higher levels of regenerated, mature subchondral bone with more intense collagen type I staining. SVF cells tended to perform best on all parameters. In summary, this pilot study demonstrated the preclinical safety and feasibility of a one-step surgical procedure for osteochondral defect regeneration. Similar regeneration was found between freshly isolated SVF cells and cultured ASCs. Larger studies with longer follow-up are required to substantiate these findings. PMID:23914338

Jurgens, Wouter J.F.M.; Kroeze, Robert Jan; Zandieh-Doulabi, Behrouz; van Dijk, Annemieke; Renders, Greetje A.P.; Smit, Theo H.; van Milligen, Florine J.; Ritt, Marco J.P.F.

2013-01-01

205

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

PubMed Central

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

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

2014-01-01

206

Soft tissue closure and plastic surgical aspects of large open myelomeningoceles.  

PubMed

The majority of open myelomeningocele defects are small enough that following the neural repair, soft tissue closure is achieved by simple undermining of the skin edges and tension-free approximation in the midline. The larger defects, greater than 5 cm diameter, cannot be closed reliably by simple skin undermining. Such larger defects call for a close cooperation between the neurosurgeon and the plastic surgeon. In the authors' experience, a reliable, safe method of reconstruction of thoracolumbar and lumbosacral meningomyelocele defects involves the en bloc medial advancement of latissimus dorsi and gluteus maximus musculocutaneous units and reapproximation in the midline. This is the authors' preferred method for all medium and large size defects greater than 5 cm in diameter. This method permits primary closure of the defect in three layers. The flaps are based on the thoracodorsal and superior gluteal vessels and the intervening thoracolumbar fascia. This method provides a tension-free, durable, and viable soft tissue coverage over the dural repair. The flaps do not alter the nerve supply of the muscles involved and merely redefine the muscle origins, without compromising muscle function. PMID:7620354

Ramasastry, S S; Cohen, M

1995-04-01

207

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

PubMed Central

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

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

2014-01-01

208

A comparison of the incidence of early postoperative infections between patients using synthetic mesh and those undergoing traditional pelvic reconstructive surgical procedures.  

PubMed

New mesh-related complications such as erosion, etc., can result from abnormal postoperative healing due to surgical site infection. The aim of our study was to compare systemic inflammatory responses and the incidence of early infectious complications after reconstructive surgery using synthetic mesh and after traditional vaginal wall repair. In this prospective observational study 99 women with symptomatic pelvic organ prolapse were included; 55 women underwent traditional repair and 44 repair using mesh. After the procedure infectious complications were monitored. The patients who underwent reconstructive surgery using mesh material were more likely to have febrile morbidity in the postoperative period than the patients who had been treated with traditional repair (p=0.031); there was a higher incidence of combination febrile morbidity with elevated C-reactive protein (CRP) > 50 mg/l; p=0.046, and a higher incidence of CRP increase over 30 mg/l; p=0.005. Reconstructive procedures using synthetic mesh are accompanied by a higher incidence of early post-operative infectious complications. PMID:23777799

Mašata, J; Martan, A; Poislová, M; Kobilková, J; Mašatová, D; Jedli?ková, A; Svabík, K; Hubka, P; Zvára, K

2013-01-01

209

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

PubMed Central

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

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

2014-01-01

210

Traumatic recurrent anterior dislocation of the shoulder: two- to four-year follow-up of an anatomic open procedure  

Microsoft Academic Search

The purpose of this study was to evaluate the results of an anatomic open stabilization procedure. Twenty-three consecutive patients with traumatic, recurrent, anterior glenohumeral instability were managed with a modified open procedure. All had a Bankart lesion. A standardized, true anatomic capsulolabral reconstruction was performed with suture anchors. Two patients were lost to follow-up, and twenty-one were evaluated after 36

Brigitte M Jolles; Stéphane Pelet; Alain Farron

2004-01-01

211

Anaesthesia for patients over 90 years of age. Outcomes after regional and general anaesthetic techniques for two common surgical procedures.  

PubMed

Peri-operative morbidity and mortality and long term outcome of patients over 90 years of age who underwent either total hip arthroplasty or transurethral prostate resection were studied retrospectively. The outcomes of patients who received regional or general anaesthesia were compared. One hundred and forty-one patients underwent total hip arthroplasty and 44 patients underwent transurethral prostate resection during the study period (1975-1985). Overall in-hospital mortality was 4.9% Mortality at 30 days was 5.3% in patients who underwent hip arthroplasty during regional anaesthesia, compared with 6.8% in those who received general anaesthesia. Long term survival was similar for these two groups and was longer than projected for age and gender-matched general population cohorts. The 30-day mortality rate was 3.2% for patients who underwent prostatic resection under regional anaesthesia; no deaths occurred in the general anaesthesia group. This difference was not statistically significant. Long term survival was similar for patients in both groups and was better than predicted. Anaesthetic technique did not influence short term morbidity and mortality or long term outcome for these procedures. PMID:2929938

Hosking, M P; Lobdell, C M; Warner, M A; Offord, K P; Melton, L J

1989-02-01

212

High-resolution computed tomography of the middle ear and mastoid. Part III. Surgically altered anatomy and pathology  

SciTech Connect

High-resolution computed tomography (CT) provides an excellent method for examination of the surgically altered middle ear and mastoid. Closed-cavity and open-cavity types of mastoidectomy are illustrated. Recurrent cholesteatoma in the mastoid bowl is easily diagnosed. Different types of tympanoplasty are discussed and illustrated, as are tympanostomy tubes and various ossicular reconstructive procedures. Baseline high-resolution CT of the postoperative middle ear and mastoid is recommended at approximately 3 months following the surgical procedure.

Swartz, J.D.; Goodman, R.S.; Russell, K.B.; Ladenheim, S.F.; Wolfson, R.J.

1983-08-01

213

Periodontal Plastic Surgery Procedures  

MedlinePLUS

... Comprehensive Periodontal Evaluation Periodontal Treatments and Procedures Non-Surgical Periodontal Treatments Gum Graft Surgery Laser Treatment for Gum Disease Regenerative Procedures Dental Crown ...

214

Periodontal Treatments and Procedures  

MedlinePLUS

... Comprehensive Periodontal Evaluation Periodontal Treatments and Procedures Non-Surgical Periodontal Treatments Gum Graft Surgery Laser Treatment for Gum Disease Regenerative Procedures Dental Crown ...

215

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

E-print Network

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

216

Minimally invasive procedures.  

PubMed

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

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

217

Minimally invasive procedures  

PubMed Central

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.

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

218

Surgical versus non-surgical treatment of mandibular condylar fractures: a meta-analysis.  

PubMed

The aim of the present study was to test whether there is a significant difference in the clinical outcomes between surgical and non-surgical treatment of mandibular condylar fractures. An electronic search was undertaken in February 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 36 publications. The estimates of an intervention were expressed as the risk ratio (RR) and mean difference (MD) in millimetres. A statistically significant effect was observed for the outcome of post-treatment malocclusion (RR 0.46, P<0.00001), lateral deviation during maximum inter-incisal opening (RR 0.56, P=0.0001, dichotomous; MD -0.75, P=0.002, continuous), protrusion (MD 0.68, P=0.01), and laterotrusion (MD 0.53, P=0.03) favouring surgical treatment, and for infection (RR 3.43, P=0.03) favouring non-surgical treatment. There was no statistically significant effect on temporomandibular joint pain (RR 0.81, P=0.46) or noise (RR 1.44, P=0.24), or maximum inter-incisal opening (MD 2.24, P=0.14). The test for overall effect showed that the difference between the procedures significantly affected the incidence of post-treatment complications, favouring surgical treatment, when all dichotomous and continuous outcomes were analysed (RR 0.70, P=0.006 and MD 1.17, P=0.0006, respectively). PMID:25457827

Chrcanovic, B R

2015-02-01

219

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

PubMed Central

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

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

2014-01-01

220

Conscious sedation for surgical procedures  

MedlinePLUS

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

221

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 ...

222

Insertion slanting strabismus surgical procedures.  

PubMed

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

Kushner, Burton J

2011-12-01

223

Short bowel syndrome in children: surgical and medical perspectives.  

PubMed

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

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

2014-10-01

224

Surgical sperm retrieval: Techniques and their indications.  

PubMed

Men with azoospermia can father a child through intra-cytoplasmic sperm injection if sperm can be retrieved from their epididymis or testis. Several percutaneous and open surgical procedures have been described to retrieve sperm. The various techniques and their merits are discussed in this review. In men with obstructive azoospermia, epididymal sperm can usually be retrieved by percutaneous epididymal sperm aspiration (PESA). If PESA fails then testicular sperm are obtained by needle aspiration biopsy (NAB). In men with non-obstructive azoospermia, there will be no sperm in the epididymis and testicular sperm retrieval is required. Percutaneous retrieval by NAB can be tried first. If that fails then testicular sperm extraction (TESE) from open microsurgical biopsies is performed using the single seminiferous tubule (SST) or the microdissection TESE techniques. The simplest, least invasive procedure should be tried first. PMID:21716933

Shah, Rupin

2011-01-01

225

Surgical correction of a sacral meningomyelocele in a dog.  

PubMed

A 15 wk old male unilateral cryptorchid German shepherd dog weighing 18 kg was referred for a nonhealing cutaneous lesion dorsally at the level of the sacrum, urinary incontinence, and a deviated tail. MRI revealed spina bifida and meningomyelocele continuous with the skin surface. Surgical correction of the meningomyelocele involved closure of the open meningeal defect, transection of the abnormal spinal nerves to the skin surface, and closure of the skin defect with a good outcome. Histopathology confirmed a meningomyelocele. This case report describes the MRI findings, surgical procedure, and proposed pathogenesis of spina bifida and meningomyelocele in a dog. PMID:25251428

Song, Rachel B; Glass, Eric N; Kent, Marc; Sánchez, Melissa D; Smith, Diana M; de Lahunta, Alexander

2014-01-01

226

Giant Choledochal Calculosis: Surgical Treatment  

PubMed Central

Context: Gallstone disease is one of the most common surgical pathologies. Choledocholithiasis may occur in some of these cases and require surgical intervention. Although there are relatively non-invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP), this technique is usually unsuccessful in patients with stones larger than 10 mm. In our case, we aimed to report a giant choledochal stone (15 cm × 4.5 cm), which is rare in surgical practice and our treatment with open surgery. Case Report: The patient was a 59-year-old woman. Magnetic resonance cholangiopancreatography (MRCP) had showed a hydropic gallbladder with an excessively dilated CBD and a 110 mm × 41 mm stone. In the operation, an excessively dilated CBD was seen and after choledochotomy and a very large calculus that filled CBD completely. Choledochotomy incision was carried forward and a T-tube choledochostomy with choledochoduodenostomy (CD) was performed. The patient was discharged without any complications on postoperative 8th day. Conclusion: Benign gallstone disease is a multifactorial process, with risk factors such as obesity, hemolytic diseases, diabetes mellitus, and pregnancy. Risk factors for choledocholithiasis are similar to those for gallstone disease. MRCP is a non-invasive technique in detecting choledocholithiasis. The gold standard intervention for CBD stones is ERCP. Stones in CBD may reach very considerable dimensions without causing serious symptoms. The most common symptom is jaundice. During preoperative radiological examination, giant stones may be interfered with malignancies. Surgeons should obey conventional algorithms in diagnosis and open surgery must be kept in mind in earlier stages without being too insistent on endoscopic interventions. PMID:25489567

Bektas, Hasan; Duzkoylu, Yigit; Cakar, Ekrem; Buyukas?k, Kenan; Colak, Sukru

2014-01-01

227

Evaluation and stages of surgical innovations.  

PubMed

Surgical innovation is an important part of surgical practice. Its assessment is complex because of idiosyncrasies related to surgical practice, but necessary so that introduction and adoption of surgical innovations can derive from evidence-based principles rather than trial and error. A regulatory framework is also desirable to protect patients against the potential harms of any novel procedure. In this first of three Series papers on surgical innovation and evaluation, we propose a five-stage paradigm to describe the development of innovative surgical procedures. PMID:19782874

Barkun, Jeffrey S; Aronson, Jeffrey K; Feldman, Liane S; Maddern, Guy J; Strasberg, Steven M; Altman, Douglas G; Barkun, Jeffrey S; Blazeby, Jane M; Boutron, Isabell C; Campbell, W Bruce; Clavien, Pierre-Alain; Cook, Jonathan A; Ergina, Patrick L; Flum, David R; Glasziou, Paul; Marshall, John C; McCulloch, Peter; Nicholl, Jon; Reeves, Bournaby C; Seiler, Christoph M; Meakins, Jonathan L; Ashby, Deborah; Black, Nick; Bunker, John; Burton, Martin; Campbell, Marion; Chalkidou, Kalipso; Chalmers, Iain; de Leval, Marc; Deeks, Jon; Grant, Adrian; Gray, Muir; Greenhalgh, Roger; Jenicek, Milos; Kehoe, Sean; Lilford, Richard; Littlejohns, Peter; Loke, Yoon; Madhock, Rajan; McPherson, Kim; Rothwell, Peter; Summerskill, Bill; Taggart, David; Tekkis, Parris; Thompson, Matthew; Treasure, Tom; Trohler, Ulrich; Vandenbroucke, Jan

2009-09-26

228

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

PubMed Central

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

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

2015-01-01

229

Surgical versus nonsurgical rejuvenation.  

PubMed

The number of cosmetic procedures for facial rejuvenation has increased steadily over the past decade. The increase in the application of nonsurgical modalities, particularly injectable shaping agents, has been remarkable. As knowledge and experience about facial aging has increased, techniques and tools have improved, and it is increasingly apparent that surgical and nonsurgical/injectable modalities are complementary. PMID:20844298

Fitzgerald, Rebecca; Graivier, Miles H; Kane, Michael; Lorenc, Z Paul; Vleggaar, Danny; Werschler, Wm Philip; Kenkel, Jeffrey M

2010-01-01

230

Nanotechnology Applications in Surgical Oncology  

PubMed Central

Surgery is currently the most effective and widely used procedure in treating human cancers, and the single most important predictor of patient survival is a complete surgical resection. Major opportunities exist to develop new and innovative technologies that could help the surgeon to delineate tumor margins, to identify residual tumor cells and micrometastases, and to determine if the tumor has been completely removed. Here we discuss recent advances in nanotechnology and optical instrumentation, and how these advances can be integrated for applications in surgical oncology. A fundamental rationale is that nanometer-sized particles such as quantum dots and colloidal gold have functional and structural properties that are not available from either discrete molecules or bulk materials. When conjugated with targeting ligands such as monoclonal antibodies, peptides, or small molecules, these nanoparticles can be used to target malignant tumor cells and tumor microenvironments with high specificity and affinity. In the “mesoscopic” size range of 10–100 nm, nanoparticles also have large surface areas for conjugating to multiple diagnostic and therapeutic agents, opening new possibilities in integrated cancer imaging and therapy. PMID:20059343

Singhal, Sunil; Nie, Shuming; Wang, May D.

