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Sample records for surgical ethical techniques

  1. Surgical innovation: the ethical agenda

    PubMed Central

    Broekman, Marike L.; Carrière, Michelle E.; Bredenoord, Annelien L.

    2016-01-01

    Abstract The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation. Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges. To answer the question “What are the main ethical aspects of surgical innovation?”, we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers. We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure. We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health

  2. Ethical issues in surgical innovation.

    PubMed

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

    2014-07-01

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

  3. Surgical forceps techniques.

    PubMed

    Malden, N

    2001-01-01

    This paper considers two new elevator and dental forceps techniques for the atraumatic removal of teeth to avoid a surgical procedure where possible. The techniques described should be applicable in relatively well defined but commonly occurring situations. The two techniques involve the unconventional use of conventional dental extraction forceps, with the aim of facilitating removal of the retained roots of certain teeth: the first for incisors, canines and premolars and the second for lower first molars. The term 'surgical forceps technique's is tentatively put forward as a description of these hybrid procedures. PMID:11819949

  4. Neuronavigation. Principles. Surgical technique.

    PubMed

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques. PMID:20108488

  5. Fundamental Ethical Issues in Unnecessary Surgical Procedures.

    PubMed

    Tayade, Motilal Chandu; Dalvi, Shashank D

    2016-04-01

    In clinical practice performing any surgical procedure is inconsistent because all surgical procedures carry definitely some degree of risk. Worldwide every year millions of patients go under knife, but many of them are enduring great pain and shelling out thousands and dollars for surgeries they don't really need. This review work was planned with an intention to focus attention towards it with reporting cited evidences of unnecessary surgical operations and discuss ethical issues concern with it. In present review the references search included standard citations Google scholar, MEDLINE and PUBMED. We also used Google search engine for screening various news concern with highlighting this topic in community and online media. For articles we go through more than 60 articles from worldwide and 12 news media views from Google search in last one year. We used following quotes for their search-unnecessary surgeries, second opinion, ethical issues in unnecessary surgeries. Geographical variations were also kept in view. Our intension was highlighting ethical issues concern with unnecessary surgical operations. Henceforth we excluded such work that does not concern with ethical issues. Unnecessary surgery is that which is medically unjustifiable when the risks and costs are more than the likely therapeutic benefits or relief to the patient based on the patient's lifestyle requirements. To avoid or minimize such interventions basic seeding of ethics in curriculum and strict laws will definitely helpful in clinical practice. In conclusion, our aim was to highlight this major issue and underline need of competency based medical bioethics education in Indian scenario. PMID:27190833

  6. Fundamental Ethical Issues in Unnecessary Surgical Procedures

    PubMed Central

    Dalvi, Shashank D.

    2016-01-01

    In clinical practice performing any surgical procedure is inconsistent because all surgical procedures carry definitely some degree of risk. Worldwide every year millions of patients go under knife, but many of them are enduring great pain and shelling out thousands and dollars for surgeries they don’t really need. This review work was planned with an intention to focus attention towards it with reporting cited evidences of unnecessary surgical operations and discuss ethical issues concern with it. In present review the references search included standard citations Google scholar, MEDLINE and PUBMED. We also used Google search engine for screening various news concern with highlighting this topic in community and online media. For articles we go through more than 60 articles from worldwide and 12 news media views from Google search in last one year. We used following quotes for their search-unnecessary surgeries, second opinion, ethical issues in unnecessary surgeries. Geographical variations were also kept in view. Our intension was highlighting ethical issues concern with unnecessary surgical operations. Henceforth we excluded such work that does not concern with ethical issues. Unnecessary surgery is that which is medically unjustifiable when the risks and costs are more than the likely therapeutic benefits or relief to the patient based on the patient’s lifestyle requirements. To avoid or minimize such interventions basic seeding of ethics in curriculum and strict laws will definitely helpful in clinical practice. In conclusion, our aim was to highlight this major issue and underline need of competency based medical bioethics education in Indian scenario. PMID:27190833

  7. Ethical dilemmas for pediatric surgical patients.

    PubMed

    Boudreaux, Arthur M; Tilden, Samuel J

    2002-03-01

    Anesthesiologists are confronted with interesting and sometimes difficult ethical situations in pediatric surgery. They are forced to deal with everything from "do not resuscitate" issues, heroic last-chance surgical efforts, religious and cultural conflicts, disputes among colleagues, and situations that are, at worst, uncomfortable and, at best, miscarriages of duty. It is incumbent on anesthesiologists to learn how to logically and appropriately handle these issues. The pediatric surgical patient requires special consideration in bioethics. This article discusses the principle of autonomy and its ascension in importance in bioethics. The concepts of informed parental permission, assent, and dissent are presented. The authors provide a framework for ethical problem-solving, as well as a discussion of judicial decision-making. In addition, several examples of clinical-ethical situations and the processes used for resolutions are discussed. By using a well-reasoned ethical decision-making process, any situation, from the simple conflict to the most serious resuscitation and withdrawal of care issues, may be appropriately resolved. PMID:11892507

  8. The importance of an ethics curriculum in surgical education.

    PubMed

    Keune, Jason D; Kodner, Ira J

    2014-07-01

    The nature of surgical work provides fertile ground in which ethical problems can grow. The concept of what it means to be a "good surgeon" includes the ability to reason and deliberate about how the surgeon's unique technical capabilities integrate with larger society. Ethics education at the resident level is important for several reasons. It can ensure that care is delivered in a socially and ethically responsible manner through global and emergent effects on institutions and traditions. It will prepare residents for leadership positions. It can allow residents to confront issues, such as the scientific underdetermination of surgical practice, the application of new technologies to trusting patients that have been developed by for-profit companies, and a surgical environment that is becoming increasingly institutionalized. Resident ethics education provides the opportunity for a model of collective deliberation to be developed that can be used to make sense of ethical problems as they arise. PMID:24728581

  9. Surgical innovation: the ethical agenda: A systematic review.

    PubMed

    Broekman, Marike L; Carrière, Michelle E; Bredenoord, Annelien L

    2016-06-01

    The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation.Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges.To answer the question "What are the main ethical aspects of surgical innovation?", we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers.We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure.We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health care system might

  10. "Reality surgery"--a research ethics perspective on the live broadcast of surgical procedures.

    PubMed

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

    2011-01-01

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

  11. The practical and ethical defects of surgical randomised prospective trials.

    PubMed Central

    Byer, A

    1983-01-01

    This paper presents a strong criticism of the current enthusiasm for clinical randomised prospective studies in surgery. In the process, the author probes the 'intellectualism' or lack thereof in present day surgical attitudes. The subjects are examined against a framework of ethics and inescapable dilemmas. Ways of correcting the more obvious weaknesses are suggested. The manuscript is, and is meant to be, provocative and is particularly aimed at the academic audience served by this journal. PMID:6876104

  12. Nanomedicine: Techniques, Potentials, and Ethical Implications

    PubMed Central

    Ebbesen, Mette; Jensen, Thomas G.

    2006-01-01

    Nanotechnology is concerned with materials and systems whose structures and components exhibit novel physical, chemical, and biological properties due to their nanoscale size. This paper focuses on what is known as nanomedicine, referring to the application of nanotechnology to medicine. We consider the use and potentials of emerging nanoscience techniques in medicine such as nanosurgery, tissue engineering, and targeted drug delivery, and we discuss the ethical questions that these techniques raise. The ethical considerations involved in nanomedicine are related to risk assessment in general, somatic-cell versus germline-cell therapy, the enhancement of human capabilities, research into human embryonic stem cells and the toxicity, uncontrolled function and self-assembly of nanoparticles. The ethical considerations associated with the application of nanotechnology to medicine have not been greatly discussed. This paper aims to balance clear ethical discussion and sound science and so provide nanotechnologists and biotechnologists with tools to assess ethical problems in nanomedicine. PMID:17489016

  13. Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique

    PubMed Central

    Vilá y Rico, Jesús; Ojeda Thies, Cristina; Parra Sanchez, Guillermo

    2016-01-01

    Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores. PMID:27073783

  14. Surgical patents and patients--the ethical dilemmas.

    PubMed

    Tołłoczko, Tadeusz

    2005-01-01

    It is obvious that every inventor should be rewarded for the intellectual effort, and at the same time be encouraged to successively improve his or her discovery and to work on subsequent innovations. Patents also ensure that patent owners are officially protected against intellectual piracy, but protection of intellectual property may be difficult to accomplish. Nevertheless, it all comes down to this basic question: Does a contradiction exist between medical ethics and the "Medical and Surgical Procedure Patents" system? It may well turn out that medical-procedure patents can have a negative influence on the standard of medical care. Medical-method patents may also interfere with the physician-patient relationship. At present, physicians do not question the usefulness of patent protection for medicines, biotechnology, equipment and devices, but they strongly oppose it for surgical procedures. PMID:15727000

  15. Surgical technique affects outcomes in acromioclavicular reconstruction.

    PubMed

    Grassbaugh, Jason A; Cole, Chad; Wohlrab, Kurt; Eichinger, Josef

    2013-01-01

    Optimal treatment for acromioclavicular (AC) dislocation is unknown. Numerous surgical procedures for AC injuries have been described with little comparison. This study sought to compare the clinical and radiographic results of various surgical techniques in order to identify the optimal surgical technique. Ninety patients met inclusion criteria of AC reconstruction at this institution. A retrospective review of outcomes was performed using the electronic records system. Radiographs were measured for pre- and postoperative grade and percent elevation versus the contralateral side. Overall revision rate was 9%. Suture button fixation had a revision rate of 0% compared to 14% (p = .01). Reconstruction procedures performed with distal clavicle excision showed a higher revision rate, 17% compared to 0% (p = .003). There were no statistically significant clinical differences. AC reconstructions performed with suture button construct were superior to other surgical techniques. Procedures performed with distal clavicle excision were inferior to those without. PMID:23449059

  16. Cochlear implant simulator for surgical technique analysis

    NASA Astrophysics Data System (ADS)

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

    2014-03-01

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

  17. Ethical issues in the management of neonatal surgical anomalies.

    PubMed

    Caniano, Donna A

    2004-06-01

    This article provides a framework for thinking about three areas in neonatal surgery that contain potential moral and ethical concerns for pediatric surgeons and the parents of a newborn and/or fetus with a surgical anomaly. The utilization of life-sustaining therapy for neonates has made survival possible for many infants with serious birth defects. Sometimes the use of these treatments is problematic in terms of their actual benefit to the infant and the potential for enhancing their future quality of life. Second, the prenatal diagnosis of congential anomalies has made counseling of the prospective parents a routine part of pediatric surgical practice and raises the issue of how best to advise and support a couple whose fetus has a significant birth defect. Finally, pediatric surgeons have a responsibility to their patients and society to provide the highest quality of care. This may involve participation in multi-institutional clinical trials, so that the optimal care of a surgical neonate with a congenital or acquired condition is ascertained by rigorous prospective research evaluation. PMID:15283103

  18. [Surgical renal biopsies: technique, effectiveness and complications].

    PubMed

    Pinsach Elías, L; Blasco Casares, F J; Ibarz Servió, L; Valero Milián, J; Areal Calama, J; Bucar Terrades, S; Saladié Roig, J M

    1991-01-01

    Retrospective study made on 140 renal surgical biopsies (RSB) performed throughout the past 4 years in our Unit. The technique's effectiveness and morbidity are emphasized and the surgical technique and type of anaesthesia described. The sample obtained was enough to perform an essay in 100% cases, and a diagnosis was reached in 98.5%. Thirty-nine patients (27.8%) presented complications, 13 (9.2%) of which were directly related to the surgical technique. No case required blood transfusion and no deaths were reported. The type of anaesthesia used was: local plus sedation in 104 (74.2%) cases, rachianaesthesia in 10 (7.1%) and general in 26 (18.5%). The same approach was used in all patients: minimal subcostal lumbotomy, using Wilde's forceps to obtain the samples. It is believed that RSB is a highly effective, low mortality procedure, easy and quick to perform, and suitable for selected patients. PMID:1927642

  19. Ethical issues: impact of the animal rights movement on surgical research.

    PubMed

    Sonnino, R E; Banks, R E

    1996-08-01

    The aggressive militancy of many animal rights or "antivivisectionist" groups is causing great consternation but little action on the part of medical and surgical researchers. Pediatric surgeons are particularly affected, since issues of tissue healing, growth and development, and organ or total-body responses to surgical insults must be established in the live organism, usually in animal models that cannot be replaced by other methods. Investigators have been threatened physically; laboratories have been vandalized and valuable data destroyed. Biomedical researchers have been called "animal-Nazis." The proliferation of animal rights groups such as the Animal Liberation Front (ALF) and People for the Ethical Treatment of Animals (PETA) have prompted the birth of pro-research organizations such as "Putting People First" and the "incurably ill For Animal Research" (iiFAR). The result of this pro and con activity is an extraordinary amount of time and expense devoted to cover the cost of new regulations and laboratory security (approximately $ 1.5 billion in the U. S. alone) at the expense of research budgets, adding to the increasing shortage of research funding. This situation has created dilemmas for the surgeon involved in basic animal research: is it worth taking personal risks to develop new techniques? Is it ethical to allow these fears to hinder progress in surgery? Should we do away with animal research entirely and test new techniques directly on children? Would that be ethical? These questions are difficult to answer, but must be addressed if we expect medicine to progress. PMID:24057778

  20. Fertility-preserving surgical procedures, techniques.

    PubMed

    Martinez, Alejandra; Poilblanc, Mathieu; Ferron, Gwenael; De Cuypere, Mariolene; Jouve, Eva; Querleu, Denis

    2012-06-01

    As a result of the trend toward late childbearing, fertility preservation has become a major issue in young women with gynaecological cancer. Fertility-sparing treatments have been successfully attempted in selected cases of cervical, endometrial and ovarian cancer, and gynaecologists should be familiar with fertility-preserving options in women with gynaecological malignancies. Options to preserve fertility include shielding to reduce radiation damage, fertility preservation when undergoing cytotoxic treatments, cryopreservation, assisted reproduction techniques, and fertility-sparing surgical procedures. Radical vaginal trachelectomy with laparoscopic lymphadenectomy is an oncologically safe, fertility-preserving procedure. It has been accepted worldwide as a surgical treatment of small early stage cervical cancers. Selected cases of early stage ovarian cancer can be treated by unilateral salpingo-ophorectomy and surgical staging. Hysteroscopic resection and progesterone treatment are used in young women who have endometrial cancer to maintain fertility and avoid surgical menopause. Appropriate patient selection, and careful oncologic, psychologic, reproductive and obstetric counselling, is mandatory. PMID:22503435

  1. Laparoscopic Surgical Techniques for Endometriosis and Adenomyosis

    PubMed Central

    Wood, C.; Maher, P.; Woods, R.

    2000-01-01

    The details of surgical techniques for laparoscopic removal of endometriosis and adenomyosis are described briefly in textbooks and gynaecological journal articles. We have described a wide variety of techniques for the various procedures required in the treatment of endometriosis and adenomyosis, excluding hysterectomy. The principles are based upon those used in removal of primary cancer lesions. The limitations of thermal ablation are discussed, and evidence of improved results after excision of lesions have been submitted for publication. PMID:18493534

  2. Surgical techniques of orthotopic rat liver transplantation.

    PubMed

    Spiegel, H U; Palmes, D

    1998-01-01

    Liver transplantation in rats is frequently used as a transplantation model. Although liver transplantation in larger laboratory animals such as dogs and pigs is technically easier, the rat has become the most important subject for experimental liver transplantation because of the availability of genetically defined animals. Numerous surgical techniques have been developed that permit the investigator to carry out studies with high clinical relevance. In this article the principal models of orthotopic rat liver transplantation and their technical modifications of vessel anastomoses, rearterialization, and bile duct reconstruction techniques are reviewed. More than 20 transplantation models are described in detail and demonstrated with clear illustrations. Finally, the advantages and uses of all the surgical procedures (e.g., suture and cuff anastomoses, bile duct anastomoses, and rearterialization techniques), specific problems, and survival criteria are discussed and the experiences of investigators who applied these techniques are analyzed. In conclusion, an overview and critical evaluation of all surgical techniques of orthotopic rat liver transplantation are given, together with instructions for learning these techniques. PMID:9700616

  3. [Idiopathic Progressive Subglottic Stenosis: Surgical Techniques].

    PubMed

    Hoetzenecker, K; Schweiger, T; Klepetko, W

    2016-09-01

    Idiopathic subglottic stenosis is a disease characterized by slow, progressive scarring and constriction of the subglottic airway. It almost always occurs in females between the 3rd and 5th decade of life. Symptoms are frequently misinterpreted as asthma and patients are referred for endoscopic evaluation only when asthma medications fail to alleviate their symptoms. Treatment options can be divided into endoscopic and open surgical techniques. Microlaryngoscopic scar reduction by laser followed by balloon dilation usually delivers good short-term results. However, the majority of patients will experience restenosis within a short period of time. Open surgical correction techniques are based on a complete removal of the affected airway segment. This must be combined with various extended resection techniques in patients with advanced stenosis. Depending on the extent and severity of the stenosis the following surgical techniques are required: standard cricotracheal resection (Grillo's technique), cricoplasty with dorsal and lateral mucosaplasty, or a combination of resection and enlargement techniques using rib cartilage grafts. In experienced centres, success rates of over 95 % are reported with good functional outcome of voice and deglutition. PMID:27607884

  4. Surgical discectomy for lumbar disc herniation: surgical techniques.

    PubMed

    Blamoutier, A

    2013-02-01

    Discectomy for lumbar discal herniation is the most commonly performed spinal surgery. The basic principle of the various techniques is to relieve the nerve root compression induced by the herniation. Initially, the approach was a unilateral posterior 5-cm incision: the multifidus was detached from the vertebra, giving access through an interlaminar space in case of posterolateral herniation; an alternative paraspinal approach was used for extraforaminal herniation. Over the past 30 years, many technical improvements have decreased operative trauma by reducing incision size, thereby reducing postoperative pain and hospital stay and time off work, while improving clinical outcome. Magnification and illumination systems by microscope and endoscope have been introduced to enable minimally invasive techniques. Several comparative studies have analyzed the clinical results of these various techniques. Although the methodology of most of these studies is debatable, all approaches seem to provide clinical outcomes of similar quality. At all events, minimally invasive techniques reduce hospital stay. While technical proficiency is essential, the final result depends on strict compliance with a prerequisite for surgical indication: close correlation between clinical symptoms and radiological findings. It is essential to discuss the risk/benefit ratio and explain the pros and cons of the recommended technique to the patient. PMID:23352565

  5. Ethical considerations in Syria regarding reproduction techniques.

    PubMed

    Arbach, Olga

    2002-01-01

    Ethical Islamic considerations concerning current medical infertility treatment are outlined, that allow application of all techniques as far as they are compatible with legal marriage: Homogenic insemination is allowed. Heterogenic insemination is not, although it bears slightly better outcome, because of the imperative Islamic rule not to mingle genealogical lines. Neither is surrogate motherhood because of the legal position of the mother in Islamic shari'a and consequent inheritance rights on the one hand and sociological significance of motherhood on the other. The question arises, which is the mother, the biological or the social. In all cases, special attention should be paid to the professionals involved in the procedures. The danger of embryonic sex selection following preimplantation diagnostics is hinted at, precautions should be taken. These ethical considerations are substantial in Arab countries, including Syria. PMID:12184614

  6. Futility and the care of surgical patients: ethical dilemmas.

    PubMed

    Grant, Scott B; Modi, Parth K; Singer, Eric A

    2014-07-01

    Futility has been a contentious topic in medicine for several decades. Surgery in critical or end-of-life situations often raises difficult questions about futility. In this article, we discuss the definition of futility, methods for resolving futility disputes, and some ways to reframe the futility debate to a more fruitful discussion about the goals of care, better communication between surgeon and patient/surrogate, and palliative surgical care. Many definitions of futile therapy have been discussed. The most controversial of these is "qualitative futility" which describes a situation in which the treatment provided is likely to result in an unacceptable quality of life. This is an area of continued controversy because it has been impossible to identify universally held beliefs about acceptable quality of life. Many authors have described methods for resolving futility disputes, including community standards and legalistic multi-step due process protocols. Others, however, have abandoned the concept of futility altogether as an unhelpful term. Reframing the issue of futility as one of inadequate physician-patient communication, these authors have advocated for methods of improving communication and strengthening the patient-physician relationship. Finally, we discuss the utilization of consultants who may be of use in resolving futility disputes: ethics committees, palliative care specialists, pastoral care teams, and dedicated patient advocates. Involving these specialists in a futility conflict can help improve communication and provide invaluable assistance in arriving at the appropriate treatment decision. PMID:24849199

  7. [Continent cecal-colonic reservoir. Surgical technique].

    PubMed

    Del Boca, C; Ferrari, C; Zanoni, V; Dieci, G; Grignani, G C; Musci, R

    1990-09-30

    The Authors discuss a recent case report treated with radial cystectomy associated with a secondary urinary derivation using the caecum-colon reservoir. After having reviewed the various surgical procedures involving the urinary derivations, the Authors describe the technique used by them paying particular attention to the positive aspects of having a low filling pressure reservoir controlled by a valid sphincter ileum-caecum valve. Considering the good postoperative result with this method, the Authors regard this procedure as an alternative to other urinary derivation techniques when carried out with correct indications. PMID:2287469

  8. History and evolution of surgical ethics: John Gregory to the twenty-first century.

    PubMed

    Namm, Jukes P; Siegler, Mark; Brander, Caroline; Kim, Tae Yeon; Lowe, Christian; Angelos, Peter

    2014-07-01

    As surgery grew to become a respected medical profession in the eighteenth century, medical ethics emerged as a response to the growing need to protect patients and maintain the public's trust in physicians. The early influences of John Gregory and Thomas Percival were instrumental in the formulation of patient-centered medical ethics. In the late nineteenth century, the modern surgical advances of anesthesia and antisepsis created the need for a discipline of ethics specific to surgery in order to confront new and evolving ethical issues. One of the founding initiatives of the American College of Surgeons in 1913 was to eliminate unethical practices such as fee-splitting and itinerant surgery. As surgery continued to advance in the era of solid organ transplantation and minimally invasive surgery in the latter half of the twentieth century, surgical innovation and conflict of interest have emerged as important ethical issues moving forward into the twenty-first century. Surgical ethics has evolved into a distinct branch of medical ethics, and the core of surgical ethics is the surgeon-patient relationship and the surgeon's responsibility to advance and protect the well-being of the patient. PMID:24763442

  9. [Salter innominate osteotomy : Indications, surgical technique, results].

    PubMed

    Schulze, A; Tingart, M

    2016-08-01

    The prevalence of congenital hip dysplasia in Germany is 2-4 % and that of hip dislocation is 0.5-1 %. If early therapy is not successful or the hip dysplasia or dislocation is diagnosed too late (children of over 1 year of age) surgical treatment is indicated to increase the femoral coverage. The innominate osteotomy, published by Robert B. Salter 1961, is a worldwide established technique to improve the lateral and ventral coverage of the femoral head in primary or secondary hip dysplasia or dislocation. In this paper we discuss Salter's technique and present indications, the perioperative procedure, operative modifications and operative extensions and demonstrate the anatomical requirements, postoperative biomechanical changes and long-term results. PMID:27351429

  10. Surgical techniques in type A dissection

    PubMed Central

    Hussain, Syed T.

    2016-01-01

    Acute aortic dissection is a surgical emergency that must be urgently managed, with the primary goal of restoring flow to the dominant true lumen in the downstream aorta. Our preference at the Cleveland Clinic is for an open distal anastomosis technique without aortic clamping, as it permits more accurate approximation of dissected layers and more homeostatically secure anastomosis. During this procedure we employ right axillary end-to-side graft perfusion, followed by deep hypothermic circulatory arrest and antegrade brain perfusion. The distal anastomosis is performed without felt strips or glue. Critical to achieving a successful outcome is meticulous de-airing of the arch, diligent myocardial protection, and a water-tight anastomosis prior to discontinuing cardiopulmonary bypass. PMID:27386412

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

    PubMed

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

    2010-09-01

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

  12. Sternoclavicular dislocation: case report and surgical technique.

    PubMed

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of

  13. Ethics and genomic medicine, how to navigate decisions in surgical oncology.

    PubMed

    Devon, Karen M; Lerner-Ellis, Jordan P; Ganai, Sabha; Angelos, Peter

    2015-01-01

    Using genetic information to make medical decisions and tailor treatments to individuals will likely provide major benefits and become an important part of health care. Surgical oncologists must ethically apply scientific genetic information in a complex and evolving environment to the benefit of their patients. In this review we address ethical issues associated with: indications for genetic testing, informed consent for testing and therapy, confidentiality, targeted therapy, prophylactic surgery, and genetic testing in children. PMID:25183289

  14. EVALUATION OF ETHICAL IN INSTRUCTIONS TO AUTHORS OF BRAZILIAN SURGICAL JOURNALS

    PubMed Central

    TEIXEIRA, Renan Kleber Costa; YAMAKI, Vitor Nagai; PONTES, Ruy Victor Simões; BRITO, Marcus Vinicius Henriques; da SILVA, José Antonio Cordero

    2015-01-01

    Background: The instructions to authors are the only means of communication between researchers and the editorial standards of a scientific journal. One of the mandatory items to be contained therein is about the ethical part, to prevent new research to carry out abuses with the enrolled on the research are published and stimulated. Aim: To verify the ethical questions on the guidelines of Brazilian surgical journals Method: Thirteen selected journals were divided into two groups: general surgery (n=3), and surgical specialty (n=10). The instructions to authors were analyzed by the quote of ethical requirements based on a specific research protocol, ranging from zero to six points. Results: The average score of the general surgery group was similar than that of the surgical specialty group (3.66±0.57 vs 3.30±1.15, p=0.6154). When each ethical requirement was compared between the groups, there was no significant difference between the ethical requirements (p<0.05). Conclusion: There was respect for most ethical questions evaluated, with no difference between the journals of general or specialty surgery. PMID:26734793

  15. Evolving Educational Techniques in Surgical Training.

    PubMed

    Evans, Charity H; Schenarts, Kimberly D

    2016-02-01

    Training competent and professional surgeons efficiently and effectively requires innovation and modernization of educational methods. Today's medical learner is quite adept at using multiple platforms to gain information, providing surgical educators with numerous innovative avenues to promote learning. With the growth of technology, and the restriction of work hours in surgical education, there has been an increase in use of simulation, including virtual reality, robotics, telemedicine, and gaming. The use of simulation has shifted the learning of basic surgical skills to the laboratory, reserving limited time in the operating room for the acquisition of complex surgical skills". PMID:26612021

  16. [Robot-assisted radical prostatectomy: surgical techniques].

    PubMed

    Kojima, Yoshiyuki; Sato, Yuichi; Ogawa, Soichiro; Haga, Nobuhiro; Yanagida, Tomohiko

    2016-01-01

    Robot-assisted radical prostatectomy (RARP) for the patients with localized prostate cancer is increasingly being adopted around the world. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) provides the advantages of simplification and precision of exposure and suturing because of allowing movements of the robotic arm in real time with increased degree of freedom and magnified 3-dimensional view. Therefore, RARP has been expected to provide superior therapeutic benefit to patients in terms of surgical outcome to open or laparoscopic radical prostatectomy. In this review, we provide our technical aspects and tips and tricks of RARP to improve surgical outcome and postoperative quality of life. PMID:26793888

  17. Contentious Conversations: Using Mediation Techniques in Difficult Clinical Ethics Consultations.

    PubMed

    Fiester, Autumn

    2015-01-01

    Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)-and surely the least discussed-are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in distinguishing positions from interests and describes a set of strategies for managing contentious ethics consultations or working with "difficult" patients, families, or patient-careprovider interactions. PMID:26752387

  18. Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit.

    PubMed

    Sur, Malini D; Angelos, Peter

    2016-08-01

    A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications. Unlike that of the surgeon, the intensivist's relationship with the individual patient must be balanced with the need to serve other acutely ill patients. Due to their unique perspectives, surgeons and intensivists may disagree about decisions to pursue life-sustaining therapies for critically ill postoperative patients. Finally, although surrogates are asked to make decisions for patients on the basis of the substituted judgment or best interest standards, these models may underestimate the nuances of postoperative surrogate decision making. Strategies to minimize conflicts regarding treatment decisions are centered on early, honest, and consistent communication between all parties. PMID:25990272

  19. Computer-Assisted Technique for Surgical Tooth Extraction.

    PubMed

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures. PMID:27127510

  20. Computer-Assisted Technique for Surgical Tooth Extraction

    PubMed Central

    Hamza, Hosamuddin

    2016-01-01

    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures. PMID:27127510

  1. Case report of autogynophilia--family, ethical and surgical implications.

    PubMed

    Duisin, Dragana; Barisić, Jasmina; Nikolić-Balkoski, Gordana

    2009-06-01

    Through the case presentation of a diagnostically and therapeutically interesting gender dysphoric individual, the authors wish to address diagnostic problems associated with this controversial category, illustrate dilemmas and emphasize the importance of diagnostic procedures in differentiating between primary transsexualism and other transgender states. Many questions have been triggered by this case, mainly about whether this patient should be classified as a paraphilia (transvestite, transvestite with transsexual trend), primary transsexualism or autogynephilia and about the most adequate treatment (e.g., sex-reassignment surgery, hormone therapy as a way of partial feminisation or exclusively psychotherapy). The issue of reconstructive surgery, i.e. its justification in the case of this particular condition is specifically discussed. Before any decision is made, both medical but also ethical consequences of the treatment choice need to be considered (e.g., the client is the father of two underage children). PMID:19556956

  2. Development of the implant surgical technique and assessment rating system

    PubMed Central

    Park, Jung-Chul; Hwang, Ji-Wan; Lee, Jung-Seok; Jung, Ui-Won; Choi, Seong-Ho; Cho, Kyoo-Sung; Chai, Jung-Kiu

    2012-01-01

    Purpose There has been no attempt to establish an objective implant surgical evaluation protocol to assess residents' surgical competence and improve their surgical outcomes. The present study presents a newly developed assessment and rating system and simulation model that can assist the teaching staffs to evaluate the surgical events and surgical skills of residents objectively. Methods Articles published in peer-reviewed English journals were selected using several scientific databases and subsequently reviewed regarding surgical competence and assessment tools. Particularly, medical journals reporting rating and evaluation protocols for various types of medical surgeries were thoroughly analyzed. Based on these studies, an implant surgical technique assessment and rating system (iSTAR) has been developed. Also, a specialized dental typodont was developed for the valid and reliable assessment of surgery. Results The iSTAR consists of two parts including surgical information and task-specific checklists. Specialized simulation model was subsequently produced and can be used in combination with iSTAR. Conclusions The assessment and rating system provided may serve as a reference guide for teaching staffs to evaluate the residents' implant surgical techniques. PMID:22413071

  3. Equine thoracoscopy: normal anatomy and surgical technique.

    PubMed

    Peroni, J F; Horner, N T; Robinson, N E; Stick, J A

    2001-05-01

    Six normal, healthy horses age 3-10 years underwent left and right thoracoscopic examination using a rigid telescope. A minimum of 30 days was allowed between procedures. Horses were restrained in stocks and sedated with a continuous detomidine infusion. After surgical preparation of the hemithorax elected for surgery, and administration of local or regional anaesthesia of the surgery sites, thoracoscopy was completed during two 15 min pneumothorax periods. During the procedures, the thoracic structures were viewed using a 57 cm, 10 mm diameter, 30 degrees rigid telescope connected to a digital camcorder to allow computer capture of digital images. The telescope was inserted into the thoracic cavity via 3 different intercostal spaces. The 8th, 10th and 12th intercostal spaces were randomly selected and used among horses. The exploration of each hemithorax started from the dorsal-caudal quadrant continued toward the cranial thorax and was completed by observing the diaphragmatic and caudal pulmonary region. Collapsed lung, aorta, oesophagus and diaphragm were viewed readily in either hemithorax. On exploration of the right hemithorax, the azygos vein, thoracic duct and pulmonary veins were also identified. Horses tolerated thoracoscopy well. Signs of discomfort, such as increased respiratory rate, coughing and decreased level of sedation, were associated with lung collapse in one horse, with pneumothorax on 2 occasions, and when the thorax was approached through the 8th intercostal space. Surgery performed via the 8th intercostal space was hindered by the rigidity of the 8th and 9th ribs, and by the presence of a greater musculature, which did not allow easy cranial and caudal movements of the telescope. PMID:11352343

  4. Innovation in pediatric surgery: the surgical innovation continuum and the ETHICAL model.

    PubMed

    Schwartz, Jennifer A T

    2014-04-01

    Innovations are indispensable to the practice and advancement of pediatric surgery. Children represent a special type of vulnerable population and must be protected since they do not have legal capacity to consent, and their parent's judgment may be compromised in circumstances when the child is very ill or no adequate therapy exists. In an effort to protect patients, legislators could pass and enforce laws that prohibit or curtail surgical innovations and thus stifle noble advancement of the practice. The goals of this paper are, 1) To clearly define the characteristics of surgical innovation types so interventions may be classified into 1 of 3 distinct categories along a continuum: Practice Variation, Transition Zone, and Experimental Research, and 2) To propose a practical systematic method to guide surgeon decision-making when approaching interventions that fall into the "Transition Zone" category on the Surgical Intervention Continuum. The ETHICAL model allows those that know the intricacies and nuances of pediatric surgery best, the pediatric surgeons and professional pediatric surgical societies, to participate in self-regulation of innovation in a manner that safeguards patients without stifling creativity or unduly hampering surgical progress. PMID:24726128

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

    PubMed Central

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

    2011-01-01

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

  6. HOSPITALIZATION TIME AFTER OPEN APPENDECTOMY BY THREE DIFFERENT SURGICAL TECHNIQUES

    PubMed Central

    XIMENES, Agláia Moreira Garcia; MELLO, Fernando Salvo Torres; de LIMA-JÚNIOR, Zailton Bezerra; FERREIRA, Cícero Faustino; CAVALCANTI, Amanda Dantas Ferreira; DIAS-FILHO, Adalberto Vieira

    2014-01-01

    Background The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated. Aim To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis. Methods Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days). Results A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186. Conclusion There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller. PMID:25184769

  7. Surgical treatment for stress urinary incontinence in women: novelties, concerns and ethics.

    PubMed

    Zimmern, Philippe E

    2012-01-01

    The International Continence Society (ICS) is the largest international body of nurses, physical therapists, drug researchers, clinicians, gynecologists, urologists and other specialists united yearly to discuss the topic of incontinence. This year, over 2500 attendees from all over the world participated in the annual meeting held in Glasgow, Scotland. Several presentations deserve recognition, but we will focus on a few key issues, such as the latest information on the surgical treatment of stress urinary incontinence, a novel approach to patient's study participation in randomized controlled trials via internet recruitment, and ethical concerns related to disclosure and transparency, as these are keenly relevant topics in women's health. PMID:22171771

  8. Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique.

    PubMed

    Ionna, Franco; Amantea, Massimiliano; Mastrangelo, Filiberto; Ballini, Andrea; Maglione, Maria Grazia; Aversa, Corrado; De Cecio, Rossella; Russo, Daniela; Marrelli, Massimo; Tatullo, Marco

    2016-07-01

    Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease. PMID:27300457

  9. Improving Skill Development: An Exploratory Study Comparing a Philosophical and an Applied Ethical Analysis Technique

    ERIC Educational Resources Information Center

    Al-Saggaf, Yeslam; Burmeister, Oliver K.

    2012-01-01

    This exploratory study compares and contrasts two types of critical thinking techniques; one is a philosophical and the other an applied ethical analysis technique. The two techniques analyse an ethically challenging situation involving ICT that a recent media article raised to demonstrate their ability to develop the ethical analysis skills of…

  10. Some Observations on Veterinary Undergraduate Training in Surgical Techniques.

    ERIC Educational Resources Information Center

    Whittick, William G.

    1978-01-01

    The undergraduate surgery course of the Faculty of Veterinary Medicine and Animal Science, Universiti Pertanian Malaysia, is described with focus on its experential method of teaching surgical techniques. Also discussed are the benefits of veterinary school cooperation with a large city Society for the Prevention of Cruelty to Animals (SPCA). (JMD)

  11. Surgical implantation techniques for electronic tags in fish

    SciTech Connect

    Wagner, Glenn N.; Cooke, Steven J.; Brown, Richard S.; Deters, Katherine A.

    2011-01-01

    Intracoelomic implantation of transmitters into fish requires making a surgical incision, incision closure, and other surgery related techniques; however, the tools and techniques used in the surgical process vary widely. We review the available literature and focus on tools and techniques used for conducting surgery on juvenile salmonids because of the large amount of research that is conducted on them. The use of sterilized surgical instruments properly selected for a given size of fish will minimize tissue damage and infection rates, and speed the wound healing of fish implanted with transmitters. For the implantation of transmitters into small fish, the optimal surgical methods include making an incision on the ventral midline along the linea alba (for studies under 1 month), protecting the viscera (by lifting the skin with forceps while creating the incision), and using absorbable monofilament suture with a small-swaged-on swaged-on tapered or reverse-cutting needle. Standardizing the implantation techniques to be used in a study involving particular species and age classes of fish will improve survival and transmitter retention while allowing for comparisons to be made among studies and across multiple years. This review should be useful for researchers working on juvenile salmonids and other sizes and species of fish.

  12. Surgical techniques for advanced stage pelvic organ prolapse.

    PubMed

    Brown, Douglas N; Strauchon, Christopher; Gonzalez, Hector; Gruber, Daniel

    2016-02-01

    Pelvic organ prolapse is an extremely common condition, with approximately 12% of women requiring surgical correction over their lifetime. This manuscript reviews the most recent literature regarding the comparative efficacy of various surgical repair techniques in the treatment of advanced stage pelvic organ prolapse. Uterosacral ligament suspension has similar anatomic and subjective outcomes when compared to sacrospinous ligament fixation at 12 months and is considered to be equally effective. The use of transvaginal mesh has been shown to be superior to native tissue vaginal repairs with respect to anatomic outcomes but at the cost of a higher complication rate. Minimally invasive sacrocolpopexy appears to be equivalent to abdominal sacrocolpopexy (ASC). Robot-assisted sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC) appear as effective as abdominal sacrocolpopexy, however, prospective studies of comparing long-term outcomes of ASC, LSC, and RSC in relation to health care costs is paramount in the near future. Surgical correction of advanced pelvic organ prolapse can be accomplished via a variety of proven techniques. Selection of the correct surgical approach is a complex decision process and involves a multitude of factors. When deciding on the most suitable surgical intervention, the chosen route must be individualized for each patient taking into account the specific risks and benefits of each procedure. PMID:26448444

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

    PubMed

    Lee, Tae Sung

    2015-12-01

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

  14. Improving skill development: an exploratory study comparing a philosophical and an applied ethical analysis technique

    NASA Astrophysics Data System (ADS)

    Al-Saggaf, Yeslam; Burmeister, Oliver K.

    2012-09-01

    This exploratory study compares and contrasts two types of critical thinking techniques; one is a philosophical and the other an applied ethical analysis technique. The two techniques analyse an ethically challenging situation involving ICT that a recent media article raised to demonstrate their ability to develop the ethical analysis skills of ICT students and professionals. In particular the skill development focused on includes: being able to recognise ethical challenges and formulate coherent responses; distancing oneself from subjective judgements; developing ethical literacy; identifying stakeholders; and communicating ethical decisions made, to name a few.

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

    NASA Astrophysics Data System (ADS)

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

    1999-06-01

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

  16. Halstedian technique revisited. Innovations in teaching surgical skills.

    PubMed Central

    Barnes, R W; Lang, N P; Whiteside, M F

    1989-01-01

    This paper reviews the laboratory models used to teach fundamental surgical skills in our general surgery residency. The laboratory modules allow supervision and self-instruction, practice, and videotape monitoring of the following techniques: skin incision, suturing, knot tying, hemostasis, vascular anastomosis, and intestinal anastomosis. Pigs' feet simulate human skin for exercises in skin incision, lesion excision, suturing, and basic plastic surgical techniques. Latex tubing and penrose drains allow experience in suturing, knot tying, and hemostasis. Polytetrafluoroethylene vascular prostheses permit quantification of the precision of needle passage and suturing by measurement of leakage of water through a vascular anastomosis. Reconstituted, lyophilized, irradiated bovine arteries and ileum provide models of biologic tissue for creating handsewn vascular anastomoses and sutured or stapled gastrointestinal anastomoses. A headlamp videocamera allows unobstructive recording of the resident's technical performance and provides subsequent visual feedback for self-improvement when compared to reference instructional videotapes. We feel that these innovations may enhance surgical dexterity of residents without the need for animal sacrifice. Our goal is to foreshorten the learning curve for basic surgical skills and improve performance in the clinical operating room. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:2742408

  17. [Surgical treatment and localization techniques in primary hyperparathyroidism].

    PubMed

    Marazuela, Mónica; Domínguez-Gadea, Luis; Manuel Bravo-Linfante, José; Larrañaga, Eduardo

    2009-04-01

    Parathyroidectomy is the only definitive cure for primary hyperparathyroidism (PHPT). While bilateral neck exploration has been the conventional surgical approach and the mainstay of therapy, recent advances in technology have revolutionized the field, making a focused or minimally invasive approach to parathyroidectomy a reality. This change has taken place because of the development of accurate preoperative localization techniques able to select patients who have single-gland parathyroid disease (single adenoma) and can be managed by a minimally invasive parathyroidectomy. Currently, the most reliable and practical diagnostic procedure is (99m)TC-sestamibi parathyroid scintigraphy, using different protocols depending on the institution's logistics and experience (classical dual-phase, oblique projections, various subtraction techniques and/or single photon-emission computed tomography or SPECT). Ultrasound has emerged as a complementary technique in the preoperative evaluation of PHPT, which can be used when scintigraphy is negative or as a confirmatory test. When these procedures fail to identify the enlarged gland, other non-invasive procedures such as computed tomographic scanning or magnetic resonance imaging are used in selected cases. A variety of surgical techniques have been employed to achieve a safe and effective minimally invasive procedure. These techniques include mini-incision unilateral parathyroid exploration and endoscopic, video-assisted and radio-guided parathyroidectomy. With optimized preoperative mapping, the success rate of these less invasive techniques equals that of the traditional bilateral approach. This review summarizes the imaging techniques and rationale for preoperative localization studies that are used before parathyroidectomy, as well as the current surgical approaches. PMID:19627757

  18. A minimally invasive surgical technique to treat distal clavicle fractures.

    PubMed

    Swanson, Kyle E; Swanson, Britta L

    2009-07-01

    Treatment of distal clavicle fractures ranges from nonoperative to operative approaches. Various surgical procedures have been described in the literature, each with potential complications. For fractures treated operatively, the goal is to maximize stability and functionality while minimizing pain and deformity. This article describes a double-button suture system using a mini-open technique to repair a distal clavicle fracture providing stable fixation with minimal disruption of the surrounding anatomy. PMID:19634845

  19. The Kock pouch reconsidered: an alternative surgical technique.

    PubMed

    Crawshaw, Alison; Williams, Julia; Woodhouse, Fran

    2014-09-24

    The psychological impact stoma surgery can have on an individual is well documented within the literature ( White and Hunt, 1997 ; Borwell, 2009 ; Williams, 2005 ; Brown, 2005 ). For many years, surgeons have explored and developed innovations in surgical techniques, in particular restorative procedures with a view of preventing permanent stoma formation; ileal anal pouch (IAP) now being the surgical procedure of choice for treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, high morbidity rates are associated with pouch longevity ( Castillo et al 2005 ; Nessar and Wu, 2012 ) and once removed can lead to a high-output ileostomy with risks of electrolyte imbalance and malabsorption. This then creates the dilemma of whether the Kock pouch (KP) should be offered as a surgical option. This article offers a historical perspective of the KP and its place in the surgical management of UC and FAP. This article also presents results from a recent audit funded by the Ileostomy Association (IA), highlighting how patients manage their KP and the importance of maintaining bowel control and being free of an incontinent stoma as a means of coming to terms with their condition. PMID:25251313

  20. Placebo in Surgical Research: A Case-Based Ethical Analysis and Practical Consequences

    PubMed Central

    Rentea, Irina

    2016-01-01

    Placebo is a form of simulated medical treatment intended to deceive the patient/subject who believes that he/she received an active therapy. In clinical medicine, the use of placebo is allowed in particular circumstances to assure a patient that he is taken care of and that he/she receives an active drug, even if this is not the case. In clinical research placebo is widely used, as it allows a baseline comparison for the active intervention. If the use of placebo is highly regulated in pharmacological trials, surgery studies have a series of particularities that make its use extremely problematic and regarded less favorably. The purpose of this paper is to present three famous cases of placebo use in surgical trials and to perform an ethical analysis of their acceptability using the Declaration of Helsinki as a main regulatory source. PMID:27595098

  1. Placebo in Surgical Research: A Case-Based Ethical Analysis and Practical Consequences.

    PubMed

    Hostiuc, Sorin; Rentea, Irina; Drima, Eduard; Negoi, Ionut

    2016-01-01

    Placebo is a form of simulated medical treatment intended to deceive the patient/subject who believes that he/she received an active therapy. In clinical medicine, the use of placebo is allowed in particular circumstances to assure a patient that he is taken care of and that he/she receives an active drug, even if this is not the case. In clinical research placebo is widely used, as it allows a baseline comparison for the active intervention. If the use of placebo is highly regulated in pharmacological trials, surgery studies have a series of particularities that make its use extremely problematic and regarded less favorably. The purpose of this paper is to present three famous cases of placebo use in surgical trials and to perform an ethical analysis of their acceptability using the Declaration of Helsinki as a main regulatory source. PMID:27595098

  2. AUDIOVISUAL RESOURCES ON THE TEACHING PROCESS IN SURGICAL TECHNIQUE

    PubMed Central

    PUPULIM, Guilherme Luiz Lenzi; IORIS, Rafael Augusto; GAMA, Ricardo Ribeiro; RIBAS, Carmen Australia Paredes Marcondes; MALAFAIA, Osvaldo; GAMA, Mirnaluci

    2015-01-01

    Background: The development of didactic means to create opportunities to permit complete and repetitive viewing of surgical procedures is of great importance nowadays due to the increasing difficulty of doing in vivo training. Thus, audiovisual resources favor the maximization of living resources used in education, and minimize problems arising only with verbalism. Aim: To evaluate the use of digital video as a pedagogical strategy in surgical technique teaching in medical education. Methods: Cross-sectional study with 48 students of the third year of medicine, when studying in the surgical technique discipline. They were divided into two groups with 12 in pairs, both subject to the conventional method of teaching, and one of them also exposed to alternative method (video) showing the technical details. All students did phlebotomy in the experimental laboratory, with evaluation and assistance of the teacher/monitor while running. Finally, they answered a self-administered questionnaire related to teaching method when performing the operation. Results: Most of those who did not watch the video took longer time to execute the procedure, did more questions and needed more faculty assistance. The total exposed to video followed the chronology of implementation and approved the new method; 95.83% felt able to repeat the procedure by themselves, and 62.5% of those students that only had the conventional method reported having regular capacity of technique assimilation. In both groups mentioned having regular difficulty, but those who have not seen the video had more difficulty in performing the technique. Conclusion: The traditional method of teaching associated with the video favored the ability to understand and transmitted safety, particularly because it is activity that requires technical skill. The technique with video visualization motivated and arouse interest, facilitated the understanding and memorization of the steps for procedure implementation, benefiting the

  3. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    PubMed

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair. PMID:26064759

  4. Developing an Ethical Appreciation in Communication Classes: Pedagogical Techniques.

    ERIC Educational Resources Information Center

    Andersen, Kenneth E.

    Integrating ethics into a communication course is one means of advancing an understanding of ethical issues. Since textbooks in most instances will not have a substantial coverage of ethical material, the instructor can look for supplementary materials in references such as the bibliography entitled "Ethical Responsibility in Communication"…

  5. Surgical techniques and radiological findings of meniscus allograft transplantation.

    PubMed

    Lee, Hoseok; Lee, Sang Yub; Na, Young Gon; Kim, Sung Kwan; Yi, Jae Hyuck; Lim, Jae Kwang; Lee, So Mi

    2016-08-01

    Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals. This review focuses on the indications of the procedure, the different surgical techniques used for meniscus allograft transplantation according to the involvement of the lateral and medial meniscus, and the associated procedures. The postoperative radiological findings and surgical complications of the meniscus allograft transplantation are also described in detail. PMID:27423673

  6. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications.

    PubMed

    Carofino, Brad C; Mazzocca, Augustus D

    2010-03-01

    The anatomic coracoclavicular ligament reconstruction (ACCR) is a surgical procedure to address acriomioclavicular joint instability. The coracoclavicular ligaments are reconstructed using a semitendinosus allograft passed beneath the coracoid and through bone tunnels in the clavicle. The graft is secured with interference screw fixation, and the acromioclavicular joint is retained. Here we describe the authors' surgical technique, indications, and rehabilitation protocol. Also, a preliminary case series of seventeen patients is presented. Patients demonstrated significant improvement in pain levels and function. The mean ASES score increased from 52 preoperatively to 92. The Constant Murley rose from 66.6 to 94.7. There were three failures in this series, and two required revision surgery. PMID:20188267

  7. Male-to-female vaginoplasty: Preecha's surgical technique.

    PubMed

    Wangjiraniran, Burin; Selvaggi, Gennaro; Chokrungvaranont, Prayuth; Jindarak, Sirachai; Khobunsongserm, Sutin; Tiewtranon, Preecha

    2015-06-01

    The inverted peno-scrotal flap is considered the standard technique for vaginoplasty in male-to-female transsexuals. Nowadays, great importance is also given by patients to the reconstruction of the clitoro-labial complex; this is also reconstructed with tissue coming from glans penis, penile skin envelop and scrotal skin. Since the first sex reassignment surgery for biological males performed in Thailand in 1975, Dr Preecha and his team developed the surgical technique for vaginoplasty; many refinements have been introduced during the past 40 years, with nearly 3000 patients operated on. The scope of this paper is to present the surgical technique currently in use for vaginoplasty and clitoro-labioplasty and the refinements introduced at the Chulalongkorn University and at the Preecha Aesthetic Institute, Bangkok, Thailand. These refinements consist of cavity dissection with blunt technique, the use of skin graft in addition to the penile flap, shaping of the clitoris complex from penis glans and clitoral hood, and the use of the urethral mucosa to line the anterior fourchette of the neo-vagina. With the refinements introduced, it has been possible to achieve a result that is very close to the biological female genitalia. PMID:25356769

  8. Surgical repair of complete atrioventricular defect (Nunn technique).

    PubMed

    El-Rassi, Issam; Charafeddine, Fatimah; Tabbakh, Anas; Aboutaka, Mohammad; Khater, Daniele; Arabi, Mariam; Bitar, Fadi

    2015-01-01

    Two procedures have been traditionally used for the surgical repair of complete atrioventricular canal. The single-patch technique includes the division of valve leaflets, and the use of one patch to close the ventricular and the atrial septal defects, whereas the double-patch technique uses two separate patches, without the division of the bridging leaflets. Between 1997 and 2007, another technique emerged, the modified single-patch technique, or the 'Australian' technique, whereby the ventricular septal defect (VSD) is closed by the direct apposition of the bridging leaflets against the crest of the defect. Because of the absence of the ventricular septal patch, concerns have been raised about the possible left ventricular outflow tract obstruction (LVOTO), or atrioventricular valve (AVV) distortion, especially in case of a deep VSD, or if the defect extends superiorly. The results of the modified single-patch technique in terms of mortality, immediate and long-term AVV function and LVOTO have been similar to the standard techniques in most reports. This article will describe in detail the operative technique and review the relevant literature. PMID:26443542

  9. Deep Anterior Lamellar Keratoplasty: Indications, Surgical Techniques and Complications

    PubMed Central

    Karimian, Farid; Feizi, Sepehr

    2010-01-01

    The concept of lamellar keratoplasty (LK) is not new. However, it had been abandoned and largely replaced by the time-honored technique of penetrating keratoplasty (PK) because LK is technically demanding, time consuming and gives suboptimal visual outcomes due to interface irregularity arising from manual lamellar dissection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as inherent advantages such as preservation of globe integrity and elimination of endothelial graft rejection have resulted in a re-introduction of LK as an acceptable alternative to conventional PK. This review article describes the indications, different techniques, clinical outcomes and complications of deep anterior LK. PMID:20543934

  10. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique

    PubMed Central

    Kyriazanos, Ioannis D.; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5–3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of “intentional open abdomen” was described and both clinical entities share common pathophysiological and clinical pathways (“postoperative open abdominal wall”). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as “frozen abdomen,” where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the “Coliseum technique” for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of “malignant” frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair. PMID:26064759

  11. Arthroscopic Surgical Techniques for the Management of Proximal Biceps Injuries.

    PubMed

    Werner, Brian C; Holzgrefe, Russell E; Brockmeier, Stephen F

    2016-01-01

    Current arthroscopic surgical techniques for the management of proximal biceps tendon disorders encompass 3 commonly advocated procedures: proximal biceps anchor reattachment (superior labrum anterior to posterior or SLAP repair), biceps tenotomy, and arthroscopic biceps tenodesis. The indications for each procedure vary based on injury pattern, symptomatic presentation, concomitant pathologic abnormality, and most notably, patient factors, such as age, functional demand, and specific sport or activity participation. Outcomes after SLAP repair are generally favorable, although recent studies have found biceps tenodesis to be the preferred treatment for certain patient populations. PMID:26614472

  12. A new plastic surgical technique for adult congenital webbed penis

    PubMed Central

    Chen, Yue-bing; Ding, Xian-fan; Luo, Chong; Yu, Shi-cheng; Yu, Yan-lan; Chen, Bi-de; Zhang, Zhi-gen; Li, Gong-hui

    2012-01-01

    Objective: To introduce a novel surgical technique for correction of adult congenital webbed penis. Methods: From March 2010 to December 2011, 12 patients (age range: 14–23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. Results: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. Conclusions: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results. PMID:22949367

  13. Surgical techniques and innovations in living related liver transplantation.

    PubMed Central

    Tanaka, K; Uemoto, S; Tokunaga, Y; Fujita, S; Sano, K; Nishizawa, T; Sawada, H; Shirahase, I; Kim, H J; Yamaoka, Y

    1993-01-01

    The authors successfully performed a series of 33 living related liver transplantations (LRLT) on children (15 males and 18 females, ranging from 7 months to 15 years of age) from June 1990 to May 1992, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. Before operation, six of the children required intensive care, another 14 were hospitalized, and 13 were homebound. Donors (12 paternal and 21 maternal) were selected solely from the parents of the recipients on the basis of ABO blood group and graft/recipient size matching determined by computed tomography scanning. Procurement of graft was performed using ultrasonic aspirator and bipolar electrocautery without blood vessel clamping and without graft manipulation. All donors subsequently had normal liver function and returned to normal life. The left lateral segment (16 cases), left lobe (16 cases), or right lobe (one case) were used as grafts. The partial liver graft was transplanted into the recipient who underwent total hepatectomy with preservation of the inferior vena cava using a vascular side clamp. Twenty-seven of 33 recipients are alive and well with the original graft and have normal liver function. The patient survival rate was 89% (24/27) in elective cases and 50% (3/6) in emergent cases. The other six recipients had functioning grafts but died of extrahepatic complications. Complications of the graft were minimal in all cases. Hepatic vein stenosis, which occurred three times in two cases, was successfully treated by balloon dilatation. In cases with sclerotic portal vein, the authors anastomosed the portal vein of the graft to the confluence of the splenic vein and the superior mesenteric vein without a vascular graft, after experiencing a case of vascular graft thrombosis. After hepatic artery thrombosis occurred in one of the initial seven recipients whose arterial anastomosis was done with surgical loupe, microsurgery was introduced for hepatic

  14. Tactical and surgical techniques issues in the surgical treatment of incisional hernias

    PubMed Central

    Gangură, AG; Palade, RŞ

    2014-01-01

    Abstract Within five years, between 2006 and 2011, a total of 368 incisional hernias have been operated in the Surgery Clinic 1, University Emergency Hospital Bucharest. The study followed the morphological and biological parameters, associated pathology, tactics and surgical technique used and postoperative morbidity. The average age of patients was 61.75 years, female sex was predominant (81.25%), and incisional hernias were large and giant in a percentage of 73.37%. Locations were predominantly median (83.42%). Recurrent incisional hernias and multiple relapsed hernias represented 25.54%. Associated pathology was dominated by obesity (51,09%) and cardiovascular disease (37,77%). We have used both methods of tissue procedures (22.83%), and the prosthetic procedures (77.17%). Prosthetic techniques, retro muscle fitting mesh in the rectus abdominis muscle sheath (Rives-Stoppa technique), fitting ov er the fascia and tissue replacement techniques were performed. Immediate postoperative morbidity was represented by seroma (14.13%), prolonged postoperative ileus (8.69%), prolonged hematic drainage (6.52%), and hematoma (1.9%). Late postoperative morbidity was given by granulomas (5.7%) and recurrence of incisional hernias (4.34%). Good and very good results were obtained in the 89.96% of the operated cases. PMID:25408770

  15. Effect of Surgical Technique on Corneal Implant Performance

    PubMed Central

    Ljunggren, Monika Kozak; Elizondo, Rodolfo A.; Edin, Joel; Olsen, David; Merrett, Kimberley; Lee, Chyan-Jang; Salerud, Göran; Polarek, James; Fagerholm, Per; Griffith, May

    2014-01-01

    Purpose Our aim was to determine the effect of a surgical technique on biomaterial implant performance, specifically graft retention. Methods Twelve mini pigs were implanted with cell-free, 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC)/N-hydroxysuccinimide (NHS) cross-linked recombinant human collagen type III (RHCIII) hydrogels as substitutes for donor corneal allografts using overlying sutures with or without human amniotic membrane (HAM) versus interrupted sutures with HAM. The effects of the retention method were compared as well as the effects of collagen concentration (13.7% to 15% RHCIII). Results All implanted corneas showed initial haze that cleared with time, resulting in corneas with optical clarity matching those of untreated controls. Biochemical analysis showed that by 12 months post operation, the initial RHCIII implants had been completely remodeled, as type I collagen, was the major collagenous protein detected, whereas no RHCIII could be detected. Histological analysis showed all implanted corneas exhibited regeneration of epithelial and stromal layers as well as nerves, along with touch sensitivity and tear production. Most neovascularization was seen in corneas stabilized by interrupted sutures. Conclusions This showed that the surgical technique used does have a significant effect on the overall performance of corneal implants, overlying sutures caused less vascularization than interrupted sutures. Translational Relevance Understanding the significance of the suturing technique can aid the selection of the most appropriate procedure when implanting artificial corneal substitutes. The same degree of regeneration, despite a higher collagen content indicates that future material development can progress toward stronger, more resistant implants. PMID:24749003

  16. Confidentiality and the physician-patient relationship -- ethical reflections from a surgical waiting room.

    PubMed

    Clark, Peter A

    2002-11-01

    The physician-patient relationship is the primary focus of ethics in medicine. It is both a personal and a professional relationship that is founded on trust, confidence, dignity and mutual respect. Trust is the bridge to the physician-patient relationship, and the burden is on the physician not only to expect the patient's trust but also to build a solid foundation upon which the patient can place his or her trust. Great strides have been made by physicians in refining the physician-patient relationship especially in understanding and respecting the patients' right of self-determination regarding medical decision-making and protecting their rights of privacy and confidentiality. However, further refinements are needed on both sides regarding this relationship. Breaches of confidentiality are occurring in places like surgical waiting rooms and as a result, the physician-patient relationship is being damaged. This article identifies some legitimate concerns and offers some concrete solutions so that the physician-patient relationship can be further refined and the virtues and rights that support it can be reinforced. PMID:12444393

  17. [Osteosynthesis of the clavicle. Indications, surgical technique, results].

    PubMed

    Lindenmaier, H L; Kuner, E H; Becker, B

    1991-05-01

    The osteosynthesis of the clavicle should be the exception and should only be indicated in the case of complicated fractures. The high rate of pseudoarthrosis given in medical literature, is due to errors in indication, selection of implants and in surgical techniques. Procedures like intramedullar wiring, axial screwing and single cerclage-wire suture are unsuited for osteosynthesis of the clavicle. After osteosynthesis of the clavicle we have found exceptional positive results, with respect to functional, radiological and after subjective evaluation, at a low rate of complication without any consequences occurring in the years to come. These results show, that mainly good or even excellent success can be achieved, at a limited indication, combined with careful surgery and a standardized surgery procedure of osteosynthesis of the clavicle. PMID:1874044

  18. Superciliary Keyhole Approach for Unruptured Anterior Circulation Aneurysms: Surgical Technique, Indications, and Contraindications

    PubMed Central

    2014-01-01

    Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications. PMID:25535512

  19. Traumatic laryngotracheal stenosis--an alternative surgical technique.

    PubMed

    Syal, Rajan; Tyagi, Isha; Goyal, Amit

    2006-02-01

    Reconstruction of combined laryngotracheal stenosis requires complex techniques including resection and incorporation of grafts and stents that can be performed as single or multistaged procedure. A complicated case of traumatic laryngotracheal stenosis was managed by us, surgical technique is discussed. A 16-year-old male presented with Stage-3 laryngotracheal stenosis of grade-3 to 4 (>70% of the complete obstruction of tracheal lumen) of 5 cm segment of the larynx and trachea. Restoration of the critical functions of respiration and phonation was achieved in this patient by resection anastomosis of the trachea and with subglottic remodeling. Resection of 5 cm long segment of trachea and primary anastomosis in this case would have created tension at the site of anastomosis. So we did tracheal resection of 3 cm segment of trachea along with subglottic remodeling instead of removing the 5 cm segment of stenosed laryngotracheal region and doing thyrotracheal anastomosis. In complicated long segment, laryngotracheal stenosis, tracheal resection and subglottic remodeling with primary anastomosis can be an alternative approach. Fibrin glue can be used to support free bone/cartilage grafts in laryngotracheal reconstructions. PMID:16102847

  20. The Ethics of Breast Surgery.

    PubMed

    Throckmorton, Alyssa; VanderWalde, Lindi; Brackett, Craig; Dominici, Laura; Eisenhauer, Thomas; Johnson, Nathalie; Kong, Amanda; Ludwig, Kandice; O'Neill, Jennifer; Pugliese, Matthew; Teller, Paige; Sarantou, Terry

    2015-10-01

    Breast surgery has evolved as a subspecialty of general surgery and requires a working knowledge of benign and malignant diseases, surgical techniques, shared decision-making with patients, collaboration with a multi-disciplinary team, and a basic foundation in surgical ethics. Ethics is defined as the practice of analyzing, evaluating, and promoting best conduct based upon available standards. As new information is obtained or as cultural values change, best conduct may be re-defined. In 2014, the Ethics Committee of the ASBrS acknowledged numerous ethical issues, specific to the practice of breast surgery. This independent review of ethical concerns was created by the Ethics Committee to provide a resource for ASBrS members as well as other surgeons who perform breast surgery. In this review, the professional, clinical, research and technology considerations that breast surgeons face are reviewed with guidelines for ethical physician behavior. PMID:26219240

  1. Beneficent persuasion: techniques and ethical guidelines to improve patients' decisions.

    PubMed

    Swindell, J S; McGuire, Amy L; Halpern, Scott D

    2010-01-01

    Physicians frequently encounter patients who make decisions that contravene their long-term goals. Behavioral economists have shown that irrationalities and self-thwarting tendencies pervade human decision making, and they have identified a number of specific heuristics (rules of thumb) and biases that help explain why patients sometimes make such counterproductive decisions. In this essay, we use clinical examples to describe the many ways in which these heuristics and biases influence patients' decisions. We argue that physicians should develop their understanding of these potentially counterproductive decisional biases and, in many cases, use this knowledge to rebias their patients in ways that promote patients' health or other values. Using knowledge of decision-making psychology to persuade patients to engage in healthy behaviors or to make treatment decisions that foster their long-term goals is ethically justified by physicians' duties to promote their patients' interests and will often enhance, rather than limit, their patients' autonomy. We describe techniques that physicians may use to frame health decisions to patients in ways that are more likely to motivate patients to make choices that are less biased and more conducive to their long-term goals. Marketers have been using these methods for decades to get patients to engage in unhealthy behaviors; employers and policy makers are beginning to consider the use of similar approaches to influence healthy choices. It is time for clinicians also to make use of behavioral psychology in their interactions with patients. PMID:20458111

  2. Moral dilemmas in surgical training: intent and the case for ethical ambiguity.

    PubMed Central

    Newton, M J

    1986-01-01

    It is often assumed that the central problem in a medical ethics issue is determining which course of action is morally correct. There are some aspects of ethical issues that will yield to such analysis. However, at the core of important medical moral problems is an irreducible dilemma in which all possible courses of action, including inaction, seem ethically unsatisfactory. When facing these issues ethical behaviour depends upon an individual's understanding and acceptance of this painful dilemma without recourse to external moral authority. PMID:3806633

  3. Perineal Urethrostomy: Surgical and Functional Evaluation of Two Techniques

    PubMed Central

    Decaestecker, Karel; Spinoit, Anne-Francoise; Hoebeke, Piet; Oosterlinck, Willem

    2015-01-01

    Introduction. PU is an option to manage complex and/or recurrent urethral strictures and is necessary after urethrectomy and/or penectomy. PU is generally assumed to be the last option before abandoning the urethral outlet. Methods. Between 2001 and 2013, 51 patients underwent PU. Mean age (± standard deviation) was 60 ± 15 years. Only 13 patients (25.5%) did not undergo previous urethral interventions. PU was performed according to the Johanson (n = 35) or Blandy (n = 16) technique and these 2 groups were compared for surgical failure, maximum urinary flow (Qmax), urinary symptoms, and quality of life (according to the International Prostate Symptom Score). Results. Both groups were similar for patient's and stricture characteristics. Only follow-up duration was significantly longer after Johanson PU (47.9 months versus 11.1 months; P = 0.003). For the entire cohort, 11 patients (21.6%) were considered a failure (9 or 25.7% for Johanson group and 2 or 12.5% for Blandy group; P = 0.248). There was a significant improvement of Qmax in both groups. Quality of life after PU was comparable in both groups. Conclusions. PU is associated with a 21.6% recurrence rate and the patient should be informed about this risk. PMID:25789316

  4. LESS living donor nephrectomy: Surgical technique and results

    PubMed Central

    Alessimi, Abdullah; Adam, Emilie; Haber, Georges-Pascal; Badet, Lionel; Codas, Ricardo; Fehri, Hakim Fassi; Martin, Xavier; Crouzet, Sébastien

    2015-01-01

    Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity. PMID:26229326

  5. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications

    PubMed Central

    Kamath, Atul F

    2016-01-01

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation. PMID:27190755

  6. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

    PubMed

    Kamath, Atul F

    2016-05-18

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation. PMID:27190755

  7. Periodontal plastic surgical technique for gingival fenestration closure.

    PubMed

    Peacock, M E; Mott, D A; Cuenin, M F; Hokett, S D; Fowler, E B

    2001-01-01

    Gingival fenestration is an opening through oral keratinized tissue, usually unattached, that is observed in thin gingiva with usually thick subgingival calculus deposits. This lesion is seen infrequently but may be more common than has been reported; lack of symptoms may inhibit patient awareness. Because surgical correction usually is not required, there are very few reports in the literature concerning this lesion. The following report describes a case of gingival fenestration and surgical treatment with a connective tissue/periosteal graft. PMID:12016683

  8. Digital imaging of surgical specimens using a wet scanning technique

    PubMed Central

    Matthews, T; Denney, P

    2001-01-01

    Aim—To develop a simple method of recording digital images of surgical specimens on to a personal computer (PC) for use in presentations for teaching and reporting of their pathology. Methods—A perspex box was constructed to international A4 size 100 mm deep. This box had a base of 3 mm clear perspex with sides and top of 5 mm white perspex. This box was partially filled with distilled water and a specimen immersed in it. It was then placed on top of a standard A4 scanner. The specimen was then scanned into a PC using image capture software. Results—The images produced showed noticeable improvement over normal photographs, especially with specimens prone to wet highlights. Conclusions—The method has proved to be a rapid and efficient means of producing macroscopic images of surgical specimens. Key Words: scanning • personal computer • macroscopic images • surgical specimens PMID:11304853

  9. An original technique for surgical stabilisation of traumatic flail chest.

    PubMed Central

    Beltrami, V; Martinelli, G; Giansante, P; Gentile, K

    1978-01-01

    The treatment of chest wall injuries with severe paradoxical movement remains controversial. Intermittent positive-pressure respiration may be appropriate, but in some, especially those requiring exploratory thoracotomy for a visceral lesion, surgical fixation is desirable. We present a simple method using two or three stainless Kirschner wires placed in the chest wall. Results in five cases have been good. Images PMID:694812

  10. Teaching and Learning the Techniques of Conflict Resolution for Challenging Ethics Consultations.

    PubMed

    Bergman, Edward J; Fiester, Autumn

    2015-01-01

    Professional mediators have long possessed a skill set that is uniquely suited to facilitation of difficult conversations between and among individuals in emotionally charged situations. This skill set has increasingly been recognized as invaluable to the work of clinical ethics consultants as they navigate conflicts involving families, surrogates, and providers. Given widespread acknowledgment that communication difficulties lie at the root of many clinical ethics conflicts, mediation offers techniques to enhance communication between conflicting parties. This special section of The Journal of Clinical Ethics focuses on core aspects of the mediation process designed for effective management of clinical conflict emanating from communication breakdowns, highly charged value conflicts, and instances of perceived disrespect. PMID:26752385

  11. [The clinical history in surgical processes. Bioethical aspects and basic professional ethics].

    PubMed

    Collazo Chao, Eliseo

    2008-11-01

    Surgeons are increasingly facing multiple civil liability claims from their patients. Against this background and taking any eventual liability claims into account, surgeons must be increasingly aware of the importance of maintaining patient medical histories, which raises numerous questions on the length of time and form of keeping them. Ethical and legal obligations need to be taken into account in order to identify the controversial aspects related to patients and their environment, as well as shedding light on the most appropriate behaviour in each case. We must never forget the case history is a clinical document, subjected to the medical art and medical ethics which regulate it. PMID:19080907

  12. Surgical techniques for the management of male infertility

    PubMed Central

    Lopushnyan, Natalya A; Walsh, Thomas J

    2012-01-01

    Evaluation and surgical treatment of male infertility has evolved and expanded, now leading to more precise diagnoses and tailored treatments with diminished morbidity and greater success. Surgeries for male infertility are divided into four major categories: (i) diagnostic surgery; (ii) surgery to improve sperm production; (iii) surgery to improve sperm delivery; and (iv) surgery to retrieve sperm for use with in vitro fertilization and intracytoplasmic sperm injection (IVF–ICSI). While today we are more successful than ever in treating male infertility, pregnancy is still not always achieved likely due to factors that remain poorly understood. Clinicians treating infertility should advocate for couple-based therapy, and require that both partners have a thorough evaluation and an informed discussion before undergoing specific surgical therapies. PMID:22120932

  13. INFLUENCE OF SURGICAL TECHNIQUE IN THE PERITONEAL CARCINOMATOSIS SURGICAL WOUND IMPLANT: EXPERIMENTAL MODEL IN MICE

    PubMed Central

    ROSA, Roberto Maranhão; CAIADO, Rafael Coelho; REIS, Paulo Roberto de Melo; LACERDA, Elisângela de Paula Silveira; SUGITA, Denis Masashi; MRUÉ, Fátima

    2015-01-01

    Background The number of malignancies increased alarmingly. Surgery constitutes one of the most efficient therapeutic modalities for the treatment of solid tumors. The neoplastic implant in surgical wound is a complication whose percentage of occurrence reported in the literature is variable, but sets with high morbidity and therapeutic difficulties. Protecting the wound is one of the recommended principles of oncologic surgery. Aim To evaluate the influence of wound protection in the development of tumor implantation. Methods Sarcoma 180 tumor cells were used, with intraperitoneal inoculation in Swiss mice. After the establishment of neoplastic ascites, animals were randomized into two groups of 10, each group consisting of five males and five females. In both groups, laparotomy and manipulation of intra-abdominal organs was performed. In a group laparotomy was performed using the protection of the abdominal wound and the other group without it. On the 9th postoperative day macroscopic evaluation of the operative scar was performed, which was later removed for microscopic evaluation. Results There was microscopic infiltration of tumor cells in the wound of all animals. However, the group that held the protection, infiltration was less intense when compared to the group without it. The infiltration was also more severe in females than in males of the same group. Conclusion Tumor infiltration into the wound was more intense in the group in which the protection of the surgical site was not performed, and in females when compared to males of the same group. PMID:25861061

  14. Sacroiliac screw fixation: A mini review of surgical technique

    PubMed Central

    Alvis-Miranda, Hernando Raphael; Farid-Escorcia, Hector; Alcalá-Cerra, Gabriel; Castellar-Leones, Sandra Milena; Moscote-Salazar, Luis Rafael

    2014-01-01

    The sacral percutaneous fixation has many advantages but can be associated with a significant exposure to X-ray radiation. Currently, sacroiliac screw fixation represents the only minimally invasive technique to stabilize the posterior pelvic ring. It is a technique that should be used by experienced surgeons. We present a practical review of important aspects of this technique. PMID:25336831

  15. Surgical Technique of Anterolateral Approach for Tibial Plateau Fracture.

    PubMed

    Wang, Peng-cheng; Ren, Dong; Zhou, Bing

    2015-11-01

    A 66-year-old woman had sustained crush injury 3 hours prior to her presentation to our hospital. The diagnosis was defined as lateral tibial plateau fracture of the right knee (Schatzker III). Supine position was set up and a pad was put under the affected hip. After sterilization of the surgical field the sterilized sheets were placed beneath the leg in order to be higher than the other side. A rolled sheet was put under the knee joint so that the knee joint was flexed around 30° to 40°. After the surgical field was draped the skin was incised. Iliotibial band was incised by blade (not by electrotomy) and sharp dissection was performed in the Gerdy's tubercle. Capsulotomy was made by cutting the tibial meniscal ligament. Then the meniscus was tagged superiorly and the articular surface was clearly visualized. A window was made in the lateral cortex beneath the plateau, so the impacted fragment was elevated through the window. The metaphyseal void was filled by bone allograft. The placement of the raft-screw plate must be ensured that the raft screws passing the plate could purchase the subchondral bone. After perfect placement of the plate was defined, the femoral distractor was removed and the knee joint was relaxed. It was ensured that the alignment of the lower leg was normal, and then the other screws were inserted. Following placing drainage in the wound the iliotibial band was closed and the subcutaneous soft tissue and skin were closed in layer. PMID:26791810

  16. Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

    PubMed

    Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

    2014-11-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours. PMID:25028075

  17. Bariatric surgery: three surgical techniques, patient care, risks, and outcomes.

    PubMed

    McGraw, Carrie A; Wool, Daniel B

    2015-08-01

    The prevalence of obesity in the United States is a serious health concern. Bariatric surgery is a recognized and accepted approach for addressing weight loss and health conditions that occur as a result of morbid or severe obesity. Lifestyle changes, dietary modifications, and regular exercise are required for optimal and lasting surgical weight loss. Perioperative care of bariatric patients requires the use of interventions that differ from those used for nonobese patients, including bariatric-specific equipment, intraoperative monitoring of blood glucose, and postoperative monitoring for respiratory compromise. This articles outlines the risks and typical outcomes associated with three common bariatric procedures-laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass-to help perioperative nurses and other health care providers successfully advise patients and monitor their care for optimal outcomes. PMID:26227518

  18. Osteoradionecrosis of the temporal bone: a surgical technique of treatment

    SciTech Connect

    Ma, K.H.; Fagan, P.A.