2010-01-01

231

3D Surgical Simulation  

PubMed Central

This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

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

2009-01-01

232

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

PubMed

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

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

2013-05-01

233

Advantages of Robot-Assisted Laparoscopic Radical Prostatectomy in Obese Patients: Comparison with the Open Procedure  

PubMed Central

Purpose Obesity has been suggested as a risk factor for worse perioperative outcomes, especially in radical prostatectomy, in several studies. However, the impact of obesity on perioperative outcomes has not yet been well elucidated for robot-assisted laparoscopic radical prostatectomy (RALP). We evaluated whether obesity had an adverse effect on outcomes following RALP compared with retropubic radical prostatectomy (RRP). Materials and Methods From April 2008 to May 2011, 181 patients underwent radical prostatectomy (RALP, 111; RRP, 70). These patients were subdivided into two groups according to body mass index (BMI): the nonobese group (BMI, 25 kg/m2 or less) and the obese group (BMI, greater than 25 kg/m2). Perioperative outcomes in RALP and RRP were retrospectively compared between the two groups. Results In RRP, patients in the obese group (n=20) showed greater blood loss and a higher complication rate than did those in the nonobese group (n=50). However, in RALP, no statistically significant differences in perioperative outcomes were observed between the obese (n=37) and the nonobese (n=74) groups. RALP showed less blood loss and a lower complication rate in both the obese and nonobese groups than did RRP. Conclusions RALP is thought to be a more effective and safer procedure in obese patients compared with traditional open radical prostatectomy. In the management of obese patients with localized prostate cancer, RALP should be considered as a primary choice for treatment. PMID:22949997

Bae, Jae Jun; Choi, Seok Hwan; Kwon, Tae Gyun

2012-01-01

234

Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with single-segment thoracolumbar fractures without neurologic injury  

PubMed Central

Abstract This study aimed to introduce a novel mini-open pedicle screw fixation technique via Wiltse approach, and compared it with the traditional posterior open method. A total of 72 cases of single-segment thoracolumbar fractures without neurologic injury underwent pedicle screw fixation via two different approaches. Among them, 37 patients were treated using posterior open surgery, and 35 patients received mini-open operation via Wiltse approach. Crew placement accuracy rate, operative time, blood loss, postoperative drainage, postoperative hospitalization time, radiation exposure time, postoperative improvement in R value, Cobb's angle and visual analog scale (VAS) scores of the two methods were compared. There were no significant differences in the accuracy rate of pedicle screw placement, radiation exposure and postoperative R value and Cobb's angle improvement between the two groups. However, the mini-open method had obvious advantages over the conventional open method in operative time, blood loss, postoperative drainage, postoperative hospitalization time, and postoperative improvement in VAS. The mini-open pedicle screw technique could be applied in treatment of single-segment thoracolumbar fracture without neurologic injury and had advantages of less tissue trauma, short operative and rehabilitative time on the premise of guaranteed accuracy rate and no increased radiation exposure.

Li, Haijun; Yang, Lei; Xie, Hao; Yu, Lipeng; Wei, Haifeng; Cao, Xiaojian

2015-01-01

235

The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: a 6-year prospective study after a change in policy.  

PubMed

Our current protocol in treating open long-bone fractures includes early administration of intravenous antibiotics and surgery on a scheduled trauma list. This represents a change from a previous protocol where treatment as soon as possible after injury was carried out. This review reports the infection rates in the period 6 years after the start of this protocol. Two hundred and twenty open long-bone fractures were reviewed. Data collected included time of administration of antibiotics, time to theatre and seniority of surgeon involved. The patients were followed up until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed. Clinical, radiological and haematological signs of infection were documented. If present, infection was classified as deep or superficial. Surgical debridement was performed within 6 h of injury in 45 % of cases and after 6 h in 55 % of cases. Overall infection rates were 11 and 15.7 %, respectively (p = 0.49). The overall deep infection rate was 4.3 %. There was also no statistically significant difference in the subgroups of deep (p = 0.46) and superficial (p = 0.78) infection. Intravenous antibiotics were administered within 3 h of injury in 80 % of cases and after 3 h in 20 % of cases. The infection rates were 14 and 12.5 %, respectively (p = 1.0). There was no statistically significant difference in the subgroups of deep (p = 0.62) and superficial (p = 0.73) infection. Further statistical analysis did not reveal a significant difference in infection rates for any combination of timing of antibiotics and surgical debridement. Infection rates where the most senior surgeon present was a consultant were 9.5 % as opposed to 16 % with the consultant not present, but this trend was not statistically significant. These results suggest that the change in policy may have contributed to an improvement of the deep infection rate to 4.3 % from the previous figure of 8.5 % although this decrease is not statistically significant. Surgeons may have had concerns that delaying theatre may lead to an increased infection rate, but these results do not substantiate this concern. PMID:25526857

Leonidou, Andreas; Kiraly, Zoltan; Gality, Hristifor; Apperley, Shane; Vanstone, Sean; Woods, David A

2014-11-01

236

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

Microsoft Academic Search

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

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

2003-01-01

237

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

PubMed Central

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.

2014-01-01

238

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

Federal Register 2010, 2011, 2012, 2013, 2014

...Environmental Quality on February 16, 2001, July 14, 2005, August 28, 2006, and May 20, 2008. The February 16, 2001 submittal relates to open burning rules...264 Open Burning Rules (February 16, 2001 Submittal) B. EPA's Review of...

2013-01-07

239

10 CFR 20.1906 - Procedures for receiving and opening packages.  

Code of Federal Regulations, 2013 CFR

...receiving and opening packages. 20.1906 Section...receiving and opening packages. (a) Each licensee...expects to receive a package containing quantities...levels unless the package contains quantities...3) Monitor all packages known to...

2013-01-01

240

10 CFR 20.1906 - Procedures for receiving and opening packages.  

Code of Federal Regulations, 2012 CFR

...receiving and opening packages. 20.1906 Section...receiving and opening packages. (a) Each licensee...expects to receive a package containing quantities...levels unless the package contains quantities...3) Monitor all packages known to...

2012-01-01

241

10 CFR 20.1906 - Procedures for receiving and opening packages.  

Code of Federal Regulations, 2011 CFR

...receiving and opening packages. 20.1906 Section...receiving and opening packages. (a) Each licensee...expects to receive a package containing quantities...levels unless the package contains quantities...3) Monitor all packages known to...

2011-01-01

242

10 CFR 20.1906 - Procedures for receiving and opening packages.  

Code of Federal Regulations, 2014 CFR

...receiving and opening packages. 20.1906 Section...receiving and opening packages. (a) Each licensee...expects to receive a package containing quantities...levels unless the package contains quantities...3) Monitor all packages known to...

2014-01-01

243

Surgical Technologists  

MedlinePLUS

... the average for all occupations. Advances in medical technology have made surgery safer, and more operations are ... universities and hospitals, have accredited programs in surgical technology. Programs range in length from several months to ...

244

Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial†  

PubMed Central

OBJECTIVES The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. METHODS An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus® and Monocryl Plus®, Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. RESULTS The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39–1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. CONCLUSIONS Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315). PMID:23435526

Thimour-Bergström, Linda; Roman-Emanuel, Christine; Scherstén, Henrik; Friberg, Örjan; Gudbjartsson, Tomas; Jeppsson, Anders

2013-01-01

245

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

PubMed Central

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

Henry, Linda; Ad, Niv

2013-01-01

246

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

PubMed Central

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

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

2014-01-01

247

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

PubMed Central

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

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

2012-01-01

248

Minimally invasive procedures on the lumbar spine  

PubMed Central

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

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

2015-01-01

249

Minimally invasive procedures on the lumbar spine.  

PubMed

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

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

2015-01-16

250

Surgical mortality score: Risk management tool for auditing surgical performance  

Microsoft Academic Search

Existing methods of risk adjustment in surgical audit are complex and costly. The present study aimed to develop a simple\\u000a risk stratification score for mortality and a robust audit tool using the existing resources of the hospital Patient Administration\\u000a System (PAS) database. This was an observational study for all patients undergoing surgical procedures over a two-year period,\\u000a at a London

Vassilis G. Hadjianastassiou; Jan D. Poloniecki; Manolis C. Gavalas; David R. Goldhill

2004-01-01

251

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

SciTech Connect

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.

Polak, Joseph F. [Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States); Berger, Markus F. [Roentgeninstitut Klinik Hirslanden, Witellikerstrasse 40, CH-8029 Zurich (Switzerland); Pagan-Marin, Heriberto [Department of Radiology, Boston University Medical Center, University Hospital, 88 East Newton Street, Roxbury, MA 02118 (United States); Aruny, John E. [Department of Radiology, DePaul Medical Center, 150 Kingsley Lane, Norfolk, VA 23505 (United States); Meyerovitz, Michael F. [Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (United States)

1998-07-15

252

Surgical treatment of pediatric rhinosinusitis.  

PubMed

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

Isaacson, G

2014-11-01

253

Surgical management for overactive bladder  

Microsoft Academic Search

The majority of patients with overactive bladder can be managed with office-based techniques. When medical therapy fails as\\u000a treatment for overactive bladder, surgical intervention ranging from electrical stimulation administered in the office to\\u000a extensive procedures, such as augmentation or urinary diversion, may be needed. Any surgical intervention should be tailored\\u000a to the patient with consideration of the degree of his

Rodney A. Appell; Timothy B. Boone

2007-01-01

254

Surgical management of overactive bladder  

Microsoft Academic Search

The majority of patients with overactive bladder (OAB) can be managed with office-based techniques. When medical therapy fails\\u000a as treatment for OAB, surgical intervention ranging from electric stimulation administered in the office to extensive procedures,\\u000a such as augmentation or urinary diversion, may be needed. Any surgical intervention should be tailored to the patient with\\u000a consideration of the degree of his

Michael Gross; Timothy B. Boone; Rodney A. Appell

2002-01-01

255

Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction  

PubMed Central

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

Thiruchelvam, Nikesh

2014-01-01

256

Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction.  

PubMed

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

Thiruchelvam, Nikesh

2014-04-01

257

Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia  

PubMed Central

Background Patients with critical lower limb ischemia without patent pedal arteries cannot be treated by the conventional arterial reconstruction. Venous arterialization has been suggested to improve limb salvage in this subgroup of patients but has not gained wide acceptance. We report our early experience after implementing deep and superficial venous arterialization of the lower limb. Materials and methods Ten patients with critical ischemia and without crural or pedal arteries available for conventional bypass surgery or angioplasty were treated with distal venous arterialization. Inflow was from the most distal unobstructed segment. Run-off was the dorsal pedal venous arch (n=5), the dorsal pedal venous arch and a concomitant vein of the posterior tibial artery (n=3), or the dorsal pedal venous arch and a concomitant vein of the common plantar artery (n=2) depending on the location of the ischemic lesion. Venous valves were destroyed using antegrade valvulotomes, guide wires, knob needles, or retrograde valvulotomes via an extra incision. Results Seven of the operated limbs were amputated after 23 (1–256) days (median [range]). The main reasons for amputation were lack of healing of either the original wound, of incisional wounds on the foot, or persisting pain at rest. In three cases, the bypass was open at the time of amputation. Two patients experienced complete wound healing after 231 and 342 days, respectively. By the end of follow-up, the last patient was ambulating with slow wound healing but without pain 309 days after surgery. Conclusion Venous arterialization may be used as a treatment of otherwise unsalveable limbs. The success rate is, however, limited. Technical optimization of the technique is warranted. PMID:24358432

Houlind, Kim; Christensen, Johnny; Hallenberg, Christian; Jepsen, Jørn M.

2013-01-01

258

DeterminingthemassofSaturn: Open a Matlab session, and then try this procedure. You will use a file with positions of Saturn's moons  

E-print Network

DeterminingthemassofSaturn: Open a Matlab session, and then try this procedure. You will use a file with positions of Saturn's moons (rather than Jupiter's) but the procedure will be the same. First, download the file Saturn_moons.xls from the course web site. Read the file Saturn

Gary, Dale E.

259

Surgical repair of tricuspid atresia  

PubMed Central

Surgical repair of tricuspid atresia has been carried out in three patients; two of these operations have been successful. A new surgical procedure has been used which transmits the whole vena caval blood to the lungs, while only oxygenated blood returns to the left heart. The right atrium is, in this way, `ventriclized', to direct the inferior vena caval blood to the left lung, the right pulmonary artery receiving the superior vena caval blood through a cava-pulmonary anastomosis. This technique depends on the size of the pulmonary arteries, which must be large enough and at sufficiently low pressure to allow a cava-pulmonary anastomosis. The indications for this procedure apply only to children sufficiently well developed. Younger children or those whose pulmonary arteries are too small should be treated by palliative surgical procedures. Images PMID:5089489

Fontan, F.; Baudet, E.

1971-01-01

260

Surgical innovation  

Microsoft Academic Search

Innovation has been an integral part of the progress of surgery. Technological advances have given a different dimension to\\u000a the intricacies of modern surgery. While some innovations have been ground-breaking, others made only a transitory impression.\\u000a This article attempts to distinguish between a true innovation and a technical refinement and explores the ethos and socio-economic\\u000a factors that propel surgical innovation.

Saumitra Saha

2009-01-01

261

Surgical challenge: endoscopic repair of cerebrospinal fluid leak  

PubMed Central

Background Cerebrospinal fluid leaks (CSF) result from an abnormal communication between the subarachnoid space and the extracranial space. Approximately 90% of CSF leak at the anterior skull base manifests as rhinorrhea and can become life-threatening condition. Endoscopic sinus surgery (ESS) has become a common otolaryngologist procedure. The aim of this article is to consider our experience and to evaluate the outcomes in patients who underwent a purely endoscopic repair of CSF leaks of the anterior skull base. Findings Retrospective chart review was performed of all patients surgically treated for CSF leaks presenting to the Section of Nasal and Sinus Disorders at the Service of ENT–Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), between 2004 and 2010. A total of 30 patients who underwent repair CSF leak by ESS. The success rate was 93.4% at the first attempt; only two patients (6.6%) required a second surgical procedure, and none of it was necessary to use a craniotomy for closure. Follow-up periods ranged from 4?months to 6?years. Conclusion Identifying the size, site, and etiology of the CSF leak remains the most important factor in the surgical success. It is generally accepted that the ESS have made procedures minimally invasive, and CSF leak is now one of its well-established indications with low morbidity and high success rate, with one restriction for fistulas of the posterior wall of the frontal sinus should be repaired in conjunction with open techniques. PMID:22925201

2012-01-01

262

Surgical access to separate branches of the cat vestibular nerve  

NASA Technical Reports Server (NTRS)

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.

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

1981-01-01

263

Re-engineering surgical services in a community teaching hospital.  

PubMed

The Grace Hospital Surgical Services redesign project began in December 1995 and concluded in November 1996. It was led by the Chief of Surgery, the Surgical/Anesthesia Services Director, and the Associate Director of Critical Care/Trauma. The project was undertaken in order to radically redesign the delivery of surgical services in the Detroit Medical Center (DMC) Northwest Region. It encompassed the Grace Hospital Main Operating Room (10 operating theatres) and Post-Anesthesia Recovery Unit, and a satellite Ambulatory Surgery Center in Southfield, Michigan. The four areas of focus were materials management, case scheduling, patient flow/staffing, and business planning. The guiding objectives of the project were to improve upon the quality of surgical services for patients and physicians, to substantially reduce costs, and to increase case volume. Because the Grace Surgical Services redesign project was conducted in a markedly open communicative, and inclusive fashion and drew participation from a broad range of medical professionals, support staff, and management, it created positive ripple effects across the institution by raising staff cost-consciousness, satisfaction, and morale. Other important accomplishments of the project included: Introduction of block scheduling in the ORs, which improved room utilization and turnaround efficiencies, and greatly smoothed the boarding process for physicians. Centralization of all surgical boarding, upgrading of computer equipment to implement "one call" surgery scheduling, and enlarging the capacity for archiving, managing and retrieving OR data. Installation of a 23-hour, overnight recovery unit and provision of physician assistants at the Ambulatory Surgery Center, opening the doors to an expanded number of surgical procedures, and enabling higher quality care for patients. Reduction of FTE positions by 27 percent at the Ambulatory Surgery Center. This yielded a total cost reduction of +1.5 million per annum in the annual budget of +10.3 million; Recruited 10 new podiatrists and increased the volume of cases brought to Northwest Region facilities by surgical specialists. This added 100 cases in 1996, and is projected to add 500 cases in 1997. A 14.5 percent reduction in the cost of operating the Surgical Services was achieved. This was accompanied by enhanced staff morale, physician satisfaction and a higher quality of patient care. PMID:10172985

Cohen, M M; Wreford, M; Barnes, M; Voight, P

1997-04-01

264

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

PubMed Central

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

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

2014-01-01

265

Intraoperative monitoring technician: a new member of the surgical team.  