    1988-05-01

    Osteoradionecrosis of the temporal bone is a well-documented complication of radiotherapy to the ear, with potentially lethal complications. Three cases of advanced disease, treated surgically, are presented. In two of these, subtotal petrosectomy with blind-sac closure of the external auditory canal was carried out via an anterior approach. The enclosed space was obliterated with pedicled temporalis muscle. Primary healing took place. One case was similarly obliterated using a prolonged posterior incision. The wound broke down, requiring a microvascular free flap for closure. Radiotherapy jeopardizes the viability of skin flaps. An anterior incision bases the flap behind on the occipital and postauricular arteries. When radiotherapy has been used, this incision has theoretical and practical advantages over a standard posterior incision.

  19. Ileocolostomy. A technique for surgical management of equine cecal impaction.

    PubMed

    Craig, D R; Pankowski, R L; Car, B D; Hackett, R P; Erb, H N

    1987-01-01

    Several surgical alternatives have been described for the management of cecal impaction in the horse, but none has met with consistently successful results. This study was done to evaluate a surgical bypass of the cecum by anastomosis of the ileum to the right ventral colon (ileocolostomy). A ventral midline celiotomy was performed on nine adult ponies (155-350 kg) and a mechanically stapled 10 cm side-to-side ileocolostomy was created. In five ponies a complete cecal bypass (CCB) was created by transecting the ileum distal to the anastomosis. In the other four, an incomplete cecal bypass (ICB) was created with no interruption of the ileum. Six horses with clinical cecal impaction also underwent cecal bypass procedures. Five had a CCB and one had an ICB. All the ponies maintained body weight, had no change in consistency of the feces and had no abdominal pain during the 6 month observation period. At necropsy, the lengths of the lateral cecal band, lateral free band of the colon, and the diameter of the anastomotic stoma were compared to measurements made at surgery. The lateral cecal band length decreased significantly more in the CCB ponies than in the ICB ponies (p = 0.008). The anastomotic stoma diameter was significantly larger in the ICB group than in the CCB group (p = 0.032). Five of the six clinical cases recovered and returned to their previous activity. CCB by an ileocolostomy resulted in removal of the cecum from the functional flow of ingesta without complication in the ponies, and was successful in five clinical cases of cecal impaction. PMID:3507180

  20. Auricular reconstruction for microtia: Part II. Surgical techniques.

    PubMed

    Walton, Robert L; Beahm, Elisabeth K

    2002-07-01

    Reconstruction of the microtic ear represents one of the most demanding challenges in reconstructive surgery. In this review the two most commonly used techniques for ear reconstruction, the Brent and Nagata techniques, are addressed in detail. Unique to this endeavor, the originator of each technique has been allowed to submit representative case material and to address the pros and cons of the other's technique. What follows is a detailed, insightful overview of microtia reconstruction, as a state of the art. The review then details commonly encountered problems in ear reconstruction and pertinent technical points. Finally, a glimpse into the future is offered with an accounting of the advances made in tissue engineering as this technology applies to auricular reconstruction. PMID:12087261

  1. Ethics.

    PubMed

    Pellegrino, E D

    1989-05-19

    This article is from the 1989 CONTEMPO issue of the Journal of the American Medical Association, the purpose of which is to keep physicians informed of recent developments in different areas of medicine through brief overviews by specialists in each field. In his article on ethics, Pellegrino focuses on the issues of euthanasia and fetal research. The practice of active, voluntary euthanasia raises questions about the difference between killing a terminally ill patient and withholding or withdrawing life-prolonging treatment, the limits of patient autonomy, the compatibility of active euthanasia with professional ethics, and the social consequences of legalizing euthanasia. The debate over the use of fetal tissue for research and treatment centers on the issue of induced abortion. PMID:2709576

  2. Leg-length inequalities following THA based on surgical technique.

    PubMed

    Nam, Denis; Sculco, Peter K; Abdel, Matthew P; Alexiades, Michael M; Figgie, Mark P; Mayman, David J

    2013-04-01

    Leg-length inequality after total hip arthroplasty (THA) is a source of patient morbidity and concern, potentially contributing to nerve palsies, low back pain, and abnormal gait mechanics. The purpose of this study was to compare the degrees of leg-length inequality in patients undergoing primary THA via 3 surgical approaches: anterior, conventional posterior, and posterior-navigated (ie, using computer navigation).The authors reviewed the most recent 90 patients who underwent primary unilateral THA performed by a senior surgeon using an anterior, conventional posterior, or posterior-navigated approach. Measurements of leg-length inequality of the operative extremity were performed using interischial and interteardrop reference lines. One-way analysis of variance demonstrated no statistical difference in postoperative absolute leg-length inequality using interischial (P=.11) and interteardrop (P=.90) reference lines between the 3 approaches. In addition, no significant difference existed in the number of outliers in each cohort when measured relative to the interteardrop reference line. When a leg-length inequality more than 5 mm was considered an outlier, 31.1%, 20.0%, and 23.3% of patients in the anterior, conventional posterior, and posterior-navigated groups, respectively, were outliers (P values range, .12 to .71). Mean±SD absolute-leg-length inequality relative to the interteardrop reference line in the anterior, conventional posterior, and posterior-navigated groups were 3.8±3.9, 3.9±3.0, and 3.9±2.7 mm, respectively. The anterior and posterior-navigated approaches demonstrated no superiority over the conventional posterior approach; all methods provided reliable leg-length equalization. PMID:23590775

  3. Robot assisted radical prostatectomy: how I do it. Part II: Surgical technique.

    PubMed

    Valdivieso, Roger F; Hueber, Pierre-Alain; Zorn, Kevin C

    2013-12-01

    The introduction of the "da Vinci Robotic Surgical System" (Intuitive Surgical, Sunnyvale, CA, USA) has been an important step towards a minimally invasive approach to radical prostatectomy. Technologic peculiarities, such as three-dimensional vision, wristed instrumentation with seven degrees of freedom of motion, lack of tremor, a 10x-magnification and a comfortable seated position for the surgeon has added value to the procedure for the surgeon and the patient. In this article, we describe the 9 step surgical technique for robot assisted radical prostatectomy (RARP) that is currently used in our institution (University of Montreal Hospital Center (CHUM) - Hopital St-Luc). We use the four-arm da Vinci Surgical System. Our experience with RARP is now over 250 cases with the senior surgeon having performed over 1200 RARPs and we have continually refined our technique to improve patient outcomes. PMID:24331353

  4. Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique.

    PubMed

    Antonini, Gabriele; Busetto, Gian Maria; De Berardinis, Ettore; Giovannone, Riccardo; Vicini, Patrizio; Gentile, Vincenzo; Perito, Paul E

    2015-12-01

    Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner's sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED) not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result. PMID:26766806

  5. A new technique for surgical treatment of vaginal agenesis using combined abdominal-perineal approach.

    PubMed

    Beksac, Mehmet Sinan; Salman, Mehmet Coskun; Dogan, Nasuh Utku

    2011-01-01

    Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent. PMID:21577259

  6. Subtle Lisfranc joint ligament lesions: surgical neoligamentplasty technique.

    PubMed

    Nery, Caio; Réssio, Cibele; Alloza, José Felipe Marion

    2012-09-01

    The results achieved with this technique after a mean follow-up of 8 years (85% excellent and good results) allow neoligamentplasty to be considered as a viable alternative to the classic procedures in the treatment of subtle intercuneiform and tarsometatarsal joint lesions. PMID:22938639

  7. A Review of Modern Surgical Hair Restoration Techniques

    PubMed Central

    Shiell, Richard C

    2008-01-01

    The field of hair restoration has had a chequered history. From the days of punch grafting to the present day techniques of follicular unit hair transplantation, the field has seen a number of new advances. This article reviews these developments. PMID:20300332

  8. Surgical repair of chronic rupture of the distal end of the biceps brachii. A modified anterior surgical repair technique.

    PubMed

    Sharma, Dinesh K; Goswami, Ved; Wood, Jane

    2004-06-01

    The authors have used a modified surgical technique for repair of the distal end of the biceps brachii in three patients who presented with chronic rupture, all more than 6 weeks old. All patients were males; two lesions were on the dominant right side and one was on the non-dominant left side. An anterior incision was made over the cubital fossa, a hole was drilled over the radial tuberosity and a simple pull-through technique with an Ethibond suture was used to attach the tendon to an endobutton over the posterior surface of the radius. All patients returned to their employment and preinjury activity levels by six months. There were no postoperative complications and clinically all repairs remained intact. The patients regained their normal range of movements in 3 months; all but one regained the endurance and strength of their bicep in 6 months as assessed by Cybex testing. Surgical repair of the distal end of the biceps using the technique reported has given excellent results in these three patients. PMID:15287407

  9. All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique

    PubMed Central

    Chalmers, Peter N.; Frank, Rachel M.; Gupta, Anil K.; Yanke, Adam B.; Trenhaile, Scott W.; Romeo, Anthony A.; Bach, Bernard R.; Verma, Nikhil N.

    2013-01-01

    Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation. PMID:24400198

  10. A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

    PubMed Central

    Marchie, Anthony; Kumar, Arun; Catre, Melanio

    2009-01-01

    We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations. PMID:20671868

  11. The surgical technique of bilateral sequential lung transplantation

    PubMed Central

    Hayanga, J. W. Awori

    2014-01-01

    Since the first successful lung transplant performed three decades ago, the technique of lung transplantation has evolved with acceptable short- and long-term outcomes such that it has become the standard for those with end stage pulmonary disease. Herein, we describe our current favored approach and discuss some of the current areas in need of further investigation as they relate to the technical aspects of the operation. PMID:25132973

  12. Teaching and evaluation of basic surgical techniques: the University of British Columbia experience.

    PubMed

    Qayumi, A K; Cheifetz, R E; Forward, A D; Baird, R M; Litherland, H K; Koetting, S E

    1999-01-01

    Surgical technical education has traditionally followed an apprenticeship format. The need for innovative undergraduate programs using dry and wet labs prior to clinical exposure continues to be an area of debate. Specific programs have been described to improve surgical skills; however, an accepted platform for training and evaluation of surgical skills programs has not been recognized. Therefore, introduction of specific programs to teach undergraduate medical students surgical skills is essential. This article describes the Basic Surgical Technique (BST) program taught at the University of British Columbia and reports the effectiveness of this program in improving the practical skills of undergraduate medical students. The program includes BST I for third-year students performed in a dry lab setting, and BST II for medical student interns (MSI) performed at the animal laboratories using female domestic swine as subjects. A total of 87 students participated in the study. The program is designed using Piaget's and Vygotsky's pedagogical philosophy of "learning by doing." A semiquantitative method is used to measure and analyze the outcome of this project. Data were validated using student self-evaluation tests and by quantitative evaluation by surgical staff from the surgical wards. Results of this prospective project indicated that the BST program significantly (p < .05) improved the surgical performance of undergraduate students, and that the time lapse between BST I and II has had a negative impact in retention of acquired surgical skills. This study concludes that the BST program taught at the University of British Columbia significantly improves the surgical skills of medical students and improves their self-confidence during their internship. PMID:10630398

  13. Intraoperative neuromonitoring techniques in the surgical management of acoustic neuromas.

    PubMed

    Oh, Taemin; Nagasawa, Daniel T; Fong, Brendan M; Trang, Andy; Gopen, Quinton; Parsa, Andrew T; Yang, Isaac

    2012-09-01

    Unfavorable outcomes such as facial paralysis and deafness were once unfortunate probable complications following resection of acoustic neuromas. However, the implementation of intraoperative neuromonitoring during acoustic neuroma surgery has demonstrated placing more emphasis on quality of life and preserving neurological function. A modern review demonstrates a great degree of recent success in this regard. In facial nerve monitoring, the use of modern electromyography along with improvements in microneurosurgery has significantly improved preservation. Recent studies have evaluated the use of video monitoring as an adjunctive tool to further improve outcomes for patients undergoing surgery. Vestibulocochlear nerve monitoring has also been extensively studied, with the most popular techniques including brainstem auditory evoked potential monitoring, electrocochleography, and direct compound nerve action potential monitoring. Among them, direct recording remains the most promising and preferred monitoring method for functional acoustic preservation. However, when compared with postoperative facial nerve function, the hearing preservation is only maintained at a lower rate. Here, the authors analyze the major intraoperative neuromonitoring techniques available for acoustic neuroma resection. PMID:22937857

  14. Sentinel lymph node biopsy for conjunctival malignant melanoma: surgical techniques

    PubMed Central

    Wainstein, Alberto JA; Drummond-Lage, Ana P; Kansaon, Milhem JM; Bretas, Gustavo O; Almeida, Rodrigo F; Gloria, Ana LF; Figueiredo, Ana RP

    2015-01-01

    Background The purpose of this report is to examine the viability and safety of preoperative lymphoscintigraphy and radio guided sentinel lymph node (SLN) biopsy for conjunctival melanoma, and to identify the best technique to perform this procedure. Methods Three patients diagnosed with malignant melanoma of the conjunctiva underwent lymphoscintigraphy and SLN biopsy using a dual technique comprising isosulfan blue dye and technetium Tc 99m sulfur colloid. Each patient was anesthetized and the conjunctival melanoma was excised. SLNs were localized by a gamma probe, identified according to radioactivity and sentinel blue printing, and dissected, along with drainage of the associated lymphatic basins. The SLNs were evaluated by a pathologist using hematoxylin-eosin staining following serial sectioning and immunohistochemistry using a triple melanoma cocktail (S-100, Melan-A, and HMB-45 antigens). Results Two SLNs were stained in the jugular chain during preoperative lymphoscintigraphy in the first patient, two SLNs were identified in the preauricular and submandibular areas in the second patient, and two SLNs were identified in the submandibular and parotid areas in the third patient. All lymph nodes identified by lymphoscintigraphy were dissected and identified at surgery with 100% accuracy in all three patients. All SLNs were histologically and immunohistochemically negative. Patients had good cosmetic and functional results, and maintained their visual acuity and ocular motility. Conclusion Patients with conjunctival melanoma can undergo preoperative lymphoscintigraphy and SLN biopsy safely using radioactive technetium and isosulfan blue dye. PMID:25565762

  15. A novel surgical technique for transverse sternal bone defects using flexible intramedullary nailing.

    PubMed

    Böcker, W; Euler, E; Schieker, M; Kettler, M; Mutschler, W

    2006-12-01

    Transverse sternal bone defects as a result of surgery or trauma remain an important clinical condition with serious sequelae. Patients sometimes complain of local pain during movement and breathing. Usually, defects are filled with prosthetic materials which remain permanently IN SITU. Small defects can be treated with autogenous bone grafts, whereas large defects are difficult to stabilize with common osteosynthetic techniques. Here, we report a new surgical technique using flexible intramedullary nailing ("Elastic Stable Intramedullary Nailing"--ESIN or "Embrochage Centro-Medullaire Elastique Stable"--ECMES) to stabilize a sternal defect after surgical removal of an osteochondral lesion. The defect was bridged by two elastic titanium nails and an autogenous corticocancellous bone graft. This new surgical technique showed a good clinical and functional outcome. PMID:17151979

  16. [Surgical treatment of hemorrhoids using Milligan-Morgan technique. Survey of 366 cases].

    PubMed

    Latteri, M; Grassi, N; Salanitro, L; Pantuso, G; Bottino, A; Gitto, C; Farro, G

    1991-10-31

    After a careful review of the Author's own case list and of the literature on this subject, Milligan-Morgans' technique is assessed and compared with different surgical techniques as far as early and late complications are concerned. The Authors conclude that the Milligan-Morgan technique is to be preferred because of its simplicity, safety and flexibility, particularly if associated with sphincterectomy, with or without rhagade, in order to prevent the cicatricial scars. PMID:1766559

  17. Laparoscopic Paravaginal Defect Repair: Surgical Technique and a Literature Review.

    PubMed

    Chinthakanan, Orawee; Miklos, John R; Moore, Robert D

    2015-11-01

    Paravaginal defects, commonly seen in patients with anterior vaginal wall prolapse, are due to the detachment of pubocervical fascia from the arcus tendineus fascia pelvis (ATFP), at or near its lateral attachment. The majority of anterior vaginal wall prolapse is thought to be caused by paravaginal defects. Richardson et al. first described and demonstrated the anatomy of the paravaginal defect, as well as described the initial technique of the abdominal approach to repair. Since that time, the laparoscopic approach for repair has been developed and described with success rates of laparoscopic paravaginal defect repair reported in the range of 60% to 89%. This minimally invasive approach to address anterior wall prolapse eliminates the need for a vaginal incision, reduces risk of vaginal shortening and can be completed at the same time as other laparoscopic procedures, such as hysterectomy, sacralcolpopexy, and/or Burch Urethropexy. Compared to the open abdominal approach, there is improved visualization, less risk of bleeding, and faster recovery with the laparoscopic method. Compared to an anterior colporrhaphy, laparoscopic paravaginal repair is a much more anatomic repair of lateral defects and does not result in vaginal shortening. The laparoscopic paravaginal repair should be considered as the first-line treatment of anterior vaginal wall prolapse caused by lateral defects, including at time of laparoscopic/robotic sacralcolpopexy. PMID:26680393

  18. Imaging techniques for infections in the surgical patient

    SciTech Connect

    Gerzof, S.G.; Oates, M.E.

    1988-02-01

    Gallium-67 citrate is easy to use and readily available, but the need to delay imaging for 2 to 4 days after injection hinders rapid diagnosis. Moreover, normal gastrointestinal activity limits its usefulness in evaluating the abdomen. Labeling leukocytes with Indium-111 oxine is a time-consuming, technically involved process, yet the images obtained at 24 hours will usually reveal sites of inflammation or infection. Although the techniques have similar sensitivities, the higher specificity of In-111 makes it the superior agent for many clinical situations. When there are localizing signs or symptoms or a reason to suspect a specific body region, CT or ultrasonography is the imaging modality of choice. Guided needle aspiration can then be performed and is usually diagnostic. Radionuclide imaging with either Ga-67 or In-111 is available as an adjunct if needle aspiration cannot be performed or is inconclusive. Since it provides total-body surveillance, radionuclide imaging is particularly useful for screening when there are no localizing signs and in cases of occult sepsis or fever of unknown origin. If positive, it can direct further imaging with CT or ultrasound. 46 references.

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

    PubMed Central

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

    2015-01-01

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

  20. Surgical Technique: Endoscopic Endonasal Transphenoidal Resection of a Large Suprasellar Mixed Germ Cell Tumor

    PubMed Central

    Chakravarthy, Vikram; Hanna, George; DeLos Reyes, Kennethy

    2016-01-01

    The endoscopic endonasal transphenoidal approach has proven to be a very versatile surgical approach for the resection of small midline skull base tumors. This is due to its minimally invasive nature, the potentially fewer neurological complications, and lower morbidity in comparison to traditional craniotomies. This surgical approach has been less commonly utilized for large midline tumors such as suprasellar germ cell tumors, due to numerous reasons including the surgeon’s comfort with the surgical approach, a higher chance of postoperative cerebrospinal fluid (CSF) leak, limited visualization due to arterial/venous bleeding, and limited working space. We present our surgical technique in the case of a large suprasellar and third ventricular mixed germ cell tumor that was resected via an endoscopic endonasal approach with favorable neurological outcome and no postoperative CSF leak. PMID:27014537

  1. A Practical Surgical Technique to Expose the Mental Nerve in Narrowing Genioplasty.

    PubMed

    Wang, Chenglong; Gui, Lai; Liu, Jianfeng

    2015-11-01

    In this article, the authors present a practical surgical technique using the anatomical character of the inferior alveolar nerve to fully expose the mental nerve (MN) in narrowing genioplasty. During the procedure, a rectangular mandibular outer cortex adjacent to the mental foramen is removed before the osteotomy. The objective is to avoid the injury of the MN from the reciprocating saw or bur and offer abundant space for the surgical operation. The technique has a minimal learning curve and will be useful to plastic surgeons to minimize unintentional cutting or pulling injury to the MN in narrowing genioplasty. PMID:26893979

  2. Latissimus dorsi tendon transfer for massive, irreparable posterosuperior rotator cuff tears: surgical technique.

    PubMed

    Qadir, Rabah; Romine, Lucas; Yao, David C; Duncan, Scott F M

    2014-09-01

    Massive rotator cuff tears remain a complex and challenging problem for both the patient and the surgeon. Although significant advancements in surgical techniques as well as technology for arthroscopic and mini-open rotator cuff repairs have been made, many massive tears result in failed repair with continued progressive tendon retraction and degeneration. In cases when primary tendon to bone healing is impractical, latissimus dorsi tendon transfer provides promising and reproducible clinical results. Herein, we present a latissimus tendon transfer surgical technique, a procedure we have used as a salvage operation for failed arthroscopic/mini-open primary rotator cuff repair. PMID:24854152

  3. Brain abscess and subdural empyema. Factors influencing mortality and results of various surgical techniques.

    PubMed Central

    Van Alphen, H A; Dreissen, J J

    1976-01-01

    The authors review the results of various surgical techniques in relation to mortality and morbidity in 100 consecutive cases of brain abscess and subdural empyema. The mortality rate is the same with total excision and fractional drainage of brain abscesses, although in acute and subacute cases slight differences between both techniques are seen. In terms of morbidity, fractional drainage appears to be more favourable than total excision. The authors believe that factors other than surgical procedure influence mortality in cases of brain abscess and subdural empyema. These factors are defined in detail. Images PMID:932767

  4. Recognition and Surgical Techniques for Management of Nonrecurrent Laryngeal Nerve during Carotid Endarterectomy.

    PubMed

    Jimenez, Juan Carlos; Jabori, Sinan; Gelabert, Hugh A; Moore, Wesley S; Quinones-Baldrich, William J; O'Connell, Jessica

    2016-05-01

    The presence of a nonrecurrent laryngeal nerve (NRLN) during carotid endarterectomy (CEA) may significantly limit the exposure of the surgical field during this operation. Although its reported incidence is rare, NRLN typically overlies the carotid bifurcation and failure to recognize this anatomic variation increases the risk of NRLN injury. A retrospective chart review of all patients who underwent CEA for hemodynamically significant extracranial carotid stenosis between January 2005 and December 2014 was performed. All patients with NRLN encountered intraoperatively were identified. Clinical outcomes, surgical techniques, and complications were reviewed and reported. Four left-sided NRLN were identified and 4 were right sided. No cranial nerve deficits or injuries occurred after CEA in patients where NRLN was encountered. Two distinct surgical techniques were used to manage patients with NRLN and they are discussed in detail. PMID:26965812

  5. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

    PubMed

    Cottom, James M; Maker, Jared M

    2016-01-01

    Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. PMID:26952313

  6. Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications

    PubMed Central

    Milone, Marco; Vignali, Andrea; Milone, Francesco; Pignata, Giusto; Elmore, Ugo; Musella, Mario; De Placido, Giuseppe; Mollo, Antonio; Fernandez, Loredana Maria Sosa; Coretti, Guido; Bracale, Umberto; Rosati, Riccardo

    2015-01-01

    AIM: To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for endometriosis. METHODS: A multicenter case-controlled study using the prospectively collected data of 90 women (22 with and 68 without post-operative complications) who underwent laparoscopic colorectal resection for endometriosis was designed to evaluate any risk factors of post-operative complications. The prospectively collected data included: gender, age, body mass index, American Society of Anesthesiologists risk class, endometriosis localization (from anal verge), operative time, conversion, intraoperative complications, and post-operative surgical complications such as anastomotic dehiscence, bleeding, infection, and bowel dysfunction. RESULTS: A similar number of complicated cases have been registered for the different surgical techniques evaluated (laparoscopy, single access, flexure mobilization, mesenteric artery ligation, and transvaginal specimen extraction). A multivariate regression analysis showed that, after adjusting for major clinical, demographic, and surgical characteristics, complicated cases were only associated with endometriosis localization from the anal verge (OR = 0.8, 95%CI: 0.74-0.98, P = 0.03). After analyzing the association of post-operative complications and each different surgical technique, we found that only bowel dysfunction after surgery was associated with mesenteric artery ligation (11 out of 44 dysfunctions in the mesenteric artery ligation group vs 2 out of 36 cases in the no mesenteric artery ligation group; P = 0.03). CONCLUSION: Although further randomized clinical trials are needed to give a definitive conclusion, laparoscopic colorectal resection for deep infiltrating endometriosis appears to be both feasible and safe. Surgical technique cannot be considered a risk factor of post-operative complications. PMID:26715819

  7. SHIELDED-NEEDLE TECHNIQUE FOR SURGICALLY IMPLANTING RADIO-FREQUENCY TRANSMITTERS IN FISH

    EPA Science Inventory

    Protruding whip antenna radio transmitters were implanted in fish with abdominal pelvic fins. This surgical technique enables the transmitter to be positioned anywhere in the peritoneal cavity without piercing vital organs through the use of a shielded needle to guide an antenna ...

  8. Surgical implant techniques of left ventricular assist devices: an overview of acute and durable devices

    PubMed Central

    2015-01-01

    Left ventricular support for the failing heart has evolved to include short-term and long-term devices. These devices are implanted percutaneously and surgically. This manuscript provides a general overview of the contemporary, typically practiced, implant techniques with additional insight on minimally invasive approaches. PMID:26793329

  9. Comparative study of 2 surgical techniques for castration of guinea pigs (Cavia porcellus)

    PubMed Central

    Guilmette, Josée; Langlois, Isabelle; Hélie, Pierre; de Oliveira El Warrak, Alexander

    2015-01-01

    The objective of this study was to compare 2 surgical approaches (scrotal or abdominal) for castration of guinea pigs and to investigate post-operative infection rates with either technique. Forty-eight guinea pigs were castrated by scrotal or abdominal technique after being randomly assigned to 1 of 2 groups (n = 24). Individuals were either castrated by an experienced exotic animal surgeon (n = 12) or by an experienced small animal surgeon (n = 12). Surgical wounds were evaluated daily before euthanasia for histological evaluation 2 wks after surgery. Post-operative infection rate was significantly higher in the scrotal group than in the abdominal group, with a higher rate for the experienced small animal surgeon. Castration of guinea pigs with the abdominal technique is significantly faster and has a significantly lower post-operative infection rate than the scrotal technique. PMID:26424914

  10. Successful surgical repair of a triple cardiac rupture using modified cohesive double patch technique.

    PubMed

    Dorobantu, Lucian Florin; Stiru, Ovidiu; Iliescu, Vlad Anton

    2016-02-01

    Introduction The association between both left and right ventricular free wall ruptures (FWR) and post-infarction anterior ventricular septal defect (VSD) is an exceptional situation. Case report We present the case of a patient who developed a VSD and two FWRs (of the left and right ventricle, respectively) shortly after the onset of an anterior AMI. We surgically closed this complex rupture using the cohesive double patch technique with two Teflon patches combined with an infarct exclusion technique. The left and right ventricular patches were attached cohesively to the septal wall and the infarcted area was excluded without reducing the left ventricular cavity. Conclusion Association between post-infarction ventricular septal rupture and both left and right free wall ruptures are a very rare and dangerous situation. The modified cohesive double patch technique associated the modified Cooley technique seems to be the correct surgical solution. PMID:27385145

  11. A Surgical Technique for the Management of Suction Cup-Induced Palatal Perforation: A Technical Note

    PubMed Central

    Rahpeyma, Amin

    2015-01-01

    Suction cap-induced palatal perforation is uncommon today. In the surgical management of such a complication, the surgeon should consider the large bony defect hidden behind the small slit in the palatal mucosa. In this article a case is presented,in which a combination of anteriorly based inferior turbinate flap and posteriorly based palatal submucosal flap solved the problem properly. The advantages of this technique are two-layer closure and predictability of the technique. PMID:26393223

  12. Simple, minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle.

    PubMed

    Levy, Ofer

    2003-01-01

    Neer type 2 fractures of the distal clavicle have a high rate of nonunion and delayed union. A simple, minimally invasive surgical technique using suture fixation is introduced. In this series 12 patients were treated with suture fixation of this fracture with absorbable suture material, resulting in union of all fractures. There was a rapid return to function and no complications. This technique allows simple, minimally invasive fixation with good fracture healing and early return to work and sports. PMID:12610482

  13. A giant, complex fronto-ethmoidal ivory osteoma: Surgical technique in a resource-limited practice

    PubMed Central

    Adeleye, Amos Olufemi

    2010-01-01

    Background: Unlike small and medium size fronto-ethmoidal osteomas which are amenable to surgical excision through limited craniofacial openings, giant lesions require extensive and complex craniofacial dissection, and post lesionectomy reconstruction using an array of modern-day surgical adjuncts. This is a report of our surgical technique for the successful and esthetically fair operative resection of a giant fronto-ethmoidal osteoma in a difficult practice setting. Case Description: A 32-year-old Nigerian lady harbored a giant complex fronto-ethmoidal ivory osteoma. Deploying our understanding of modern-day advanced microsurgical anatomy and technique of skull base surgery, but under severe resource limitations, a radical total surgical resection was performed and an esthetically fair post lesionectomy reconstruction was achieved. The patient remains tumor-free in 20 months, so far, of postoperative follow-up. Conclusions: Even under severe resource limitations, inventive adaptations of modern-day skull base surgery techniques can facilitate hitherto unusual functional and esthetically successful resection of giant osteomas of the fronto-ethmoidal sinus complex. PMID:21245944

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

    PubMed

    Leanza, V; Intagliata, E; Leanza, G; Cannizzaro, M A; Zanghì, G; Vecchio, R

    2013-01-01

    Rectocele is defined as a herniation of the rectal wall inside the vagina due to a defect of the recto-vaginal septum. It is traditionally considered a posterior compartment damage with weakness of posterior vaginal wall support resulting in a bulging of the rectum into the vaginal cavity. One of the main causes of rectal prolapse is the operative vaginal birth, although the evidence of the defect may occur after many years The treatment of rectocele is surgical, and the approach can be transperineal, transvaginal, and transanal or, in selected cases, transperitoneal through open or laparoscopic techniques. In this study we compare two transvaginal surgical techniques - i.e. the perineal body anchorage to the posterior septum and the traditional Denonvilliers' transversal suture after removing of the vaginal skin, with the mostly performed transanal procedure, the STARR - comparing the data from the literature on their results. Mean hospital stay, rectal symptoms, dyspareunia, quality of life, recurrence rate and postoperative complications have been considered. Both transvaginal and transrectal surgical techniques are effective to solve posterior compartment defect and to improve the quality of life. Vaginal approach may interfere with the sexual activity; furthermore it is associated with minimal postoperative pain than the transanal approach. Better anatomic results are assured after endovaginal surgery, while better rectal function prevail after the transanal approach. Vaginal techniques are more suitable to gynecologists, whereas the transrectal ones are usually performed by colo-proctologists or general surgeons. PMID:24342163

  15. Distal humerus shear-fractures: “Built-on” surgical technique

    PubMed Central

    Rapariz, Jose M.; Martin, Silvia; Far-Riera, Aina; Lirola-Palmero, Serafin

    2014-01-01

    When treating a distal humeral shear fracture, comminution of the lateral column may preclude the reconstruction of the lateral articular fragments. In this article a new strategy for the management lateral column comminuted shear-fractures (LCCSF) is presented, called the “built-on” surgical technique. Three goals are obtained by this technique: (1) Restoration of the lateral column bone stock; (2) Provision of a solid scaffold for the repair of the lateral ulnar collateral ligament (LUCL); and (3) Provision of a sable platform for the reconstruction and fixation of the articular fragments. We will obtain these goals through the following surgical steps: 1/ Reconstruction of the lateral trochlea. 2/ Reconstruction of the lateral column 3/ Fixation of the Capitellum 4/ Reconstruction of the LUCL PMID:24926163

  16. Minimally invasive corticotomy in orthodontics: a new technique using a CAD/CAM surgical template.

    PubMed

    Cassetta, M; Pandolfi, S; Giansanti, M

    2015-07-01

    Accelerating orthodontic tooth movement is a topical issue. Despite the different techniques described in the literature, the corticotomy is the only effective and safe means of accelerating orthodontic tooth movement. Although effective, the corticotomy presents significant postoperative discomfort. The aggressive nature of these particular methods, related to the elevation of mucoperiosteal flaps and to the length of the surgery, has resulted in reluctance to proceed with this technique among both patients and the dental community. To overcome the disadvantages of the corticotomy, this technical note describes an innovative, minimally invasive, flapless procedure combining piezoelectric surgical cortical micro-incisions with the use of a 3D Printed CAD/CAM surgical guide. PMID:25840860

  17. "Security loop" tie: a new technique to overcome loosening of surgical knots.

    PubMed

    Alzacko, Saadallah Mohammad; Majid, Omer Waleed

    2007-11-01

    Sutures require knots so as to ensure optimal tissue closure strength. Loosening of surgical knots during or after tying can lead to an ineffective suture and compromise the final result. Loosening is affected mainly by the type of suture material and nature of surgical field. In palatal surgery, tying secure knots is a major consideration and may present a technical challenge. In this article, and after a review of the literature, we present a new modification of the usual knot-tying technique to maximize knot security and prevent knot loosening after the first throw is done. This technique was found to be effective, simple, fast, easy to learn, and saves time and material. PMID:17964468

  18. Minimally invasive surgical techniques in the management of differentiated thyroid cancer

    PubMed Central

    Tucker, N.; Mitchem, J.; Gillanders, W.

    2015-01-01

    Thyroid cancer is the fifth most common cancer in women with approximately 60,220 expected new cases in the United States in 2013, and the incidence continues to increase each year. Fortunately, the majority are well-differentiated thyroid cancers with excellent overall prognosis. Controversy persists regarding the optimal surgical management of differentiated thyroid cancer in terms of the extent of thyroid resection (thyroid lobectomy vs total thyroidectomy) and the utility of prophylactic central neck dissection (pCND) in low-risk PTC, and papillary thyroid microcarcinoma (PTMC, defined as <10 mm). Thyroid surgical approaches have progressed from the Kocher open incision to minimally invasive techniques that include endoscopic and robotic thyroidectomy. Overall, these minimally invasive techniques have been shown to be safe, and appear to be associated with improved cosmesis and decreased pain compared to open thyroidectomy. PMID:26504264

  19. Management of posttraumatic kyphosis: surgical technique to facilitate a combined approach.

    PubMed

    Marré, Bartolomé

    2005-07-01

    This report describes a variation of the "posterior-anterior-posterior" surgical techniques to correct posttraumatic kyphosis of the thoracic and lumbar spine with the USS internal fixator. This modification is based on the use of "temporary screws" to mark the entrance of the pedicles in the first stage of the operation (posterior approach, with the patient in prone position). Approaching both columns of the spine simultaneously facilitates correction of the kyphotic defect and permits 360 reconstruction of the spine. PMID:15993120

  20. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications.

    PubMed

    Visser, Nienke; Bauer, Noël J C; Nuijts, Rudy M M A

    2013-04-01

    We present an overview of currently available toric intraocular lenses (IOLs) and multifocal toric IOLs. Relevant patient selection criteria, IOL calculation issues, and surgical techniques for IOL implantation are discussed. Clinical outcomes including uncorrected visual acuity, residual refractive astigmatism, and spectacle independency, which have been reported for both toric IOLs and multifocal toric IOLs, are reviewed. The incidence of misalignment, the most important complication of toric IOLs, is determined. Finally, future developments in the field of toric IOLs are discussed. PMID:23522584

  1. A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch.

    PubMed

    Becher-Deichsel, Anja; Aurich, Jörg E; Schrammel, Nadine; Dupré, Gilles

    2016-07-15

    The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5-10.5 years; median weight 37.0 kg, range 12.9-64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1-7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0-7.0 cm). Median surgical time was 57 minutes (range 48-65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm. PMID:27039076

  2. Cranial cruciate ligament rupture in the dog--a retrospective study comparing surgical techniques.

    PubMed

    Moore, K W; Read, R A

    1995-08-01

    Three surgical techniques, grouped as intra-articular techniques, extracapsular techniques and fibular head transposition, were used for repair of the cranial cruciate ligament (CCL)-deficient stifle in 113 dogs over a 4 year 4 month period. The clinical outcome of the techniques were compared using information provided by the owners and physical examination. Regardless of surgical technique, 85.7 to 91.0% of dogs showed clinical improvement after surgery. However, less than 50% of dogs became clinically sound on the operated leg and 9.0 to 14.3% of dogs remained persistently lame on the operated leg. No statistical association was found between result after surgery and age, body weight, sex, duration of injury before surgery, association with injury, tibial plateau angle, degree of radiographic osteoarthritis before surgery or the presence of concurrent medial meniscal injury. On physical examination, extra-capsular techniques appeared superior to the fibular head transposition in terms of joint stability and limb function. Concurrent medial meniscal injury necessitating meniscectomy existed in 48.0% of cases. Twenty-two percent of dogs ruptured their contralateral CCL at an average of 14 months after the first. PMID:8579557

  3. The ethical challenges of the clinical introduction of mitochondrial replacement techniques.

    PubMed

    Appleby, John B

    2015-11-01

    Mitochondrial DNA (mtDNA) diseases are a group of neuromuscular diseases that often cause suffering and premature death. New mitochondrial replacement techniques (MRTs) may offer women with mtDNA diseases the opportunity to have healthy offspring to whom they are genetically related. MRTs will likely be ready to license for clinical use in the near future and a discussion of the ethics of the clinical introduction of MRTs is needed. This paper begins by evaluating three concerns about the safety of MRTs for clinical use on humans: (1) Is it ethical to use MRTs if safe alternatives exist? (2) Would persons with three genetic contributors be at risk of suffering? and (3) Can society trust that MRTs will be made available for humans only once adequate safety testing has taken place, and that MRTs will only be licensed for clinical use in a way that minimises risks? It is then argued that the ethics debate about MRTs should be reoriented towards recommending ways to reduce the possible risks of MRT use on humans. Two recommendations are made: (1) licensed clinical access to MRTs should only be granted to prospective parents if they intend to tell their children about their MRT conception by adulthood; and (2) sex selection should be used in conjunction with the clinical use of MRTs, in order to reduce transgenerational health risks. PMID:26239841

  4. [THE FORMS OF DELIBERATION INVOLVED IN THE FIELD OF BIOETHICS: TECHNIQUE DELIBERATION AND ETHICS DELIBERATION].

    PubMed

    Neves Pinto, Gerson

    2015-12-01

    In this article the author examines the formulation of the problem of new technologies with their ethical limits and legal. To do this, in a first it is d'assess the contribuitions of the two most important contemporary philosophers who have treated this subject: Jürgen Habermas and Ronald Dworkin, while trying to put them into dialog with the one who has been one of the founders of l'classic ethics: Aristotle. Then, it tries to answer the question of how could we understand this notion that Dworkin nome "moral dislocation" between the random and the choice or well, as the appointed Habermas, "l'extension of the contingency". Finally, we questioned how the Aristotelian distinction between the technical deliberation and deliberative ethical-moral can contribute to a better understanding of the questions on the decisions and choices that will make the moral agents (such as patients or the judges), as well as those relating to the type of deliberation technique chosen by the doctor or by the health professional. PMID:27120826

  5. Objective measurement of the deviated nose and a review of surgical techniques for correction.

    PubMed

    Erdem, Tamer; Ozturan, Orhan

    2008-03-01

    Although many surgical techniques have been introduced, there are few clinical studies investigating postoperative results in crooked nose deformity. The aim of this study is to discuss the surgical choices for specific deformities and to report the long-term quantitative surgical results of our cases. One hundred and twenty cases (38 women, 82 men) with crooked noses (48 I-shaped, 72 C-shaped) operated on by the authors were included in the study. The patients have been followed for 6 to 46 months (mean 19 months) postoperatively. The Scion Image software program was utilized for numerical measurement of the nasal crookedness. In cases with I-shaped and C-shaped crooked nose deformity, preoperative and postoperative angle values were as follows: 6.84 +/- 2.58 degrees, 2.01 +/- 1.53, 152.97 +/- 9.03 degrees and 173.67 +/- 4.55 degrees, respectively. In both groups, postoperative correction rates were statistically significant (p = 0.0001). Despite these results, patients undergoing surgical treatment should be informed about imperfect outcomes, possibility of persistent deformity and the need of revision surgery. PMID:18444494

  6. [NEW SURGICAL APPROACH IN PRIMARY OPEN-ANGLE GLAUCOMA: XEN GEL STENT A MINIMALLY INVASIVE TECHNIQUE].

    PubMed

    Dupont, G; Collignon, N

    2016-02-01

    Primary open-angle glaucoma is a progressive ocular disease affecting adults and associated with visual field defect. The aim of its treatment is to lower the ocular pressure by means of ocular drops, laser or surgery. To date, traditional surgical techniques still remain quite invasive, but recent research efforts have been made with a view to develop minimally invasive techniques. The Xen Gel Stent is one of them. It allows a safe and efficient lowering of ocular pressure by creating a sub-conjunctival flow, following an ab interno procedure that highly preserves the architecture of the treated eye. PMID:27141652

  7. Unique Technique for Open Surgical Repair after Failed Endovascular Aneurysm Repair with Proximal Anastomoses

    PubMed Central

    Hirota, Jun; Mori, Kazuki; Shuto, Takashi; Okamoto, Keitaro; Sato, Aiko; Wada, Tomoyuki; Anai, Hirofumi; Miyamoto, Shinji

    2016-01-01

    Endovascular aortic aneurysm repair (EVAR) has revolutionized the management of abdominal aortic aneurysms (AAAs), with lower perioperative morbidity and mortality compared to conventional surgical repair. However, late secondary re-interventions after EVAR are still needed before aneurysm rupture in many cases. A patient with impending rupture of an AAA associated with a type I endoleak 7 years after EVAR who was successfully treated with a unique technique of fixation of the proximal aortic neck taking into account the structure of the stent graft is reported. This technique offers a safe solution to late open conversion after failed EVAR. PMID:27375808

  8. Comparative study of two surgical techniques for root coverage of large recessions in heavy smokers.

    PubMed

    Reino, Danilo M; Maia, Luciana P; Novaes, Arthur B; Souza, Sérgio L S

    2015-01-01

    Reduced root coverage due to diminished periodontal vascularity can be expected in heavy smokers. The aim of this study was to evaluate the root coverage obtained for large gingival recessions in heavy smokers using two different surgical techniques. Twenty heavy smokers were selected. Each patient had large, bilateral Miller class I or II gingival recessions (Control Group (CG): 3.30 ± 1.29; Test Group (TG): 3.45 ± 0.80) on nonmolar teeth. Clinical measurements of probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), keratinized mucosa height (KMH), and keratinized mucosa thickness (KMT) were determined at baseline and after 12 months. One side received a coronally positioned flap (CPF), while the contralateral side received the extended flap technique (EFT), both procedures carried out in conjunction with a subepithelial connective tissue graft (SCTG). Saliva samples to measure cotinine levels were taken at baseline and after 12 months as an indicator of the level of exposure to nicotine. Intergroup and intragroup analysis showed no statistical differences for the evaluated clinical parameters. Patients maintained the same exposure to smoke during the evaluation period. Both techniques resulted in low root coverage (CPF: 48.60%; EFT: 54.28%), but both techniques were effective in decreasing the gingival recessions (P ≤ 0.01). The variables smoke exposure, root coverage, and the thickness and height of keratinized tissue were subjected to linear regression. Regardless of the surgical technique used, heavy smoking strongly limits root coverage, especially for large recessions. PMID:26171447

  9. Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity

    PubMed Central

    Wojcinski, Sebastian; Nuengsri, Sirin; Hillemanns, Peter; Schmidt, Werner; Deryal, Mustafa; Ertan, Kubilay; Degenhardt, Friedrich

    2012-01-01

    Lymphedema of the arm is the most common and impairing complication after breast cancer surgery with axillary lymph node dissection (ALND). Our prospective study evaluated the effect of two different surgical techniques for ALND on postoperative morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n = 17) underwent the most common and standard technique of ALND, which uses sharp dissection of the tissue and subsequent electro-coagulation of bleedings. Patients in group 2 (n = 17) underwent a modified standard technique of ALND with clamping and ligatures of all resection margins. Postoperative wound secretion was quantified and patients were followed up for 6 months to assess long-term morbidity. The variations in surgical technique had no significant influence on the outcome variables. However, patients in group 2 showed a tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P = nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P = nonsignificant). Moreover, the number of resected lymph nodes correlated with the total amount of drained fluid (P = 0.006), the duration of the drain (P = 0.015), and the risk for the development of lymphedema after 3 months (P = 0.016). The described variations in surgical technique had no influence on the outcomes of the patients. The number of resected axillary lymph nodes remains the most important risk factor for treatment-related morbidity. Therefore, a well-balanced choice of the extent of the axillary dissection should be the surgeon’s main concern. PMID:22570566

  10. Axillary dissection in primary breast cancer: variations of the surgical technique and influence on morbidity.

    PubMed

    Wojcinski, Sebastian; Nuengsri, Sirin; Hillemanns, Peter; Schmidt, Werner; Deryal, Mustafa; Ertan, Kubilay; Degenhardt, Friedrich

    2012-01-01

    Lymphedema of the arm is the most common and impairing complication after breast cancer surgery with axillary lymph node dissection (ALND). Our prospective study evaluated the effect of two different surgical techniques for ALND on postoperative morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n = 17) underwent the most common and standard technique of ALND, which uses sharp dissection of the tissue and subsequent electro-coagulation of bleedings. Patients in group 2 (n = 17) underwent a modified standard technique of ALND with clamping and ligatures of all resection margins. Postoperative wound secretion was quantified and patients were followed up for 6 months to assess long-term morbidity. The variations in surgical technique had no significant influence on the outcome variables. However, patients in group 2 showed a tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P = nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P = nonsignificant). Moreover, the number of resected lymph nodes correlated with the total amount of drained fluid (P = 0.006), the duration of the drain (P = 0.015), and the risk for the development of lymphedema after 3 months (P = 0.016). The described variations in surgical technique had no influence on the outcomes of the patients. The number of resected axillary lymph nodes remains the most important risk factor for treatment-related morbidity. Therefore, a well-balanced choice of the extent of the axillary dissection should be the surgeon's main concern. PMID:22570566

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

    PubMed Central

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

    2012-01-01

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

  12. Surgical Removal of Neglected Soft Tissue Foreign Bodies by Needle-Guided Technique

    PubMed Central

    Ebrahimi, Ali; Radmanesh, Mohammad; Rabiei, Sohrab; kavoussi, Hossein

    2013-01-01

    Introduction: The phenomenon of neglected foreign bodies is a significant cause of morbidity in soft tissue injuries and may present to dermatologists as delayed wound healing, localized cellulitis and inflammation, abscess formation, or foreign body sensation. Localization and removal of neglected soft tissue foreign bodies (STFBs) is complex due to possible inflammation, indurations, granulated tissue, and fibrotic scar. This paper describes a simple method for the quick localization and (surgical) removal of neglected STFBs using two 23-gauge needles without ultrasonographic or fluoroscopic guidance. Materials and Methods: A technique based on the use of two 23-gauge needles was used in 41 neglected STFBs in order to achieve proper localization and fixation of foreign bodies during surgery. Results: Surgical removal was successful in 38 of 41 neglected STFBs (ranging from 2–13mm in diameter). Conclusion: The cross-needle-guided technique is an office-based procedure that allows the successful surgical removal of STFBs using minimal soft tissue exploration and dissection via proper localization, fixation, and propulsion of the foreign body toward the surface of the skin. PMID:24303416

  13. The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

    PubMed Central

    Buac, Suzana; Schadde, Erik; Schnitzbauer, Andreas A.; Vogt, Kelly; Hernandez-Alejandro, Roberto

    2016-01-01

    Background ALPPS was developed to induce accelerated future liver remnant (FLR) hypertrophy in order to increase hepatic tumour resectability and reduce the risk of post-operative liver failure. While early studies demonstrated concerning complication rates, others reported favourable results. This inconsistency may be due to variability in surgical indications and technique. Methods A web-based survey was sent to surgeons participating in the International ALPPS Registry in September of 2014. Questions addressed surgeon demographics and training, surgical indications and technique, and clinical management approaches. Results Fifty six out of 85 surgeons from 78 centers responded (66%) and half (n = 30) had training in liver transplantation. Forty seven (84%) did not reserve ALPPS solely for colorectal liver metastases (CRLM) and 30 (54%) would perform ALPPS for an FLR over 30%. Neoadjuvant chemotherapy for CRLM was recommended by 37 (66%) respondents. Surgical approaches varied considerably, with 30% not preserving outflow to the middle hepatic vein and 39% believing it necessary to skeletonize the hepatoduodenal ligament. Twenty five (45%) surgeons have observed segment 4 necrosis. Conclusion There is considerable variability in how ALPPS is performed internationally. This heterogeneity in practice patterns may explain the current incongruity in published outcomes, and highlights the need for standardization. PMID:27154808

  14. GPU-based Efficient Realistic Techniques for Bleeding and Smoke Generation in Surgical Simulators

    PubMed Central

    Halic, Tansel; Sankaranarayanan, Ganesh; De, Suvranu

    2010-01-01

    Background In actual surgery, smoke and bleeding due to cautery processes, provide important visual cues to the surgeon which have been proposed as factors in surgical skill assessment. While several virtual reality (VR)-based surgical simulators have incorporated effects of bleeding and smoke generation, they are not realistic due to the requirement of real time performance. To be interactive, visual update must be performed at least 30 Hz and haptic (touch) information must be refreshed at 1 kHz. Simulation of smoke and bleeding is, therefore, either ignored or simulated using highly simplified techniques since other computationally intensive processes compete for the available CPU resources. Methods In this work, we develop a novel low-cost method to generate realistic bleeding and smoke in VR-based surgical simulators which outsources the computations to the graphical processing unit (GPU), thus freeing up the CPU for other time-critical tasks. This method is independent of the complexity of the organ models in the virtual environment. User studies were performed using 20 subjects to determine the visual quality of the simulations compared to real surgical videos. Results The smoke and bleeding simulation were implemented as part of a Laparoscopic Adjustable Gastric Banding (LAGB) simulator. For the bleeding simulation, the original implementation using the shader did not incur in noticeable overhead. However, for smoke generation, an I/O (Input/Output) bottleneck was observed and two different methods were developed to overcome this limitation. Based on our benchmark results, a buffered approach performed better than a pipelined approach and could support up to 15 video streams in real time. Human subject studies showed that the visual realism of the simulations were as good as in real surgery (median rating of 4 on a 5-point Likert scale). Conclusions Based on the performance results and subject study, both bleeding and smoke simulations were concluded to be

  15. Surgical techniques for the treatment of ankyloglossia in children: a case series

    PubMed Central

    JUNQUEIRA, Marina Azevedo; CUNHA, Nayara Nery Oliveira; SILVA, Lidiane Lucas Costa e; ARAÚJO, Leandro Borges; MORETTI, Ana Beatriz Silveira; COUTO FILHO, Carlos Eduardo Gomes; SAKAI, Vivien Thiemy

    2014-01-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort. PMID:25025566

  16. Computer-assisted surgical techniques: can they really improve laser surgery?

    NASA Astrophysics Data System (ADS)

    Reinisch, Lou; Arango, Pablo; Howard, John G.; Mendenhall, Marcus H.; Ossoff, Robert H.

    1995-05-01

    As part of our Computer-Assisted Surgical Techniques (CAST) program, we use computers to guide surgical lasers, create minimal incision widths, regulate the rate of tissue ablation, monitor the types of tissue being ablated with photo-acoustic feedback, and track and compensate for patient motions due to respiration and heart beat. The union of the computer, robotics and lasers can assist the surgeon and permit several new applications. Although these advances in laser surgery appear to have obvious benefits, it is important to evaluate and quantify the clinical advantages. We have compared the CAST system to manually controlled laser surgery and studied the wound healing after laser incision. We have found definite advantages to the CAST system. However, the computer, alone, cannot compensate for the thermal damage lateral to the incision site. The results suggest the need for motion tracking and compensation to be a part of the CAST system.

  17. Components separation in complex ventral hernia repair: surgical technique and post-operative outcomes.

    PubMed

    Ross, Samuel W; Oommen, Bindhu; Heniford, B Todd; Augenstein, Vedra A

    2014-03-01

    There are over 350,000 ventral hernia repairs (VHR) performed in the United States annually and a variety of laparoscopic and open surgical techniques are described and utilized. Complex ventral hernias such as recurrent hernias, those with infected mesh, open wounds, coexisting enteric fistulas, parastomal hernias, and massive hernias-especially those with loss of abdominal domain-require sophisticated repair techniques. Many of these repairs are performed via an open approach. Ideally, the aim is to place mesh under the fascia with a large overlap of the defect and obtain primary fascial closure. However, it is often impossible to bring together fascial edges in very large hernias. Component separation is an excellent surgical technique in selected patients which involves release of the different layers of the abdominal wall and in turn helps accomplish primary fascial approximation. The posterior rectus sheath, external oblique or the transverse abdominis fascia can be cut and allows for closure of fascia in a tension free manner in a majority of patients. In this chapter we describe the various techniques for component separation, indications for use, how to select an appropriate type of release and post-operative outcomes. PMID:24700223

  18. Trapping and marking terrestrial mammals for research: integrating ethics, performance criteria, techniques, and common sense.

    PubMed

    Powell, Roger A; Proulx, Gilbert

    2003-01-01

    We propose that researchers integrate ethics, performance criteria, techniques, and common sense when developing research trapping programs and in which members of institutional animal care and use committees address these topics when evaluating research protocols. To ask questions about ethics is in the best tradition of science, and researchers must be familiar with codes of ethics and guidelines for research published by professional societies. Researchers should always work to improve research methods and to decrease the effects on research animals, if for no other reason than to minimize the chances that the methods influence the animals' behavior in ways that affect research results. Traps used in research should meet performance criteria that address state-of-the-art trapping technology and that optimize animal welfare conditions within the context of the research. The proposal includes the following criteria for traps used in research: As Criterion I, killing-traps should render >/= 70% of animals caught irreversibly unconscious in /= 70% of animals with techniques for short-term, long-term, and permanent marking of mammals. PMID:13130157

  19. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  20. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia.

    PubMed

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or "tongue-tie" is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  1. A systematic review on skin complications of bone-anchored hearing aids in relation to surgical techniques.

    PubMed

    Mohamad, Shwan; Khan, Imran; Hey, S Y; Hussain, S S Musheer

    2016-03-01

    A systematic review to study the skin complications associated with the bone-anchored hearing aid in relation to surgical techniques. The following databases have been searched: MEDLINE, EMBASE, the Cochrane Library , Google scholar and the PubMed. The literature search date was from January 1977 until November 2013. Randomised controlled trials and retrospective studies were included. Initial search identified 420 publications. Thirty articles met the inclusion criteria of this review. The most common surgical techniques identified were full-thickness skin graft, Dermatome and linear incision techniques. The result shows that dermatome technique is associated with higher rate of skin complications when compared to linear incision and skin graft techniques. Based on the available literature, the use of a linear incision technique appears to be associated with lower skin complications; however, there is limited data available supporting this. Higher quality studies would allow a more reliable comparison between the surgical techniques. PMID:25503356

  2. The impact of surgical technique on neck dissection nodal yield: making a difference.

    PubMed

    Lörincz, Balazs B; Langwieder, Felix; Möckelmann, Nikolaus; Sehner, Susanne; Knecht, Rainald

    2016-05-01

    The nodal yield of neck dissections is an independent prognostic factor in several types of head and neck cancer. The authors aimed to determine whether the applied dissection technique has a significant impact on nodal yield. This is a single-institution, prospective study with internal control group (level of evidence: 2A). Data of 150 patients undergoing 223 neck dissections between February 2011 and March 2013 have been collected in a comprehensive cancer centre. Eighty-two patients underwent neck dissection with unwrapping the cervical fascia from lateral to medial, while 68 patients were operated without specifically unwrapping the fascia, in a caudal to cranial fashion. The standardised, horizontal neck dissection technique along the fascial planes resulted in a significantly higher nodal count in Levels I, II, III and IV, as well as in terms of overall nodal yield (mean: n = 22.53) than that of the vertical dissection applied in the control group (mean: n = 15.00). This is the first publication showing a direct correlation between neck dissection nodal yield and surgical technique. Therefore, it is paramount to optimise the applied surgical concept to maximise the oncological benefit. PMID:25784183

  3. Reconstruction of medial patello-femoral ligament: Comparison of two surgical techniques.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2016-06-01

    The medial patello-femoral ligament is considered the most important passive patellar stabilizer and its proper functionality is essential for the patello-femoral joint stability. In this work, 18 human knees were randomly divided into two groups and reconstructed through two different surgical techniques: the "Through tunnel tendon" and the "Double converging tunnel" reconstructions. Subsequently, the samples were mechanically tested to evaluate the structural properties of reconstructed femur-MPFL-Patella complex (rFMPC). Particular attention was given to maintain the anatomical orientation between the patella and the graft. Both procedures showed lower stiffness and higher ultimate strain and absorbed energy compared to the native MPFL, but the advantages of the double converging tunnel technique are related to the restoration of the native MPFL sail-shape, to a better stress distribution on the patella, to the use of a single interference screw as fixation device and to the simplicity, rapidity and cost-effectivity of the surgical procedure. The evaluation of the structural properties of rMPFL is fundamental to evaluate the adequacy of the different techniques to restore the physiological structural properties of the native MPFL. PMID:26894660

  4. The Venetian blind technique: modification of the Pi procedure for the surgical correction of sagittal synostosis.

    PubMed

    Wexler, Andrew; Cahan, Leslie

    2012-11-01

    Numerous methods of surgical repair for scaphocephaly (sagittal synostosis) have been reported in the literature, from strip craniectomies to more complex methods of calvarial vault remodeling. While good cosmesis and restoration of a normal anteroposterior diameter may be obtained with these methods, a more rounded contour of the biparietal areas is often more difficult to achieve. We describe a modification of the Pi technique, described by Jane in 1976, that results in a more rounded contour of the biparietal areas. We report our experience on cranial vault remodeling for the correction of scaphocephaly in 51 patients from 1998 to 2011. PMID:23154346

  5. Novel techniques for the surgical management of abdominopelvic constriction rings in amniotic band syndrome.

    PubMed

    Capone, Avery C; Balasundaram, Naveen; Caouette-Laberge, Louise; Papay, Frank A; Lucas, Armand R; Seifarth, Federico G; Doumit, Gaby D

    2015-02-01

    Constriction rings are associated with amniotic band syndrome and most often present in the extremities. Constriction bands of the trunk are rare, and a standard of surgical care remains elusive. Traditional methods of constriction ring excision rely on soft-tissue rearrangement with multiple Z-plasties, but renewed interest in linear closure and limited Z-plasty has emerged. The authors review contemporary literature and report two cases of abdominopelvic constriction ring reconstruction with long-term follow-up. Novel techniques including anterior sheath Y-V plasty, pteruges release of the Scarpa fascia, and limited Z-plasty closure may minimize the need for serrated scar patterns. PMID:25626800

  6. Lateralization of the inferior alveolar nerve with simultaneous implant placement: surgical techniques.

    PubMed

    Garg, A K; Morales, M J

    1998-01-01

    In the event of moderate to severe mandibular bone resorption posterior to the mental foramen, repositioning of the inferior alveolar nerve provides a greater amount of available bone for implant placement and reduces the risk of nerve injury. While neural paresthesia may initially occur, this altered sensation generally resolves spontaneously. Alveolar nerve repositioning may be possible in cases in which other procedures cannot be performed due to the extent of atrophy of the posterior mandibular alveolar crest. This article presents the surgical technique to achieve this objective. PMID:10093565

  7. Peroneal Tenodesis With the Use of Tendoscopy: Surgical Technique and Report of 1 Case

    PubMed Central

    Mattos e Dinato, Mauro Cesar; de Faria Freitas, Marcio; Pereira Filho, Miguel Viana

    2014-01-01

    Peroneus brevis tendon injury is the most common lesion of the peroneal tendons. The initial treatment is conservative, and surgical treatment is indicated if conservative treatment fails. It is often necessary to open the entire upper and lower retinaculum to obtain adequate visualization of the structures. We present a case in which the peroneus brevis tenodesis was used with the aid of tendoscopy. This technique should be used for patients with lesions affecting more than 50% of the tendon diameter. We found that, by making small incisions, the patient recovered well, quickly, with resolution of pain. PMID:24749027

  8. Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique.

    PubMed

    Vilá Mollinedo, Luis Gustavo; Jaime Uribe, Andrés; Aceves Chimal, José Luis; Martínez-Rubio, Roberto Pablo; Hernández-Romero, Karen Patricia

    2016-01-01

    Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta. PMID:27547381

  9. Case Report: ALCAPA syndrome: successful repair with an anatomical and physiological alternative surgical technique

    PubMed Central

    Vilá Mollinedo, Luis Gustavo; Jaime Uribe, Andrés; Aceves Chimal, José Luis; Martínez-Rubio, Roberto Pablo; Hernández-Romero, Karen Patricia

    2016-01-01

    Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta. PMID:27547381

  10. Racial and ethnic disparities in gastric cancer outcomes: More important than surgical technique?

    PubMed Central

    Merchant, Shaila J; Li, Lily; Kim, Joseph

    2014-01-01

    Racial and ethnic disparities in cancer care are major public health concerns and their identification is necessary to develop interventions to eliminate these disparities. We and others have previously observed marked disparities in gastric cancer outcomes between Eastern and Western patients. These disparities have long been attributed to surgical technique and extent of lymphadenectomy. However, more recent evidence suggests that other factors such as tumor biology, environmental factors such as Helicobacter pylori infection and stage migration may also significantly contribute to these observed disparities. We review the literature surrounding disparities in gastric cancer and provide data pertaining to potential contributing factors. PMID:25206261

  11. Minimally Invasive Surgical Technique in Periodontal Regeneration: A Randomized Controlled Clinical Trial Pilot Study.

    PubMed

    Ghezzi, Carlo; Ferrantino, Luca; Bernardini, Luigi; Lencioni, Margherita; Masiero, Silvia

    2016-01-01

    The purpose of this study was to compare two minimally invasive surgical techniques (MISTs) for the treatment of periodontal defects: (1) guided tissue regeneration (GTR) using resorbable minimembrane and particulate xenograft (DBBM); and (2) inductive periodontal regeneration (IPR) using enamel matrix derivatives and DBBM. A sample of 20 infrabony periodontal defects in 20 patients were randomly assigned to either the GTR or the IPR group. A follow-up was performed at 12 months postoperative. Significant improvement in clinical parameters was observed in both groups, although no intergroup differences were found. MIST with GTR or IPR demonstrated very good outcomes 1 year after surgery, with no differences between treatment groups. PMID:27333004

  12. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.

    PubMed

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M

    2015-12-28

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  13. Evaluation of a training course on open vascular surgical techniques in aortoiliac pathology - 5 years of experience

    PubMed Central

    STANCU, BOGDAN; BETEG, FLORIN; MIRONIUC, AUREL; MUSTE, AUREL; GHERMAN, CLAUDIA

    2015-01-01

    Introduction The aim of this prospective study was to assess the efficacy of a vascular surgery course (2008–2012), and to verify the viability and the feasibility of vascular anastomoses. Material and method The vascular surgical techniques performed simultaneously on pigs were: enlargement prosthetic angioplasty, abdominal aortic interposition graft and aortoiliac bypass. The endpoints of the study were the surgical skills and the technical quality, assessed on a scale ranging from 1 (satisfactory) to 3 (very good) for our participants. Results A significant improvement in vascular surgical skills tasks was observed during the study years and we also found a significant statistical association between the quality of the suture and the surgical technique used (Kendall coefficient=0.71, p=0.001<0.05). Conclusions Our course contributed to the improvement of the technical vascular surgical skills of the operator teams, reproducing in vivo, in pigs, the intraoperative environment of human patients. PMID:26528071

  14. Comparison of surgically induced astigmatism between one-handed and two-handed cataract surgery techniques

    PubMed Central

    Kawahara, Asushi; Kurosaka, Daijiro; Yoshida, Aktoshi

    2013-01-01

    Background The purpose of this study was to compare surgically induced astigmatism (SIA) between one-handed and two-handed cataract surgery techniques. Methods Eighty-eight eyes of 44 patients with no ocular disease other than cataract, who underwent cataract surgery by a single surgeon, were selected for this study. Cataract surgery was performed by coaxial phacoemulsification and intraocular lens implantation via a 2.4 mm transconjunctival single-plane sclerocorneal incision at the 12 o’clock position. In each patient, one eye was subjected to coaxial phacoemulsification using a one-handed technique while the fellow eye was subjected to coaxial phacoemulsification using a two-handed technique. For the two-handed technique, a corneal side port was created at the 2 o’clock position. The appropriate incision meridian was identified by a preoperative axis mark. SIA was calculated using the Alpins method. Results Mean SIA was 0.40 ± 0.28 diopters (D) in the one-handed technique group and 0.39 ± 0.25 D in the two-handed technique group. No statistically significant difference was found in the mean SIA score. The mean torque value was −0.05 ± 0.26 D in the one-handed technique group and 0.11 ± 0.37 D in the two-handed technique group. Mean torque was significantly lower (P<0.05) in the one-handed technique group than in the two-handed technique group. Conclusion The results indicate that the corneal side port in two-handed cataract surgery has a rotating effect on the axis of astigmatism. PMID:24124349

  15. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    PubMed Central

    Varghese, Roy; Saheed, Sanni; Ravi, Amrutha K; Sherrif, Ejaz Ahmed; Agarwal, Ravi; Kothandam, Sivakumar

    2016-01-01

    Background: Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby “excluding” the conduction system and the tensor apparatus of the tricuspid valve from the suture line. Materials and Methods: Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset. Results: Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed. Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed. PMID:27625520

  16. Laparoscopy in the morbidly obese: physiologic considerations and surgical techniques to optimize success.

    PubMed

    Scheib, Stacey A; Tanner, Edward; Green, Isabel C; Fader, Amanda N

    2014-01-01

    The objectives of this review were to analyze the literature describing the benefits of minimally invasive gynecologic surgery in obese women, to examine the physiologic considerations associated with obesity, and to describe surgical techniques that will enable surgeons to perform laparoscopy and robotic surgery successfully in obese patients. The Medline database was reviewed for all articles published in the English language between 1993 and 2013 containing the search terms "gynecologic laparoscopy" "laparoscopy," "minimally invasive surgery and obesity," "obesity," and "robotic surgery." The incidence of obesity is increasing in the United States, and in particular morbid obesity in women. Obesity is associated with a wide range of comorbid conditions that may affect perioperative outcomes including hypertension, atherosclerosis, angina, obstructive sleep apnea, and diabetes mellitus. In obese patients, laparoscopy or robotic surgery, compared with laparotomy, is associated with a shorter hospital stay, less postoperative pain, and fewer wound complications. Specific intra-abdominal access and trocar positioning techniques, as well as anesthetic maneuvers, improve the likelihood of success of laparoscopy in women with central adiposity. Performing gynecologic laparoscopy in the morbidly obese is no longer rare. Increases in the heaviest weight categories involve changes in clinical practice patterns. With comprehensive and thoughtful preoperative and surgical planning, minimally invasive gynecologic surgery may be performed safely and is of particular benefit in obese patients. PMID:24100146

  17. Comparison of two surgical techniques for the management of cervical spondylomyelopathy in dobermanns.

    PubMed

    Rusbridge, C; Wheeler, S J; Torrington, A M; Pead, M J; Carmichael, S

    1998-09-01

    A study was undertaken to compare the efficacy of two surgical techniques for the treatment of caudal cervical spondylomyelopathy (CCSM): ventral decompression (slot) and vertebral distraction and stabilisation with a screw and washer (screw/washer). Twenty-eight dobermanns managed surgically for disc-associated CCSM during a four-year period were studied retrospectively. The maximum postoperative period was 40 months. Cases were excluded if a minimum follow-up of 24 months after surgery could not be made. A 'slot' took a longer time to perform and had a higher rate of immediate postoperative deterioration. Duration of hospital stay was similar for both procedures. At six months after surgery the two techniques were comparable; 12/14 (screw/washer) and 13/14 (slot) patients were deemed to have a satisfactory outcome. Recurrence of cervical spinal cord disease was higher in the screw/washer dogs. At one year after surgery the recurrence rate was zero (slot) and 5/14 (screw/washer), respectively. At two years after surgery 4/14 of the slot dogs had deteriorated compared to 7/14 of the screw/washer dogs. Where investigated, the cause of deterioration was either a domino disc lesion or vertebral endplate collapse and dorsal displacement of the screw and washer. PMID:9791829

  18. Surgical techniques for smile restoration in patients with Möbius syndrome

    PubMed Central

    Ortiz-Rincones, María A.; Suárez-Gorrin, Fabiola

    2013-01-01

    Möbius syndrome is a congenital condition, the etiology when is not associated with misoprostol is not well defined. Signs and symptoms include difficulty swallowing, speech problems, drooling, strabismus, limitation of eye movement and more importantly, the facial blankness that these individuals have, result of the facial paralysis, due to atrophy of the cranial nerves that are involved in this condition. The ability to express emotions is affected and are considered “children without a smile.” There is currently no treatment to solvent the birth defects, the treatment options for reduce these alterations is the surgical option that has as main objective to restore muscle function through various techniques, used as required, the possibilities of applying them, is taking into consideration the outcome of the procedure to execute. Among the surgical techniques used mainly: the lengthening myoplasty of the temporal muscle,muscle transfers, cross-facial grafting, neurorrhaphy and nerve transposition, of which latter are the best performers, giving the patient a more natural, in as far as regards expression and function. Key words:Möbius syndrome, surgery, smile, facial nerve, muscle transfer, transfer nerve, temporalis muscle. PMID:24455082

  19. A variant technique for the surgical treatment of left ventricular aneurysms

    PubMed Central

    Evora, Paulo Roberto Barbosa; Tubino, Paulo Victor Alves; Gali, Luis Gustavo; Alves Junior, Lafaiete; Ferreira, Cesar Augusto; Bassetto, Solange; Menardi, Antônio Carlos; Rodrigues, Alfredo José; Vicente, Walter Vilella de Andrade

    2014-01-01

    Objective To present a surgical variant technique to repair left ventricular aneurysms. Methods After anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to eliminate the entire septal scar; 3) Then, a second encircling suture is placed, completing the occlusion of the aneurysm, and; 4) Finally, the remaining scar tissue is oversewn with an invaginating suture, to ensure hemostasis. Myocardium revascularization is performed after correction of the left ventricle aneurysm. The same surgeon performed all the operations. Results Regarding the post-surgical outcome 4 patients (40%) had surgery 8 eight years ago, 2 patients (20%) were operated on over 6 years ago, and 1 patient (10%) was operated on more than 5 years ago. Three patients (30%) were in functional class I, class II in 2 patients (20%) and 2 patients (20%) with severe comorbidities remains in class III of the NYHA. There were three deaths (at four days, 15 days and eight months) in septuagenarians with acute myocardial infarction, diabetes and pulmonary emphysema. Conclusion The technique is easy to perform, safe and it can be an option for the correction of left ventricle aneurysms. PMID:25714220

  20. Laparoscopic vasectomy in African savannah elephant (Loxodonta africana); surgical technique and results.

    PubMed

    Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine

    2013-12-01

    Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications. PMID:24437080

  1. Thirteen years follow-up of heart myxoma operated patients: what is the appropriate surgical technique?

    PubMed Central

    Siminelakis, Stavros; Kakourou, Alexandra; Batistatou, Alexandra; Sismanidis, Stelios; Ntoulia, Alexandra; Tsakiridis, Kosmas; Syminelaki, Theodora; Apostolakis, Eleftherios; Tsiouda, Theodora; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Dryllis, Georgios; Machairiotis, Nikolaos; Mpakas, Andreas; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    Background Cardiac myxoma is a benign neoplasm that represents the most prevalent primary tumor of the heart. If not treated with the right surgical technique recurrence occurs. Aim of our study is to present our surgical approach and the histology of the tumors resected. Methods All patients, except for one, underwent extracorporeal circulation and mild hypothermia, right atrial or both atrial incision and excision of the fossa ovalis, followed by prosthetic patch suturing. All specimens were submitted for microscopic evaluation (haematoxylin-eosin). We contacted personally each patient and asked them to complete a standardized questionnaire, concerning their peri-operative characteristics. Results Six cases were “active” myxomas, 3 were “mildly active” and 3 were “inactive”. “Normal differentiation” was seen in 6, “medium” in 1 and “poor” in 5 cases. In our series there were no recurrences recorded during the follow-up period. Conclusions The ideal approach, according to our experience is right atrial or both atrial incision as described by Shumacker and King, with excision of the fossa ovalis and the surrounding tissues and closure with a pericardial patch. Such a technique provides an excellent long-term survival in these patients. PMID:24672697

  2. Surgical technique for transscleral fixation of a foldable posterior chamber intraocular lens.

    PubMed

    Yepez, Juan B; de Yepez, Jazmin Cedeño; Valero, Alejandro; Arevalo, J Fernando

    2006-01-01

    The safety and efficacy of a modified technique for transscleral fixation of a foldable posterior chamber intraocular lens (IOL) for intracapsular aphakia (secondary IOL) or after complicated phacoemulsification was evaluated. All eyes had inadequate or no posterior capsular support. Follow-up was between 4 and 26 months (mean, 12 months). Uncorrected visual acuity improved (> 2 lines) in all patients. During follow-up, the IOL was correctly positioned in all cases. There were no major complications, such as endophthalmitis or suture erosion through the conjunctiva at the site of fixation. No patient required further surgical interventions. This modified technique of transscleral fixation of foldable posterior chamber IOL offers the advantages of a small incision and rapid visual rehabilitation, and minimizes the risk of intraoperative and postoperative complications. PMID:16749265

  3. ARTHROSCOPIC RELEASE OF THE SUPRASCAPULAR NERVE: SURGICAL TECHNIQUE AND EVALUATION OF CLINICAL CASES

    PubMed Central

    Garcia Júnior, José Carlos; Paccola, Ana Maria Ferreira; Tonoli, Cristiane; Zabeu, José Luis Amin; Garcia, Jesely Pereira Myrrha

    2015-01-01

    To describe a specific surgical technique for arthroscopic decompression of the suprascapular nerve (SSN) and evaluate its preliminary results. Methods: Ten shoulders of nine patients were operated using a technique with portals differing from the already-known techniques, which did not use traction and made use of materials available within the public healthcare system. Results: Among the ten shoulders of nine patients, eight were right shoulders and two were left shoulders. The mean age was 69.5 years. The UCLA score increased from 11.7 to 26.1 points over the postoperative follow-up of 16.6 months. The SF-36 questionnaire score was 122.9 and the raw pain scale value was 88%. Conclusion: Arthroscopic decompression of the SSN in accordance with the described technique is reproducible and less traumatic than the open techniques. The patients achieved improvements in many of the parameters evaluated, particularly with regard to pain. Arthroscopic decompression of the SSN may be a therapeutic option for pathological compression of the SSN. PMID:27027028

  4. Percutaneous Endoscopic Lumbar Foraminotomy: An Advanced Surgical Technique and Clinical Outcomes

    PubMed Central

    Oh, Hyun-Kyong; Kim, Ho; Lee, Sang-Ho; Lee, Haeng-Nam

    2014-01-01

    BACKGROUND: Although several authors have reported the use of endoscopic techniques to treat lumbar foraminal stenosis, the practical application of these techniques has been limited to soft disc herniation. OBJECTIVE: To describe the details of the percutaneous endoscopic lumbar foraminotomy (ELF) technique for bony foraminal stenosis and to demonstrate the clinical outcomes. METHODS: Two years of prospective data were collected from 33 consecutive patients with lumbar foraminal stenosis who underwent ELF. The surgical outcomes were assessed using the visual analog scale, Oswestry Disability Index, and modified MacNab criteria. The procedure begins at the safer extraforaminal zone rather than the riskier intraforaminal zone. Then, a full-scale foraminal decompression can be performed using a burr and punches under endoscopic control. RESULTS: The mean age of the 18 female and 15 male patients was 64.2 years. The mean visual analog scale score for leg pain improved from 8.36 at baseline to 3.36 at 6 weeks, 2.03 at 1 year, and 1.97 at 2 years post-surgery (P < .001). The mean Oswestry Disability Index improved from 65.8 at baseline to 31.6 at 6 weeks, 19.7 at 1 year, and 19.3 at 2 years post-surgery (P < .001). Based on the modified MacNab criteria, excellent or good results were obtained in 81.8% of the patients, and symptomatic improvements were obtained in 93.9%. CONCLUSION: Percutaneous ELF under local anesthesia could be an efficacious surgical procedure for the treatment of foraminal stenosis. This procedure may offer safe and reproducible results, especially for elderly or medically compromised patients. ABBREVIATIONS: ELF,endoscopic lumbar foraminotomy ODI, Oswestry Disability Index VAS, visual analog scale PMID:24691470

  5. True Percutaneous Transforaminal Lumbar Interbody Fusion: Case Illustrations, Surgical Technique, and Limitations.

    PubMed

    Syed, Hasan; Voyadzis, Jean-Marc

    2016-07-01

    Objective The last decade has seen significant advances in minimally invasive techniques for lumbar interbody fusion that have reduced approach-related morbidity. Percutaneous lumbar interbody fusion involves a posterior transforaminal approach to the disk space with a minimal access port through the Kambin triangle. This technique obviates the need for the facetectomy or laminectomy required in a traditional transforaminal approach. This article describes the surgical technique, potential advantages and limitations, and representative case illustrations. Methods Percutaneous transforaminal interbody fusion was performed on two patients with axial back and leg pain as a result of degenerative disk disease. Diskectomy and interbody cage insertion were completed through a tubular dilator placed onto the disk space in the Kambin triangle. Posterior fixation was achieved with percutaneous transfacet screws. Clinical outcome and postoperative complications are discussed. Results Both patients demonstrated significant clinical improvement after surgery with > 1 year follow-up despite experiencing transient neurologic symptoms. Conclusion Although this report demonstrates the feasibility and advantages of the approach, the technique is limited by the potential for nerve root injury and pseudoarthrosis. PMID:26291889

  6. [Surgical technique: reconstruction of deficient extensor apparatus of the knee - a case report].