PubMed

As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes. PMID:21281767

Brown, Molly S; Brown, Debra S

2011-02-01

266

Surgical management of urolithiasis in spinal cord injury patients.  

PubMed

Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative complications. PMID:24740271

Nabbout, Philippe; Slobodov, Gennady; Culkin, Daniel J

2014-06-01

267

Endoscopy-MR Image Fusion for Image Guided Procedures  

PubMed Central

Minimally invasive endoscope based abdominal procedures provide potential advantages over conventional open surgery such as reduced trauma, shorter hospital stay, and quick recovery. One major limitation of using this technique is the narrow view of the endoscope and the lack of proper 3D context of the surgical site. In this paper, we propose a rapid and accurate method to align intraoperative stereo endoscopic images of the surgical site with preoperative Magnetic Resonance (MR) images. Gridline light pattern is projected on the surgical site to facilitate the registration. The purpose of this surface-based registration is to provide 3D context of the surgical site to the endoscopic view. We have validated the proposed method on a liver phantom and achieved the surface registration error of 0.76 ± 0.11?mm. PMID:24298281

Huang, Xishi; Ren, Jing

2013-01-01

268

Thoracoscopy: a collaborative surgical approach.  

PubMed

Perioperative nurses, surgeons, anesthesiologists, certified registered nurse anesthetists, and pharmacists are meeting the challenge of decreasing thoracic surgical patients' length of hospital stay with thoracoscopy. This innovative alternative to traditional thoracotomy procedures has been achieved through an attentive team approach using the fundamental perioperative skills of assessment, positioning, safety, and sharing of knowledge. PMID:7647761

Brand, A F

1995-07-01

269

Basilar invagination: Surgical results  

PubMed Central

Introduction: Basilar invagination (BI) is a congenital craniocervical junction (CCJ) anomaly represented by a prolapsed spine into the skull-base that can result in severe neurological impairment. Materials and Methods: In this paper, we retrospective evaluate the surgical treatment of 26 patients surgically treated for symptomatic BI. BI was classified according to instability and neural abnormalities findings. Clinical outcome was evaluated using the Nürick grade system. Results: A total of 26 patients were included in this paper. Their age ranged from 15 to 67 years old (mean 38). Of which, 10 patients were male (38%) and 16 (62%) were female. All patients had some degree of tonsillar herniation, with 25 patients treated with foramen magnum decompression. Nine patients required a craniocervical fixation. Six patients had undergone prior surgery and required a new surgical procedure for progression of neurological symptoms associated with new compression or instability. Most of patients with neurological symptoms secondary to brainstem compression had some improvement during the follow-up. There was mortality in this series, 1 month after surgery, associated with a late removal of the tracheal cannula. Conclusions: Management of BI requires can provide improvements in neurological outcomes, but requires analysis of the neural and bony anatomy of the CCJ, as well as occult instability. The complexity and heterogeneous presentation requires attention to occult instability on examination and attention to airway problems secondary to concomitant facial malformations. PMID:25210337

Joaquim, Andrei F.; Ghizoni, Enrico; Giacomini, Leonardo A.; Tedeschi, Helder; Patel, Alpesh A.

2014-01-01

270

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

PubMed

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

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

2014-11-01

271

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

PubMed Central

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

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

2014-01-01

272

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

PubMed

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

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

2014-11-01

273

Severe plantar hyperhidrosis: an effective surgical solution.  

PubMed

Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database. Plantar sweating was graded as cured, improved, or unchanged. ELS (using 5-mm titanium clips) was performed in 154 patients, 68.2 per cent at the third lumbar vertebrae and 31.8 per cent at the fourth lumbar vertebrae. Follow-up averaged 15 months and ranged up to 4.7 years. Anhidrosis was achieved in 97.4 per cent of patients with the remainder reporting major reduction in symptoms. All patients were discharged home within 24 hours of surgery, requiring only oral analgesics, if any. There were two surgical complications (lymphatic leak and misidentification of genitofemoral nerve for sympathetic nerve). Six early patients required conversion to an open surgical procedure. Partial recurrence, usually mild, occurred in 4.5 per cent with 2.6 per cent requiring revision surgery. Severe plantar hyperhidrosis can be safely and effectively treated by endoscopic lumbar sympathectomy using the clamping method. It can be accomplished on an outpatient basis with low morbidity, complete resolution of symptoms, and a significant improvement in quality of life. PMID:23896256

Reisfeld, Rafael; Pasternack, Glenn A; Daniels, Parviz D; Basseri, Eraj; Nishi, Gregg K; Berliner, Karen I

2013-08-01

274

Retained surgical sponges, needles and instruments  

PubMed Central

Introduction Retained sponges and instruments (RSI) due to surgery are a recognised medical ‘never event’ and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies. Methods A comprehensive literature search was performed on MEDLINE®, Embase™, the Science Citation Index and Google™ Scholar for articles published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and attempts to prevent RSI following surgical intervention were retrieved. Results The overall incidence of RSI is low although its incidence is substantially higher in operations performed on open cavities. Sponges are the most commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations, operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate sponge and instrument counts. The existing strategy for prevention is manual counting of sponges and instruments undertaken by surgical personnel. This, however, is fallible. Computer assisted counting of sponges using barcodes and gauze sponges tagged with a radiofrequency identification device aiding manual counting have been trialled recently, with success. Conclusions Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely. PMID:23484986

Hariharan, D

2013-01-01

275

[Open heart radio frequency left atrial compartmentation during mitral valve surgery: an alternative to the labyrinth procedure?].  

PubMed

The authors report their experience of radiofrequency left atrial compartimentation during open heart mitral valve surgery on 37 patients with a 42 +/- 12 months history of atrial fibrillation. The preoperative left ventricular ejection fraction was 62 +/- 8%; the left atrial diameter was 59 +/- 11 mm. The mean operative time was 245 +/- 60 minutes, which included 19 +/- 5 minutes for the ablation procedure. There were 2 early postoperative deaths and 2 deaths from non-cardiac causes at 3 and 6 months. The left ventricular ejection fraction and left atrial dimension were significantly decreased at the time of hospital discharge (54 +/- 12% and 51 +/- 7 mm respectively) (p < 0.01). After an average follow-up of 1 year, 81% of patients were free of atrial fibrillation: 6 patients had undergone DC cardioversion and 1 had a dual-chamber pacemaker. Patients in sinus rhythm after the ablation were associated with shorter periods of atrial fibrillation and smaller left atrial dimensions postoperatively than those who remained in fibrillation. The authors conclude that radiofrequency compartimentation of the left atrium associated with antiarrhythmic therapy can interrupt atrial fibrillation in 81% of patients at 1 year: the ablation procedure takes only 8% of the operation time. Predictive factors of success of ablation should be defined to determine which patients benefit most from this technique. PMID:12055767

Schläpfer, J; Ruchat, P; Delabays, A; Hurni, M; Milne, J; von Segesser, L K

2002-04-01

276

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

PubMed Central

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

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

2014-01-01

277

Pathogenesis of postoperative oral surgical pain.  

PubMed Central

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

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

2003-01-01

278

Simultaneous Open Rhinoplasty and Alar Base Excision for Secondary Cases  

Microsoft Academic Search

Background: Simultaneous open rhinoplasty and alar base excision are a very safe procedure for protecting the vascular supply of the nasal dip and the columellar skin in primary cases when surgical dissection is performed below the musculoaponeurotic layer of the nose. Major arteries of the external nose lie above the musculoaponeurotic layer. However, secondary cases may pose increased risks to

Ali Teoman Tellio?lu; ?brahim Vargel; Tarik Çavu?o?lu; Kadir Çimen

2005-01-01

279

Levitsky ankle stabilization procedure.  

PubMed

The article discusses surgical reconstruction of torn or partially torn and refibrosed lateral ankle collateral ligaments. The anatomy and historical literature are reviewed. The authors present the Levitsky ankle stabilization procedure. PMID:2625511

Ting, G; Levitsky, D R

1989-01-01

280

Stereolithographic surgical template: a review.  

PubMed

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

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

2013-09-01

281

[Surgical therapy of liver echinococcosis].  

PubMed

There is still no other therapeutic management for echinococcosis of the liver than surgical treatment. Indeed, drug therapy with Mebendazol prevents parasitosis from spreading. However, a complete regression has not been observed hitherto. Surgical procedure is dependent on expansion, localisation and type of echinococcosis. Generally, cystectomy is possible and adequate in case of Echinococcus granulosus, in case of Echinococcus multilocularis with its infiltrating growth, a complete healing can only be attained by lobectomy. With the hilus being invaded and obstructive jaundice proceeding, an improvement can be reached by Mebendazol or a palliative endless drainage tube. PMID:4013541

Bähr, R; Gaebel, G

1985-01-01

282

The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach  

Microsoft Academic Search

Introduction  Ligation of the deep inferior epigastric vessels prior to transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction\\u000a (delay procedure) was introduced to augment vascularity to the island flap through improved superior epigastric flow, thus\\u000a decreasing flap morbidity. There are various surgical approaches described, including open and laparoscopic approaches, for\\u000a ligation of inferior epigastric arteries. We describe an extraperitoneal laparoscopic technique (EPLT)

Panduranga Yenumula; Erick F. Rivas; Keith M. Cavaness; Ed Kang; Edward Lanigan

2011-01-01

283

Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching  

PubMed Central

OBJECTIVES To investigate a single institution experience with radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) with respect to pathological and biochemical outcomes. SUBJECTS AND METHODS A group of 522 consecutive patients who underwent RARP between 2003 and 2008 were matched by propensity scoring on the basis of patient age, race, preoperative prostate-specific antigen (PSA), biopsy Gleason score and clinical stage with an equal number of patients who underwent LRP and RRP at our institution. Pathological and biochemical outcomes of the three cohorts were examined. RESULTS Overall positive surgical margin rates were lower among patients who underwent RRP (14.4%) and LRP (13.0%) compared to patients who underwent RARP (19.5%) (P = 0.010). There were no statistically significant differences in positive margin rates between the three surgical techniques for pT2 disease (P = 0.264). In multivariate logistic regression analysis, surgical technique (P = 0.016), biopsy Gleason score (P < 0.001) and preoperative PSA (P < 0.001) were predictors of positive surgical margins. Kaplan–Meier analysis did not show any statistically significant differences with respect to biochemical recurrence for the three surgical groups. CONCLUSIONS RRP, LRP and RARP represent effective surgical approaches for the treatment for clinically localized prostate cancer. A higher overall positive SM rate was observed for the RARP group compared to RRP and LRP; however, there was no difference with respect to biochemical recurrence-free survival between groups. Further prospective studies are warranted to determine whether any particular technique is superior with regard to long-term clinical outcomes. PMID:21044243

Magheli, Ahmed; Gonzalgo, Mark L.; Su, Li-Ming; Guzzo, Thomas J.; Netto, George; Humphreys, Elizabeth B.; Han, Misop; Partin, Alan W.; Pavlovich, Christian P.

2011-01-01

284

Evaluation of game engines for simulated surgical training  

Microsoft Academic Search

The increasing complexity and costs of surgical training and the constant development of new surgical procedures has made virtual surgical training an essential tool in medical education. Unfortu- nately, commercial tools are very expensive and have a small sup- port base. Game engines offer unique advantages for the creation of highly interactive and collaborative environments. This paper examines the suitability

Stefan Marks; John Windsor; Burkhard Wünsche

2007-01-01

285

Transcatheter aortic valve implantation with Core Valve: First Indian experience of three high surgical risk patients with severe aortic stenosis  

PubMed Central

The prevalence of aortic stenosis is increasing with aging population. However with multiple co-morbidities and prior procedures in this aging population, more and more patients are being declared unfit for the ‘Gold Standard’ treatment i.e. surgical aortic valve replacement (AVR). Among the patients who are unfit or high risk for aortic valve replacement (AVR) by open heart surgery, transcatheter aortic valve implantation (TAVI) has been proven to be a valuable alternative improving survival and quality of life. We report first Indian experience of Core Valve (Medtronic Inc.) implantation in three high surgical risk patients performed on 22nd and 23rd February 2012. PMID:23993000

Seth, Ashok; Rastogi, Vishal; Kumar, Vijay; Maqbool, Syed; Mustaqueem, Arif; Sekar, V. Ravi

2013-01-01

286

Outcomes of surgical treatment of Peyronie's disease.  

PubMed

The aims of the present review were to assess the literature on published outcomes and complications associated with surgical treatments for Peyronie's disease (PD) and to assist clinicians in the effective management of PD by increasing understanding and awareness of the outcomes associated with current surgical treatment options. A PubMed literature search was conducted to identify relevant, peer-reviewed clinical and review articles published between January 1980 and October 2013 related to outcomes of surgical correction of PD. Search terms for this non-systematic review included 'Peyronie's disease', 'outcomes', 'complications', 'erectile dysfunction or ED', 'patient expectation', and 'patient satisfaction'; search terms were searched separately and in combination. Case studies and editorials were excluded, primary manuscripts and reviews were included, and bibliographies of articles of interest were reviewed and key references were obtained. Assessment of the study design, methodology, clinical relevance and impact on the surgical outcomes of PD was performed on the sixty-one articles that were selected and analysed. Currently, there are several investigational minimally invasive and non-surgical treatment options for PD; however, surgical treatment remains the standard of care for patients with stable disease and disabling deformity or drug-resistant erectile dysfunction. Each of the different surgical procedures that are used for treatment of PD, including tunical shortening, tunical lengthening (plaque incisions or partial excision and grafting), and use of inflatable penile prostheses, carries its own advantages and disadvantages in terms of potential complications and postoperative satisfaction. Because of the variety of ways that PD may present in affected patients, no single, standard, surgical treatment for this disorder has prevailed and multiple variations of each type of procedure may exist. Surgical outcomes of the most commonly used procedures are not substantially different; therefore, the appropriateness of each treatment option may often depend on disease and patient characteristics (e.g. deformity and erectile function). Surgical algorithms have been published to guide surgeons and patients through the selection of surgical procedures in the absence of conclusive, long-term outcome data. Accumulating data on outcomes associated with established procedures, modifications to these procedures, and new surgical techniques and materials may serve to further guide practice and refine evidence-based selection of the surgical approach. PMID:24219080

Carson, Culley C; Levine, Laurence A

2014-05-01

287

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

...characterize the open biological treatment unit during unsafe sampling...following open biological treatment unit characterization...in the open biological treatment unit (depth, area...characterization parameters for surface aeration,...