    PubMed

    Wilken, F; Harrasser, N; Pohlig, F; Laux, F M; von Eisenhart-Rothe, R

    2015-04-01

    Injuries to the extensor apparatus of the knee are a rare but in case of their occurrence a serious injury. In the following discussion, the focus is on treatment of chronic patellar tendon tears. The aim of surgical treatment is the recovery of the active extension and full weight-bearing ability of the leg. The video presentation shows the operative treatment of a patient with a chronic extensor mechanism deficiency of the knee after multiple revision of a total knee arthroplasty due to periprosthetic infection and three-times occurrence of a patella tendon tear. A frame-shaped reinforcement between patella and tibial tuberosity by FiberTape® combined with a medial gastrocnemius flap was performed. This type of surgery is indicated in cases of large defects of the patellar tendon that cannot be treated with end-to-end suture or simple augmentation with autologous tendons (e.g. semitendinosus). In addition to augmentation of the tendon defect, cutaneous soft tissue defects around the knee and proximal lower leg can be covered. In general, the best treatment option is chosen according to size of the defect, the quality of the tendon tissue and possible previous surgery on the knee joint. There are no reports of large series of chronic patella tendon tears, but only isolated cases using a variety of techniques. In addition with low level of evidence, there is currently no established gold standard in the surgical treatment of insufficiencies of the extensor apparatus of the knee. PMID:25874403

  7. The utilization of six sigma and statistical process control techniques in surgical quality improvement.

    PubMed

    Sedlack, Jeffrey D

    2010-01-01

    Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services. PMID:20946422

  8. Triceps fascial tongue exposure for total elbow arthroplasty: surgical technique and case series.

    PubMed

    Marinello, Patrick G; Peers, Sebastian; Styron, Joseph; Pervaiz, Khurram; Evans, Peter J

    2015-06-01

    During a posterior approach to the elbow, the triceps muscle body and tendon insertion must be addressed during exposure. Several methods exist including performing an olecranon osteotomy. The triceps fascial tongue exposure, originally described by Van Gorder in 1940, provides an excellent view of the joint while causing minimal trauma to the extensor mechanism facilitating tendon healing, and easy intraoperative conversion from fracture fixation to a total elbow arthroplasty if a fracture is not able to be reconstructed. Using a standard posterior approach to the elbow, a triceps tongue is created. A distally based flap of the triceps tendon approximately 10 cm long and 2 to 3 cm wide is created and a remnant of the tendon is kept on all sides to secure a meticulous repair with nonabsorbable figure-of-eight sutures at the conclusion of the case. In our case series, 29 patients underwent 30 total elbow arthroplasties. There were no triceps-related failures. This surgical technique is a useful alternative surgical exposure to the posterior elbow for fractures and arthroplasty. PMID:25929418

  9. Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry

    PubMed Central

    Allvin, Renée; Rawal, Narinder; Johanzon, Eva; Bäckström, Ragnar

    2016-01-01

    Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient's perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (P = 0.012). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean ≥ 5 in both groups). Pain interference with mobilization was reported by 87–93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given. PMID:27127649

  10. Surgical resection technique of a fused supernumerary lateral incisor: a clinical report and review of the literature.

    PubMed

    Beier, Ulrike Stephanie; Dumfahrt, Herbert; Widmann, Gerlig; Puelacher, Wolfgang

    2012-01-01

    This case report presents the surgical and restorative management of a fused supernumerary left lateral incisor. The diagnosis was confirmed using conventional radiographs and CT. The case report discusses the value of CT for evaluation of the root relationships and describes the varied morphology associated with supernumerary incisors, the surgical resection technique, partial pulpotomy, and restoration with composite resin after mechanical exposure of the remaining tooth's pulp. PMID:22782063

  11. "Modified Adductor Sling Technique"- a surgical therapy for patellar instability in children and adolescents

    PubMed Central

    Alm, Lena; Frosch, Karl-Heinz; Preiss, Achim; Heitmann, Maximilian; Akoto, Ralph

    2016-01-01

    Aims and Objectives: Due to open femoral physis, the therapy of patellar instability in children and adolescents is challenging. We developed a surgical technique, modified form of the "Adductor-Sling-Technique" by Sillanpää which offers a surgical treatment to avoid damage to the femoral physis. The purpose of this study is to determine whether there is a benefit in the clinical outcome for patients operated by the "modified Adductor Sling Technique" in comparison to patients with other surgical procedures. Materials and Methods: Twenty "modified Adductor Sling" reconstructions in 19 patients (age 11-24) were included in the study until now, 15 patients with open physis and 4 patients with closed physis with special indications. Since 2010 "modified Adductor Sling" reconstruction was performed by looping the gracilis tendon around the adductor magnus tendon and attaching it at the medial facette of the patella. Clinical outcome was retrospectively evaluated at a mean follow-up period of 1.3 years (range 0.5-3.6). The evaluation also included Lysholm Score, Kujala Score and DGU score. Statistical analysis was performed using IBM®SPSS®Statistics Version 21. A P value less than 0.5 was considered significant. Results: The average age at the time of operation was 14.9 years (range 11.2-24.3). Recurrent dislocation occurred in 4 out of 20 cases (20%). It was noticeable that out of those 4 patients 2 patients had a lateral release in addition to the "modified Adductor Sling Technique" due to lateral hyperpression. No other patients had a lateral release in our patient population. Also, out of those 4 patients 3 patients had an additional maltracking of the patella, caused by a high TTTG, severe trochlea dysplasia or additional axial deformity. The overall Kujala Score was 87 (range 46-100) points, in patients without re-dislocation it was 94 (range 46-100) points. The overall Lysholm Score was 85 (range 39-100) points, in the group without re-dislocation 90 (range

  12. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    PubMed Central

    Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  13. [Surgical Techniques for Patella Replacement in Cases of Deficient Bone Stock in Revision TKA].

    PubMed

    Ritschl, P; Machacek, F; Strehn, L; Kloiber, J

    2015-06-01

    The patella replacement in revision surgery is a challenge especially in cases of unsufficient bone stock. Depending on the extent of the bone defect, the following videos demonstrate different approaches: Video 1: bone sparing removal of the patella implant: onlay-type patella implants. Video 2: complete cortical bone rim of the patella, residual thickness between 6 to 10 mm: biconvex patella implant. Video 3 and 4: small defects of the cortical bone rim of the patella, residual thickness 1 to 5 mm (patella shell): gull-wing osteotomy, patella bone grafting techniques. Video 5: partial necrosis/defect of the patella shell with incomplete cortical bone rim: porous tantalum patella prosthesis. On account of the various surgical options for different bone defects of the patella, patellectomy and pure patelloplasty should be avoided to prevent functional shortcomings. PMID:26114564

  14. Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

    PubMed Central

    Shadid, Rola Muhammed; Sadaqah, Nasrin Rushdi; Othman, Sahar Abdo

    2014-01-01

    Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs) conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability. PMID:25126094

  15. Surgical Rehabilitation Techniques in Children with Poor Prognosis Short Bowel Syndrome.

    PubMed

    Dore, Mariela; Junco, Paloma Triana; Andres, Ane M; Sánchez-Galán, Alba; Amesty, Maria Virginia; Ramos, Esther; Prieto, Gerardo; Hernandez, Francisco; Lopez Santamaria, Manuel

    2016-02-01

    Intestinal failure (IF) requires a multidisciplinary management based on nutritional support, surgical and medical rehabilitation, and transplantation. The aim of this study is to review our experience with surgical rehabilitation techniques (SRTs: enteroplasty, Bianchi, Serial Transverse Enteroplasty Procedure [STEP]) in patients with short bowel syndrome (SBS) and poor prognosis due to complex abdominal pathology. We performed a single-center retrospective study of patients with IF evaluated for intestinal transplantation in the Intestinal Rehabilitation Unit who underwent an SRT. Nonparametric tests were used for statistical analysis.A total of 205 patients (107 males/98 females) with mean age of 25 ± 7 months were assessed for IF. A total of 433 laparotomies were performed on 130 patients including intestinal resection, enteroplasties, adhesiolysis, and transit reconstruction. SRT were performed in 22 patients: 12 enteroplasties, 8 STEPs, and 4 Bianchi procedures. All patients were parenteral nutrition (PN) dependent with different stages of liver disease: mild (13), moderate (5), and severe (4). The adaptation rate for patients who underwent enteroplasty, STEP, and Bianchi were 70, 63, and 25%, respectively, although the techniques are not comparable. Overall, intestinal adaptation was achieved in nine (41%) patients, and four (18%) patients showed significant reduction of PN needs. One child did not respond to SRT and did not meet transplantation criteria. The remaining eight (36%) patients were included on the waiting list for transplant: four were transplanted, two are still on the waiting list, and two died. Better outcomes were observed in milder cases of liver disease (mild 77%, moderate 40%, severe 25%) (p < 0.05). Conversely, a trend toward a poorer outcome was observed in cases with ultrashort bowel (p > 0.05). One patient required reoperation after a Bianchi procedure due to intestinal ischemia and six needed further re-STEP or adhesiolysis

  16. Effect of Opiates, Anesthetic Techniques, and Other Perioperative Factors on Surgical Cancer Patients

    PubMed Central

    Kaye, Alan David; Patel, Nayan; Bueno, Franklin Rivera; Hymel, Brad; Vadivelu, Nalini; Kodumudi, Gopal; Urman, Richard D.

    2014-01-01

    Background Opioid pharmacotherapy is often used to treat cancer pain. However, morphine and other opioid-like substance use in patients with cancer may have significant adverse consequences, including the suppression of both innate and acquired immune responses. Although studies have examined the possibility that regional anesthesia attenuates the immunosuppressive response of surgery, the effects of morphine and other opioid-related substances on tumor progression remain unknown. Methods This article presents an evidence-based review of the influence of opioids and anesthetic technique on the immune system in the context of cancer recurrence. The review focuses on the field of regional anesthesia and the setting of surgical oncologic procedures. The method for perioperative pain management and the technique of anesthesia chosen for patients in cancer surgery were explored. Results General anesthetics have been indicated to suppress both cell-mediated immunity and humoral immunity. Evidence suggests that intravenous opioids suppress the immune system. However, the mechanisms by which anesthetics and analgesics inhibit the immune system are not understood. Compared with the alternatives, regional analgesia offers reduced blood loss and superior postoperative analgesia. Because of these advantages, the use of regional analgesia has increased in oncologic surgeries. Conclusion Immune responses from all components of the immune system, including both the humoral and cell-mediated components, appear to be suppressed by anesthetics and analgesics. The clinical anesthesiologist should consider these factors in the application of technique, especially in cancer surgery. PMID:24940132

  17. Surgical Technique for Repair of Peripheral Pulmonary Artery Stenosis and Other Complex Peripheral Reconstructions.

    PubMed

    Mainwaring, Richard D; Ibrahimiye, Ali N; Hanley, Frank L

    2016-08-01

    Surgical reconstruction of peripheral pulmonary artery stenosis is a technically challenging procedure due to the need to access all lobar and segmental branches. This paper describes our surgical approach that entails division of the main pulmonary and separation of the branch pulmonary arteries. This surgical approach can also be utilized for other complex peripheral pulmonary artery reconstructions. PMID:27449462

  18. Ethical Issues in the Introduction of New Technologies: From Mis to POEM.

    PubMed

    Ferreres, Alberto R; Patti, Marco

    2015-07-01

    The ethical debate regarding the introduction of new technologies in the surgical health care environment is discussed in this manuscript, with a special emphasis on minimally invasive and NOTES procedures for the treatment of esophageal achalasia. It offers an overview of the ethical principles and considerations about the implementation of new techniques and technologies. PMID:25894402

  19. Legal, ethical, and procedural bases for the use of aseptic techniques to implant electronic devices

    USGS Publications Warehouse

    Mulcahy, Daniel M.

    2013-01-01

    animals often mask the signs of infection to avoid attracting predators (Wobeser 2006). Guidance specific to sterilization of electronic devices for implantation is limited in the wildlife record (Burger et al. 1994; Mulcahy 2003). Few biologists have been formally trained in aseptic technique, but most biologists know that electronic devices should be treated in some way to reduce the chance for infection of the host animal by bacteria, viruses, parasites, and fungi. Most biologists (73%) who implant devices into fishes believe aseptic techniques are important (Wagner and Cooke 2005). However, I maintain that many biologists find it difficult to place the concept of asepsis into practice in their work because of confusion about what constitutes aseptic technique, a lack of surgical knowledge and training, the perception of increased costs, or the belief that aseptic surgeries are impractical or unnecessary for their application. Some have even argued that, while compromising surgical techniques in the field might result in complications or mortalities, the money saved would allow for a compensatory increase in sample size (Anderson and Talcott 2006). In this paper I define aseptic surgical techniques, document the legal and professional guidance for performing aseptic surgeries on wild animals, and present options for sterilizing electronic devices and surgical instruments for field use.

  20. Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

    PubMed Central

    Schulz-Drost, Stefan; Oppel, Pascal; Grupp, Sina; Schmitt, Sonja; Carbon, Roman Th.; Mauerer, Andreas; Hennig, Friedrich F.; Buder, Thomas

    2015-01-01

    Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method. This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture’s morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels. Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology. PMID

  1. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo

    PubMed Central

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below. PMID:26157306

  2. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo.

    PubMed

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below. PMID:26157306

  3. RADIOGRAPHIC ABNORMALITIES OF THE TALUS IN PATIENTS WITH CLUBFOOT AFTER SURGICAL RELEASE USING THE MCKAY TECHNIQUE

    PubMed Central

    Pinto, José Antonio; Hernandes, Andréa Canizares; Buchaim, Thais Paula; Blumetti, Francesco Camara; Chertman, Carla; Yamane, Patrícia Corey; da Rocha Corrêa Fernandes, Artur

    2015-01-01

    Objective: To analyze morphological abnormalities of the talus in patients with clubfoot after surgical treatment using the McKay technique. Method: Lateral standing-position radiographs of the feet of 14 patients with unilateral clubfoot who underwent treatment by means of the doubleincision McKay technique were retrospectively analyzed. All the patients were operated by the same surgeon, with an average of 6.53 years between surgery and the radiograph. We compared the radiographic characteristics of the talus between the operated and the contralateral foot. We assessed the presence of deformity of the talar dome and head (sphericity evaluation); the talar length and height; the percentage and degree of navicular subluxation; abnormalities of the Gissane angle; and the trabecular bone pattern. Results: Abnormalities of the talar head occurred in 92.8% of the patients; of the talar dome in 92.8%; and of the trabecular pattern in 100%. The talar length ratio between the operated and the contralateral foot ranged from 0.61 to 0.88 (mean 0.79; SD = 0.09), while the height ratio ranged from 0.57 to 0.98 (mean 0.82; SD = 0.12). The Gissane angle was greater in all of the operated feet, and all of them also showed navicular subluxation, at a rate ranging from 6.43 to 59.75% (mean 26.34%; SD = 16.66%). Conclusion: Talar abnormalities occurred in 100% of the feet treated using the McKay technique. It was shown that establishing radiographic parameters to describe and quantify these deformities was feasible, through simple and easy-to-perform techniques. PMID:27047821

  4. Efficiency of Various Cerebral Protection Techniques Used during the Surgical Treatment of Chronic Pulmonary Thromboembolism

    PubMed Central

    Kamenskaya, Oksana Vasilyevna; Cherniavsky, Alexander Mikhailovich; Klinkova, Asya Stanislavovna; Cherniavsky, Mikhail Alexandrovich; Meshkov, Ivan Olegovich; Lomivorotov, Vladimir Vladimirovich; Kornilov, Igor Anatolyevich; Karaskov, Alexander Mikhailovich

    2015-01-01

    Abstract: Circulatory arrest during pulmonary thromboendarterectomy (PTE) for chronic pulmonary embolism leads to an increased risk of cerebral ischemia and neurological complications. This study aimed to assess the efficacy of various cerebral protection techniques used during the surgical treatment of chronic pulmonary thromboembolism. We prospectively studied 61 patients with chronic pulmonary thromboembolism who underwent PTE. We compared the dynamics of cerebral oxygen saturation (rSO2, %) during the surgical treatment and analyzed neurological complications during the early postoperative period in two groups of patients: 30 patients who underwent surgery under conditions of moderate hypothermia (23°C–24°C) combined with antegrade unilateral cerebral perfusion (ACP group) and 31 patients who underwent thromboendarterectomy under deep hypothermic circulatory arrest (18°C, DHCA group) combined with craniocerebral hypothermia. In the ACP group, regional rSO2 decreased by less than 20% from baseline during the course of PTE. In the DHCA group, a more profound reduction of cerebral oxygen supply (by >30% from baseline) was recorded compared with the ACP group (p < .05). During the early postoperative period, 29% of patients in the DHCA group exhibited neurological complications, compared with only 7% of patients from the ACP group. The results of logistic regression analysis indicated that the risk of progressive neurological deficit depended on the duration of the intraoperative period when the absolute values of regional rSO2 were <40%. The method with the best adjustment to human physiology in patients with chronic pulmonary thromboembolism was antegrade cerebral perfusion. This method provides a smaller decrease in cerebral oxygen supply during thromboendarterectomy and significantly reduces the risk of ischemia and neurological complications in the early postoperative period. PMID:26405357

  5. ‘Minimum-incision’ endoscopically assisted transvesical prostatectomy: Surgical technique and early outcomes

    PubMed Central

    El-Karamany, Tarek M.; Al-Adl, Ahmed M.; Abdel-Baky, Shabieb A.; Abdel-Azeem, Abdallah F.; Zaazaa, Mohamed A.

    2014-01-01

    Objective To describe the surgical technique and report the early outcomes of a ‘minimum-incision’ endoscopically assisted transvesical prostatectomy (MEATP) for managing benign prostatic obstruction secondary to a large (>80 g) prostate. Patients and methods In a prospective feasibility trial, 60 men with large benign prostates underwent MEATP. The baseline and postoperative evaluation included the International Prostate Symptom Score (IPSS), a measurement of maximum urinary flow rate (Qmax), and the postvoid residual (PVR) urine volume. The adenoma was enucleated digitally through a 3-cm suprapubic skin incision, and haemostasis was completed with endoscopic coagulation of the prostatic fossa. Perioperative complications were recorded and stratified according to the modified Clavien–Dindo score. Results The mean (SD, range) prostate weight estimated by ultrasonography was 102.9 (15.4, 80–160) g, the operative duration was 52 (8, 40–65) min, the haemoglobin loss was 2.1 (1, 0.4–5) g/dL, the catheterisation time was 5.2 (1.3, 4–9) days, and the hospital stay was 6.2 (1.4, 5–10) days. There were 21 complications recorded in 16 (27%) patients, and most (86%) were of grades 1 and 2. The most frequent complications were bleeding requiring a blood transfusion (8%), and prolonged drainage (5%). There was a significant improvement at 3 months after surgery in the IPSS (8.6 vs. 21.6, P < 0.001), Qmax (19.5 vs. 7.7, P < 0.001), and PVR (15.8 vs. 83.9 mL, P < 0.001). Conclusion MEATP is feasible, safe and effective. Comparative studies and long-term data are required to determine its role in the surgical treatment of large-volume BPH. PMID:26019954

  6. Complete mesocolic excision and central vascular ligation for colon cancer: Principle, anatomy, surgical technique, and outcomes.

    PubMed

    Kim, Nam Kyu; Kim, Young Wan; Han, Yoon Dae; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young

    2016-09-01

    Classic colon cancer surgery refers to a wide resection of the tumor-bearing segment and the lymphatics draining along the named artery. The concept of TME has been applied to colon cancer and complete mesocolic excision (CME) in conjuction with central vascular ligation (CVL) has been introduced as the surgical treatment for colon cancer. Here, we discuss appropriate CME procedure with regard to the oncologic backgrounds, essential components, applied anatomy, laparoscopic technique, short-term, and oncologic outcomes. The introduction of CME has improved oncologic outcomes greatly in patients with colon cancer. The improved outcomes with CME can be attributed to underlying sound oncologic principles such as dissection through the proper plane of mesocolic excision, central vascular ligation, and sufficient length of proximal and distal margins. Thereby, CME technique can achieve en bloc removal of the diseased lesion with the increased amount of the colonic mesentery even though the length of for both bowel and mesentery resection remains a matter of debate. CME is a technically demanding operation thus, comprehensive understanding of the applied vascular anatomy is essential for successful CME. Favorable outcomes of open CME have been replicated with a laparoscopic approach. In future perspective, incorporating a structured education program on minimally invasive (laparoscopy or robot) CME would be beneficial. PMID:27566031

  7. Interview or inquisition: Successful communication techniques (Or what does ethics have to do with it, anyway?)

    SciTech Connect

    Pratt, R.C.

    1993-02-01

    Auditing and being audited can be a very stressful event. The auditor has to be sensitive to the anxiety of all auditees and should do everything possible to put the auditee at ease and help the audit process to proceed smoothly. In this paper, the human factors associated with auditing are discussed and methods of communication and other interfacing techniques are discussed which, hopefully, can act as stress reducers. The ``bottom-line`` of any audit should be to provide feedback to the auditees that will help validate or improve their process and management system. Reducing the stress and enhancing communication will help to better achieve this goal. Although some evidence during an audit is gathered from records and documents, a significant portion of audit time is spent interviewing the audited organization`s personnel. Therefore, much of this paper deals with interview techniques. It is up to the auditor to establish an initial atmosphere of trust and open communication. The goal is to obtain as much valid information as possible in the shortest time possible. Auditors should emphasize that they are there to audit the systems or program, not the person. Auditors should help the auditees` line management view the audit not as a ``search for the guilty,`` but an audit that will identify problems and assist in correction of existing or potential system problems. It should be the clearly defined policy of any audit program that there be no surprises involved with the evaluation. An ethical audit is not the place for cloak-and-dagger tactics, for witch hunting, or for the identification of situations that are then sprung at a critical and embarrassing time (a ``gotcha``).

  8. Interview or inquisition: Successful communication techniques (Or what does ethics have to do with it, anyway )

    SciTech Connect

    Pratt, R.C.

    1993-02-01

    Auditing and being audited can be a very stressful event. The auditor has to be sensitive to the anxiety of all auditees and should do everything possible to put the auditee at ease and help the audit process to proceed smoothly. In this paper, the human factors associated with auditing are discussed and methods of communication and other interfacing techniques are discussed which, hopefully, can act as stress reducers. The bottom-line'' of any audit should be to provide feedback to the auditees that will help validate or improve their process and management system. Reducing the stress and enhancing communication will help to better achieve this goal. Although some evidence during an audit is gathered from records and documents, a significant portion of audit time is spent interviewing the audited organization's personnel. Therefore, much of this paper deals with interview techniques. It is up to the auditor to establish an initial atmosphere of trust and open communication. The goal is to obtain as much valid information as possible in the shortest time possible. Auditors should emphasize that they are there to audit the systems or program, not the person. Auditors should help the auditees' line management view the audit not as a search for the guilty,'' but an audit that will identify problems and assist in correction of existing or potential system problems. It should be the clearly defined policy of any audit program that there be no surprises involved with the evaluation. An ethical audit is not the place for cloak-and-dagger tactics, for witch hunting, or for the identification of situations that are then sprung at a critical and embarrassing time (a gotcha'').

  9. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

    PubMed

    Succo, G; Berrone, M; Battiston, B; Tos, P; Goia, F; Appendino, P; Crosetti, E

    2015-06-01

    At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection. PMID:24816745

  10. “Two-step” technique with OsiriX™ to evaluate feasibility of C2 pedicle for surgical fixation

    PubMed Central

    Marques, Luis Miguel Sousa; d’Almeida, Gonçalo Neto; Cabral, José

    2016-01-01

    Background: Surgical treatment of craniovertebral junction pathology has evolved considerably in recent decades with the implementation of short atlanto-axial fixation techniques, notwhithstanding increasing neurovascular risks. Also, there is strong evidence that fixation of C2 anatomical pedicle has the best biomechanical profile of the entire cervical spine. However, it is often difficult and misleading, to evaluate anatomical bony and vascular anomalies using the three orthogonal planes (axial, coronal, and sagittal) of CT. Objectives: The authors describe an innovative and simple technique to evaluate the feasibility of C2 pedicle for surgical screw fixation using preoperative planning with the free DICOM (Digital Imaging and Communications in Medicine) software OsiriX™. Materials and Methods: The authors report the applicatin of this novel technique in 5 cases (3 traumatic, 1 Os Odontoideum, and 1 complex congenital malformation) collected from our general case series of the Department in the last 5 years. Results: In this proof of concept study, the pre-operative analysis with the two-step tecnique was detrimental for choosing the surgical tecnique. Detailed post-operative analysis confirmed correct position of C2 screws without cortical breach. There were no complications or mortality reported. Conclusion: This two-step technique is an easy and reliable way to determine the feasibility of C2 pedicle for surgical fixation. The detailed tridimensional radiological preoperative evaluation of craniovertebral junction anatomy is critical to the sucess and safety of this surgeries, and can avoid, to certain degree, expensive intra-operative tridimensional imaging facilities. PMID:27217652

  11. Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template

    PubMed Central

    Giansanti, Matteo

    2016-01-01

    Background A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. Material and Methods An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. Results This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. Conclusions The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use. Key words:Corticotomy, orthodontics, CAD/CAM, minimally invasive, surgical template, 3D printer. PMID:27031067

  12. [Cervical laminoplasty--review of surgical techniques, indications, methods of efficacy evaluation, and complications].

    PubMed

    Derenda, Marek; Kowalina, Ireneusz

    2006-01-01

    Techniques of expansive cervical laminoplasty evolved in the 1970s in Japan as an alternative to laminectomy connected with many complications. They were developed and modified in the following years. Nowadays cervical laminoplasty is the standard method of posterior decompression of the cervical spine which reflects the aspiration to preserve the spine stabilising structures. Indications for laminoplasty are multilevel cervical pathological changes leading to spinal canal stenosis and myelopathy as a consequence. Historical background is discussed. Technical details of Z-type laminoplasty (Oyama), open-door laminoplasty (Hirabayashi), spinous process-splitting laminoplasty (Kurokawa), hardware-augmented laminoplasty (O'Brien with Shaffrey's modification) and dorso-lateral decompression (Ohtsuka) are described. The Japanese Orthopaedic Association scale is widely accepted for the clinical evaluation of cervical myelopathy. Effectiveness of surgical treatment is evaluated using the Hirabayashi recovery rate. Postoperative complications are: diminution of neck motion range, kyphotic deformity, axial neck pain, C5 nerve root palsy, restenosis and late deterioration of neurological postoperative outcome. Contemporary theories explaining problems connected with the complications are described. The subject is discussed based on a review of literature and own practice. PMID:17103356

  13. Peritoneal inflammatory response to surgical correction of left displaced abomasum using different techniques.

    PubMed

    Wittek, T; Fürll, M; Grosche, A

    2012-12-01

    The objective of this study was to compare the inflammatory response within the abdominal cavity between three surgical methods. The study comprised 45 cows with left displacement of the abomasum, which were allocated into three groups (n = 15). Right flank laparotomy and omentopexy (group R), left flank laparotomy and omentopexy (group L), and laparoscopic abomasopexy (group J) have been applied. Laparoscopic abomasopexy was the only technique that requires perforation of the abomasal wall. Blood and peritoneal fluid (PF) samples were obtained before, and on days 1, 2 and 3 after surgery. Macroscopic and microscopic evaluation of PF were performed. Cytological and biochemical parameters were analysed in blood and PF. No bacteria were present in PF after surgery. The number of PF leukocytes increased in all groups on day 1 after surgery with the highest value after laparoscopy (median, 1st quartile, 3rd quartile, R: 13.1, 6.4, 16.0; L: 13.6, 9.9, 17.4; J: 33.7, 21.1, 46.9 G/l). Laparotomy resulted in an increase of blood and PF CK on day 1 after surgery, whereas, laparoscopy caused an increased PF CK only. All groups had elevated PF D-dimer concentrations before surgery, with further increase in groups R and L on day 1 after surgery. PMID:23092974

  14. Should We Place Ureteral Stents in Retroperitoneal Laparoscopic Ureterolithotomy?: Consideration of Surgical Techniques and Complications

    PubMed Central

    You, Jae Hyung; Kim, Young Gon

    2014-01-01

    Purpose There is some debate over the necessity of ureteral stenting after laparoscopic ureterolithotomy. We evaluated the need for ureteral stenting after retroperitoneal laparoscopic ureterolithotomy (RLU). Materials and Methods Between January 2009 and January 2013, 41 patients underwent RLU to remove upper ureteral stones. The retroperitoneal approach was used in all patients by a single surgeon. A double J (D-J) stent was placed in the first 17 patients after the procedure but not in any of the next 24 patients. Results The mean patient age, serum creatinine levels, and stone size were not significantly different between the two groups. The stone-free rate was 100%. The mean operative time was significantly shorter in the stentless group than in the stent group (59.48 minutes vs. 77.88 minutes, p<0.001). Parenteral analgesic use and anticholinergic medication use were observed in the stent group only. The blood loss, drain removal day, and hospital stay were not significantly different between the two groups. No other significant complications occurred during or after the operation in any patients. Conclusions RLU is a safe and effective treatment modality for large impacted ureteral stones. In this study, D-J stent placement was not necessary after RLU. In the future, large-scale studies of RLU without D-J stenting, especially on the frequency of the development of complications according to the surgical technique, may be needed. PMID:25132944

  15. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum

    PubMed Central

    2014-01-01

    This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric = 0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826

  16. Optimal Suturing Technique and Number of Sutures for Surgical Implantation of Acoustic Transmitters in Juvenile Salmonids

    SciTech Connect

    Deters, Katherine A.; Brown, Richard S.; Boyd, James W.; Eppard, M. B.; Seaburg, Adam

    2012-01-02

    The size reduction of acoustic transmitters has led to a reduction in the length of incision needed to implant a transmitter. Smaller suture knot profiles and fewer sutures may be adequate for closing an incision used to surgically implant an acoustic microtransmitter. As a result, faster surgery times and reduced tissue trauma could lead to increased survival and decreased infection for implanted fish. The objective of this study was to assess the effects of five suturing techniques on mortality, tag and suture retention, incision openness, ulceration, and redness in juvenile Chinook salmon Oncorhynchus tshawytscha implanted with acoustic microtransmitters. Suturing was performed by three surgeons, and study fish were held at two water temperatures (12°C and 17°C). Mortality was low and tag retention was high for all treatments on all examination days (7, 14, 21, and 28 days post-surgery). Because there was surgeon variation in suture retention among treatments, further analyses included only the one surgeon who received feedback training in all suturing techniques. Incision openness and tissue redness did not differ among treatments. The only difference observed among treatments was in tissue ulceration. Incisions closed with a horizontal mattress pattern had more ulceration than other treatments among fish held for 28 days at 17°C. Results from this study suggest that one simple interrupted 1 × 1 × 1 × 1 suture is adequate for closing incisions on fish under most circumstances. However, in dynamic environments, two simple interrupted 1 × 1 × 1 × 1 sutures should provide adequate incision closure. Reducing bias in survival and behavior tagging studies is important when making comparisons to the migrating salmon population. Therefore, by minimizing the effects of tagging on juvenile salmon (reduced tissue trauma and reduced surgery time), researchers can more accurately estimate survival and behavior.

  17. Tension plate for treatment of olecranon fractures: new surgical technique and case series study

    PubMed Central

    Lukšic, Bruno; Juric, Ivo; Boschi, Vladimir; Pogorelic, Zenon; Bekavac, Josip

    2015-01-01

    Background Our aim was to determine the effectiveness of a new surgical technique for olecranon fractures using a tension plate (TP) designed by the operating surgeon. Methods We included patients with olecranon fractures treated between September 2010 and August 2013 in our study. Treatment involved a new implant and operative technique, which combined the most favourable characteristics of 2 frequently used methods, tension band wiring and plate osteosynthesis, while eliminating their shortcomings. The new method was based on the newly constructed implant. Results Twenty patients participated in our study. We obtained the following functional results with our TP: median flexion 147.5° (interquartile range [IQR] 130°–155°), median extension 135°/deficit 10° (IQR 135°–145°), median pronation 90° (IQR 81.3°–90°), median supination 90° (IQR 80°–90°). Implant-related complications were noted in 1 patient, and implants were removed in 3 patients. The mean functional Mayo elbow performance score was 94.8 (range 65–100). The removal of the implant was considerably less frequent in patients operated using the new method and implant than in patients operated using conventional methods at our institution (p < 0.001). Mean duration of follow-up was 8 months. Conclusion Our TP for the treatment of olecranon fractures is safe and effective. Functional results are very good, with significantly decreased postoperative inconveniences and need to remove the implant. Less osteosynthetic material was used for TP construction, but stability was preserved. PMID:25427338

  18. The lateral lesser toe fillet flap for diabetic foot soft tissue closure: surgical technique and case report

    PubMed Central

    Chung, Sze-Ryn; Wong, Keng L.; Cheah, Andre E. J.