2012-07-01

288

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

...characterize the open biological treatment unit during unsafe sampling...following open biological treatment unit characterization...in the open biological treatment unit (depth, area...characterization parameters for surface aeration,...

2011-07-01

289

[Surgical complications in kidney transplantation].  

PubMed

Kidney transplantation has become the treatment of choice for patients with end stage renal disease since it offers an excellent quality of life. Moreover, the economic impact is considerable, particularly beyond the first year. Indeed, the annual cost of a successful renal transplantation is ten fold lower than haemodialysis. But surgical complications remain one of our main concerns. Surgical complications are various. They may be non-specific as haematomas, incision-induced hernias and wound infections. They may also be directly related to the procedure as vascular thrombosis and urinary fistula in the early postoperative period or arterial stenosis and ureteral obstruction in the late post-operative period. The accurate diagnosis and the appropriate management of these complications are the most important tasks for the surgical team. This review is based upon our experience in kidney transplantation and upon the medical published data. PMID:18457318

Karam, G; Maillet, F; Braud, G; Battisti, S; Hétet, J F; Glémain, P; Le Normand, L; Bouchot, O; Rigaud, J

2007-12-01

290

Bacterial migration through punctured surgical gloves under real surgical conditions  

PubMed Central

Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves) were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes). Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25%) punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98) of outer gloves and in 1% (1/96) of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers), the calculated migration was 50% (n = 5). The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods. PMID:20594293

2010-01-01

291

Surgical management of Peyronie's disease.  

PubMed

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

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

2014-10-01

292

[Surgical treatment of gastric carcinoma].  

PubMed

The gastric cancer is the most common cancer in Korea. The only treatment modality showing improved survival for gastric cancer is curative surgical resection, which comprises the resection of stomach, proper lymphadenectomy, and reconstruction. However, specific surgical procedures should be decided according to the location of the cancer, advancement of the tumor, and patients condition. Surgical treatment for gastric cancer has been developed toward two directions that are minimal invasive surgery for early gastric cancer and multi-disciplinary approach for advanced gastric cancer. Laparoscopic surgery for early gastric cancer has been accepted for minimally invasive surgery. Moreover, the advancement of diagnostic tools to assess biological aggressiveness of the tumor enables physicians to perform endoscopic resection or minimized resection for early gastric cancer. Recently, surgeons try to extend the application of laparoscopic gastric resection and D2 lymphadenectomy to advanced gastric cancer. However, technical and oncological evidences based on clinical trials should be filed up before adopting it as a standard therapy. In case of advanced gastric cancer, in addition to radical surgery, various treatment modalities including chemotherapy, radiation, and molecular target therapy also have been applied in many clinical trials. However, it should be stressed that a prerequisite for precise evaluation of the efficacy of these combined treatment modalities would be the standardization of surgical procedure. PMID:19696536

Hur, Hoon; Park, Cho Hyun

2009-08-01

293

Surgical management of hepatolithiasis  

PubMed Central

Background: Globalization and intercontinental migration have not just changed the socioeconomic status of regions, but have also altered disease dynamics across the globe. Hepatolithiasis, although still rare, is becoming increasingly evident in the West because of immigration from the Asia-Pacific region, where the disease prevails in endemic proportions. Such rare but emerging diseases pose a therapeutic challenge to doctors. Methods: Here, we briefly introduce the topic of hepatolithiasis and describe features of intrahepatic stones, the aetiology of hepatolithiasis and the symptoms and sequelae of the condition. We then provide a comprehensive review of the various management modalities currently in use to treat hepatolithiasis. Conclusions: In our opinion, and as is evident from the literature, surgery remains the definitive treatment for hepatolithiasis. However, non-surgical procedures such as cholangiography, although limited in their therapeutic capabilities, play a vital role in diagnosis and preoperative evaluation. PMID:19590647

Sakpal, Sujit Vijay; Babel, Nitin; Chamberlain, Ronald Scott

2009-01-01

294

Simulation in Surgical Education  

PubMed Central

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

de Montbrun, Sandra L.; MacRae, Helen

2012-01-01

295

Surgical innovation as sui generis surgical research.  

PubMed

Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients. PMID:24242289

Lotz, Mianna

2013-12-01

296

Techniques and devices in neuroendovascular procedures.  

PubMed

The management of patients who have cerebrovascular disorders is challenging. Historically, treatments have been limited to medical therapy and open surgical procedures. Our current ability to treat complex vascular disorders in a minimally invasive fashion is improving at a remarkable rate because of advances in neuroendovascular technology. As treatment options in patients with cerebral aneurysms, cerebral arteriovenous malformations, ischemic stroke, and intracranial stenosis continue to increase, patient morbidity and mortality continue to decline. This article reviews and discusses many of the currently available techniques and devices in the neuroendovascular arena. PMID:19778702

Liebman, Kenneth M; Severson, Meryl A

2009-07-01

297

Surgical Robotics Research in Cardiovascular Disease  

SciTech Connect

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.

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

2008-02-29

298

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.  

PubMed

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure. PMID:23132540

Oztemür, Zekeriya; Bulut, Okay; Korkmaz, Murat; Gölge, Umut Hatay; Oztürk, Hayati; Tezeren, Gündüz; Günayd?n, Ilhan

2013-05-01

299

Open Versus Laparoscopic Radical Prostatectomy  

PubMed Central

Expert laparoscopic surgeons have demonstrated that laparoscopic radical prostatectomy with or without robotic assistance can be performed with excellent results. There is no evidence that laparoscopic radical prostatectomy with or without robotic assistance offers any clinically relevant advantage over open radical prostatectomy. Laparoscopic radical prostatectomy with or without robotic assistance requires a significant learning curve, is a longer surgical procedure, carries greater costs, and requires an expanded operating room team. The literature suggests that laparoscopic radical prostatectomy is associated with more intraoperative complications and higher positive surgical margins. The lesser amount of postoperative bleeding associated with laparoscopic radical prostatectomy is not clinically relevant. Laparoscopic radical prostatectomy is not associated with less pain and does not facilitate earlier urinary catheter removal. The best way to improve overall outcomes after radical prostatectomy is to direct patients to expert open or laparoscopic surgeons. PMID:16985822

Lepor, Herbert

2005-01-01

300

Surgical treatment for residual or recurrent strabismus  

PubMed Central

Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator's preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia. PMID:25540765

Wang, Tao; Wang, Li-Hua

2014-01-01

301

Surgical correction of saddle nose deformity.  

PubMed

Persons with saddle nose deformity can benefit from any of various surgical procedures for correction of the defect, and from various materials -- organic or inorganic -- used for filler material. Usually, other nasal defects co-exist and must be corrected at the time of surgery performed for the main deformity. Techniques and guidelines for surgical treatment have been presented. The use of polyamide mesh as filler material in 70 patients has given outstanding good results, which are briefly discussed. PMID:1209836

Beekhuis, G J

1975-01-01

302

Local antimicrobial administration for prophylaxis of surgical site infections.  

PubMed

Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made. PMID:23124722

Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

2012-11-01

303

Three-piece Inflatable Penile Prosthesis: Surgical Techniques and Pitfalls  

PubMed Central

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

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

2011-01-01

304

Multimodal Imaging and Detection Strategy With 124 I-Labeled Chimeric Monoclonal Antibody cG250 for Accurate Localization and Confirmation of Extent of Disease During Laparoscopic and Open Surgical Resection of Clear Cell Renal Cell Carcinoma  

PubMed Central

Renal cell carcinoma (RCC) accounts for approximately 85% to 90% of all primary kidney malignancies, with clear cell RCC (ccRCC) constituting approximately 70% to 85% of all RCCs. This study describes an innovative multimodal imaging and detection strategy that uses 124I-labeled chimeric monoclonal antibody G250 (124I-cG250) for accurate preoperative and intraoperative localization and confirmation of extent of disease for both laparoscopic and open surgical resection of ccRCC. Two cases presented herein highlight how this technology can potentially guide complete surgical resection and confirm complete removal of all diseased tissues. This innovative 124I-cG250 (ie, 124I-girentuximab) multimodal imaging and detection approach, which would be clinically very useful to urologic surgeons, urologic medical oncologists, nuclear medicine physicians, radiologists, and pathologists who are involved in the care of ccRCC patients, holds great potential for improving the diagnostic accuracy, operative planning and approach, verification of disease resection, and monitoring for evidence of disease recurrence in ccRCC patients. PMID:22455975

Hall, Nathan C.; Murrey, Douglas A.; Sharp, David S.; Hitchcock, Charles L.; Mojzisik, Cathy M.; Bahnson, Eamonn E.; Knopp, Michael V.; Martin, Edward W.; Bahnson, Robert R.

2013-01-01

305

The surgical management and outcome of congenital mediastinal malformations  

PubMed Central

We reviewed our institutional experience with congenital mediastinal masses and compared the postnatal management and outcome of patients with or without prenatal diagnosis. Between January 1997 and August 2011, 24 patients underwent surgical procedures for congenital mediastinal mass. For eight patients, the mass was detected by prenatal ultrasonography at 27 weeks of gestation (range 22–35). Postnatal management consisted in open surgery for seven patients at a mean age of 9 months (range 1 day–20 months) and sclerotherapy for one lymphangioma at 5 months of life. Sixteen patients had postnatal diagnosis at 137 months (±194) of median age. Eight bronchogenic cysts, seven bronchopulmonary foregut malformations, five teratomas, three lymphangiomas and one haemangioma were operated on. The median age at resection was 28 months (1 day–15 years). There were four emergency procedures and no surgical mortality. The median follow-up was 45 months (3–144). The duration of mechanical ventilation and hospital stay was, respectively, 4.6 h and 7.5 days for antenatal patients and 24.3 h and 14.3 days for postnatal diagnosed patients. Prenatal diagnosis allows early management of congenital mediastinal malformations. Early resection can be performed prior to the occurrence of symptoms ?1 year of life and is associated with an excellent outcome and less morbidity. PMID:22394988

Ballouhey, Quentin; Galinier, Philippe; Abbo, Olivier; Andrieu, Guillaume; Baunin, Christiane; Sartor, Agnès; Rittié, Jean Luc; Léobon, Bertrand

2012-01-01

306

Surgical rehearsal platform: potential uses in microsurgery.  

PubMed

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

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

2013-10-01

307

Surgical treatment of anal stenosis  

PubMed Central

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms. PMID:19399922

Brisinda, Giuseppe; Vanella, Serafino; Cadeddu, Federica; Marniga, Gaia; Mazzeo, Pasquale; Brandara, Francesco; Maria, Giorgio

2009-01-01

308

Surgical management of primary carcinomas of the lower lip.  

PubMed

Carcinomas of lower lips are common neoplasms of the muco-cutaneous junction. Surgical resection of these tumors has the advantages of permitting histologic examination of the margins, achieving excellent cure rates, and yielding good aesthetic and functional results. We present the fundamental surgical procedures for management of pre-cancerous and primary cancerous neoplasms of the lower lip with which the surgical dermatologist should be familiar. These procedures may be done with local anesthesia in an outpatient surgical office. The techniques and case examples we describe include vermilionectomy and mucosal advancement, V-wedge resection, pentagonal wedge resection, and vermilionectomy combined with wedge resection. PMID:7175001

Knabel, M R; Koranda, F C; Olejko, T D

1982-11-01

309

[Surgical Managment of Retinal Detachment.  

PubMed

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

Haritoglou, C; Wolf, A

2014-11-13

310

Critical anatomic concepts for safe surgical mesh.  

PubMed

A comprehensive knowledge of the boundaries, contents, and interactions between surgical spaces is essential to safely and effectively perform mesh-augmented prolapse repairs and anti-incontinence procedures. This knowledge is also critical when managing intraoperative and postoperative complications such as bleeding, visceral injury, mesh erosion, exposure, or extrusion, and pelvic pain, groin pain, and dyspareunia. We present a detailed description of the surgical spaces entered during mesh augmented vaginal repair procedures and suggest strategies to avoid nerve and visceral injuries. PMID:23632640

Corton, Marlene M

2013-06-01

311

Achondroplasia in female twins: surgical indications.  

PubMed

Although in literature achondroplasia has been described profusely, reports on achondroplastic twins are limited. We present two cases of monozygotic female twins with achondroplasia, who underwent limb-lengthening surgical procedure with external fixation in the following five steps: tibia, femur, tibia; femur, homer. Both the cases presented a good limb length and an optimal correction of associated deformities after the treatment, fulfilling the indications. Surgical indications were mostly led by the axial deviations of the lower limbs, and the timing of the limb-lengthening procedures has been the same in both couples showing the importance of this aspect. PMID:21088624

Albisetti, Walter; Pedretti, Leopoldo; De Bartolomeo, Omar; Verdoni, Fabio; Memeo, Antonio

2011-03-01

312

Ultrasound-guided surgical treatment for ulnar nerve entrapment: a cadaver study.  

PubMed

Several open and endoscopic techniques for the surgical treatment of ulnar nerve entrapment at the elbow (cubital tunnel syndrome) have been described that provide decompression with or without anterior transposition. Based on our experience with US-guided decompression for carpal tunnel syndrome in our department, we developed a similar surgical technique for the decompression of the ulnar nerve at the elbow. Using sixteen cadaver upper limbs, we performed decompression of all the structures possibly responsible for ulnar nerve compression at the elbow. The structures involved were Struthers' arcade, the cubital tunnel retinaculum, Osborne's fascia and Amadio-Beckenbaugh's arcade. The procedure was followed by anatomical dissection to confirm complete sectioning of the compressive structures, absence of iatrogenic vascular or nervous injuries and absence of nerve dislocation or instability. There were no remaining compressive structures after the release procedure. There was no iatrogenic damage to the nerves and no nerve dislocation was observed during elbow flexion or extension. In 3.4% cases, a thin superficial layer of one or more of the identified structures remained but these did not appear to compress the nerve based on US imaging. Using ultrasonographic visualization of the nerve and compressive structures is easy. Each procedure can be tailored according to the nerve compression sites. Our cadaveric study shows the feasibility of an US-guided percutaneous surgical release for ulnar nerve entrapment. PMID:24981578

Poujade, T; Hanouz, N; Lecoq, B; Hulet, C; Collon, S

2014-09-01

313

Surgical Management for Peyronie's Disease.  

PubMed

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

Segal, Robert L; Burnett, Arthur L

2013-04-01

314

Surgical Management for Peyronie's Disease  

PubMed Central

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

Segal, Robert L.

2013-01-01

315

Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system - a retrospective analysis from Southern China  

PubMed Central

Background The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method Methods We retrospectively included 843 patients from March 2006 to November 2012, of whom 88 had laparoscopic radical nephrectomy (LRN), 526 had open radical nephrectomy (ORN), 42 had laparoscopic partial nephrectomy (LPN), and 187 had open partial nephrectomy (OPN). A modified Clavien classification system was applied to quantify complications of nephrectomy. Fisher’s exact or chi-square test were used to compare complication rates between laparoscopic and open approaches. Results The overall complication rate was 19.31%, 30.04%, 35.71%, and 36.36% in LRN, ORN, LPN, and OPN, respectively. More Grade II complications (odds ratio?=?2.593, 95% CI 1.172 to 5.737, P?=?0.010) and longer postoperation hospital stay (9.2 days and 7.6 days, P?surgical approach (LRN/ORN) (P?=?0.036), age (P?=?0.044), height (P?=?0.020), systolic pressure (P?=?0.012), fasting blood glucose level (P?=?0.032), and blood loss during operation (P?=?0.011) were significant predictors for grade II complications in radical nephrectomy. LPN had similar complication rates compared with OPN. Conclusions In conclusion, LRN had the advantages of less grade II complications and shorter postoperation hospital stay than ORN. Older age and more blood loss during operation would also contribute to more grade II complications in radical nephrectomy. PMID:25081928

2014-01-01

316

The Aggregate National Supply of Job Openings and Firms' Procedures for Filling Positions. IAB Labour Market Research Topics.  