    2014-01-01

    Wound closure for the diabetic foot can be challenging and often involves amputation or reconstruction. The authors describe a surgical technique and a case report of lateral lesser toe fillet flap in the management of a diabetic foot wound. The lateral lesser toe fillet flap reconstruction is a reproducible technique that incurs comparatively minimal technical complexity and provides a favorable option in the management of diabetic foot wounds where soft tissue coverage is required. PMID:25527137

  19. Pilot study: evaluation of the use of the convergent interview technique in understanding the perception of surgical design and simulation

    PubMed Central

    2013-01-01

    Background It is important to understand the perceived value of surgical design and simulation (SDS) amongst surgeons, as this will influence its implementation in clinical settings. The purpose of the present study was to examine the application of the convergent interview technique in the field of surgical design and simulation and evaluate whether the technique would uncover new perceptions of virtual surgical planning (VSP) and medical models not discovered by other qualitative case-based techniques. Methods Five surgeons were asked to participate in the study. Each participant was interviewed following the convergent interview technique. After each interview, the interviewer interpreted the information by seeking agreements and disagreements among the interviewees in order to understand the key concepts in the field of SDS. Results Fifteen important issues were extracted from the convergent interviews. Conclusion In general, the convergent interview was an effective technique in collecting information about the perception of clinicians. The study identified three areas where the technique could be improved upon for future studies in the SDS field. PMID:23782771

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

  2. Limb Angular Deformity Correction Using Dyna-ATC: Surgical Technique, Calculation Method, and Clinical Outcome

    PubMed Central

    Park, Hoon; Kim, Hyun Woo; Park, Hui-Wan

    2011-01-01

    Purpose Dyna-ATC is a unilateral external fixator with angulator, lengthener, and translator, which allows for angular correction and compensation of the secondary displacement during angular correction. The purpose of this study is to introduce surgical technique and calculation methods and to evaluate the clinical outcome of angular deformity correction using Dyna-ATC. Materials and Methods The amounts of secondary displacement were calculated with the distances between axis of correction of angulation, Center of Rotational Angulation, and osteotomy and the amount of angular deformity. The rate of angular correction was determined to distract the corticotomy at 1 mm/day. Clinical and radiographic evaluation was performed on 13 patients who underwent deformity correction using Dyna-ATC. There were 8 proximal tibia vara, 1 tibia valga, 2 varus and 4 valgus deformities on distal femur. One patient underwent pelvic support femoral reconstruction. Concomitant lengthening was combined in all femur cases. Mean age at surgery was 17.5 years (7 to 64). Results All but one achieved bony healing and normal alignment with the index procedure. Mean mechanical axis deviation improved from 31.9 mm to 3.0 mm. The average amount of angular correction was 11.0° on tibiae and 10.0° on femora. The average length gain on femora was 6.4 cm, and the healing index averaged to 1.1 mo/cm. One patient underwent quadricepsplasty and one patient had three augmentation surgeries due to poor new bone formation. Conclusion We believe that Dyna-ATC is a useful alternative to bulky ring fixators for selective patients with angular deformity less than 30 degrees in the coronal plane around the knee joint. PMID:21786448

  3. Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique.

    PubMed

    Uysal, Ismail Onder; Ozçimen, Muammer; Yener, Halil Ibrahim; Kal, Ali

    2011-09-01

    The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission. PMID:21442420

  4. Comparison of early postoperative pain among surgical techniques for obstructive sleep apnea.

    PubMed

    Akcam, Timur; Arslan, Hasan Huseyin; Deniz, Suleyman; Genc, Hakan; Karakoc, Omer; Senkal, Serkan; Gerek, Mustafa

    2012-11-01

    One of the criticized aspects of surgeries for obstructive sleep apnea (OSA) is postoperative pain. We performed a study to compare the severity of pain occurring after different surgical techniques and to determine analgesic requirements in the first postoperative 24 h. Forty-eight patients with primary snoring or OSA who underwent anterior palatoplasty (AP), lateral pharyngoplasty (LP) or tongue base suspension suture (TBS) were included in this study. A visual analog scale (VAS) was used for measuring pain intensity. Tramadol with patient-controlled analgesia (PCA) device and when necessary rescue pethidine was used for pain relief. VAS pain scores, total PCA-tramadol consumptions and requirement of rescue analgesic in AP, LP and TBS groups were compared. Pain scores in TBS group were higher than AP group in all of the study time points except at 12th hour and LP group until the 10th hour. When compared with AP group, VAS was significantly higher in LP group at the 1st hour. Mean total tramadol consumptions were significantly different between the groups (AP-LP, p = 0.039; AP-TBS, p < 0.001; LP-TBS, p < 0.001). It was highest in the TBS group and lowest in the AP group. In the LP group, three patients (16.7 %) needed rescue analgesia in comparison with 11 (73.3 %) in the TBS group. None of the patients in the AP group needed rescue analgesic. AP is the least painful and TBS is the most painful procedure. PCA-bolus tramadol effectively treats pain caused by AP and LP; however, alleviation of pain caused by TBS usually needs rescue opioid analgesic. PMID:22699627

  5. Old technique revisited with surgical innovation: complicated Mallory–Weiss tear with bleeding gastric ulcer exclusion

    PubMed Central

    Yoshino, Osamu; Prichard, Peter J.; Choi, Julian

    2016-01-01

    Mallory–Weiss tears (MWTs) rarely require surgical intervention. A 60-year-old female presented with massive hematemesis secondary to MWT and gastric ulceration. After failure of endoscopic management, an operative approach was embarked on, with a direct surgical hemostasis of the Mallory–Weiss tear and exclusion of the gastric ulcer. This exclusion strategy may be applicable for other patients with uncontrolled upper gastrointestinal bleeding in whom a simple repair would be difficult. PMID:26757734

  6. Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument.

    PubMed

    Murase, Tsuyoshi

    2016-06-01

    The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius. PMID:27454626

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

    PubMed Central

    2014-01-01

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

  8. Growth and physiological responses to surgical and gastric radio transmitter implantation techniques in subyearling chinook salmon (Oncorhynchus tshawytscha)

    USGS Publications Warehouse

    Martinelli, T.L.; Hansel, H.C.; Shively, R.S.

    1998-01-01

    We examined the effects of surgical and gastric transmitter implantation techniques on the growth, general physiology and behavior of 230 subyearling chinook salmon (Oncorhynchus tshawytscha, Walbaum) (100 mm-154 mm fork length). The transmitter weighed 1.3 g in air (0.9 g in water) and comprised, on average, 6% of the body weight of the fish (in air). Individuals were randomly assigned to an experimental group (control, surgical or gastric) and a sampling period (day 5 or day 21). Relative growth rate was expressed as% body weight gained/day. General condition was assessed by necropsy. Physiological response variables included hematocrit, leucocrit and plasma protein concentration. The mean relative growth rates of control, surgical and gastric fish were not significantly different at day 5. By day 21, the gastric group had a significantly lower relative growth rate (1.3%) as compared to the surgical group (1.8%) and the control group (1.9%) (P = 0.0001). Mean hematocrit values were significantly lower in the surgical (41.8%) and gastric (42.2%) groups as compared to controls (47.3%) at day 5 (P = 0.01), but all were within normal range for salmonids. No significant differences in hematocrit values were detected at day 21. Leucocrit values for all groups were ??? 1% in 99% of the fish. Both tagged groups had significantly lower mean plasma protein levels as compared to controls at day 5 (P = 0.001) and day 21 (P = 0.0001). At day 21 the gastric group (64.4 g 100 m1-1) had significantly lower mean plasma protein levels than the surgical group (68.8 g 100 ml-1) (P = 0.0001). Necropsies showed decreasing condition of gastrically tagged fish over time, and increasing condition of surgical fish. Paired releases of surgically and gastrically implanted yearling chinook salmon in the lower Columbia River in spring, 1996 revealed few significant differences in migration behavior through two reservoirs. We conclude that gastrically implanted fish show decreased growth and

  9. Arthroscopic-Assisted Acromioclavicular Joint Reconstruction Using the TightRope Device With Allograft Augmentation: Surgical Technique

    PubMed Central

    Frank, Rachel M.; Trenhaile, Scott W.

    2015-01-01

    Surgical management of acromioclavicular (AC) joint separations remains challenging, especially in the revision setting. Most commonly, Rockwood type I and II injuries are managed nonoperatively whereas type IV, V, and VI injuries are managed with surgery. Type III separations are more controversial, with evidence supporting both nonoperative and operative treatment options. Multiple different arthroscopic techniques have been described; however, there is no current gold standard. AC joint reconstruction with the TightRope device (Arthrex, Naples, FL) with the patient in the lateral decubitus position is a method of restoring joint stability that allows for a minimally invasive, low-profile fixation construct using a single drill hole through the clavicle. Allograft augmentation of this fixation construct helps to eliminate the stress risers potentially created by this device while increasing overall repair construct stability. The purpose of this article is to describe the surgical technique for arthroscopic AC joint reconstruction using a TightRope device with allograft augmentation. PMID:26759765

  10. Investigation of a Technique for Measuring Ethical Development of Students in Business: A Heuristic Example.

    ERIC Educational Resources Information Center

    DuFrene, Debbie D.; And Others

    Administering measures of students' ethical orientation at various points in the education of business students would be helpful in determining the affective impact of the curriculum. Procedures for eliminating item bias and maximizing the validity and reliability of such measures are discussed and illustrated through actual data collected in the…

  11. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

    PubMed Central

    Petis, Stephen; Howard, James L.; Lanting, Brent L.; Vasarhelyi, Edward M.

    2015-01-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of THA, although their relative risk varies by approach. Numerous clinical trials have sought to elicit differences in patient-reported outcomes, complication rates and return to function among the surgical approaches. This review outlines some of the technical pearls of performing a THA through either a direct anterior, direct lateral or posterior approach. A literature review outlines the impact of surgical approach on clinical outcomes and clinically relevant complication rates. PMID:25799249

  12. A Novel Surgical Technique for Removing Buried Cannulated Screws Using a Guidewire and Countersink: A Report of Two Cases

    PubMed Central

    Chen, Yongsheng; Giri, Krishna Prasad; Pearce, Christopher Jon

    2015-01-01

    Removal of metal implants is a common procedure that is performed for a variety of indications. However, problems such as a buried screw head may occasionally arise and render hardware removal difficult or even impossible. The problem is further compounded when the initial screw was inserted percutaneously or via a minimally-invasive (MIS) technique. In the present paper, we introduce a novel, minimally invasive technique to remove buried cannulated screws which obviates the need for excessive extension of the skin incision, surgical exploration, soft tissue dissection or excess bone removal, which surgeons may otherwise have to undertake to uncover the buried screw head. This technique is especially useful in removing cannulated screws which have been inserted using small stab incisions and MIS techniques initially. This technique can be applied to the removal of buried cannulated screws which are placed into any bone in the body. PMID:26161159

  13. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

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

  14. [Surgical treatment of genital prolapse with a new lateral prosthetic hysteropexia technique combining vaginal and laparoscopic methods].

    PubMed

    Husaunndee, M; Rousseau, E; Deleflie, M; Geoffrion, H; Dallay, D; Descamps, P

    2003-06-01

    We describe a new surgical treatment of pelvic organ prolapse. The anterior and medium compartments are treated by a transversal hysteropexy by means of an anterior prosthesis fixed by vaginal route and by laparoscopy. The principle is based on the operative technique described by Kapandji but the prosthesis is fixed to the fascia of the external oblique muscle in a subperitoneal path. The posterior compartment is treated by a vaginal route exclusively. A posterior prosthesis is placed in the rectovaginal space and fixed to the elevator muscles. Further studies are necessary to evaluate this new operative technique. PMID:12843879

  15. Current surgical instrument labeling techniques may increase the risk of unintentionally retained foreign objects: a hypothesis

    PubMed Central

    2013-01-01

    Background Marking of surgical instruments is essential to ensure their proper identification after sterile processing. The National Quality Forum defines unintentionally retained foreign objects in a surgical patient as a serious reportable event also called "never event." Presentation of the hypothesis We hypothesize that established practices of surgical instrument identification using unkempt tape labels and plastic tags may expose patients to "never events" from retained disintegrating labels. Testing of the hypothesis We demonstrate the near miss of a "never event" during a surgical case in which the breakage of an instrument label remained initially unwitnessed. A fragment of the plastic label was accidentally found in the wound upon closing. Further clinical testing of the occurrence of this "never event" appears not feasible. As the name implies a patient should never be exposed to the risk of fragmenting labels. Implication of the hypothesis Current practice does not mandate verifying intact instrument markers as part of the instrument count. The clinical confirmation of our hypothesis mandates a change in perioperative practice: Mechanical labels need to undergo routine inspection and maintenance. The perioperative count must not only verify the quantity of surgical instruments but also the intactness of labels to ensure that no part of an instrument is left behind. Proactive maintenance of taped and dipped labels should be performed routinely. The implementation of newer labeling technologies - such as laser engraved codes - appears to eliminate risks seen in traditional mechanical labels. This article reviews current instrument marking technologies, highlights shortcomings and recommends safe instrument handling and marking practices implementing newer available technologies. PMID:24079615

  16. Surgical Technologists

    MedlinePlus

    ... in place during the procedure, or set up robotic surgical equipment. Technologists also may handle specimens taken ... sterilization techniques, how to set up technical or robotic equipment, and preventing and controlling infections. In addition ...

  17. Inferior Alveolar Nerve Lateralization and Transposition for Dental Implant Placement. Part I: a Systematic Review of Surgical Techniques

    PubMed Central

    Juodzbalys, Gintaras

    2015-01-01

    ABSTRACT Objectives The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. Material and Methods A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. Results A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. Conclusions Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments. PMID:25937873

  18. Surgical technique: hemi-extensor carpi radialis brevis tenodesis for stabilizing the midcarpal joint in Ehlers-Danlos syndrome.

    PubMed

    Krijgh, David D; Harley, Oliver J; Hovius, Steven E; Coert, J Henk; Walbeehm, Erik T

    2014-10-01

    Patients with the hypermobility type of Ehlers-Danlos (EDS-HT) often complain of wrist pain, usually originating from subluxations. As a result of the laxity, wrist function in these patients can be highly limited. This paper presents a surgical technique that stabilizes the lunocapitate joint with the use of an extensor carpi radialis brevis strip. Five patients with confirmed EDS-HT were treated with an extensor carpi radialis brevis tenodesis for their midcarpal instability. Two patients presented with complications following surgery, one major and one minor. This paper presents a potentially satisfactory surgical solution to recurrent midcarpal instability in EDS-HT patients and demonstrates that the use of an autologous tendon might be feasible in spite of a background of abnormal collagen metabolism. PMID:25194773

  19. The management of thoracic inlet syndrome associated with Hurler's syndrome: a novel surgical technique.

    PubMed

    Ahsan, Rauf M; Early, Sarah A; O'Meara, Anne; Nölke, Lars

    2009-12-01

    A 21-year-old male developed significant swelling of his tongue after a respiratory arrest. The patient had a history of Hurler's syndrome. Magnetic resonance imaging (MRI) angiogram delineated that the swelling was due to compression of his internal jugular veins at the level of the first rib, resulting in thoracic inlet obstruction. The standard surgical treatment of thoracic inlet obstruction was not suitable in this patient's case due to his short thick neck and his characteristic Hurler's syndrome body habitus. Therefore, a novel surgical strategy was used to decompress his head and neck vessels. The manubrium was widened using an iliac crest bone graft, stabilised using internal fixation plates and reconstructed with a pectoral muscle flap. PMID:19864154

  20. Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in “difficult cholecystectomies”

    PubMed Central

    Kulen, Fatih; Tihan, Deniz; Duman, Uğur; Bayam, Emrah; Zaim, Gökhan

    2016-01-01

    Objective Laparoscopic cholecystectomy has become the “gold standard” for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly. Material and Methods The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared. Results The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications. Conclusion LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients. PMID:27528821

  1. Modern surgical techniques for management of soft tissue sarcomas involving the spine: outcomes and complications.

    PubMed

    Mattei, Tobias A; Teles, Alisson R; Mendel, Ehud

    2015-04-01

    Several types of soft tissue sarcomas may locally extend to the spine. The best therapeutic strategy for such lesions strongly depends on the histological diagnosis. In this article the authors provide an up-to-date review of current guidelines regarding the management of soft tissue sarcomas involving the spine. Special attention is given to outcomes and complications of modern surgical series in order to highlight current challenges in the management of such lesions. PMID:25413665

  2. Alveolar Antral Artery: Review of Surgical Techniques Involving this Anatomic Structure

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2014-01-01

    Introduction: The horizontal bony canal in the lateral maxillary wall is the site of anastomosis between the arterial branches from the posterior superior alveolar artery (PSAa) and the infraorbital artery. This anatomic structure is known as the ‘alveolar antral artery’. Materials and Methods: We performed a literature review. The anatomic location of the alveolar antral artery in the lateral maxillary sinus wall was researched and its importance in surgical procedures routinely performed on this bony wall discussed. Results: This artery can be accidentally involved during surgical procedures on the lateral maxillary sinus wall, such as open sinus lift surgery, horizontal osteotomy of the maxilla, Le Fort I fracture treatment, and Caldwell-Luc surgeries. Conclusion: The alveolar antral artery is an important anatomic structure in the lateral maxillary sinus wall. A preoperative cone beam computed tomography (CBCT) scan can be used as a good diagnostic procedure to reduce surgical complications in suspected cases as well as conditions that may involve this artery. PMID:24744995

  3. Production of piglets with sexed semen employing a non-surgical insemination technique.

    PubMed

    Grossfeld, R; Klinc, P; Sieg, B; Rath, D

    2005-05-01

    The aim of the present study was to ascertain whether multiparous sows could successfully be inseminated with sexed semen non-surgically. Spermatozoa were stained with Hoechst 33342 and separated flowcytometrically in X- and Y-chromosome bearing sperm populations employing the Beltsville Sperm Sexing Technology (BSST). After weaning, estrus was induced in sows with PMSG and hCG. Animals were inseminated once per estrus non-surgically with a specially designed catheter into the tip of the uterine horn, employing 50x10(6) of either sexed or non-sexed spermatozoa diluted in 2 ml Androhep. Pregnant sows were allowed to go to term. Mean pregnancy rate from inseminations with unsexed spermatozoa was 54.5% whereas inseminations with sexed spermatozoa resulted in 33.3% pregnant sows. All but one piglet born after insemination with sexed semen were of the predicted sex. The sex of those piglets born after inseminations with non-sexed spermatozoa was 61.1% for male and 38.9% for female sex. It is concluded that non-surgically inseminations with flowcytometrically sexed spermatozoa can be conducted successfully. PMID:15826689

  4. Surgical hand antisepsis in veterinary practice: evaluation of soap scrubs and alcohol based rub techniques.

    PubMed

    Verwilghen, Denis R; Mainil, Jacques; Mastrocicco, Emilie; Hamaide, Annick; Detilleux, Johann; van Galen, Gaby; Serteyn, Didier; Grulke, Sigrid

    2011-12-01

    Recent studies have shown that hydro-alcoholic solutions are more efficient than traditional medicated soaps in the pre-surgical hand antisepsis of human surgeons but there is little veterinary literature on the subject. The aim of this study was to compare the efficiency of medicated soaps and a hydro-alcoholic solution prior to surgery using an in-use testing method in a veterinary setting. A preliminary trial was performed that compared the mean log(10) number of bacterial colony forming units (CFU) and the reduction factors (RF) between two 5-min hand-scrubbing sessions using different soaps, namely, povidone iodine (PVP) and chlorhexidine gluconate (CHX), and the 1.5-min application of a hydro-alcoholic rub. A clinical in-use trial was then used to compare the hydro-alcoholic rub and CHX in a surgical setting. Sampling was performed using finger printing on agar plates. The hydro-alcoholic rub and CHX had a similar immediate effect, although the sustained effect was significantly better for the hydro-alcoholic rub, while PVP had a significantly lower immediate and sustained effect. The hydro-alcoholic rub showed good efficiency in the clinical trial and could be considered as a useful alternative method for veterinary surgical hand antisepsis. PMID:21316990

  5. An in-use microbiological comparison of two surgical hand disinfection techniques in cardiothoracic surgery: hand rubbing versus hand scrubbing.

    PubMed

    Carro, C; Camilleri, L; Traore, O; Badrikian, L; Legault, B; Azarnoush, K; Dualé, C; De Riberolles, C

    2007-09-01

    Surgical site infection after heart surgery increases morbidity and mortality. The method of presurgical hand disinfection could influence the infection risk. From February to April 2003, we compared the microbiological efficacy of hand-rubbing (R) and hand-scrubbing (S) procedures. The surgical team alternately used hand-scrubbing or hand-rubbing techniques every two weeks. Fingertip impressions were taken before and immediately after hand disinfection, every 2h and at the end of the operation. Acceptability of hand rubbing was assessed by a questionnaire. Mean durations of surgical procedures were 259+/-68 and 244+/-69min for groups S and R respectively (P=0.43). Bacterial counts immediately after hand disinfection were comparable with the two techniques, but significantly lower in group R at the end of surgery. No differences were observed between the percentages of negative samples taken after 2h, 4h and at the end of surgery between the two groups. Bacterial skin flora reduction immediately after hand disinfection, after 2h and 4h of operating time and at the end of surgery was better in group R, but the difference was not statistically significant. Before surgery, the hand-rubbing method with alcohol solution preceded by hand washing with mild neutral soap is as effective as hand scrubbing to reduce bacterial counts on hands. It decreased the bacterial counts both immediately after hand disinfection and at the end of long cardiothoracic surgical procedures. The acceptability of hand rubbing was excellent and it can be considered to be a valid alternative to the conventional hand-scrubbing protocol. PMID:17719131

  6. Cartilage repair: A review of Stanmore experience in the treatment of osteochondral defects in the knee with various surgical techniques

    PubMed Central

    Vijayan, S; Bentley, G; Briggs, TWR; Skinner, JA; Carrington, RWJ; Pollock, R; Flanagan, AM

    2010-01-01

    Articular cartilage damage in the young adult knee, if left untreated, it may proceed to degenerative osteoarthritis and is a serious cause of disability and loss of function. Surgical cartilage repair of an osteochondral defect can give the patient significant relief from symptoms and preserve the functional life of the joint. Several techniques including bone marrow stimulation, cartilage tissue based therapy, cartilage cell seeded therapies and osteotomies have been described in the literature with varying results. Established techniques rely mainly on the formation of fibro-cartilage, which has been shown to degenerate over time due to shear forces. The implantation of autologous cultured chondrocytes into an osteochondral defect, may replace damaged cartilage with hyaline or hyaline-like cartilage. This clinical review assesses current surgical techniques and makes recommendations on the most appropriate method of cartilage repair when managing symptomatic osteochondral defects of the knee. We also discuss the experience with the technique of autologous chondrocyte implantation at our institution over the past 11 years. PMID:20697474

  7. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    PubMed Central

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  8. Sigmoid vaginoplasty in testicular feminising syndrome: surgical technique, outcome and review of the literature.

    PubMed

    Sinha, Rahul Janak; Bhaskar, Ved; Mehrotra, Seema; Singh, Vishwajeet

    2016-01-01

    Vaginal agenesis occurs in approximately 1:5000 live female births. It results from failure of the sinovaginal bulbs to develop and form the vaginal plate. Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is the most common cause of vaginal absence followed by complete or partial androgen insensitivity syndrome. Treatment of these patients encompasses a spectrum from simple non-operative dilation to the more complicated surgical creation of a neovagina. We present a case of a patient with testicular feminising syndrome who was reared as a female and underwent bilateral gonadal excision and sigmoid vaginoplasty. PMID:26873917

  9. Minced articular cartilage--basic science, surgical technique, and clinical application.

    PubMed

    McCormick, Frank; Yanke, Adam; Provencher, Matthew T; Cole, Brian J

    2008-12-01

    Minced articular cartilage procedures are attractive surgical approaches for repairing articular cartilage, as they are 1-staged, autologous, and inserted on a carrier that can potentially be placed arthroscopically. The principle of mincing the autologous donor cartilage is to create a larger surface area for cartilage expansion. Placement on a scaffold carrier allows for a chondro-inductive and chondro-conductive milieu. Early animal and preclinical models have demonstrated hyaline-like tissue repair. Further work needs to be conducted in this promising approach. PMID:19011553

  10. A Comparasion in Graft Resorption between Three Techniques of Diced Cartilage Using Surgical Blade, Electrical Grinder and Grater in Rabbit

    PubMed Central

    Manafi, Ali; Sabet, Mohammad; Emami, Abolhasan; Vasei, Mohammad; Mosavi, Jaber; Manafi, Amir; Hamedi, Zahra Sadat; Manafi, Farzad; Mehrabani, Golnoush; Manafi, Navid

    2014-01-01

    BACKGROUND In recent years, there is an increasing tendency to use diced cartilage grafts in rhinoplasty surgery for improving dorsum contour irregularities. This study was designed to compare graft resorption between three techniques of diced cartilage using surgical blade, electrical grinder and grater in rabbit model. METHODS Thirteen New Zealand rabbits were divided into three groups. Three 2×2 cm cartilage specimens were harvested from one of their ears. In group one, the cartilage was diced by use of No:11 surgical blade to o.5 to 1 mm cube pieces. In group two, an electrical grinder was used and in group three, a grater was applied. The grafts were placed in three subcutaneous pockets in the back of rabbits and after 12 weeks, the implants were removed and their weight and volume were recorded and were evaluated by histological techniques. RESULTS There was no difference between the three methods in the 3 groups for graft resorption. There was no change in the volume, but the weight showed a decrease in the control group. CONCLUSIONS As the histological results had no statistically difference between groups, we may recommend use of these two techniques in reconstructive and in aesthetic cases. PMID:25489525

  11. The iLappSurgery taTME app: a modern adjunct to the teaching of surgical techniques.

    PubMed

    Atallah, S; Brady, R R W

    2016-09-01

    Application-based technology has emerged as a method of modern information communication, and this has been applied towards surgical training and education. It allows surgeons the ability to obtain portable and instant access to information that is otherwise difficult to deliver. The iLappSurgery Foundation has recently launched the transanal total mesorectal excision educational application (taTME app) which provides a useful adjunct, especially for surgeons interested in mastery of the taTME technique and its principles. The article provides a detailed review of the application, which has achieved a large user-base since its debut in June, 2016. PMID:27503235

  12. Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques.

    PubMed

    Smith, Gabriel A; Kochar, Arshneel S; Manjila, Sunil; Onwuzulike, Kaine; Geertman, Robert T; Anderson, James S; Steinmetz, Michael P

    2014-08-01

    Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient. PMID:25081960

  13. Surgical management of corneal limbal dermoids: retrospective study of different techniques and use of Mitomycin C

    PubMed Central

    Lang, S J; Böhringer, D; Reinhard, T

    2014-01-01

    Purpose We retrospectively studied the efficacy and safety of different surgical approaches to treating pediatric limbal dermoids with regard to intra and postoperative complications. Methods The data of 12 consecutive patients (14 eyes), who underwent monocentric surgery of a limbal demoid in the past 9 years, were retrospectively analyzed for intra and postoperative complications. Group one consists of eleven eyes: seven eyes with a bare-sclera deep lamellar excision of the dermoid and four eyes with an additional amniotic membrane transplantation subsequent to excision. Group two consists of three eyes: two eyes treated with Mitomycin C 0.02% over 2 min following the excision, and one eye treated with Mitomycin C and amniotic membrane transplantation after removal of the dermoid. Follow-up ranged from 2 to 53 months (median 17 months). Results Intraoperative complications did not occur in any of the patients. Postoperatively, all patients showed corneal reepithelialization within a week. Limbal stem cell deficiency with a pseudopterygium developed in four eyes, one treated with bare-sclera excision and the others with amniotic membrane transplantation. One pseudopterygium had to be removed surgically because of visual acuity deterioration. Not a single eye treated with Mitomycin C developed a pseudopterygium. Conclusions The transplantation of amniotic membrane following removal of a limbal dermoid cannot prevent the occurrence of a pseudopterygium. However, the use of Mitomycin C seems to have a protective effect. PMID:24858530

  14. A Novel Surgical Technique for Thyroid Cancer with Intra-Cricotracheal Invasion: Windmill Resection and Tetris Reconstruction.

    PubMed

    Enomoto, Keisuke; Uchino, Shinya; Noguchi, Hitoshi; Enomoto, Yukie; Noguchi, Shiro

    2015-12-01

    The most effective treatment for thyroid cancer (TC) invading into the larynx and trachea is a complete surgical resection of the tumor, but currently employed techniques are less than ideal. We report a novel surgical technique, which we named Windmill resection and Tetris reconstruction, for patients with TC invading into the laryngeal lumen. We treated eight cases of TC with invasion into the laryngeal lumen by Windmill resection and Tetris reconstruction. We analyzed complications, clinical data, and pathological findings for all patients. Patients included one man and seven women (mean age 69 ± 10 years). Histopathology of TC indicated papillary cancer in five patients, poorly differentiated cancer in one patient, anaplastic cancer in one patient, and squamous cell carcinoma in one patient. Unilateral recurrent laryngeal nerve (RLN) palsy was confirmed preoperatively by laryngoscope in four patients, and none had bilateral RLN palsy. All patients underwent Windmill resection and Tetris reconstruction along with total thyroidectomy (three patients), subtotal thyroidectomy (three patients), and lobectomy (two patients). Neck dissection was performed in all patients. The average resected length of the larynx and trachea was 29 ± 6 mm. Air leakage at the suture line occurred in three patients; two required further surgery, while the third was closed by insertion of a Penrose drain. Postoperative RLN palsy occurred in five patients. Aspiration was observed in two patients and resolved within 4 weeks. Pneumonia, atelectasis, and pleural effusion occurred in some patients. No other complications, including hemorrhage, wound infection, or airway stenosis, occurred. There was no postoperative mortality and no recurrence at the anastomotic site. Two patients underwent permanent tracheostomy due to permanent bilateral RLN palsy. Two patients, one with anaplastic cancer and the other with poorly differentiated cancer, recurred 13 and 21 months after surgery

  15. A non-surgical uterine lavage technique in large cats intended for treatment of uterine infection-induced infertility.

    PubMed

    Hildebrandt, T B; Göritz, F; Boardman, W; Strike, T; Strauss, G; Jewgenow, K

    2006-10-01

    This paper presents the successful use of a non-surgical, transcervical uterine lavage technique for the treatment of uterine infection-induced infertility in three female large cats. We developed a non-surgical uterine lavage technique, which allowed repeated flushing of the uterine lumen and installation of therapeutic antibiotics. The entire procedure was performed under general anaesthesia (duration of anesthesia ranged from 40 to 70 min). It was successfully applied in a Sumatran tiger (Panthera tigris sumatrae), a Corbett tiger (Panthera tigris corbetti) and an Amur leopard (Panthera pardus orientalis). The tigers were treated only once, whereas the leopard received four uterine treatments, due to re-infection after mating. Decisions to conduct uterine treatments were based on detection of uterine fluid during previous transrectal ultrasound examinations. The catheter was guided into the vagina, with the aid of an endoscope, passing the urethra, and then into the uterus, with the aid of transrectal ultrasonography. Both uterine horns were separately flushed with approximately 300 mL of cell medium M199, followed by an antibiotic infusion. Upon ultrasonographic re-examination, the topical uterine treatments resulted in an apparent decline in the inflammatory and/or degenerative processes. The Corbett tiger had the most severe uterine alterations, in addition to an aseptic pyometra. As a result, she was treated 1 month prior to ovariohysterectomy (in order to reduce the surgical risk). The Sumatran tiger was artificially inseminated twice after hormone-induced estrus, and the Amur leopard expressed a spontaneous estrus and re-initiated mating behaviour. PMID:16530816

  16. Evaluation of coblation lingual tonsil removal technique for obstructive sleep apnea in Asians: preliminary results of surgical morbidity and prognosticators.

    PubMed

    Wee, Jee Hye; Tan, Kenglu; Lee, Woo-Hyun; Rhee, Chae-Seo; Kim, Jeong-Whun

    2015-09-01

    Retroglossal obstruction is one of the etiologies causing obstructive sleep apnea (OSA) and can be addressed by removing some tissues of the tongue base. However, because of its deep-seated location, its surgical removal is still challenging. Although coblation technique has been introduced, its efficacy and morbidity need further evaluation, particularly in Asians. This study aimed to assess its safety and effectiveness and to identify outcome prognosticators. Forty-seven OSA patients who underwent coblation lingual tonsil removal were included. Retroglossal obstruction was confirmed by drug-induced sleep videofluoroscopy. Attended full-night polysomnography was performed twice; before and 6 months after surgery in 27 patients. The tongue base was fully exposed with three deep-seated traction sutures, visualized with a 30° or 70° endoscope, and ablated using a coblator. Surgical success was defined with postoperative apnea hypopnea index (AHI) <20 and reduction >50 %. Postoperative morbidities were evaluated. Demographic and polysomnographic parameters between success and failure groups were compared. None of the patients had immediate postoperative hemorrhage. Postoperatively, one patient had delayed hemorrhage and one patient severe respiratory difficulty. Taste loss, tongue dysmotility, dental injury or severe oropharyngeal stricture were absent. A mean AHI decreased from 37.7 ± 18.6 to 18.7 ± 14.8/h (P < 0.001). The success rate was 55.6 %. Their mean minimal oxygen saturation was significantly lower (P = 0.004) in the failure group. Coblation lingual tonsil removal technique showed minimal morbidity and favorable outcome in Koreans. The surgical outcome might be associated with the severity of single respiratory events. PMID:25323152

  17. The Future of Rheumatoid Arthritis and Hand Surgery - Combining Evolutionary Pharmacology and Surgical Technique

    PubMed Central

    M, Malahias; H, Gardner; S, Hindocha; A, Juma; Khan, W

    2012-01-01

    Rheumatoid arthritis is a systemic autoimmune disease of uncertain aetiology, which is characterized primarily by synovial inflammation with secondary skeletal destructions. Rheumatoid Arthritis is diagnosed by the presence of four of the seven diagnostic criteria, defined by The American College of Rheumatology. Approximately half a million adults in the United Kingdom suffer from rheumatoid arthritis with an age prevalence between the second and fourth decades of life; annually approximately 20,000 new cases are diagnosed. The management of Rheumatoid Arthritis is complex; in the initial phase of the disease it primarily depends on pharmacological management. With disease progression, surgical input to correct deformity comes to play an increasingly important role. The treatment of this condition is also intimately coupled with input from both the occupational therapists and physiotherapy. PMID:22423304

  18. Arthroscopic contact Nd:YAG laser meniscectomy: surgical technique and clinical follow-up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Miller, Drew V.; Fealy, Stephen V.; Gibney, Mary A.; Kelly, Anne M.

    1991-05-01

    Fifteen patients were studied prospectively as a pilot study to evaluate the safety and efficacy of the contact Neodynium: Yttrium Aluminum Garnet (Nd:YAG) laser in performing arthroscopic meniscal resection in a saline medium, (Surgical Laser Technologies; Malverne, PA). All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing, and post-operative swelling. Although there was increased time involved with setting up and calibrating the laser, there was not an increase in time for meniscal resection. In addition, the decreased need for secondary trimming and increased accessibility to the posterior horns of the menisci represent advantages over conventional instruments. Based on the findings, arthroscopic contact Nd:YAG laser surgery is a safe and effective clinical tool for meniscal resection which may, with increased technological advancements and cost reduction, replace standard instrumentation.

  19. Surgical Simulation

    PubMed Central

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

    2006-01-01

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

  20. Comparison of a CO2 (Carbon Dioxide) Laser and Tissue Glue with Conventional Surgical Techniques in Circumcision

    PubMed Central

    Mungnirandr, Akkrapol; Wiriyakamolphan, Suwanna; Ruangtrakool, Ravit; Ngerncham, Monawat; Tumrongsombutsakul, Sureerat; Leumcharoen, Bungorn

    2015-01-01

    Introduction: CO2 (Carbon Dioxide) laser application in circumcision, for cutting and coagulation, has been reported to have excellent results. Also, tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies focused on comparisons between CO2 laser and scalpel, or between tissue glue and sutures. This study prospectively compared the results and complications CO2 laser and tissue glue, with standard surgical techniques in circumcision. Methods: Thirty boys were prospectively divided into two groups. Group 1 (n = 17) underwent circumcision by scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision with CO2 laser and approximation of the wound edges using tissue glue. Patient age, indications for surgery, operative time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded. Results: Group 1 had a significantly longer operative time (P= 0.011), higher rate of local irritation (P= 0.016), and poorer cosmetic appearance (P< 0.001) than group 2. Bleeding only occurred in one patient in group 1. There were no significant differences in pain score, wound infection rate, or cost of surgery between the two groups. Conclusions: CO2 laser and tissue glue have advantages over standard surgical techniques in circumcision, with a significantly shorter operative time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar between the two groups. PMID:25699165

  1. Two-flap palatoplasty: description of the surgical technique and reporting of results at a single center.

    PubMed

    Koudoumnakis, Emmanouel; Vlastos, Ioannis M; Parpounas, Kostas; Houlakis, Michael

    2012-03-01

    Two-flap palatoplasty is commonly used to treat cleft palate defects, but only a few reports on outcomes have been published in the literature. We conducted a retrospective analysis of 257 cases of cleft palate treated with two-flap palatoplasty at a single center in Greece over a 13-year period. Our outcomes data included surgical complication rates, the results of speech assessments, midface development, and other parameters. We found a low rate of short- and long-term complications that required revision surgery, such as symptomatic fistula (5.4%) and velopharyngeal insufficiency (5.3%). Speech outcomes in relation to intelligibility, hypernasality, and nasal emissions were satisfactory in 70 to 86% of patients. Dental arch relationships, as estimated by the 5-Year-Olds Index, were judged to be either good or excellent in 62% of those evaluated. A considerable proportion of patients (45%) who had otitis media with effusion experienced a spontaneous resolution without the use of tympanostomy tubes 2 to 8 months after their operation. We conclude that two-flap palatoplasty is an effective procedure that warrants further attention. We describe the surgical technique in detail. Our technique includes a modified intravelar veloplasty that incorporates near-total muscle retropositioning. PMID:22430346

  2. Novel Endoscopic and Surgical Techniques for Treatment of Morbid Obesity: A Glimpse into the Future.

    PubMed

    Davis, Matthew; Kroh, Matthew

    2016-08-01

    The burden of obesity and weight-related comorbid disease is significant. Existing laparoscopic techniques show excellent efficacy and safety. New endoscopic and laparoscopic procedures offer different approaches, as primary and revisional techniques, to treat obesity and associated metabolic disease. PMID:27473806

  3. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak.

    PubMed

    Kaya, Bulent; Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-05-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial. PMID:27212998

  4. Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak

    PubMed Central

    Ozcabi, Yetkin; Tasdelen, Iksan; Onur, Ender; Memisoglu, Kemal

    2016-01-01

    Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial. PMID:27212998

  5. Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications

    PubMed Central

    Ohanyan, Ani; Kechagias, Nikos; Tsekos, Antonis; Vahtsevanos, Konstantinos

    2015-01-01

    Background Post-operative complications of various degrees of severity are commonly observed in third molar impaction surgery. For this reason, a surgical procedure that decreases the trauma of bone and soft tissues should be a priority for surgeons. In the present study, we compare the efficacy and the post-operative complications of patients to whom two different surgical techniques were applied for impacted lower third molar extraction. Material and Methods Patients of the first group underwent the classical bur technique, while patients of the second group underwent another technique, in which an elevator was placed on the buccal surface of the impacted molar in order to luxate the alveolar socket more easily. Results Comparing the two techniques, we observed a statistically significant decrease in the duration of the procedure and in the need for tooth sectioning when applying the second surgical technique, while the post-operative complications were similar in the two groups. We also found a statistically significant lower incidence of lingual nerve lesions and only a slightly higher frequency of sharp mandibular bone irregularities in the second group, which however was not statistically significant. Conclusions The results of our study indicate that the surgical technique using an elevator on the buccal surface of the tooth seems to be a reliable method to extract impacted third molars safely, easily, quickly and with the minimum trauma to the surrounding tissues. Key words:Mandibular third molar, impacted, surgical technique, extraction, elevator. PMID:26116843

  6. A useful surgical technique for retrieval of a broken guide pin in the midfoot.

    PubMed

    Roy, Shuvendu Prosad; Lim, Chin Tat; Tan, Ken Jin

    2014-01-01

    Perioperative instrument breakage is not an infrequent occurrence, even for experienced surgeons. The most commonly reported instrument breaks in orthopedic procedures are drill bits, followed by Kirschner wires and cannulated guide pins. The reasons for failure include improper technique and repetitive use. The retrieval of broken hardware can be technically challenging, particularly if the fragment has become embedded in bone. Retrieval methods have been described for cannulated guide pin fragments in the hip; however, no specific techniques have been described for the retrieval of guide pin fragments embedded in the bones of the foot. In the present report, we describe a technique we have found useful for retrieval of a guide pin fragment that had broken off during a Lisfranc fracture repair 6 weeks earlier. The technique was used in a delayed situation; however, we believe it would be even easier to use during an intraoperative breakage. PMID:23871172

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

    PubMed

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

    2000-02-01

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

  8. Arthroscopic contact Nd:YAG laser meniscectomy: basic science, surgical technique, and clinical follow up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Fealy, Stephen V.; Gibney, Mary A.; Miller, Drew V.; Kelly, Anne M.

    1990-06-01

    Recent basic science studies (5) have provided a scientific foundation for the use of the Contact Nd:YAG Laser as an arthroscopic tool for xneniscal resection and acroxnioplasty of the shoulder in a saline medium. This study prospectively evaluates the results of a three stage laboratory investigation as well as the clinical results of arthroscopic xneniscal resection. Fifteen patients with meniscal tears underwent subtotal meniscectomies utilizing a Contact Nd:YAG Laser (Surgical Laser Technologies; Malvern, Pennsylvania) . This was done in a saline medium with an average laser wattage of 25 W, (range 20 W to 30 W). Patients were evaluated postoperatively with reference to subjective and objective parameters at one week and four weeks postoperatively. Patients were evaluated with regard to wound healing, intraarticular swelling and pain. Assessment of technical parameters such as ease of resection, time of resection and instrument access were compared to conventional instruments. All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing and swelling. In addition, although there was increased time with setting up the laser and calibrating it, there was not an increase in time for meniscal resection. Little, or no, secondary "trimmuning" was necessary with the laser. Increased accessibility was noted due to the small size of the laser. Arthroscopic Contact Nd:YAG Laser surgery is a safe and effective tool for menisca]. resection and coagulation in arthroscopic acromioplasties. It provides significant advantages over conventional cutting instruments with regard to accessibility and reduced need for secondary instruments.

  9. Ethical Issues in Cardiac Surgery

    PubMed Central

    Kavarana, Minoo N.; Sade, Robert M.

    2012-01-01

    While ethical behavior has always been part of cardiac surgical practice, ethical deliberation has only recently become an important component of cardiac surgical practice. Issues such as informed consent, conflict of interest, and professional self-regulation, among many others, have increasingly attracted the attention of cardiac surgeons. This review covers several broad topics of interest to cardiac surgeons and cardiologists, and treats several other topics more briefly. There is much uncertainty about what the future holds for cardiac surgical practice, research, and culture, and we discuss the background of ethical issues to serve as a platform for envisioning what is to come. PMID:22642634

  10. Laparoscopic totally extraperitoneal (TEP) hernioplasty using two trocars: anatomical landmarks and surgical technique

    PubMed Central

    IUAMOTO, Leandro Ryuchi; KATO, Juliana Mika; MEYER, Alberto; BLANC, Pierre

    2015-01-01

    Background Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. Aim To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. Method Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anatomical landmarks: pubic bone, arcuate line and inferior epigastric vessels. Exposure of "triangle of pain" and "triangle of doom". Insertion through the 10 mm trocar polypropylene mesh of 10x15 cm to cover the hernia sites. Peritoneal sac and the dorsal edge of the mesh are repositioned in order to avoid bending or mesh displacement. It is also important to remember that the drainage is not necessary. Results The 2-port TEP required less financial costs than usual because it is not necessary an auxiliary surgeon to perform the technique. Trocars, suturing material and wound dressing were spared in comparison to the classical technique. Besides, there were only two incisions, which provides a better plastic result and less postoperative pain. Conclusion The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes. PMID:26176249

  11. Enhanced regeneration of corneal tissue via a bioengineered collagen construct implanted by a nondisruptive surgical technique.

    PubMed

    Koulikovska, Marina; Rafat, Mehrdad; Petrovski, Goran; Veréb, Zoltán; Akhtar, Saeed; Fagerholm, Per; Lagali, Neil

    2015-03-01

    Severe shortage of donor corneas for transplantation, particularly in developing countries, has prompted the advancement of bioengineered tissue alternatives. Bioengineered corneas that can withstand transplantation while maintaining transparency and compatibility with host cells, and that are additionally amenable to standardized low-cost mass production are sought. In this study, a bioengineered porcine construct (BPC) was developed to function as a biodegradable scaffold to promote corneal stromal regeneration by host cells. Using high-purity medical-grade type I collagen, high 18% collagen content and optimized EDC-NHS cross-linker ratio, BPCs were fabricated into hydrogel corneal implants with over 90% transparency and four-fold increase in strength and stiffness compared with previous versions. Remarkably, optical transparency was achieved despite the absence of collagen fibril organization at the nanoscale. In vitro testing indicated that BPC supported confluent human epithelial and stromal-derived mesenchymal stem cell populations. With a novel femtosecond laser-assisted corneal surgical model in rabbits, cell-free BPCs were implanted in vivo in the corneal stroma of 10 rabbits over an 8-week period. In vivo, transparency of implanted corneas was maintained throughout the postoperative period, while healing occurred rapidly without inflammation and without the use of postoperative steroids. BPC implants had a 100% retention rate at 8 weeks, when host stromal cells began to migrate into implants. Direct histochemical evidence of stromal tissue regeneration was observed by means of migrated host cells producing new collagen from within the implants. This study indicates that a cost-effective BPC extracellular matrix equivalent can incorporate cells passively to initiate regenerative healing of the corneal stroma, and is compatible with human stem or organ-specific cells for future therapeutic applications as a stromal replacement for treating blinding

  12. New technique for treating abdominal surgical site infection using CT woundgraphy and NPWT: A case report

    PubMed Central

    Ito, Eisaku; Yoshida, Masashi; Nakashima, Keigo; Suzuki, Norihiko; Imakita, Tomonori; Tsutsui, Nobuhiro; Ohdaira, Hironori; Kitajima, Masaki; Suzuki, Yutaka

    2016-01-01

    Introduction Negative pressure wound therapy (NPWT) for abdominal surgical site infection (SSI) is becoming increasingly common, although enterocutaneous fistula (ECF) has been reported as a complication. To avoid ECF, we used computed tomography (CT) woundgraphy to evaluate the relationship between the wound and the intestine, and then safely treated the abdominal SSI with NPWT. Case presentation Following a laparoscopic intersphincteric resection for low rectal neuroendocrine tumor and covering ileostomy, a 59-year-old woman underwent stoma closure. Six days after surgery, we diagnosed SSI. We suspected ECF, because the wound was deep and the pus resembled enteric fluid. However, CT woundgraphy showed that the wound was separated from the abdominal cavity and the intestine by the abdominal rectus muscle. Accordingly, we performed NPWT. SSI was cured and the wound was well granulated. Twenty-three days after surgery, the patient was discharged. Eventually, the wound was completely epithelialized. Discussion Although successful NPWT has been reported for open abdominal wounds, ECF is a common complication. ECF can be prevented by separating the wound from the intestine by the omentum or muscle fascia, protecting the intestinal serosa during surgery, and applying low vacuum pressure. The relationships among the wound, the fascia, and the intestine must be evaluated before abdominal SSI treatment. One good method is CT woundgraphy, which evaluates wound extent and depth, closure of muscle fascia, and the relationship between the wound and the intestine. Conclusion We report a case of CT woundgraphy before NPWT for abdominal SSI. CT woundgraphy is a good candidate for evaluating wound condition. PMID:27002290

  13. Surgical therapy of Peyronie's disease by partial plaque excision and grafting with collagen fleece: feasibility study of a new technique.

    PubMed

    Hatzichristodoulou, G; Gschwend, J E; Lahme, S

    2013-09-01

    Surgery is gold-standard for correction of Peyronie's curvature. Grafting is preferred in advanced deviations. We present our novel surgical technique and early results of grafting with collagen fleece. Patients with stable Peyronie's disease (PD) were included. Grafting was performed by a ready-to-use collagen fleece coated with tissue sealant (TachoSil, Nycomed, Konstanz, Germany), following partial plaque excision/incision. Results of correction were documented by artificial erection. In all, n=70 consecutive patients underwent surgery. Mean patient age was 56.4 years (range: 33-72); 88.6% of patients had dorsal deviation, 11.4% lateral or ventral deviation. Grafting after partial plaque excision was performed in 61 patients (87.1%), after plaque incision in 2 (2.9%) patients. In the former patients, mean operative time was 94.2 min (range: 65-165). Totally straightness was achieved in 83.6%. Three patients required surgical drainage because of subcutaneous haematoma formation. After mean early follow-up of 5.2 days (range: 2-15), glans sensation was normal in 56 patients (91.8%). Seven patients (10.0%) underwent Nesbit procedure alone. Grafting by collagen fleece in PD is feasible and promising. Major advantages are decreased operative times and easy application. Moreover, an additional haemostatic effect is provided. However, long-term clinical outcomes are necessary to confirm these encouraging findings. PMID:23446807

  14. Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

    PubMed Central

    Chen, Ming; Xu, Bin; Liu, Ning; Jiang, Hua; Wang, Yiduo; Yang, Yu; Zhang, Xiaowen; Sun, Chao; Liu, Jing; Zhu, Weidong; Chen, Shuqiu

    2015-01-01

    Introduction: We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass. Methods: In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed. Results: Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery. Conclusion: Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions. PMID:26600890

  15. Arthroscopic Labrum Reconstruction in the Hip Using the Indirect Head of Rectus Femoris as a Local Graft: Surgical Technique.

    PubMed

    Sharfman, Zachary T; Amar, Eyal; Sampson, Thomas; Rath, Ehud

    2016-04-01

    The importance of the acetabular labrum has been well documented for the health and function of the hip joint. Labral reconstruction has proven effective but often requires the use of a cadaveric allograft or auto graft from the fascia lata or gracilis. The indirect head of the rectus femoris is in close proximity with the anterior superior acetabulum, which is the most common site of labral tears. Using the indirect head of the rectus femoris as a local graft minimizes surgical invasiveness by mitigating the need to harvest the graft from a different location, in case of an autograft, and by minimizing donor site morbidity and damage to local tissues. The graft is harvested and fixed to the acetabular rim through the same arthroscopic portals. Hip labral reconstruction using the reflected head of the rectus femoris tendon is a minimally invasive surgical procedure that restores stability to the hip joint, is applicable in all patients undergoing hip labral reconstruction, and offers decreased tissue morbidity compared with other grafting techniques. PMID:27462534

  16. Surgical technique: coupling of intrastromal corneal ring segments for ectatic corneal disorders in eye bank corneas

    PubMed Central

    Moshirfar, Majid; Hsu, Maylon; Khalifa, Yousuf M

    2011-01-01

    The management of corneal ectasia is evolving, with intrastromal corneal ring segments playing an important role in delaying or eliminating the need for penetrating keratoplasty. This paper describes a modification in the implantation technique of intrastromal corneal ring segments that allows for coupling of the two segments with suture, affording more structural support. PMID:22034567

  17. Type 2 fractures of the distal clavicle: a new surgical technique.

    PubMed

    Goldberg, J A; Bruce, W J; Sonnabend, D H; Walsh, W R

    1997-01-01

    Neer type 2 fractures of the distal clavicle have a high rate of nonunion and delayed union. In this series nine cases of coracoclavicular ligament reconstruction with Dacron graft material led to union at the fracture site. All patients had no symptoms and returned to full activity. This technique allows for stable fixation with early mobilization and return to work and sports. PMID:9285878

  18. Laser treatment of 13 benign oral vascular lesions by three different surgical techniques

    PubMed Central

    Romeo, Umberto; Del Vecchio, Alessandro; Russo, Claudia; Gaimari, Gianfranco; Arnabat-Dominguez, Josep; España, Antoni J.

    2013-01-01

    Objectives: Benign Oral Vascular Lesions (BOVLs) are a group of vascular diseases characterized by congenital, inflammatory or neoplastic vascular dilations clinically evidenced as more or less wide masses of commonly dark bluish color. If traumatized BOVLs are characterized by a great risk of hemorrhage and their treatment usually requires great caution to prevent massive bleeding. In the last decades lasers have dramatically changed the way of treatment of BOVLs permitting the application of even peculiar techniques that gave interesting advantages in their management reducing hemorrhage risks. The aim of this study was to evaluate the capabilities and disadvantages of three laser assisted techniques in the management of BOVLs. Study design: In this study 13 BOVLs were treated by three different laser techniques: the traditional excisional biopsy (EB), and two less invasive techniques, the transmucosal thermocoagulation (TMT) and the intralesional photocoagulation (ILP). Two different laser devices were adopted in the study: a KTP laser (DEKA, Florence, Italy, 532nm) and a GaAlAs laser (Laser Innovation, Castelgandolfo, Italy, 808nm) selected since their great effectiveness on hemoglobin. Results: In each case, lasers permitted safe treatments of BOVLs without hemorrhages, both during the intervention and in the post-operative period. The minimally invasive techniques (TMT and ILP) permitted even the safe resolution of big lesions without tissue loss. Conclusions: Laser devices confirm to be the gold standard in BOVLs treatment, permitting even the introduction of minimal invasive surgery principles and reducing the risks of hemorrhage typical of these neoplasms. As usual in laser surgery, it is necessary a clear knowledge of the devices and of the laser-tissue interaction to optimize the results reducing risks and disadvantages. Key words:Oral vascular diseases, laser, photocoagulation. PMID:23385496

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

    PubMed Central

    Mani, Vishnu R.; Ahmed, Leaque

    2015-01-01

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

  20. “Bird-Wing” abdominal phalloplasty: A novel surgical technique for penile reconstruction

    PubMed Central

    Bajpai, Minu

    2013-01-01

    Aim: To describe a technique of phalloplasty that is devoid of donor site scarring and suitable for urethral inlay and penile prosthesis in subsequent stages in cases of aphallia. Materials and Methods: Four patients with various disorders of sex development with 46 XY and severe penile deficiency, including one with complete androgen insensitivity syndrome who was initially raised as female, have been operated using a “Bird Wing” lower abdominal skin crease incision. Results: The patients’ age ranged from 6 to 17 years with preoperative stretched penile lengths between 1 and 2.5 cm. Phallic sizes between 7.5 and 12.5 cm was achieved leaving the donor site unremarkable with lower abdominal skin crease linear scar and excellent postoperative recovery. Conclusions: This phalloplasty technique can be utilized as a definitive procedure in many situations of penile insufficiency. Subsequent stages of urethral repair and insertion of penile prosthesis can be easily added. PMID:23798805

  1. Liver transplantation in children from living related donors. Surgical techniques and results.

    PubMed Central

    Broelsch, C E; Whitington, P F; Emond, J C; Heffron, T G; Thistlethwaite, J R; Stevens, L; Piper, J; Whitington, S H; Lichtor, J L

    1991-01-01

    three procedures, in which a full left hepatectomy was performed. After alteration of the procedure into a left lateral segmentectomy, no complications were encountered. The left lateral segmentectomy presents minimal surgical trauma to the liver and should remain the primary approach for obtaining a liver graft from a living donor. For children, transplantation of a left lateral segment from a live donor provides a new way of providing a transplant of appropriate size and with good function. The success of this program has led to the acceptance of LRT for general clinical application in the authors' institution. PMID:1953097

  2. Two-stage closed sinus lift: a new surgical technique for maxillary sinus floor augmentation.

    PubMed

    Krasny, Kornel; Krasny, Marta; Kamiński, Artur

    2015-12-01

    Bone tissue atrophy may constitute a relative contraindication for implantation. The methods used in reconstruction of the alveolar ridge within the lateral section of the maxilla have been well known but not perfect. Presentation of the two-stage, closed sinus lift technique as well as efficacy evaluation of reconstruction of the alveolar ridge in the maxilla within its vertical dimension with the use of this technique. The total procedure was performed in 26 out of 28 patients qualified for the study. The height of the alveolar ridge at the site of the planned implantation was no <3 mm, the width of the ridge was no <5 mm. During the treatment stage 1 the sinus lift was performed for the first time. The created hollow was filled with allogeneic granulate. After 3-6 months stage 2 was performed consisting in another sinus lift with simultaneous implantation. The treatment was completed with prosthetic restoration after 6 months of osteointegration. In 24 out of 26 cases stage 1 was completed with the average ridge height of 7.2 mm. In stage 2, simultaneously with the second sinus lift, 26 implants were placed and no cases of sinusitis were found. In the follow-up period none of the implants were lost. The presented method is efficient and combines the benefits of the open technique-allowing treatment in cases of larger reduction of the vertical dimension and the closed technique-as it does not require opening of the maxillary sinus. PMID:25754426

  3. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    PubMed Central

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  4. Lateral high abdominal ovariopexy: an original surgical technique for protection of the ovaries during curative radiotherapy for Hodgkin's disease

    SciTech Connect

    Gaetini, A.; De Simone, M.; Urgesi, A.; Levis, A.; Resegotti, A.; Ragona, R.; Anglesio, S.

    1988-09-01

    An original surgical method for gonadal protection in young women given pelvic radiation for Hodgkin's disease is presented. Lateral high ovarian transposition (LHAO) consists of the transposition of the ovaries into the paracolic gutter during staging laparotomy, after disconnecting the gonads from the fallopian tubes by dividing the tubo-ovarian vessels. The technique's effectiveness was assessed by a study using clinical investigation, radioimmunoassay (RIA) determination of sex hormones, and dosimetry; of 18 patients treated, 10 participated in the study. All but one have normal menses and hormone values, and one pregnancy occurred. We also calculated the doses absorbed by the ovaries and proved that, during inverted Y irradiation following LHAO, the ovaries are exposed to nearly one-half the dose they receive after traditional medial transposition. During subtotal nodal irradiation after LHAO, the irradiation dose is higher than after medialisation, but absolute values are minimal and castration is not induced.

  5. Assessment of surgical outcomes of limbal transplantation using simple limbal epithelial transplantation technique in patients with total unilateral limbal deficiency.

    PubMed

    Queiroz, Ana Gabriela; Barbosa, Martina Maria Oiticica; Santos, Myrna Serapião; Barreiro, Telma Pereira; Gomes, José Álvaro Pereira

    2016-04-01

    This study aimed to evaluate the effectiveness of the novel simple limbal epithelial transplantation (SLET) technique, which reduces the risk of iatrogenic limbal stem cell deficiency in the donor eye. Four patients with total unilateral limbal stem cell deficiency received a limbal graft, measuring 4 mm × 2 mm, from the contralateral healthy eye in a single surgical procedure. The graft was divided into 10-20 pieces and distributed on the corneal surface. At 6-month follow-up, a completely avascular corneal epithelial surface was obtained in two patients, and there was improvement in visual acuity in one patient. The limbal grafts did not adhere to the cornea in one patient. No serious complications related to the surgery were observed in this study. PMID:27224077

  6. Reversal of Peroneal Tenodesis With Allograft Reconstruction of the Peroneus Brevis and Longus: Case Report and Surgical Technique.

    PubMed

    Pellegrini, Manuel J; Adams, Samuel B; Parekh, Selene G

    2014-06-24

    Chronic peroneal tendinopathy and tears represent a challenging clinical situation. Traditionally, tenodesis of the torn tendon to the remaining healthy tendon has been advocated if more than half of the tendon is compromised. Allograft reconstructions have been reserved for patients with functional muscles and both peroneal tendons extensively compromised. We report a unique case of a peroneal tenodesis takedown and reconstruction of both peroneal tendons using semitendinosus allograft. A description of the surgical technique and tips are provided. Peroneal tendon function is crucial to maintain a balanced hindfoot. To the best of our knowledge, reconstruction of both peroneal tendons after a tenodesis has not been previously reported. Allograft reconstruction of the peroneal tendons arises as a feasible alternative in patients with residual pain and weakness after a failed tenodesis surgery LEVELS OF EVIDENCE: Therapeutic Level IV, case study. PMID:24962697

  7. Unstable elbow dislocations: the description and cadaveric feasibility study of a new surgical technique

    PubMed Central

    Harris, Mark; Bishop, Timothy; Bernard, Jason

    2015-01-01

    Introduction: A small proportion of simple elbow dislocations are grossly unstable and joint congruence is not maintained after reduction. In this rare situation operative treatment is indicated. We describe a new intra articular reconstruction that utilises a slip of triceps tendon to provide immediate stability to the elbow. Methods: We assessed 20 cadaveric elbows, measuring the length of triceps tendon available and required to complete the reconstruction. We then sequentially sectioned the ligamentous stabilisers of an elbow before performing the new technique. We measured the displacement and angulation possible at the elbow before and after the reconstruction. Results: All 20 elbows had sufficient triceps tendon length to complete the new technique. Prior to the reconstruction greater than 30 mm of joint distraction and 90 degrees varus or valgus angulation was possible. Following the reconstruction it was not possible to re-dislocate the elbow. Only 2 mm of joint distraction and 10 degrees of varus or valgus angulation were possible with the triceps graft fixed in position. Discussion: This novel technique elegantly avoids many of the problems associated with current methods. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs. PMID:27163079

  8. A Simple Technique for Surgical Placement of Occipital Nerve Stimulators without Anchoring the Lead.

    PubMed

    Plazier, Mark; Camp, Tim Van; Mevnosky, Tomas; Ost, Jan; De Ridder, Dirk; Vanneste, Sven

    2016-09-01

    Introduction Greater occipital nerve stimulation is applied in the treatment of occipital neuralgia, headache, and fibromyalgia. Multiple techniques have been described along with their subsequent complications. The most frequent complications are related to lead migration, infection, and undesired stimulation effects. Revision surgery occurs in up to 60% of the cases. Patients and Methods A total of 92 implantations, 51 trials (6-10 weeks), and 41 permanent implantations (follow-up: 36-72 months) were performed in a single center using a simple technique without an anchoring device. The electrode is tunneled at a 45-degree angle to prevent migration. Complications and additional surgeries were recorded during the follow-up period. Results All patients had bilateral greater occipital nerve stimulation. A total of 16 complications (17.4%) occurred. Seven patients (7.6%) underwent additional surgery. The major complication was infection; lead migration made up only 3.3% of the complications. Conclusions We present a simple technique without the use of an anchoring device that is feasible in achieving bilateral occipital nerve stimulation and decreases the complications, especially lead migration. PMID:26444964

  9. Supracondylar osteotomy of the paediatric femur using the locking compression plate: a refined surgical technique.

    PubMed

    Brunner, Reinald; Camathias, Carlo; Gaston, Mark; Rutz, Erich

    2013-12-01

    Locking compression plates (LCP) have been developed for paediatric patients, and these provide safe bone fixation and allow for immediate weight-bearing. These plates are becoming increasingly popular and are proving to especially useful for the treatment of proximal and distal (supracondylar) femoral osteotomies. They are thought to provide better grip in osteoporotic bone. The technique has been described in the provider's manual as well as recently by Joeris et al. (Int Orthop 2012: 36:2299-2306). The LCP system offers optimal stability after the final fixation, but temporary fixation using the originally described method is unstable, and we consider the medialisation instrument unsatisfactory as it has very small contact area with the lateral aspect of the femur and does not provide sound rotational control. For this reason we have developed a technique whereby temporary, stable fixation using fine K-wires can be attained for the proximal, diaphyseal fragment, following sound fixation with locking screws of the distal fragment. This procedure allows for full clinical (including rotation) and radiographic assessment intraoperatively, as well as fine adjustment in all three planes. This modification enables optimal correction before the final fixation and avoids unnecessary, large drill holes which may otherwise act as dangerous tress risers, endangering stability and weight-bearing. Here we describe a refined technique of the supracondylar femoral osteotomy using the paediatric LCP Condylar Plate. PMID:24432123

  10. Vascular Surgery Trainees Still Need to Learn How to Sew: Importance of Learning Surgical Techniques in the Era of Endovascular Surgery

    PubMed Central

    Aziz, Faisal

    2015-01-01

    Vascular surgery represents one of the most rapidly evolving specialties in the field of surgery. It was merely 100 years ago when Dr. Alexis Carrel described vascular anastomosis. Over the course of next several decades, vascular surgeons distinguished themselves from general surgeons by horning the techniques of vascular surgery operations. In the era of minimally invasive interventions, the number of endovascular interventions performed by vascular surgeons has increased exponentially. Vascular surgery trainees in the current times spend considerable time in mastering the techniques of endovascular operations. Unfortunately, the reduction in number of open surgical operations has lead to concerns in regards to adequacy of learning open surgical techniques. In future, majority of vascular interventions will be done with minimally invasive techniques. Combination of poor training in open operations and increasing complexity of open surgical operations may lead to poor surgical outcomes. It is the need of the hour for vascular surgery trainees to realize the importance of learning and mastering open surgical techniques. One of the most distinguishing features of contemporary vascular surgeons is their ability to perform both endovascular and open vascular surgery operations, and we should strive to maintain our excellence in both of these arenas. PMID:26029698

  11. Vascular surgery trainees still need to learn how to sew: importance of learning surgical techniques in the era of endovascular surgery.

    PubMed

    Aziz, Faisal

    2015-01-01

    Vascular surgery represents one of the most rapidly evolving specialties in the field of surgery. It was merely 100 years ago when Dr. Alexis Carrel described vascular anastomosis. Over the course of next several decades, vascular surgeons distinguished themselves from general surgeons by horning the techniques of vascular surgery operations. In the era of minimally invasive interventions, the number of endovascular interventions performed by vascular surgeons has increased exponentially. Vascular surgery trainees in the current times spend considerable time in mastering the techniques of endovascular operations. Unfortunately, the reduction in number of open surgical operations has lead to concerns in regards to adequacy of learning open surgical techniques. In future, majority of vascular interventions will be done with minimally invasive techniques. Combination of poor training in open operations and increasing complexity of open surgical operations may lead to poor surgical outcomes. It is the need of the hour for vascular surgery trainees to realize the importance of learning and mastering open surgical techniques. One of the most distinguishing features of contemporary vascular surgeons is their ability to perform both endovascular and open vascular surgery operations, and we should strive to maintain our excellence in both of these arenas. PMID:26029698

  12. Improving Double Docking for Robot-assisted Para-aortic Lymphadenectomy in Endometrial Cancer Staging: Technique and Surgical Outcomes.

    PubMed

    Ekdahl, Linnea; Salehi, Sahar; Falconer, Henrik

    2016-01-01

    Robot-assisted para-aortic lymphadenectomy (PALND) may prove to be a challenging procedure, and the ability to reach the planned anatomic landmarks is critical. In this retrospective study between 2012 and 2015, we present surgical data using a modified technique to perform infrarenal PALND for endometrial cancer using double side docking. All women with high-risk endometrial cancer scheduled for complete robotic staging including infrarenal PALND were included in the analysis. During the study period, a total of 76 women were identified. Three patients had disseminated disease and were treated with palliative hysterectomy only. The remaining 73 women underwent surgery with the intention to perform infrarenal PALND. In 7 cases, PALND was aborted because of technical inability to reach the left renal vein (10%). A median of 36 lymph nodes were harvested (pelvic n = 20, para-aortic n = 16). The median operating time (skin to skin) for patients with completed infrarenal PALND was 228 minutes (range, 181-371 minutes). Among all 76 patients, postoperative complications according to the Clavien-Dindo nomenclature were observed in 27 (36%) patients, with 6 (8%) having grade III complications. No patient died within 30 days from surgery. Our technique of double docking for robot-assisted PALND was associated with a success rate of 90%. The described technique seems to be a useful strategy to maximize the likelihood of completing the planned procedure. PMID:27063093

  13. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

    PubMed Central

    Kiran, Kopuri Ravi; Srikanth, I Muni; Chinnusamy, Lenin; Deepti, K

    2015-01-01

    The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup. PMID:26806970

  14. Development of a Surgically Optimized Graft Insertion Suture Technique to Accommodate a Tissue-Engineered Tendon In Vivo

    PubMed Central

    Sawadkar, Prasad; Alexander, Susan; Tolk, Marten; Wong, Jason; McGrouther, Duncan; Bozec, Laurent

    2013-01-01

    Abstract The traumatic rupture of tendons is a common clinical problem. Tendon repair is surgically challenging because the tendon often retracts, resulting in a gap between the torn end and its bony insertion. Tendon grafts are currently used to fill this deficit but are associated with potential complications relating to donor site morbidity and graft necrosis. We have developed a highly reproducible, rapid process technique to manufacture compressed cell-seeded type I collagen constructs to replace tendon grafts. However, the material properties of the engineered constructs are currently unsuitable to withstand complete load bearing in vivo. A modified suture technique has been developed to withstand physiological loading and off load the artificial construct while integration occurs. Lapine tendons were used ex vivo to test the strength of different suture techniques with different sizes of Prolene sutures and tissue-engineered collagen constructs in situ. The data were compared to standard modified Kessler suture using a standard tendon graft. Mechanical testing was carried out and a finite element analysis stress distribution model constructed using COMSOL 3.5 software. The break point for modified suture technique with a tissue-engineered scaffold was significantly higher (50.62 N) compared to a standard modified Kessler suture (12.49 N, p<0.05). Distributing suture tension further proximally and distally from the tendon ends increased the mechanical strength of the repairs. We now have ex vivo proof of concept that this suture technique is suitable for testing in vivo, and this will be the next stage of our research. PMID:24083088

  15. Urolift: a New Face of Minimally Invasive Surgical Technique for Benign Prostatic Hyperplasia?

    PubMed

    Tsui, Johnson F; Dixon, Christopher M

    2016-09-01

    The management of clinical benign prostatic hyperplasia (BPH) remains a common problem in daily urologic practice. Recently, a new minimally invasive procedure for BPH, the Urolift System, has been introduced. This article reviews the current literature discussing the technique, efficacy, adverse events, limitations, and possible concerns. The existing data which includes a 3-month, sham-controlled multicenter trial with a subsequent 3-year follow-up indicates significant improvements in the outcome measures in particular urinary symptoms. The adverse event profile and reoperation rates are acceptable. A particular benefit includes the lack of negative effects on erectile or ejaculatory function. The procedure can be performed with minimal anesthesia, but is limited to lateral lobe enlargement as it is unsuitable for median lobe or central zone obstruction. Another potential drawback is the placement of permanent implants into the prostatic urethra. The adoption of this procedure will ultimately be determined by multiple factors including ease of use, patient satisfaction, durability, and reimbursement. PMID:27432380

  16. Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique

    PubMed Central

    Raup, Valary T.; Eswara, Jairam R.; Marshall, Stephen D.; Brandes, Steven B.

    2015-01-01

    Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique. PMID:26483985

  17. Osteochondral Autograft Transplantation: A Review of the Surgical Technique and Outcomes.

    PubMed

    Richter, Dustin L; Tanksley, John A; Miller, Mark D

    2016-06-01

    Isolated chondral and osteochondral defects of the knee are challenging clinical entities, particularly in younger patients. Cartilage treatment strategies have previously been characterized as palliation (ie, chondroplasty and debridement), repair (ie, drilling and microfracture), or restoration (ie, autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft). The osteochondral autograft transplantation procedure allows defects to be filled immediately with mature, hyaline articular cartilage by utilizing either an arthroscopic or a mini-open procedure. Graft harvest and placement can be technically demanding, but results show trends toward greater longevity, durability, and improved outcomes in high-demand patients when compared with alternative techniques. Improved results are shown in younger patients with isolated lesions between 1 and 4 cm. PMID:27135290

  18. Principles and techniques used to create a natural hairline in surgical hair restoration.

    PubMed

    Shapiro, Ronald

    2004-05-01

    The principles and techniques outlined in this article will help the surgeon create hairlines that have the high degree of naturalness and substance expected by today's discerning patients. Surgeons can now establish a natural hairline during the first surgery that can stand on its own, independent of further sessions. It is not enough to "just use micrografts."Proper selection and use of FUs combined with artistry and skill provide surgeons with the tools to follow nature's lead in creating natural-appearing,soft hairlines while establishing the illusion of density. The author's approach is to create an initial framework based on the principles of hairline design,then use artistic ability and experience to fine-tune this framework. PMID:15135130

  19. Robot-Assisted Extended Pelvic Lymph Nodes Dissection for Prostate Cancer: Personal Surgical Technique and Outcomes

    PubMed Central

    Francesco, Porpiglia; Stefano, De Luca; Riccardo, Bertolo; Roberto, Passera; Fabrizio, Mele; Matteo, Manfredi; Daniele, Amparore; Ivano, Morra; Cristian, Fiori

    2015-01-01

    ABSTRACT Objective: Extended pelvic lymph nodes dissection (EPLND) allows the removal of a higher number of lymph nodes than limited PLND. The aims of this study were to describe our robot-assisted EPLND (RAEPLND) technique with related complications, and to report the number of lymph nodes removed and the rate of lymph nodal metastasis. Materials and Methods: 153 patients underwent RAEPLND prior to robot-assisted radical prostatectomy (RARP). Indications were defined according to Briganti nomogram, to predict risk of lymph-nodal metastasis. Lymphatic packages covering the distal tract of the common iliac artery, the medial portion of the external iliac artery, the external iliac vein and the internal iliac vessels, together with the obturator and the presacral lymphatic packages were removed on both sides. Results: Median preoperative PSA was 7.5 ng/mL (IQR 5.5–11.5). Median operative time was 150 min (135–170). Median RAEPLND alone operative time was 38 min (32.75–41.25); for right and left side, 18 (15–29) and 20 min (15.75–30) (p=0.567). Median number of lymph nodes retrieved per patient was 25 (19.25–30); 13 (11–16) and 11 (8–15) for right and left side. In 19 patients (12.41%) metastasis was found at the level of pelvic lymph nodes. Median number of positive lymph nodes was 1 (1–4.6) per patient. Complications occurred in 11 patients (7.3%). Conclusions: the number of lymph nodes removed was comparable to published data about open series, allowing the increase of detection rate of lymph nodal metastasis for minimally invasive approach without compromising complications' rate if performing the procedure following reported technique. PMID:26742982

  20. [Prostate cancer: what treatment techniques for which tumors? Ethical and methodological issues].