ERIC Educational Resources Information Center

Surveys by the Institut fur Arbeitsmarkt- und Berufsforschung (IAB) of German firms' job openings have been combined with job registry data from the Bundesanstalt fur Arbeit on an annual basis since 1989 in order to determine the scope and structure of the aggregate national supply of job openings. The surveys also indicated problems encountered…

Magvas, Emil; Spitznagel, Eugen

317

Pleural lipoma: a non-surgical lesion?  

PubMed

Pleural lipomas are benign tumours that develop at the expense of adipose tissues, and they never evolve towards liposarcoma. Located usually at the mediastinal, bronchial and pulmonary levels, a pleural situation is extremely rare. Chest X-rays usually detect them and computed tomography scans confirm the diagnosis. As complications occur, a wait-and-see policy is common. We report our pleural lipoma surgical exeresis experience since 1999. We have operated on five cases of pleural lipomas among nearly 1800 cases of thoracic exeresis: three male and two female patients, without obesity (in all cases, body mass index (BMI) < 28). The mean age was 54.6 years (range 35-72 years). Four patients were electively operated and one in emergency, three with video-assisted thoracic surgery (VATS) procedure and two with open chest surgery, without recurrent cases. Advancements in VATS have greatly reduced the morbidity rate of these benign tumours especially if exeresis is performed early on a small, uncomplicated adhesion-free tumour. On the other hand, the operation may be deleterious, complicated by the presence of a large lipoma or in a complicating situation. In our opinion, we should revise the wait-and-see policy when facing these lesions considering their evolutionary potential. We should advise VATS in pleural lipomas. PMID:22371386

Jayle, Christophe; Hajj-Chahine, Jamil; Allain, Geraldine; Milin, Serge; Soubiron, Laurent; Corbi, Pierre

2012-06-01

318

[Posterior percutaneous arthrodesis under CT guidance after surgical anterior arthrodesis: a new technique].  

PubMed

Transfacet screws may be useful for stabilizing segments reconstructed with bone graft or cages, the role of supplementary posterior fixation, particularly minimally invasive techniques such as transfacetar percutaneous screws is relevant. To benefit from a mechanical fixation after anterior arthrodesis without the inconveniences of the open classical posterior surgical intervention, we have developed a new procedure performed under local anesthesia and CT guidance and based on the intra-articular application of screws. This study was designed to demonstrate the feasibility of using a CT-scan to perform posterior arthrodesis of the spine under local anesthesia. PMID:21496925

Amoretti, N; Amoretti, M-E; Hauger, O; Marcy, P-Y; Browaeys, P; Hovorka, I; Benarrous, A; Benzaken, T; Coco, L; Brunner, P; Boileau, P

2011-07-01

319

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

PubMed

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

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

2014-07-23

320

Gallbladder removal - open  

MedlinePLUS

Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen. ... In open gallbladder removal surgery, a surgeon makes a large surgical cut in your belly. Surgery is done while you are under general ...

321

Procedures for restoring vestibular disorders  

PubMed Central

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

Walther, Leif Erik

2005-01-01

322

Procedures for restoring vestibular disorders.  

PubMed

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

Walther, Leif Erik

2005-01-01

323

Surgical Results of the Carotid Occlusion Surgery Study  

PubMed Central

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

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

2014-01-01

324

Hemorrhoidectomy - making sense of the surgical options  

PubMed Central

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

Yeo, Danson; Tan, Kok-Yang

2014-01-01

325

Hemorrhoidectomy - making sense of the surgical options.  

PubMed

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

Yeo, Danson; Tan, Kok-Yang

2014-12-01

326

Inpatient procedures in elderly women: An analysis over time  

PubMed Central

Objectives To describe inpatient surgical and diagnostic/therapeutic procedures in women ?65 years old and assess procedure trends over time. Study Design Procedure data for all women ?65 years was collected using the National Hospital Discharge Survey, a federal dataset drawn from a representative sampling of U.S. inpatient hospitals which includes patient and hospital demographics and ICD-9-CM diagnosis and procedure codes for admissions from 1979-2006. Main Outcome Measures Age-adjusted rates (AAR) per 1000 women were created using 1990 U.S. Census data to compare trends over time. Results Over 96 million procedures were performed in women age ?65 years from 1979-2006. Women age ?65 years constituted 17% of women with ?1 inpatient procedure in 1979, rising to 32% in 2006. The most common surgical procedures were lower extremity joint replacement, open reduction internal fixation, and cholecystectomy. The most common concurrent diagnosis was femoral neck fracture. Women with femoral neck fracture were more likely to undergo open reduction internal fixation compared to joint replacement. AARs for ORIF fell from 4.3 to 3.2 (p=.02) from 1979-2006, while AARs for joint replacement increased from 0.2 to 3.4 (p=<.001, 1979-1988; p=.14, 1990-2006). Conclusions The rate of women age ?65 years undergoing inpatient procedures has increased dramatically in the last 30 years. Hip fracture was the most common diagnosis for elderly women, highlighting the impact of osteoporosis and falls and the importance of prevention strategies and optimization of peri-operative care in this population. Further comparative study of hip fracture treatment strategies in this population is needed. PMID:23707727

OLIPHANT, Sallie S.; GHETTI, Chiara; MCGOUGH, Richard L.; WANG, Li; BUNKER, Clareann H.; LOWDER, Jerry L.

2013-01-01

327

Robot-Assisted Radical Hysterectomy for Cervical Cancer: Review of Surgical and Oncological Outcomes  

PubMed Central

Robot-assisted procedures are being increasingly incorporated in gynaecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over other surgical approaches with regard to operative time, blood loss, and hospital stay. Also initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be partially offset by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches. The development of robotic technology may facilitate the spread of minimally invasive surgery in gynaecological oncology, overcoming some drawbacks of laparoscopic technique for challenging intervention such as radical hysterectomy. Further studies are needed to evaluate overall and disease-free survival of this technique and associated morbidity after adjuvant therapies. PMID:22111022

Renato, Seracchioli; Mohamed, Mabrouk; Serena, Solfrini; Giulia, Montanari; Giulia, Ferrini; Giulia, Giovanardi; Diego, Raimondo; Riccardo, Schiavina

2011-01-01

328

Jannin P, Raimbault M, Morandi X, Riffaud L and Gibaud B. Models of Surgical Procedures for Multimodal Image-Guided Neurosurgery, Journal of Computer Aided Surgery, 2003;8(2):98-106  

E-print Network

for Multimodal Image-Guided Neurosurgery, Journal of Computer Aided Surgery, 2003;8(2):98-106 Models of Surgical.M.,L.R.) Abstract Objective: Improvement of the planning stage in image-guided surgery requires a better manuscript, published in "Computer Aided Surgery 8, 2 (2003) 98-106" #12;Jannin P, Raimbault M, Morandi X

Boyer, Edmond

329

[Surgical treatment of skeletal metastases].  

PubMed

The prevalence of cancerous diseases in Germany is rising. The skeletal system represents the third most common localization for metastases. Nearly two thirds of metastases are found in the region of the spine. Due to longer survival times of tumor patients in the metastasis stage, an increase in the number of patients with bone metastases is to be expected. The treatment of patients with osseus metastases is nowadays an integral component of orthopedic trauma surgery practices. This article presents the principles of the diagnostics, provides aids for estimation of the prognosis and danger of fractures and discusses the various surgical treatment procedures for skeletal metastases with the accompanying advantages and disadvantages. PMID:25835208

Gösling, T; Becker-Schiebe, M

2015-04-01

330

Emerging surgical pathways of thoracotomy.  

PubMed

Thoracic incisions are the portals of choice for accessing thoracic organs. There are instances, however, that more than one incision are required at the same or a later stage, in order to access other, thoracic or extrathoracic, organs for more complicated procedures. Then again, a single thoracic incision may offer more than adequate access to extrathoracic organs and in selected cases becomes valuable surgical approach to organs of the upper abdomen or the contralateral hemithorax. The experience with this technique is discussed. PMID:25381550

Kanakis, Meletios A; Chatzis, Andrew C; Mitropoulos, Fotios A; Alexiou, Konstantinos; Lioulias, Achilleas G

2014-12-01

331

Medical and Surgical Evaluation of the Adult Kidney Transplant Candidate  

Microsoft Academic Search

\\u000a This chapter details the evaluation of the adult patient with advanced kidney disease or ESRD being considered for kidney\\u000a transplantation. Transplantation involves upfront risks to mortality stemming from a major surgical procedure in a recipient\\u000a with medical and surgical comorbidity that is compounded by pharmacologic immunosuppression. This complex scenario demands\\u000a the involvement of a multidisciplinary medical and surgical team to

Richard A. Fatica; Stuart M. Flechner; Titte R. Srinivas

332

VATS Lobectomy: Surgical Evolution from Conventional VATS to Uniportal Approach  

PubMed Central

There is no standardized technique for the VATS lobectomy, though most centres use 2 ports and add a utility incision. However, the procedure can be performed by eliminating the two small ports and using only the utility incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resection, the technique has been spreading worldwide. The single-port technique provides a direct view to the target tissue. The conventional triple port triangulation creates a new optical plane with genesis of dihedral or torsional angle that is not favorable with standard two-dimension monitors. The parallel instrumentation achieved during single-port approach mimics inside the maneuvers performed during open surgery. Furthermore, it represents the less invasive approach possible, and avoiding the use of trocar, we minimize the compression of the intercostal nerve. Further development of new technologies like sealing devices for all vessels and fissure, robotic arms that open inside the thorax, and wireless cameras will facilitate the uniportal approach to become the standard surgical procedure for pulmonary resection in most thoracic departments. PMID:23346022

Gonzalez-Rivas, Diego

2012-01-01

333

Pelvic Surgical Site Infections in Gynecologic Surgery  

PubMed Central

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery. PMID:25788822

Lachiewicz, Mark P.; Moulton, Laura J.; Jaiyeoba, Oluwatosin

2015-01-01

334

Pelvic surgical site infections in gynecologic surgery.  

PubMed

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery. PMID:25788822

Lachiewicz, Mark P; Moulton, Laura J; Jaiyeoba, Oluwatosin

2015-01-01

335

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

PubMed Central

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

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

2014-01-01

336

Successful Surgical Treatment for Thoracoabdominal Aortic Aneurysm with Leriche Syndrome  

PubMed Central

Thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare combination of aortic diseases, the surgical management of which has not been described to date. We report the successful treatment of one such case through open surgical repair of the thoracoabdominal aorta.

Chong, Byung Kwon; Kim, Joon Bum

2015-01-01

337

Long-term management of bradyarrhythmias following open heart surgery: surgical A-V block and sick sinus syndrome after surgery for secundum atrial septal defects treated with permanent cardiac pacing.  

PubMed

Postoperative clinical findings from 25 patients with surgical A-V block and 12 with SSS following surgery for ASD who received permanent pacemakers were analyzed in order to consider the long-term management of postoperative bradyarrhythmias. Surgical A-V block: Episodes of Adams-Stokes were observed in 11/25 patients before pacemaker implantation, and in 6 of these (55%) the onset of episodes occurred more than a year after open heart surgery. Of 8 cases for which ECG's during Adams-Stokes were available, 2 had bifascicular or trifascicular block which progressed to complete A-V block below the His bundle. The 6 others (75%) had ventricular tachycardia or ventricular flutter-fibrillation during Adams-Stokes. 2 of these had blocks above the His bundle. 4/25 had improvement of complete A-V block within a month. Following pacemaker implantation, 3 died of heart failure and 3 of sudden death. 5 year survival was 70%. Therefore, surgical A-V block requires careful long-term management, and the presence of ventricular tachyarrhythmias as well as the location of block are important predictors of patient risk. SSS after surgery for ASD: 10/12 patients had Adams-Stokes, of which 6 (60%) had initial onset over 5 years after surgery, and 9 had paroxysmal atrial flutter and fibrillation which coincided with the onset of Adams-Stokes. 3 of 7 patients (42%) for whom preoperative ECG's were available had sinus bradycardia. Thus, SSS after ASD surgery may be preceded by preoperative deterioration of sinus node function and succeeded by late onset of Adams-Stokes, necessitating pre- and postoperative assessment of sinus node function. The presence of atrial tachyarrhythmias also serves as an important indicator of the severity of SSS after ASD surgery. The onset of Adams-Stokes varied by patient over a wide range of time, emphasizing the need for careful long-term follow-up. Clinical symptoms and prognosis were affected by tachyarrhythmias as well as the severity of the bradycardia. Therefore, the presence of ventricular/atrial tachyarrhythmias is an important factor in the long-term management of postoperative bradyarrhythmias. PMID:3099026

Ohnishi, S; Kasanuki, H; Takamizawa, K; Takao, A; Hirosawa, K

1986-09-01

338

Triage of high-risk surgical patients for intensive care  

Microsoft Academic Search

Patients who undergo high-risk non-cardiac surgical procedures represent a large proportion of admissions to intensive care units (ICUs) in the developed world [1]. Ideally, surgeons, anesthesiologists, and intensivists admitting surgical patients to ICUs target the patients who will benefi t most from this highest level of postoperative care. However, accurately identifying which patients are at high risk of complications or

Julia B Sobol; Hannah Wunsch

2011-01-01

339

Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction  

Microsoft Academic Search

Background Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular recon- struction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone.

Robert H. Jones; Eric J. Velazquez; Robert E. Michler; George Sopko; Jae K. Oh; Christopher M. O'Connor; James A. Hill; Lorenzo Menicanti; Zygmunt Sadowski; Patrice Desvigne-Nickens; Jean-Lucien Rouleau; Kerry L. Lee

2009-01-01

340

Debridement of vaginal radiation ulcers using the surgical Ultrasonic Aspirator  

SciTech Connect

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

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

1990-10-01

341

Surgical aspects of celiac disease.  

PubMed

Celiac disease, characterized by intestinal inflammation and malabsorption, occurs in 1 per cent of the population and is often undiagnosed. These patients are at increased risk for surgical procedures resulting from symptoms, associated intestinal disorders, and malignancy. Our aim was to determine the incidence and outcome of abdominal operations in patients with celiac disease. Records of 512 adult patients with celiac disease evaluated over a 22-year period were reviewed. Operations were classified as related or unrelated to celiac disease. One hundred eighty-eight (36%) of 512 patients underwent abdominal operations. One hundred twenty-seven (68%) of the 188 patients had unrelated procedures. Sixty-one (32%) had operations considered related to celiac disease. Twenty-six (43%) of 61 with related procedures were diagnosed preoperatively. Procedures were performed for pain, obstruction, motility disorders, and malignancy. Six patients had recurrent pancreatitis. Seven patients underwent liver transplantation. Thirty-five (57%) related procedures led to the diagnosis of celiac disease including "unmasking" (n = 25) and diagnostic findings (n = 10). One-third of patients with celiac disease undergo abdominal operations of which one-third are related to celiac disease. Operations are related to complications of celiac disease and often lead to the initial diagnosis. PMID:25642877

Thompson, Jon S; Thompson, David S; Meyer, Avishai

2015-02-01

342

Serious games for knee replacement surgery procedure education and training  

Microsoft Academic Search

Total knee arthroplasty (TKA) is a commonly performed surgical procedure whereby knee joint surfaces are replaced with metal and polyethelene components that serve to function in the way that bone and cartilage previously had. Here we describe a multi-player, serious game that was designed to train orthopedic surgical procedures to orthopedic surgical residents, and to gauge whether learning in an

Hamed Sabri; Brent Cowan; Bill Kapralos; Mark Porte; David Backstein; Adam Dubrowskie

2010-01-01

343

42 CFR 482.51 - Condition of participation: Surgical services.  

Code of Federal Regulations, 2014 CFR

...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,...

2014-10-01

344

42 CFR 482.51 - Condition of participation: Surgical services.  

Code of Federal Regulations, 2010 CFR

...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,...

2010-10-01

345

42 CFR 482.51 - Condition of participation: Surgical services.  

Code of Federal Regulations, 2011 CFR

...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,...

2011-10-01

346

42 CFR 482.51 - Condition of participation: Surgical services.  

Code of Federal Regulations, 2012 CFR

...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,...

2012-10-01

347

42 CFR 482.51 - Condition of participation: Surgical services.  

Code of Federal Regulations, 2013 CFR

...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,...

2013-10-01

348

Surgical and non-surgical treatment of frozen shoulder. Survey on surgeons treatment preferences  

PubMed Central

Summary Background: frozen shoulder is a common condition and its management can be surgical or non-surgical. The aim was to determine current trends in the management of frozen shoulder amongst surgical members of the British Elbow and Shoulder Society (BESS). Methods: a single electronic questionnaire was emailed to surgical members of the BESS. Participants were asked about their surgical and non-surgical treatments of choice and the reasoning behind that, as well as which components of arthroscopic arthrolysis they favoured. Results: 87 BESS members completed the questioner. The majority of respondents used physiotherapy as their preferred means of non-surgical management while arthroscopic arthrolysis was the most frequently used surgical intervention. A substantial proportion of surgeons based their choice on personal experience and training rather than published evidence. Conclusions: management of frozen shoulder amongst surgeons varies substantially and is highly based on personal experience and training rather than strong evidence. Arthroscopic arthrolysis is a heterogeneous procedure with a wide variation in the use of its various components. Our results highlight the need for high quality clinical trials to compare the management options available.

Kwaees, Tariq Adam; Charalambous, Charalambos P.

2014-01-01

349

Collagen-Glycosaminoglycan Matrix Implantation Promotes Angiogenesis following Surgical Brain Trauma  

PubMed Central

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

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

2014-01-01

350

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

PubMed Central

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

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

2014-01-01

351

Surgical Management of Urolithiasis in Patients after Urinary Diversion  

PubMed Central

Objective To present our experience in surgical management of urolithiasis in patients after urinary diversion. Patients and Methods Twenty patients with urolithiasis after urinary diversion received intervention. Percutaneous nephrolithotomy, percutaneous based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy and open operation were performed in 8, 3, 2, 6, and 1 patients, respectively. The operative finding and complications were retrospectively collected and analyzed. Results The mean stone size was 4.5±3.1 (range 1.5–11.2) cm. The mean operation time was 82.0±11.5 (range 55–120) min. Eighteen patients were rendered stone free with a clearance of 90%. Complications occurred in 3 patients (15%). Two patients (10%) had postoperative fever greater than 38.5°C, and one patient (5%) suffered urine extravasations from percutaneous tract. Conclusions The percutaneous based procedures, including percutaneous nephrolithotomy, antegrade ureteroscopy with semi-rigid ureteroscope or flexible ureteroscope from percutaneous tract, and percutaneous pouch lithotripsy, provides a direct and safe access to the target stones in patients after urinary diversion, and with high stone free rate and minor complications. The surgical management of urolithiasis in patients after urinary diversion requires comprehensive evaluation and individualized consideration depending upon the urinary diversion type, stone location, stone burden, available resource and surgeon experience. PMID:25360621

Zhong, Wen; Yang, Bicheng; He, Fang; Wang, Liang; Swami, Sunil; Zeng, Guohua

2014-01-01

352

Medical & Surgical Management of Pelvic Floor Disorders Affecting Defecation  

PubMed Central

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

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

2014-01-01

353

Cochlear implant simulator for surgical technique analysis  

NASA Astrophysics Data System (ADS)

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.

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

2014-03-01

354

Current aspects of surgical management of GERD.  

PubMed

Gastroesophageal reflux disease (GERD) is one of the most common pathologies treated by primary care physicians. Despite advances in antacid pharmacological treatments, many patients remain refractory to maximal medical therapy. In addition, many others are either unable to tolerate the side effects of the drugs or simply are unwilling to receive life-long daily medications. Laparoscopic Nissen fundoplication has evolved as the surgical procedure of choice for patients with GERD. Although the durability of surgical management has been questioned, experienced surgeons achieve long-term reflux cure rates of about 85% to 95%. Barrett's esophagus has recently been considered an additional indication for surgical therapy of reflux due to evidence of dysplasia regression following a 360 degrees fundoplication. However, the timing of surgical intervention and the exact procedure for patients with both short- and long-segment Barrett's esophagus remains debatable. Esophageal dysmotility in surgical patients with GERD has traditionally been approached by "tailoring" the degree of fundoplication. Recent evidence suggests that partial fundoplication may not be effective and that full fundoplication should still be employed. The degree of dysmotility prohibitive to a full 360 degrees fundoplication remains controversial and should be addressed with future randomized trials. Finally, patients with failed fundoplication represent a formidable diagnostic dilemma and a technical challenge. In experienced hands, these patients can still benefit from minimally-invasive restorative or "re-do" fundoplications with minimal perioperative morbidity and good long-term results. PMID:17029162

Novitsky, Yuri W; Paton, B Lauren; Kercher, Kent W; Heniford, B Todd

2006-01-01

355

Assessment of mouse anxiety-like behavior in the light-dark box and open-field arena: role of equipment and procedure.  

PubMed

Light-dark box and open field are conventional tests for assessment of anxiety-like behavior in the laboratory mice, based on approach-avoidance conflict. However, except the basic principles, variations in the equipment and procedures are very common. Therefore, contribution of certain methodological issues in different settings was investigated. Three inbred strains (C57BL/6, 129/Sv, DBA/2) and one outbred stock (ICR) of mice were used in the experiments. An effect of initial placement of mice either in the light or dark compartment was studied in the light-dark test. Moreover, two tracking systems were applied - position of the animals was detected either by infrared sensors in square box (1/2 dark) or by videotracking in rectangular box (1/3 dark). Both approaches revealed robust and consistent strain differences in the exploratory behavior. In general, C57BL/6 and ICR mice showed reduced anxiety-like behavior as compared to 129/Sv and DBA/2 strains. However, the latter two strains differed markedly in their behavior. DBA/2 mice displayed high avoidance of the light compartment accompanied by thigmotaxis, whereas the hypoactive 129 mice spent a significant proportion of time in risk-assessment behavior at the opening between two compartments. Starting from the light side increased the time spent in the light compartment and reduced the latency to the first transition. In the open field arena, black floor promoted exploratory behavior - increased time and distance in the center and increased rearing compared to white floor. In conclusion, modifications of the apparatus and procedure had significant effects on approach-avoidance behavior in general whereas the strain rankings remained unaffected. PMID:24832050

Kulesskaya, Natalia; Voikar, Vootele

2014-06-22

356

A Hemodilution Technique for Open-Heart Surgery  

PubMed Central

With the extension of open-heart procedures and the increasing success of open-heart surgery, a great strain has been placed on many hospital laboratories and on the Red Cross for the maintenance of equipment and the supply of blood. In order to decrease both of these needs, hemodilution techniques combined with disposable oxygenators have been introduced. The authors have used a disposable oxygenator with low molecular weight dextran prime, along with moderate hypothermia, in a consecutive series of 15 patients operated upon for congenital and acquired heart lesions. In this consecutive series there has been one death and this could not be attributed to the perfusion technique but to the surgical procedure carried out. It is felt that this combination not only broadens the horizons of open-heart surgery but makes the procedure more readily available and safer, as well as being economical of blood donors and time. ImagesFig. 1 PMID:14226092

Kelkar, K.; Paloschi, G. B.; West, R. O.; Horne, G. R.; Lynn, R. B.

1964-01-01

357

[Surgical therapy focusing mainly on endoscopic treatment].  

PubMed

Endoscopic surgery was popularized at the beginning of the 1990s in Japan, along with the development of video optical instruments, and it was soon applied to the treatment of solid cancers. Less invasive surgical techniques were sought using various approaches in various fields in the 2000s, and now in 2010 three approaches are notable: (1) single incision laparoscopic surgery using a one window method, which is attracting considerable interest because of its low invasiveness; (2) natural orifice translumenal endoscopic surgery (NOTES); and (3) robotic surgery, which is being pursued as a new modality. Further improvements in all these methods are anticipated as a result of the development of new instruments and the mastery of surgical techniques. However, an assurance of the safety of surgical procedures and a good prognosis are requisites for all these methods, and a level of quality equivalent to that of surgical techniques such as traditional thoracic and abdominal surgery must be maintained. Although these methods seem to represent difference paths, investigations of the various surgical techniques pursued by surgeons reveal that the various paths merge to reach the same goal. Therefore, extensive studies of new surgical techniques in various fields are needed to ensure that these new techniques hold up to the expectations of surgeons. PMID:20535949

Iwazaki, Masayuki; Oiwa, Kana; Nakazato, Kenei; Masuda, Ryota

2010-06-01

358

Identifying and reducing errors with surgical simulation  

PubMed Central

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

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

2004-01-01

359

The history of dermatologic surgical reconstruction.  

PubMed

Over the last 40-50 years, reconstructive surgery in dermatology has undergone expansive growth and development. As dermatologists began to provide a greater array of surgical services during this period, it became apparent that new skills and techniques in the area of reconstruction would be required. Initially many of the procedures and concepts were adopted from other specialties, however, in the years since, significant contributions have been made by dermatologists which in turn have benefited other specialties as well. This review attempts to summarize some of the significant historical events and innovations that have established and supported dermatologic surgical reconstruction. PMID:11096380

Zelac, D E; Swanson, N; Simpson, M; Greenway, H T

2000-11-01

360

Development of test procedures to determine emissions from open burning of agricultural and forestry wastes. Final report on Phase 1  

SciTech Connect

The University of California-Davis designed, constructed and demonstrated a test system to determine air-polluting emissions from the open burning of agricultural and forestry wastes. The system consists of a conveyer and fan, contained in a tunnel and hood enclosure, which allow emissions quantification while maintaining known environmental and fuel parameters. Several shakedown runs were conducted, using rice straw as fuel, to evaluate the operability and performance of the system. A final series of demonstration runs, using rice straw fuel, showed the reproducibility of emission measurements. The emission rates for SO2, NOx and particulate matter were comparable to those measured at the University of California-Riverside in a much earlier study. In a subsequent project, the University will use the test system to quantitatively determine emissions from the simulated open burning of a variety of agricultural and forestry waste materials.

Jenkins, B.M.; Chang, D.P.Y.; Raabe, O.G.

1990-01-01

361

Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by Magnetic Resonance Imaging  

PubMed Central

Background Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs. Methods Consecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique. Results Postoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery. Conclusions This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery. PMID:21073724

2010-01-01

362

Reinterventions after open and endovascular AAA repair.  

PubMed

Reinterventions seem to occur more frequently after endovascular aneurysm repair than after open surgical repair and are encountered in about 20% versus 10% of the cases, respectively. However, reinterventions following endovascular repair are predominantly endoluminal and early reinterventions are more frequent after open repair. The indications for reintervention after EVAR have changed over time. The incidence and type of reintervention depends on the complexity of the primary procedure, irrespective of whether it was open or endovascular. The use of a device outside instructions for use is associated with a higher complication rate but it may nevertheless be fully justified. Advanced stent-grafts such as fenestrated and branched devices require secondary procedures more often than a standard stent-graft. Similarly, more complex open repair, e.g. a bifurcated bypass, reimplantation of visceral arteries or a redo procedure, is also associated with more reinterventions than a simple tube graft. This manuscript presents some of the most common complications of open and endovascular aortic aneurysm repair and the reinterventions they require. Many of the complications are similar with both open and endovascular techniques. Limb thrombosis, infections and endoleaks are the most frequent indications for reintervention. PMID:25644827

Malina, M

2015-04-01

363

Type II arch hybrid debranching procedure  

PubMed Central

Management of aortic arch aneurysm and dissection continues to evolve as endovascular options play an increasing role in treating thoracic aortopathies. Although conventional open treatment of aortic arch disease with total arch replacement still remains the gold standard, in patients with old age and/or high comorbid disease index, there is significant associated morbidity and mortality. The hybrid arch procedure, which aims to minimize cardiopulmonary bypass and circulatory arrest times, is a particularly appealing surgical option in this cohort of patients. The hybrid arch concept essentially entails three main principles: (I) open debranching of the great vessels; (II) creation of proper proximal (zone 0 landing) and distal landing zones, and; (III) concomitant or delayed endovascular stent grafting of the aortic arch. The classification scheme for hybrid arch debranching procedures is based on the extent of proximal and distal landing zone reconstruction required, and thus the need and extent of cardiopulmonary bypass and circulatory arrest management strategies to be employed. In this illustrated article, we describe the details of the type II hybrid arch debranching procedure, where the ascending aorta and aortic arch pathology is typically treated by reconstruction of ascending aorta ? arch vessel debranching, with concomitant antegrade stent grafting of the aortic arch. PMID:23977611

Szeto, Wilson Y.; Desai, Nimesh; Komlo, Caroline; Bavaria, Joseph E.

2013-01-01

364

A Noval Approach of Altered Cast Technique in Bilateral Partial Maxillectomy Patient with Severely Restricted Mouth Opening  

PubMed Central

Patients with extensive head and neck injuries due to trauma and/or extensive surgical procedures often exhibit a severely limited ability to open the mouth. For the dentist involved in prosthodontic treatment of such patients, restricted mouth opening commonly leads to compromised impressions and prostheses especially in cases where both hard and soft palatal parts have been resected. In prosthodontic treatment, the loaded impression tray is the largest item requiring intraoral placement. During impression procedures, wide mouth opening is required for proper tray insertion and alignment. This is not possible in patients with restricted mouth opening, so a modification of the standard impression procedure is often necessary to accomplish this fundamental step in the fabrication of a successful prosthesis. An alteration in the final impression procedure was made using altered cast technique for fabricating an obturator prosthesis with soft palate extension, and the result obtained was quite satisfactory. PMID:21991482

Tripathi, Shuchi; Chand, Pooran; Singh, Raghuwar D.; Siddharth, Ramashankar; Singh, Balendra P.

2011-01-01

365

Applying the World Health Organization Surgical Safety Checklist to obstetrics and gynaecology  

Microsoft Academic Search

About 234 million operations are performed worldwide each year. In industrialized countries major complications are reported to occur in 3–16% of inpatient surgical procedures and more than half of such events are preventable. In 2008, an initiative from the World Health Organization (WHO) to improve surgical safety and reduce perioperative harm to patients led to the development of the surgical

Nikolaos Burbos; Edward Morris

2011-01-01

366

Surgical team mapping: implications for staff allocation and coordination.  

PubMed

Perioperative team membership consistency is not well researched despite being essential in reducing patient harm. We describe perioperative team membership and staffing across four surgical specialties in an Australian hospital. We analyzed staffing and case data using social network analysis, descriptive statistics, and bivariate correlations and mapped 100 surgical procedures with 171 staff members who were shared across four surgical teams, including 103 (60.2%) nurses. Eighteen of 171 (10.5%) staff members were regularly shared across teams, including 12 nurses, five anesthetists, and one registrar. We found weak but significant correlations between the number of staff (P < .001), procedure start time (P < .001), length of procedure (P < .05), and patient acuity (P < .001). Using mapping, personnel can be identified who may informally influence multiple team cultures, and nurses (ie, the majority of team members in surgery) can lead the development of highly functioning surgical teams. PMID:25645040

Sykes, Mark; Gillespie, Brigid M; Chaboyer, Wendy; Kang, Evelyn

2015-02-01

367

Surgical treatment of early-stage non-small-cell lung cancer  

PubMed Central

Surgical resection remains the standard of care for functionally operable early-stage non-small-cell lung cancer (NSCLC) and resectable stage IIIA disease. The role of invasive staging and restaging techniques is currently being debated, but they provide the largest biopsy samples which allow for precise mediastinal staging. Different types of operative procedures are currently available to the thoracic surgeon, and some of these interventions can be performed by video-assisted thoracic surgery (VATS) with the same oncological results as those by open thoracotomy. The principal aim of surgical treatment for NSCLC is to obtain a complete resection which has been precisely defined by a working group of the International Association for the Study of Lung Cancer (IASLC). Intraoperative staging of lung cancer is of utmost importance to decide on the extent of resection according to the intraoperative tumour (T) and nodal (N) status. Systematic nodal dissection is generally advocated to evaluate the hilar and mediastinal lymph nodes which are subdivided into seven zones according to the most recent 7th tumour-node-metastasis (TNM) classification. Lymph-node involvement not only determines prognosis but also the administration of adjuvant therapy. In 2011, a new multidisciplinary adenocarcinoma classification was published introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications. The role of limited or sublobar resection, comprising anatomical segmentectomy and wide wedge resection, is reconsidered for early-stage lesions which are more frequently encountered with the recently introduced large screening programmes. Numerous retrospective non-randomised studies suggest that sublobar resection may be an acceptable surgical treatment for early lung cancers, also when performed by VATS. More tailored, personalised therapy has recently been introduced. Quality-of-life parameters and surgical quality indicators become increasingly important to determine the short-term and long-term impact of a surgical procedure. International databases currently collect extensive surgical data, allowing more precise calculation of mortality and morbidity according to predefined risk factors. Centralisation of care has been shown to improve results. Evidence-based guidelines should be further developed to provide optimal staging and therapeutic algorithms.

Van Schil, Paul E.; Balduyck, Bram; De Waele, Michèle; Hendriks, Jeroen M.; Hertoghs, Marjan; Lauwers, Patrick

2013-01-01

368

New surgical approach for late complications from spinal cord injury  

PubMed Central

Background The most frequent late complications in spinal cord injury result from arachnoiditis and consequent alterations in dynamics of cerebrospinal fluid flow. A surgical procedure carried out on patients with these alterations, resolved the various pathologies more efficiently in all cases. Methods From October 2000 to March 2006, 23 patients were selected for surgery: three showed signs of syringomyelia, three presented with microcystic lesions, three presented with arachnoid cysts in different locations but always confluent to the scar area, and 14 showed evidence of tethered cords. The surgery consisted of laminectomy at four levels, followed by dural opening in order to remove all the arachnoiditis at the level of the scar and to remove the altered arachnoid and its cysts, at least at two levels above and below the lesion. The dentate ligaments were cut at all exposed levels. Results The patients had no postoperative problems and not only retained all neurological functions but also showed neurological recovery. According to the motor and sensory scale of the American Spinal Injury Association, the recoveries were motor 20.6% (P < 0.001), touch 15.6% ((P < 0.001) and pinprick 14.4% (P < 0.001). These patients showed no signs of relapse at 4–66 month follow-up. Conclusion This alternative surgery resolved the pathologies provoking neurological deterioration by releasing the complete spinal cord at the level of the scar and the levels above and below it. It thus avoids myelotomies and the use of shunts and stents, which have a high long-term failure rate and consequent relapses. Nevertheless, this surgical procedure allows patients the chance to opt for any further treatment that may evolve in the future. PMID:17059598

Reis, Antonio J

2006-01-01

369

Smart surgical tool.  

PubMed

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

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

2015-02-01

370

Smart surgical tool  

NASA Astrophysics Data System (ADS)

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.

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

2015-02-01

371

Surgical Management in Sicklemia  

PubMed Central

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

Warner, Clinton E.

1979-01-01

372

Surgical problems in space: an overview.  

PubMed

Terrestrial experience indicates that surgical emergencies may cause significant morbidity in space, and may present unique problems. Microgravity physiologic changes that may increase susceptibility to, and complications from, injury include fluid redistribution and diuresis, bone demineralization, and immune system alterations. Conventional diagnostic tests may be unavailable or unreliable--e.g. the radiologic finding of "air under the diaphragm", which conventionally indicates perforation of an air-containing hollow viscus, such as the stomach, with a gravity-dependent rising of gas in the abdominal cavity to collect under the diaphragm. Microgravity surgical experience is limited, but studies conducted in the U.S.S.R. and on KC-135 aircraft indicate that, although surgical procedures are possible, weight and volume constraints, lack of gravity, altered fluid mechanics, and risk of environmental contamination mandate considerable modifications of conventional equipment and technique. PMID:8089263

McCuaig, K

1994-05-01

373

Simulation for ward processes of surgical care.  

PubMed

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. PMID:23548577

Pucher, Philip H; Darzi, Ara; Aggarwal, Rajesh

2013-07-01

374

MR imaging guidance for minimally invasive procedures  

NASA Astrophysics Data System (ADS)

Image guidance is one of the major challenges common to all minimally invasive procedures including biopsy, thermal ablation, endoscopy, and laparoscopy. This is essential for (1) identifying the target lesion, (2) planning the minimally invasive approach, and (3) monitoring the therapy as it progresses. MRI is an ideal imaging modality for this purpose, providing high soft tissue contrast and multiplanar imaging, capability with no ionizing radiation. An interventional/surgical MRI suite has been developed at Brigham and Women's Hospital which provides multiplanar imaging guidance during surgery, biopsy, and thermal ablation procedures. The 0.5T MRI system (General Electric Signa SP) features open vertical access, allowing intraoperative imaging to be performed. An integrated navigational system permits near real-time control of imaging planes, and provides interactive guidance for positioning various diagnostic and therapeutic probes. MR imaging can also be used to monitor cryotherapy as well as high temperature thermal ablation procedures sing RF, laser, microwave, or focused ultrasound. Design features of the interventional MRI system will be discussed, and techniques will be described for interactive image acquisition and tracking of interventional instruments. Applications for interactive and near-real-time imaging will be presented as well as examples of specific procedures performed using MRI guidance.

Wong, Terence Z.; Kettenbach, Joachim; Silverman, Stuart G.; Schwartz, Richard B.; Morrison, Paul R.; Kacher, Daniel F.; Jolesz, Ferenc A.

1998-04-01

375

Surgical Reconstruction of Radiation Injuries  

PubMed Central

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

Fujioka, Masaki

2014-01-01

376

Medical and surgical treatment of obesity.  

PubMed

The prevalence of obesity has reached epidemic proportions. Conceptualization of obesity as a chronic disease facilitates greater understanding its treatment. The NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity provides a framework by which to manage the severely obese--specifically providing medical versus surgical recommendations which are based on scientific and outcomes data. Medical treatments of obesity include primary prevention, dietary intervention, increased physical activity, behavior modification, and pharmacotherapy. Surgical treatment for obesity is based on the extensive neural-hormonal effects of weight loss surgery on metabolism, and as such is better termed Metabolic Surgery. Surgery is not limited to the procedure itself, it also necessitates thorough preoperative evaluation, risk assessment, and counseling. The most common metabolic surgical procedures include Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion. Surgical outcomes for metabolic surgery are well studied and demonstrate superior long-term weight loss compared to medical management in cases of severe obesity. PMID:21516910

Kissane, Nicole A; Pratt, Janey S A

2011-03-01

377

Noise characteristics of surgical space suits.  

PubMed

Several studies indicate that the noise generated by performing orthopedic surgery has the potential to cause hearing loss. Noise-induced hearing loss was found in 50% of the orthopedic surgeons studied using audiometric testing, with a greater incidence associated with years of practice. Noise produced by several orthopedic surgical instruments such as saws, drills, and hammers during surgery exceeds 100 dB, especially during knee replacement procedures. In one study, surgical space suits (personal protection systems) were suggested to help protect against noise-induced hearing loss, although space suit manufacturers do not market them as noise-reduction devices. A research protocol was developed to determine if commercially available surgical space suits help to reduce noise at the surgeon's ear. With the commercially available personal protection systems used in this research, there was no significant extra-helmet noise decrease by wearing the space suit. Sound inside the helmet at the level of the ear averaged 61 dBA, approximately the level of conversational speech, which may explain the difficulty the surgical staff may have hearing speech in the operating room when the space suit is worn with the fan on. If surgical noise is to be decreased, earplugs or muffs must be worn not only by the surgeon, but also by all personnel in the operating theater. At greatest risk may be the anesthesiologist, who may experience several orthopedic surgeries in a single day and is positioned close to the patient. PMID:19902889

Pearlman, Ronald T; Sandidge, Olisa

2009-11-01

378

Surgical Treatment of Pediatric Epileptic Encephalopathies  

PubMed Central

Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed. PMID:24288601

Fridley, J.; Reddy, G.; Curry, D.; Agadi, S.

2013-01-01

379

Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature  

PubMed Central

This review was undertaken to better understand the debate regarding the issue of osteoarthritis associated with anterior cruciate ligament (ACL) injuries, from a surgical and biomechanical standpoint. Much of the current debate focuses on contributory surgical factors and their relative roles in increasing or decreasing the risk of future osteoarthritis development, primarily highlighting the controversy over whether reconstructive surgery itself is necessarily protective. This review addresses the evolution of ACL reconstruction techniques over time, and with a view to thoroughly examine the role of surgery, outcome differences in procedural technique are reviewed, with a focus on open versus arthroscopic methods, graft choice and the use of a double versus single bundle reconstruction technique. Moreover, other potentially important contributory factors are identified and discussed, such as intrinsic biomechanical alterations sustained at the time of initial injury, and how these may have a more significant role with regard to future osteoarthritic changes in the knee than previously attributed. PMID:24015160

Fu, Richard Z; Lin, David D

2013-01-01

380

Surgical management of necrotizing pancreatitis: An overview  

PubMed Central

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

Kokosis, George; Perez, Alexander; Pappas, Theodore N

2014-01-01

381

New Directions in Surgical Therapy of Arrhythmias  

Microsoft Academic Search

.   The success of the radiofrequency catheter ablation procedure for most types of supraventricular and ventricular tachycardia,\\u000a particularly in young patients, largely eliminated the role of surgical therapy of arrhythmias. However, there remains a subset\\u000a of arrhythmia patients in whom the catheter approach has not been successful and types of arrhythmias with high recurrence\\u000a rates following initially successful catheter ablation

B. J. Deal; C. Mavroudis; C. L. Backer; C. L. Johnsrude

2000-01-01

382

Complex Common and Internal Iliac or Aortoiliac Aneurysms and Current Approach: Individualised Open-Endovascular or Combined Procedures  

PubMed Central

Objective. Bilateral internal iliac artery aneurysms constitute the utmost configuration of infrarenal aortoiliac disease. We detail characteristic aortoiliac disease patterns and reconstructive techniques we have used, along with a visualized decision-making chart and a short review of the literature. Material and Methods. A retrospective, observational study of twelve clinical cases of patients with aortoiliac disease are described. Two patients had a common iliac artery aneurysm and were managed by the application of inversed stent-grafts; another case was repaired by the insertion of a standard bifurcated stent-graft flared in the right common iliac artery and with an iliac branched device in the left iliac arterial axis. Open approach was used in 5 cases and in 4 cases a combination of aortouniliac stent-grafting with femoral-femoral bypass was applied. Results. Technical success was 100%. One endoleak type Ib in a flared iliac limb was observed and corrected by internal iliac embolism and use of an iliac limb stent-graft extension. We report 100% patency rate during 26.3 months of followup. Conclusion. Individualized techniques for the management of isolated iliac or aortoiliac aneurismal desease with special concern in maintaining internal iliac artery perfusion lead to elimination of perioperative complications and long-term durability and patency rates. PMID:25328706

Kotsis, Thomas; Louizos, Louizos Alexander; Theodoraki, Kassiani

2014-01-01

383

Preventing surgical site infections: a surgeon's perspective.  

PubMed Central

Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. National studies have defined the patients at highest risk for infection in general and in many specific operative procedures. Advances in risk assessment comparison may involve use of the standardized infection ratio, procedure-specific risk factor collection, and logistic regression models. Adherence to recommendations in the 1999 Centers for Disease Control and Prevention guidelines should reduce the incidence of infection in surgical patients. PMID:11294711

Nichols, R. L.

2001-01-01

384

Management of surgical patients with bleeding disorders.  

PubMed

Invasive procedures for patients with bleeding disorders require planning on the part of the health care team. The patient population affected involves those with hereditary bleeding disorders, such as von Willebrand disease or hemophilia; in addition, patients who use antithrombotic drugs must be considered and their care managed. The choice of treatment depends on a number of factors, including the procedure planned, the type and severity of the disorder, and the age and morbidity of the patient. The indications, dosing, and timing of presurgical and surgical interventions will be reviewed, as well as special considerations for vascular access devices. PMID:24583938

Kauffman, Judy

2014-01-01

385

PARFLEX--a very useful drug for management of surgical pain.  

PubMed

The aim was to assess and document the efficacy and tolerability of parflex (FDC of aceclofenac with paracetamol and serratiopeptidase) in management of pain and inflammation in adult patients undergoing surgical procedures (or operations). The design was open, prospective, non-comparative and multi-dose study of patients undergoing surgical procedures at a leading, tertiary-care, teaching hospital (setting) in Lucknow, the name being, King George's Medical College, Lucknow 226003. The patients were 50 adult patients of either sex undergoing surgery. They were given 1 tablet twice daily, taken after meals. Treatment duration was for a total of up to 7 days (intervention). Primary efficacy variables were relief from postoperative pain. Secondary efficacy variables were global assessment of efficacy and toleration by patients and treating physicians. Record was made of spontaneously reported adverse events with their nature, intensity and outcome (tolerability). Out of 50 patients, 31% were (ENT), 36% were (Orthopaedic) and 33% were (Gynaecology). They were enroled in this study. The observations made were mean pain score showed significant improvement with study drug - decreasing from 2.66 at baseline to 1.36 after 48 hours, and to 0.8 at the end of study. Composite score for pain, fever and swelling also showed substantial gains visit-on- visit-decreasing from 3.62 at baseline to 2.04 after 48 hours, and to 0.98 at final visit. None of the patients reported any adverse event. Global efficacy assessment was rated as 'excellent or good' by 54% of patients and in 59% of patients by their treating physicians. To conclude, parflex is an effective analgesic, anti-inflammatory drug that has a valuable therapeutic option for controlling pain and inflammation after surgical procedures. PMID:18839656

Pant, K K; Das, Vineeta; Grawal, S P A; Singh, Ajay; Khattri, Sanjay; Nath, Rajendra; Nischal, Anuradha; Dabholkar, Pareen

2008-06-01

386

Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study  

PubMed Central

Background The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study. Methods Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant. Results During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC. Conclusion Under the studied conditions, the authors’ hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture. PMID:24991234

2014-01-01

387

Minimally invasive surgical approach to treat posterior urethral diverticulum  

PubMed Central

Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.

Alsowayan, Ossamah; Almodhen, Fayez; Alshammari, Ahmed

2015-01-01

388

Evaluation of the motion of surgical instruments during intraocular surgery  

PubMed Central

Purpose Robot assistance in ocular microsurgery could improve precision, dexterity, save time or prevent complications by task automation, and provide access to ocular surgery in undeserved countries by teleoperation. However, to design robotic devices, the range of motion of surgical instruments needs to be precisely quantified. Methods An electromagnetic tracking system was developed for intraocular surgery in order to quantify the movements of ophthalmic surgeons. Kinematics of surgical steps during phacoemulsification and pars plana vitrectomy procedures were determined by measuring the maximum translation and angular range of motion of intraocular surgical tools in the three planes. Conclusion Important variations in amplitudes of rotation and translation were measured between both hands and between surgical tasks. These parameters may be used to develop a robotic intraocular surgical system or to improve training. PMID:21527954

Hubschman, J-P; Son, J; Allen, B; Schwartz, S D; Bourges, J-L

2011-01-01

389

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

NASA Astrophysics Data System (ADS)

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.

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

2010-03-01

390

Surgical Treatment of Adult Degenerative Scoliosis  

PubMed Central

The rapid increase of elderly population has resulted in increased prevalence of adult scoliosis. Adult scoliosis is divided into adult idiopathic scoliosis and adult degenerative scoliosis. These two types of scoliosis vary in patient age, curve pattern and clinical symptoms, which necessitate different surgical indications and options. Back pain and deformity are major indications for surgery in adult idiopathic scoliosis, whereas radiating pain to the legs due to foraminal stenosis is what often requires surgery in adult degenerative scoliosis. When selecting a surgical method, major symptoms and underlying medical diseases should be carefully evaluated, not only to relieve symptoms but also to minimize postoperative complications. Surgical options for adult degenerative scoliosis include: decompression alone; decompression and limited short fusion; and decompression coupled with long fusion and correction of deformity. Decompression and limited short fusion can be applied to patients with a small Cobb's angle and normal sagittal imbalance. For those with a large Cobb's angle and positive sagittal imbalance, long fusion with correction of deformity is required. When long fusion is applied, a careful decision regarding the extent of fusion level should be made when selecting L5 or S1 as the distal fusion level and T10 or the thoracolumbar junction as the proximal fusion level. For the fusion extending to the sacrum, restoration of sagittal balance and rigid fixation with additional iliac screws should be considered. Any surgical procedures for adult degenerative scoliosis are known to have relatively high occurrences of complications; therefore, risks and benefits should be meticulously considered before selecting a surgical procedure. PMID:24967054

Kim, Young-Tae; Shin, Sang-hyun; Suk, Se-Il

2014-01-01

391

Surgical Treatment of Winged Scapula  

PubMed Central

Injuries to the long thoracic and spinal accessory nerves present challenges in diagnosis and treatment. Palsies of the serratus anterior and trapezius muscles lead to destabilization of the scapula with medial and lateral scapular winging, respectively. Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles. Our preferred method of reconstruction for serratus anterior palsy is a two-incision, split pectoralis major transfer without fascial graft. For trapezius palsy, we prefer a modified version of the Eden-Lange procedure. At a minimum followup of 16 months (mean, 47 months), six patients who underwent the Eden-Lange procedure showed improvement in mean American Shoulder and Elbow Surgeons Shoulder scores (33.3–64.6), forward elevation (141.7–151.0), and visual analog scale (7.0–2.3). At a minimum followup of 16 months (mean, 44 months), 10 patients (11 shoulders) who underwent split pectoralis transfer also improved American Shoulder and Elbow Surgeons Shoulder scores (53.3–63.8), forward elevation (158.2–164.5), and visual analog scale (5.0–2.9). We encountered two complications, both superficial wound infections. These tendon transfers were effective for treating scapular winging in patients who did not respond to nonoperative treatment. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196359

Galano, Gregory J.; Bigliani, Louis U.; Ahmad, Christopher S.

2008-01-01

392

Surgical management of gastrointestinal bleeding.  

PubMed

Severe gastrointestinal bleeding has historically been a clinical problem primarily under the purview of the general surgeon. Diagnostic advances made as the result of newer technologies, such as fiberoptic and video endoscopy, selective visceral arteriography, and nuclear scintigraphy, have permitted more accurate and targeted operations. More importantly, they have led to safe, effective nonoperative therapeutic interventions that have obviated the need for surgery in many patients. Today, most gastrointestinal bleeding episodes are initially managed by endoscopic or angiographic control measures. Such interventions are often definitive in obtaining hemostasis. Even temporary cessation or attenuation of massive bleeding in an unstable patient permits a safer, more controlled operative procedure by allowing an adequate period of preoperative resuscitation. Despite the less frequent need for surgical intervention, traditional operative approaches, such as suture ligation, lesion or organ excision, vagotomy, portasystemic anastomosis, and devascularization procedures, continue to be life-saving in many instances. The proliferation of laparoscopic surgery has fostered the application of minimally invasive techniques to highly selected patients with gastrointestinal bleeding. Intraoperative endoscopy has greatly facilitated the accuracy of laparoscopic surgery by endoscopic localization of bleeding lesions requiring excision. It is anticipated that the evolving technologies pertinent to the diagnosis and management of gastrointestinal bleeding will continue to promote collaboration and cooperation between gastroenterologists, radiologists, and surgeons. PMID:10752022

Stabile, B E; Stamos, M J

2000-03-01

393

CULTIVATING NETWORKS: IMPLEMENTING SURGICAL  

E-print Network

i CULTIVATING NETWORKS: IMPLEMENTING SURGICAL TELEMEDICINE Margunn Aanestad THE INTERVENTIONAL TELEMEDICINE by Margunn Aanestad Submitted as partial fulfilment of the requirements of the degree Doctor;iii TABLE OF CONTENTS 1. Introduction 1 2. Telemedicine ­ visions and challenges 3 3. Related research

Sahay, Sundeep

394

Surgical experiences in Nepal.  

PubMed Central

Some examples of surgical problems presenting to the authors during a 2-year attachment to the British Military Hospital, Dharan, Nepal, are described. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 5 Fig. 6 Fig. 7 PMID:1200575

Melsom, M. A.

1975-01-01

395

Arthroscopic Latarjet and Capsular Shift (ALCS) Procedure: A New "Freehand" Technique for Anterior Shoulder Instability Associated With Significant Bone Defects.  

PubMed

Anterior shoulder instability associated with significant bone loss has been described as "bony-instability," and this condition is usually treated with an anterior glenoid bone grafting procedure (Latarjet procedure). The Latarjet procedure involves transfer of the horizontal limb of the coracoid process along with the conjoint tendon to the anterior glenoid rim, and is traditionally performed as an open surgical procedure. Recently, an arthroscopic technique for the Latarjet procedure has been described; the technique necessitates the use of specialized instrumentation and involves excision of the entire anterior capsule to facilitate coracoid fixation. We describe a new "freehand" arthroscopic technique for the Latarjet procedure, and, in addition, a simultaneous capsular shift to further optimize mid and end range stability. This technique eliminates the use of additional instrumentation and can be done using routine arthroscopic instruments. Preliminary experience with this technique suggests that the arthroscopic Latarjet and capsular shift is a technically demanding procedure. Glenohumeral capsule can be preserved, and this should be attempted wherever possible to optimize stability. Additional specialized instrumentation would probably reduce surgical time; however, the procedure can be performed with routine instruments. PMID:25393057

Bhatia, Deepak N

2015-03-01

396

Surgical treatment for congenital curved nail of the fourth toe.  

PubMed

Since congenital curved nail of the fourth toe (CNFT) was reported by Iwasawa et al in 1991, there have been only 19 cases of CNFT in 6 reports, which were from Japan and Taiwan. We performed surgery on 4 patients with CNFT and report here good results. There has been no previous detailed report on surgical treatment for this condition. This report will describe the treatment, mainly the surgical procedure. PMID:23797024

Mitsukawa, Nobuyuki; Karube, Daisuke; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Kuriyama, Motone; Satoh, Kaneshige

2015-03-01

397

A new surgical approach to the canine prostate gland  

E-print Network

and completed in 12 male dogs 1-1/2 to 9 years of age. Prosta- tectomy is sometimes necessary in cases of neoplasia, persistent hyperplasia, and abscessation. . This technique offered maximum exposure for surgical access to the bladder neck, prostate... of persistent benign hyperplasia, neoplasia, abscessation, and perineal hernia. These conditions are often present in dogs and sometimes are unresponsive to medical treatment. Prostatectomy in the dog is considered a difficult surgical procedure...

Howard, Donald Robert

1969-01-01

398

Perioperative Strategies to Prevent Surgical-Site Infection  

PubMed Central

Colon and rectal resections are among the most common surgical procedures performed in the United States. Complication rates of up to 25% have been reported and result in a substantial impact on quality of life and cost of care. Recently, the Surgical Care Improvement Program (SCIP) has promoted guidelines to prevent postoperative and potentially preventable complications. A comprehensive evidenced-based review of these guidelines and other perioperative strategies for practicing colorectal surgeons is the basis of this review. PMID:24436669

Poggio, Juan Lucas

2013-01-01

399

Prospective cost analysis of laparoscopic vs. open pyeloplasty in children: Single centre contemporary evaluation comparing two procedures over a 1-year period  

PubMed Central

Introduction: Laparoscopy in pediatric urological surgery continues to gradually gain acceptance. Since economic implications are of increasing importance in our cost-containment environment, few studies have compared the expense associated with open to laparoscopic approaches. We present a prospective comparative cost-analysis between the laparoscopic (LP) and open pediatric pyeloplasty (OP). Methods: Over a period of a year (2007–2008), 54 consecutives pyeloplasties were performed. The “traditional” OP was performed in 33 patients and the remaining 21 children underwent LP. Costs were prospectively collected for each group and divided based on amounts incurred by all different departments involved: nursing, laboratory, diagnostic imaging, pharmacy and operative room. Results: Overall, the average cost for a LP was CDN$6240 compared to CDN$5079 for an OP with a median hospital stay of 2 days (range OP: 1–18, LP: 1–7). The main difference was found in operative room expenses (OP: $2508 vs. LP: $3925). The higher cost could not be solely explained by the use of disposable items, which only subtracts $335 per procedure (23.6% of the cost difference between OP and LP). Length of time spent in the operating room was 1.2 hours longer for the LP and appears to be the main factor explaining the cost difference. Conclusion: Our findings show that at our institution, pediatric LP is more expensive than OP. This cost difference is mainly due to operating room time. For cost-containment purposes, efforts aimed at increasing efficiency in the operating room may help equalize both approaches. PMID:22277634

Moore, Katherine; Lorenzo, Armando J.; Turner, Suzanne; Bägli, Darius J.; Pippi Salle, Joao L.; Farhat, Walid A.

2013-01-01

400

[First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the daVinci Surgical System].  

PubMed

In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1,000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced. PMID:18546856

Yoshioka, Kunihiko; Hatano, Tadashi; Nakagami, Yoshihiro; Ozu, Choichiro; Horiguchi, Yutaka; Sakamoto, Noboru; Yonov, Hiroyuki; Ohno, Yoshio; Ohori, Makoto; Tachibana, Masaaki; Patel, Vipul R

2008-05-01

401

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

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.

Brown, R.S.; Eppard, M.B.; Murchie, K.J.; Nielsen, J.L.; Cooke, S.J.

2011-01-01

402

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

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.

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

2011-01-01

403

Deep space neck infection: principles of surgical management.  

PubMed

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

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

2008-08-01

404

Surgical Techniques Used for the Treatment of Atrial Fibrillation  

PubMed Central

The use of surgical lesion sets for the treatment of atrial fibrillation has been increasing, particularly in patients with complicated anatomical substrates and those undergoing concomitant surgery. Preferences in terms of lesion set, surgical approach and ablation technology vary by center. This review discusses both the surgical techniques and the outcomes for the most commonly performed procedures in the context of recent consensus guidelines. The Cox-Maze IV, pulmonary vein isolation, extended left atrial lesion sets, the hybrid approach and ganglionated plexus ablation are each reviewed in an attempt to provide insight into current clinical practice and patient selection PMID:23823731

Robertson, Jason O.; Lawrance, Christopher P.; Maniar, Hersh S.; Damiano, Ralph J.

2015-01-01

405

Toward fluorescence detection of protein residues on surgical instruments  

NASA Astrophysics Data System (ADS)

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.

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

2004-06-01

406

Mini-Bentall procedure  

PubMed Central

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.

2015-01-01

407

The surgical value of community hospitals: a closer look.  

PubMed

To assess and compare the safety and efficiency of a surgical unit at a District General Hospital and a Community Hospital for elective cold surgery. A retrospective survey was made using regional computer Hospital Activity Analysis data and monthly audit meeting records of all inpatients having selected elective general surgical operations on one consultant's firm over a period of one year, at Torbay Hospital, Torquay, (DGH) and Newton Abbot Hospital, Newton Abbot (CH). All inpatients and day cases admitted under CACC from April 1, 1987, until March 31, 1988, were studied comparing mortality, morbidity and efficiency for comparable elective surgical procedures. A postal questionnaire to assess patient satisfaction with surgical care at both hospitals was included in the study. 350 patients underwent elective surgical procedures at the DGH and 380 patients underwent similar procedures at the CH. There was no significant increase in mortality and morbidity at the CH, which was preferred by most patients for routine surgical operations. The Community Hospital unit was found to be satisfactory and more efficient for routine elective surgery as determined from the above parameters and the patients themselves. PMID:1863060

Sanger, R; Clyne, C A

1991-07-01

408

Open fenestration for complicated acute aortic B dissection  

PubMed Central

Acute type B aortic dissection (ABAD) is a serious cardiovascular emergency in which morbidity and mortality are often related to the presence of complications at clinical presentation. Visceral, renal, and limb ischemia occur in up to 30% of patients with ABAD and are associated with higher in-hospital mortality. The aim of the open fenestration is to resolve the malperfusion by creating a single aortic lumen at the suprarenal or infrarenal level. This surgical procedure is less invasive than total aortic replacement, thus not requiring extracorporeal support and allowing preservation of the intercostal arteries, which results in decreased risk of paraplegia. Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD, particularly for patients with no aortic dilatation. In the current endovascular era, this open technique serves as an alternative option in case of contraindications or failure of endovascular management of complicated ABAD. PMID:25133107

Segreti, Sara; Grassi, Viviana; Lomazzi, Chiara; Cova, Marta; Piffaretti, Gabriele; Rampoldi, Vincenzo