    PubMed

    de Crevoisier, R; Castelli, J; Guérif, S; Pommier, P; Créhange, G; Chauvet, B; Lagrange, J L

    2014-10-01

    The identification of the optimal radiation technique in prostate cancer is based on the results of dosimetric and clinical studies, although there are almost no randomized studies comparing different radiation techniques. The feasibility of the techniques depends also on the technical and human resources of the radiation department, on the cost of the treatment from the points of view of the society, the patient and the radiation oncologist, and finally on the choice of the patient. The slow evolution of prostate cancer leads to consider the biochemical failure as the main judgment criteria in the majority of the studies. A proper urinary radio-induced toxicity evaluation implies a long follow-up. Intensity-modulated radiotherapy (IMRT) combined with image-guided radiotherapy (IGRT) is recommended in case of high dose (≥76Gy) to the prostate, pelvic lymph nodes irradiation and hypofractionation schedules. For low-risk tumors, the aim of the treatment is to preserve quality of life, while limiting costs. Stereotactic body radiotherapy shows promising results, although the follow-up is still limited and phase III trials are ongoing. Focal radiation techniques are in the step of feasibility. For intermediate and high-risk tumors, the objective of the treatment is to increase the locoregional control, while limiting the toxicity. IMRT combined with IGRT leads to either a well-validated dose escalation strategy for intermediate risk tumors, or to a strategy of moderate hypofractionated schedules, which cannot be yet considered as a standard treatment. These combined radiation techniques allow finally large lymph node target volume irradiation and dose escalation potentially in the dominant intraprostatic lesion. The feasibility of simultaneous integrated boost approaches is demonstrated. PMID:25199865

  1. Reconstruction of the mandible and the maxilla: the evolution of surgical technique.

    PubMed

    Genden, Eric M

    2010-01-01

    The upper and lower jaws play an essential role in mastication, articulation, and cosmetic form. The mandible provides support for tongue position and elevation of the larynx during swallowing, while the maxilla provides support for the nasal structures as well as an opposing structure to the mandible during mastication. The evolution of mandibular and maxillary reconstruction dates back to the early 19th century. Before the introduction of free tissue transfer, a variety of local flaps, regional flaps, and prosthetics were introduced, yet each was met with eventual failure. Since the introduction of free tissue transfer, mandibular and maxillary reconstruction has become as much of an art as it has a science. Whether the mandibular or the palatomaxillary defects are a result of trauma, congenital deformity, or tumor extirpation, the resultant effect often disrupts both form and function. With these considerations taken together, jaw reconstruction is a unique undertaking in which the artistic reconstruction of the facial skeleton is met with the science of reestablishing the mechanics of mastication. The site, size, and associated soft-tissue defects represent the 3 most important factors in determining the impact of a given defect on function and aesthetics. There is also an inherent difference between defects that are sustained in a controlled fashion, such as during cancer ablation, and those that result from trauma. The consideration of these complexities in jaw reconstruction is reflected in the wide variety of approaches and techniques that have evolved over the past century. PMID:20231587

  2. Comparison of 3 different anesthetic techniques on 24-hour recovery after otologic surgical procedures.

    PubMed

    Jellish, W S; Leonetti, J P; Fahey, K; Fury, P

    1999-03-01

    Intravenous propofol anesthesia is better than inhalational anesthesia for otologic surgery, but cost and intraoperative movement make this technique prohibitive. This study compares a propofol sandwich anesthetic with a total propofol or inhalational anesthetic for otologic surgery to determine which produces the best perioperative conditions and least expense. One hundred twenty patients undergoing ear surgery were randomly chosen to receive an anesthetic with either isoflurane (INHAL), total propofol (TPROP), or propofol used in conjunction with isoflurane (PSAND). Postoperative wakeup and the incidence and severity of nausea, vomiting, and pain were compared among groups. Antiemetic administration and discharge times from recovery and the hospital were also compared. The groups were similar, but anesthesia times were longer in the INHAL group. Emergence from anesthesia after PSAND or TPROP was more rapid than after INHAL. Recovery during the next 24 hours was associated with less nausea and vomiting with PSAND than with INHAL. The cost of the PSAND anesthetic was similar to that of INHAL, and both were less than TPROP. PSAND anesthesia may be similar to TPROP and better than INHAL for otologic procedures. PSAND was less expensive than TPROP and produced a similar recovery profile and antiemetic effect in the 24-hour period after surgery. PMID:10064647

  3. Dependency between treatment outcome in pseudarthrosis of the humeral shaft and the surgical technique applied.

    PubMed

    Piotrowski, Maciej; Baczkowski, Bogusław; Markowicz, Agnieszka; Pankowski, Rafał; Luczkiewicz, Piotr

    2005-08-30

    Background. Treatment of non-union has always been one of the most difficult problems in bone pathology. In the present study we compare outcomes using 9 different methods of non-union treatment. Material and methods. From 1976 to 2003, 70 patients with 85 cases of pseudoarthrosis in the humeral shaft were operated. During that period, 103 operations using 9 different methods were performed. The study group consisted of 17 females, 36 males and 17 children, ranging in age from 3 to 85 years. The operation techniques were compared based on the achievement of bone union and recovery of limb functional efficiency. Nonunion type was also taken into account. Results. A high percentage of bone union was obtained by using a perforated block of corticocancellous graft taken from the iliac crest. The most complete limb function recovery was achieved using this method, as well as Judet's decortication with cancellous grafting and firm osteosynthesis. Conclusions. In oligotrophic and non-viable humeral shaft non-union, the most effective method is pseudarthrosis excision, using a perforated block of corticocancellous graft from the iliac crest to fill the gap, and firm osteosynthesis. Judet's decortication with cancellous grafting and firm osteosynthesis secured good outcome in hypertrophic pseudarthrosis. PMID:17611455

  4. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol

    PubMed Central

    Drew, Howard

    2015-01-01

    The case report will present some novel techniques for using a “staged” protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sinus lift in an optimum location. The depth of the bone needed for the osteotome sinus floor elevation was planned. The staged appliance allowed these sinus-augmented sites to heal for an extended period of time compared to implants, which were uncovered and loaded at an earlier time frame. The staged protocol and CBCT analysis enabled the immediate implants to be placed in proper alignment to the adjacent fixture. After teeth were extracted, the osseointegrated implants were converted to abutments for the transitional appliance. Finally, the staged protocol allowed for soft tissue enhancement in the implant and pontic areas prior to final insertion of the prosthesis. PMID:25632356

  5. Novel Techniques with the Aid of a Staged CBCT Guided Surgical Protocol.

    PubMed

    Chasioti, Evdokia; Sayed, Mohammed; Drew, Howard

    2015-01-01

    The case report will present some novel techniques for using a "staged" protocol utilizing strategic periodontally involved teeth as transitional abutments in combination with CBCT guided implant surgery. Staging the case prevented premature loading of the grafted sites during the healing phase. A CBCT following a tenting screw guided bone regeneration procedure ensured adequate bone to place an implant fixture. Proper assessment of the CBCT allowed the surgeon to do an osteotome internal sinus lift in an optimum location. The depth of the bone needed for the osteotome sinus floor elevation was planned. The staged appliance allowed these sinus-augmented sites to heal for an extended period of time compared to implants, which were uncovered and loaded at an earlier time frame. The staged protocol and CBCT analysis enabled the immediate implants to be placed in proper alignment to the adjacent fixture. After teeth were extracted, the osseointegrated implants were converted to abutments for the transitional appliance. Finally, the staged protocol allowed for soft tissue enhancement in the implant and pontic areas prior to final insertion of the prosthesis. PMID:25632356

  6. Long-term results of the surgical treatment of Peyronie's disease with Egydio's technique: a European multicentre study

    PubMed Central

    Sansalone, Salvatore; Garaffa, Giulio; Djinovic, Rados; Pecoraro, Stefano; Silvani, Mauro; Barbagli, Guido; Zucchi, Alessandro; Vespasiani, Giuseppe; Loreto, Carla

    2011-01-01

    The long-term outcomes of 157 patients affected by Peyronie's disease (PD) who underwent penile straightening with Egydio's technique between January 2004 and December 2008 are reported. Only patients with PD who were stable for at least 6–12 months prior to surgery were enrolled in this study. Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 (IIEF-5) questionnaire. Stretched penile length was recorded pre- and postoperatively. Surgical complications, cosmesis and sexual function, patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months, 1 year and 2 years, respectively. After a median follow-up period of 20 months (range: 12–24 months), we found that mild residual curvature (12%) and glans hypoesthesia (3%) were the only causes of partial dissatisfaction. No rejection of the graft was observed. All patients recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.5 cm (range: 1.7–4.1 cm) in stretched penile length was recorded, with all patients engaging in penetrative sexual intercourse. In conclusion, this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results. PMID:21743482

  7. The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature

    PubMed Central

    Cornelius, Carl-Peter; Ehrenfeld, Michael

    2010-01-01

    Mandibulo-maxillary fixation (MMF) screws are inserted into the bony base of both jaws in the process of fracture realignment and immobilisation. The screw heads act as anchor points to fasten wire loops or rubber bands connecting the mandible to the maxilla. Traditional interdental chain-linked wiring or arch bar techniques provide the anchorage by attached cleats, hooks, or eyelets. In comparison to these tooth-borne appliances MMF screws facilitate and shorten the way to achieve intermaxillary fixation considerably. In addition, MMF screws help to reduce the hazards of glove perforation and wire stick injuries. On the downside, MMF screws are attributed with the risk of tooth root damage and a lack of versatility beyond the pure maintenance of occlusion such as stabilizing loose teeth or splinting fragments of the alveolar process. The surgical technique of MMF screws as well as the pros and cons of the clinical application are reviewed. The adequate screw placement to prevent serious tooth root injuries is still an issue to rethink and modify conceptual guidelines. PMID:22110819

  8. Clinical Outcome of a Wide-diameter Bone-anchored Hearing Implant and a Surgical Technique With Tissue Preservation

    PubMed Central

    Mowinckel, Marius S.; Møller, Martin N.; Wielandt, Kirsten N.; Foghsgaard, Søren

    2016-01-01

    Objective: To investigate the clinical outcome of a surgical technique with tissue preservation for a wide bone-anchored hearing implant concerning postoperative complications, skin reactions, implant loss, and implant stability. Study Design: Consecutive, prospective case series. Setting: Tertiary referral center. Patients: Twenty-four adult patients with normal skin quality were enrolled. Intervention(s): Implantation of bone-anchored implant was performed using a one-stage linear-incision technique with tissue preservation surgery. Main Outcome Measures(s): Skin and soft tissue reactions according to Holgers grading system. Pain and numbness measured according to visual analogue scale. Implant stability quotient values were recorded using resonance frequency analysis. Follow-up at 10 days, 6 weeks, 6 months, and 1 year after surgery. Results: Primary implant stability was good and a significant increase in implant stability quotient occurred during the first 10 days and continued to be stable throughout the 1-year observation period. No implants were lost. Skin and soft tissue reactions were few, no reaction (Holger grade 0) was observed in 88% of the follow-up examinations and no grade 4 reactions occurred. Pain and numbness were minimal. Conclusion: The wide implant showed good stability initially and throughout the observation period. Skin and soft tissue reactions were rare and minor. No implants were lost. PMID:26954348

  9. Basal Cell Carcinoma of the Outer Nose: Overview on Surgical Techniques and Analysis of 312 Patients

    PubMed Central

    Wollina, Uwe; Bennewitz, Annett; Langner, Dana

    2014-01-01

    Background: Basal cell carcinoma of the nose is common, with a potential of local recurrence and high-risk features. Materials and Methods: We provide a review on anatomy of the nose, tumour surgery and defect closure on the nose. We analysed our own patients with nasal BCC of a 24 months period. Results: We identified 321 patients with nasal BCC. There was a predominance of female patients of 1.2 to 1. The mean age was 74.8 years. Slow Mohs technique was employed for all tumours until 3D tumour-free margins were achieved. That resulted on average in 1.8 ± 0.7 Mohs stages. The most common histologic types were solitary (n = 182), morpheic (79), and micronodular (20), Perineural infiltration was evident in 56 tumours. Primary closure after mobilisation of soft tissue was possible in 105 BCCs. Advancement flaps were used in 91 tumours, rotation flaps in 47, transposition flaps in 34 tumours, and combined procedures in 6 cases. In 36 patients full-thickness skin grafting was performed. In two patients healing by second intention was preferred. Partial flap loss was seen in four patients (1.4%). All of them had significant underlying pathologies. None of the tumours treated showed a relapse during the observation time. However, this is a limitation of the present study since follow-up was on average only 10 months. Conclusions: BCCs of the nose are common. Only 3D-controlled micrographic surgery (Mohs or slow Mohs) guarantee a high rate of complete tumour removal and a very low risk of recurrence. PMID:25538434

  10. Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results

    PubMed Central

    Mascarenhas, Randy; Raleigh, Eden; McRae, Sheila; Leiter, Jeff; Saltzman, Bryan; MacDonald, Peter B.

    2014-01-01

    Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency. PMID:25538432

  11. Early surgical and functional outcomes comparison of the supercapsular percutaneously-assisted total hip and traditional posterior surgical techniques for total hip arthroplasty: protocol for a randomized, controlled study

    PubMed Central

    Cronin, Michael D.; Gofton, Wade; Erwin, Lindsey; Chow, James

    2015-01-01

    Background Total hip arthroplasty (THA) is one of the most commonly performed and successful orthopaedic surgeries. While the long-term success of THA is well documented, there is still significant room for improving patient speed of recovery and return to activities. The surgical technique used during THA has the potential to affect these early outcomes. Methods The described design is a single center, prospective, randomized, controlled study. Subjects will be randomized to receive THA using either the supercapsular percutaneously-assisted total hip (SuperPath) or traditional posterior surgical techniques. Subjects will be evaluated using Timed Up and Go (TUG), Timed Stair Climb (TSC), Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and Visual Analog Scale (VAS) for pain level estimation preoperatively, during the hospital stay, and at 2, 6 weeks, and 100 days post-discharge. Other endpoints to be evaluated include: length of stay (LOS); discharge status; transfusion rates; readmission rates; complication rates; operative time; date returned to work; and acetabular component anteversion and inclination angles. Discussion The described study will determine the effect of a tissue-sparing surgical technique on short term subject recovery following THA in comparison to the most commonly used technique in clinical practice. PMID:26734645

  12. Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

    PubMed Central

    Berger, Cezar Augusto Sarraf; Freitas, Renato da Silva; Malafaia, Osvaldo; Pinto, José Simão de Paula; Macedo Filho, Evaldo Dacheux; Mocellin, Marcos; Fagundes, Marina Serrato Coelho

    2014-01-01

    Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures. PMID:25992149

  13. Comparison of Surgical Blade and Cryosurgery with Liquid Nitrogen Techniques in Treatment of Physiologic Gingival Pigmentation: Short Term Results

    PubMed Central

    Rahmati, Saeed; Darijani, Mansoore; Nourelahi, Maryam

    2014-01-01

    Statement of the Problem: Melanin pigmentation of the gingiva is a crucial esthetic problem. A variety of methods have been used for gingival depigmentation. Purpose: The purpose of this study was to compare the results of two treatment modalities: scalpel technique and cryotherapy with liquid nitrogen in treatment of gingival pigmentation. Materials and Method: Twenty patients with chief complaint of gingival pigmentation participated in our study. 10 patients were treated with cryotherapy and remaining 10 participants were undergone the scalpel technique surgery. We evaluated acquiescence and comfort of the patients, degree of depigmentation, based on the area of pigmentation shown by gridlines option in Microsoft Paint software, and the presence or absence of gingival recession before and one month after treatment. Data was analyzed using Mann-Whitney and Chi-Square tests. A significance level of p≤ 0.05 was adopted. Results: Mean value and standard deviation of depigmentation for group A and group B was 96.17±2.51 and 95±2.48, respectively. The difference was not statistically significant (p= 0.225). There was no association between the treatment modality and the gingival recession (p= 0.303) or the treatment modality and the patient satisfaction (p= 0.346). No significant difference was found between gingival recession measures before and after the operation in the two treatment modalities. Conclusion: Surgical blade and cryosurgery with liquid nitrogen had no significant difference in treatment of physiologic gingival pigmentation. Both Techniques are acceptable in the treatment of gingival pigmentation. PMID:25469354

  14. Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases

    PubMed Central

    2011-01-01

    Background We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM) tendon using endobuttons to strengthen initial fixation. Methods Five male patients (3 judo players, 1 martial arts player, and 1 body builder) were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33) and 28.8 months (range, 24-36). A rectangular bone trough (about 1 × 4 cm) was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM), outcome of treatment, and isometric power were measured at final follow-up. Results There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases) or good (1/5). In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side. Conclusions Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon. PMID:21955511

  15. Comparison of two cochlear implantation techniques and their effects on the preservation of residual hearing. Is the surgical approach of any importance?

    PubMed

    Postelmans, J T F; Stokroos, R J; van Spronsen, E; Grolman, W; Tange, R A; Maré, M J; Dreschler, Wouter Albert

    2014-05-01

    The goal of this work was to review the pre-and postsurgical auditory thresholds of two surgical implantation techniques, namely the mastoidectomy with posterior tympanotomy approach (MPTA) and suprameatal approach (SMA), to determine whether there is a difference in the degree of preservation of residual hearing. In a series of 430 consecutive implanted patients 227 patients had measurable pre-operative hearing thresholds at 250, 500, and 1,000 Hz. These patients were divided into two groups according to the surgical technique that was used for implantation. The SMA approach was followed for 84 patients in Amsterdam, whereas the MPTA technique was adhered to 143 patients in Maastricht. The outcome variables of interest were alteration of pre-and postoperative auditory thresholds after cochlear implantation. Complete or partial preservation of residual hearing was obtained in 21.4 and 21.7% in the SMA and MPTA group, respectively. No statistical differences could be found between the SMA and MPTA group (p = 0.96; Chi-square test). The SMA technique is correlated with a similar degree of hearing loss after cochlear implantation compared to the MPTA technique. However, both techniques were not able to conserve a measurable amount of hearing in patients with a substantial degree of residual hearing. Therefore, both surgical techniques need to be refined for patients in which residual acoustical hearing is pursued. PMID:23632865

  16. PRE-OPERATIVE PLANNING AND SURGICAL TECHNIQUE OF THE OPEN WEDGE SUPRACONDYLAR OSTEOTOMY FOR CORRECTION OF VALGUS KNEE AND FIXATION WITH A FIXED-ANGLE IMPLANT

    PubMed Central

    Paccola, Cleber Antonio Jansen

    2015-01-01

    The step-by-step preoperative planning for supracondylar opening wedge osteotomy of the femur for precise correction of the load axis of the lower limb using a fixed-angle implant (95° AO blade plate) is presented. The surgical technique and the use of a bone graft from the same site for filling in the defect are also presented. PMID:27026976

  17. Intermediate-Term Outcomes of Dual Adult versus Single-Kidney Transplantation: Evolution of a Surgical Technique

    PubMed Central

    Islam, Ana K.; Mayer, Wesley A.; Hollander, Adam B.; Patel, Samir; Teeter, Larry D.; Graviss, Edward A.; Saharia, Ashish; Podder, Hemangshu; Asham, Emad H.; Gaber, A. Osama

    2016-01-01

    Background. Acceptance of dual kidney transplantation (DKT) has proven difficult, due to surgical complexity and concerns regarding long-term outcomes. We herein present a standard technique for ipsilateral DKT and compare outcomes to single-kidney transplant (SKT) recipients. Methods. A retrospective single-center comparison of DKT and SKT performed between February 2007 and July 2013. Results. Of 516 deceased donor kidney transplants, 29 were DKT and 487 were SKT. Mean follow-up was 43 ± 67 months. DKT recipients were older and more likely than SKT recipients to receive an extended criteria graft (p < 0.001). For DKT versus SKT, the rates of delayed graft function (10.3 versus 9.2%) and acute rejection (20.7 versus 22.4%) were equivalent (p = ns). A higher than expected urologic complication rate in the DKT cohort (14 versus 2%, p < 0.01) was reduced through modification of the ureteral anastomosis. Graft survival was equivalent between DKT and SKT groups (p = ns) with actuarial 3-year DKT patient and graft survivals of 100% and 93%. At 3 years, the groups had similar renal function (p = ns). Conclusions. By utilizing extended criteria donor organs as DKT, the donor pool was enlarged while providing excellent patient and graft survival. The DKT urologic complication rate was reduced by modification of the ureteral anastomosis. PMID:27478630

  18. Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer.

    PubMed

    Gall, Tamara M H; Jacob, Jimmy; Frampton, Adam E; Krell, Jonathan; Kyriakides, Charis; Castellano, Leandro; Stebbing, Justin; Jiao, Long R

    2014-05-01

    Circulating tumor cells (CTCs) disseminate from the primary tumor and travel through the bloodstream and lymphatic system. The detection of and/or increase in the number of CTCs during a patient’s clinical course may be a harbinger of forthcoming overt metastasis. We aimed to examine the impact of 2 different surgical techniques, standard (ST) pancreaticoduodenectomy (PD) and no-touch isolation (NT) PD, on tumor behavior and outcome in patients with pancreatic cancer by using CTCs as biomarkers. In this pilot study, patients were randomized to either ST-PD (n = 6) or NT-PD (n = 6). Intraoperatively, blood samples were taken from the portal vein for measurement of CTCs before and immediately after removal of the tumor. An increase in CTCs was seen in 5 of 6 patients (83%) with ST-PD but no patients with NT-PD (P = .003). In the ST-PD and NT-PD groups, median overall survival was 13.0 and 16.7 months, respectively (P = .33); there was no difference in disease-free survival (P = .42). The use of NT-PD significantly reduced the number of CTCs in the portal vein with no benefit in survival outcomes compared with ST-PD, although more extensive studies are required. PMID:24599353

  19. Surgical approaches for the management of idiopathic thoracic scoliosis and the indications for combined anterior-posterior technique.

    PubMed

    Rauzzino, M J; Shaffrey, C I; Wagner, J; Nockels, R; Abel, M

    1999-05-15

    The indications for surgical intervention in patients with idiopathic scoliosis have been well defined. The goals of surgery are to achieve fusion and arrest progressive curvature while restoring normal coronal and sagittal balance. As first introduced by Harrington, posterior fusion, the gold standard of treatment, has a proven record of success. More recently, anterior techniques for performing fusion procedures via either a thoracotomy or a retroperitoneal approach have been popularized in attempts to achieve better correction of curvature, preserve motion segments, and avoid some of the complications of posterior fusion such as the development of the flat-back syndrome. Anterior instrumentation alone, although effective, can be kyphogenic and has been shown to be associated with complications such as pseudarthrosis and instrumentation failure. Performing a combined approach in patients with scoliosis and other deformities has become an increasingly popular procedure to achieve superior correction of deformity and to minimize later complications. Indications for a combined approach (usually consisting of anterior release, arthrodesis with or without use of instrumentation, and posterior segmental fusion) include: prevention of crankshaft phenomenon in juvenile or skeletally immature adolescents; correction of large curves (75 degrees ) or excessively rigid curves in skeletally mature or immature patients; correction of curves with large sagittal-plane deformities such as thoracic kyphosis (> 90 degrees ) or thoracic lordosis (> 20 degrees ); and correction of thoracolumbar curves that need to be fused to the sacrum. Surgery may be performed either in a staged proceedure or, more commonly, in a single sitting. The authors discuss techniques for combined surgery and complication avoidance. PMID:17031912

  20. First Robotic-Assisted Dual Kidney Transplant: Surgical Technique and Report of a Case With 24-month Follow-up

    PubMed Central

    Frongia, Mauro; Cadoni, Rossano; Solinas, Andrea

    2015-01-01

    Background Open surgery is the gold standard procedure for kidney transplantation. There is a strong rationale for using minimally invasive surgery in patients with end-stage renal disease. A robotic-assisted dual kidney transplant was performed for the first time at our institution. Methods In August 2013, a 63-year-old man with end-stage renal disease and diabetes mellitus under pharmacological control received both kidneys from a 70-year-old marginal donor. Pretransplant donor biopsy demonstrated a bilateral Karpinski score greater than 5. The organs did not exhibit malformations and each had an artery and a vein. The procedure was carried out by a 7-port intraperitoneal approach using the da Vinci surgical system. The procedure was identical for the 2 kidneys except that mobilization of the sigmoid colon was required to introduce the left graft. The renal vessels were anastomosed to the left external iliac vessels. The novel aspect of the technique was the introduction of both grafts through a single, 7-cm upper midline incision. Results Total operative time was 400 minutes and blood loss was 120 mL. Both grafts immediately began functioning. There were no intraoperative or postoperative complications. The patient was discharged on the seventh postoperative day with normal renal function. At 24 months, he is well and does not require hemodialysis. Conclusions Minimally invasive robotic-assisted technology is a promising technique that provides exceptional patient outcomes by reducing operative morbidity, immobilization, and time to recovery, while affording better esthetic results. Selected patients with multiple comorbidities benefit most. Grafts from marginal donors are an extremely valuable resource. PMID:27500234

  1. Surgical Management of Oro-Antral Communications Using Resorbable GTR Membrane and FDMB Sandwich Technique: A Clinical Study.

    PubMed

    Sandhya, G; Reddy, P Bal; Kumar, K A Jeevan; Sridhar Reddy, B; Prasad, N; Kiran, G

    2013-09-01

    The paper describes a new technique for closure of the oro-antral communication, in which both hard (bone) and soft tissue closure was achieved. The technique uses a Guided Tissue Regeeration (GTR) membrane and Freez Dried Mineralized Bone (FDMB) allograft for closure of the defect. Aim of the study was to assess the advantages of the surgical management of oro-antral communications using resorbable GTR membrane and FDMB sandwich technique. A total 10 patients were selected in whom dental extractions were complicated by formation of oro-antral communication (OAC). The resorbable guided tissue regeneration membrane (PERIOCOL-GTR) and freeze dried mineralized bone allograft material was used. Some cancellous granules of freeze dried bone allograft was sandwiched between sheaths of appropriately trimmed collagen membrane which was previously sutured together on three sides using 3/0 resorbable polyglycolic acid suture (vicryl). The fourth side was then adequately closed using the same suture after the bone graft had been inserted, thus creating a closed sandwich. The prepared sandwich was then tucked into the OAC in such a way that it formed a convexity towards the sinus and a concavity towards the alveolar bone. The rough surface of the sandwich is faced to the alveolar bone and additional bone graft is filled into this concavity. Suturing done without tension. Post-operative orthopantomogram was taken to radiologically quantify the amount of bone grafting/augmentation and closure of oro-antral fistula. There was an average of 11.84 mm bone formation after 6 months, the average width preserved and obtained was 6.9 mm. By the end of 4 months there was evidence of bone formation in 7 subjects and in three subjects bony trabeculae formed was almost similar to the adjacent bone. By the end of 6 months follow-up of 7 subjects showed trabeculae indistinguishable from the adjacent bone. The study was done in 10 patients with a follow-up period of 6 months and found to

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

    PubMed Central

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

    2014-01-01

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

  3. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... problem. Your pregnancy is harmful to your health (therapeutic abortion). The pregnancy resulted after a traumatic event ...

  4. The clinical application of the sliding loop technique for renorrhaphy during robot-assisted laparoscopic partial nephrectomy: Surgical technique and outcomes

    PubMed Central

    Kim, Hyung Suk; Lee, Young Ju; Ku, Ja Hyeon; Kwak, Cheol; Kim, Hyeon Hoe

    2015-01-01

    Purpose To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass. Materials and Methods We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping. Results In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons. Conclusions From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT. PMID:26568794

  5. Abortion - surgical

    MedlinePlus

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

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

    USGS Publications Warehouse

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

    2011-01-01

    The intracoelomic surgical implantation of electronic tags (including radio and acoustic telemetry transmitters, passive integrated transponders and archival biologgers) is frequently used for conducting studies on fish. Electronic tagging studies provide information on the spatial ecology, behavior and survival of fish in marine and freshwater systems. However, any surgical procedure, particularly one where a laparotomy is performed and the coelomic cavity is opened, has the potential to alter the survival, behavior or condition of the animal which can impair welfare and introduce bias. Given that management, regulatory and conservation decisions are based on the assumption that fish implanted with electronic tags have similar fates and behavior relative to untagged conspecifics, it is critical to ensure that best surgical practices are being used. Also, the current lack of standardized surgical procedures and reporting of specific methodological details precludes cross-study and cross-year analyses which would further progress the field of fisheries science. This compilation of papers seeks to identify the best practices for the entire intracoelomic tagging procedure including pre- and post-operative care, anesthesia, wound closure, and use of antibiotics. Although there is a particular focus on salmonid smolts given the large body of literature available on that group, other life-stages and species of fish are discussed where there is sufficient knowledge. Additional papers explore the role of the veterinarian in fish surgeries, the need for minimal standards in the training of fish surgeons, providing a call for more complete and transparent procedures, and identifying trends in procedures and research needs. Collectively, this body of knowledge should help to improve data quality (including comparability and repeatability), enhance management and conservation strategies, and maintain the welfare status of tagged fish. ?? 2010 Springer Science+Business Media B.V.

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

    SciTech Connect

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

    2011-01-01

    The intracoelomic surgical implantation of electronic tags (including radio and acoustic telemetry transmitters, passive integrated transponders and archival biologgers) is frequently used for conducting studies on fish. Electronic tagging studies provide information on the spatial ecology, behavior and survival of fish in marine and freshwater systems. However, any surgical procedure, particularly one where a laparotomy is performed and the coelomic cavity is opened, has the potential to alter the survival, behavior or condition of the animal which can impair welfare and introduce bias. Given that management, regulatory and conservation decisions are based on the assumption that fish implanted with electronic tags have similar fates and behavior relative to untagged conspecifics, it is critical to ensure that best surgical practices are being used. Also, the current lack of standardized surgical procedures and reporting of specific methodological details precludes cross-study and cross-year analyses which would further progress the field of fisheries science. This compilation of papers seeks to identify the best practices for the entire intracoelomic tagging procedure including pre- and post-operative care, anesthesia, wound closure, and use of antibiotics. Although there is a particular focus on salmonid smolts given the large body of literature available on that group, other life-stages and species of fish are discussed where there is sufficient knowledge. Additional papers explore the role of the veterinarian in fish surgeries, the need for minimal standards in the training of fish surgeons, providing a call for more complete and transparent procedures, and identifying trends in procedures and research needs. Collectively, this body of knowledge should help to improve data quality (including comparability and repeatability), enhance management and conservation strategies, and maintain the welfare status of tagged fish.

  8. Professional Ethics.

    ERIC Educational Resources Information Center

    Prentice, Ann E.

    1984-01-01

    Discusses professional ethics in librarianship as system of values and rules that govern way in which librarians view and practice their profession. Background, definition of terms (ethics, professional), development of codes of ethics, history of American Library Association Code of Ethics and 1981 statement, and role of education are covered.…

  9. Statistics and Ethics in Surgery and Anesthesia

    ERIC Educational Resources Information Center

    Gilbert, John P.; And Others

    1977-01-01

    Analyzes 46 medical research papers on the effects of innovative versus standard surgical procedures on the health of patients. Results reveal that innovations generally reduce complications. The ethics of experimental surgery are also discussed. (CP)

  10. A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS; the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas

    PubMed Central

    Agarwal, Smita; Singh, Pankaj Kumar

    2014-01-01

    Context: Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by charitable organisations. SICS continues to be a time tested technique for cataract removal in such patients. In recent times, camp patients are sometimes treated by clear corneal phacoemulsification with implantation of a rigid IOL, which being more cost effective is often provided for camp patients. This study was undertaken to find out which surgical technique yielded better outcomes and was more suited for high volume camp surgery. Aim: To find the better surgical option- phacoemulsification with rigid IOL or SICS, in poor patients from rural areas. Settings and Design: A prospective randomised controlled trial of cataract patients operated by two different techniques. Materials and Methods: One hundred and twelve eyes were selected and were randomly allocated into two groups of 56 eyes each. At completion of the study, data was analysed for 52 eyes operated by clear corneal phacoemulsification and implantation of a rigid IOL, and 56 eyes operated by SICS. Statistical Analysis Used: Unpaired t-test was used to calculate the p- value. Results: The results were evaluated on the following criteria. The mean post-operative astigmatism at the end of four weeks - was significantly higher in phacoemulsification group as compared to SICS group The BCVA (best corrected visual acuity) at the end of four weeks - was comparable in both groups. Subjective complaints and/ or complications: In phaco group two patients required sutures and seven had striate keratitis , while none in SICS group. Complaint of irritation was similar in both groups. Surgical time- was less for SICS group as compared to phaco group. Conclusion: SICS by virtue of being a faster surgery with more secure wound and significantly less astigmatism is a better option in camp patients from rural areas as compared to phacoemulsification with rigid IOL. PMID:25584291

  11. Ethical Impotence

    ERIC Educational Resources Information Center

    Sternberg, Robert J.

    2015-01-01

    Ethical impotence occurs when one wants to act ethically but feels powerless to do anything about the perceived unethical behavior. One may feel that one's actions will have no impact or that those actions actually will have harmful consequences to oneself and/or others. Ethical impotence can be understood in terms of an eight-step model of…

  12. Medical Ethics

    MedlinePlus

    ... have an ethical aspect. For example, there are ethical issues relating to End of life care: Should a patient receive nutrition? What about advance directives and resuscitation orders? Abortion: When does life begin? Is it ethical to terminate a pregnancy with a birth defect? ...

  13. New surgical techniques and surgical site infections.

    PubMed Central

    Gordon, S. M.

    2001-01-01

    Technologic advances in surgery include a trend toward less invasive procedures, driven by potential benefits to patients and by health-care economics. These less invasive procedures provide infection control personnel opportunities for direct involvement in outcomes measurement. PMID:11294710

  14. Evaluation of surgical impaction technique and how it affects locking strength of the head-stem taper junction.

    PubMed

    Scholl, Laura; Schmidig, Gregg; Faizan, Ahmad; TenHuisen, Kevor; Nevelos, Jim

    2016-07-01

    Cases of fretting and corrosion at the taper junction have been reported in large metal-on-metal bearing combinations, and more recently, this concern has included metal-on-polyethylene bearing combinations. Many of these patients have been revised due to adverse local tissue reaction secondary to taper corrosion. This taper corrosion-related adverse local tissue reaction seems to be a multifactorial issue and difficult to assess. The aim of this study was to look at one potential variable, the impaction behavior (impaction force, number of blows, etc.) of orthopedic surgeons, and understand how this can affect the locking strength of tapers. A group of experienced orthopedic surgeons were asked to use their typical surgical approach to impact a femoral head onto a hip femoral stem using an Operating Room (OR)-simulated test setup. Impaction parameters such as impaction force, velocity, and energy, as well as the number of impacts, were characterized and applied in a bench-top study used to evaluate the effect of these parameters on the initial stability of the taper junction. High variation was found in the surgical impaction parameters, but overall it was determined that increased impaction force correlated to superior stability of the taper junction. PMID:27107031

  15. Talus fractures: surgical principles.

    PubMed

    Rush, Shannon M; Jennings, Meagan; Hamilton, Graham A

    2009-01-01

    Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment. Even with the best surgical care complications are common and seem to correlate with injury severity and open injuries. PMID:19121756

  16. Successful surgical treatment for total circumferential aortic and mitral annulus calcification: application of half-and-half technique.

    PubMed

    Takahashi, Yosuke; Sasaki, Yasuyuki; Hattori, Koji; Kato, Yasuyuki; Motoki, Manabu; Morisaki, Akimasa; Nishimura, Shinsuke; Shibata, Toshihiko

    2016-07-01

    Patients with total circumferential mitral annular calcification (MAC) extending into the intervalvular fibrous body and aortic annulus have a high risk of cardiac surgery, which remains a technical challenge for surgeons. Our technique for MAC is characterized as simple supra-mitral annular prosthesis insertion after minimum debridement of calcification ("half-and-half technique"). To date, our technique has been applied in only simple MAC cases and has good results. Herein, we report successful two cases of total circumferential MAC, extending into the intervalvular fibrous body and aortic annulus that were treated by a simple double valve replacement with application of our "half-and-half technique". PMID:25385543

  17. Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care

    PubMed Central

    Namrata; Ahmad, Shabi

    2015-01-01

    Introduction Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings. Aim This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia. Materials and Methods This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years. Results Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome. Conclusion Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin

  18. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

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

  19. Retrograde Approach Using Surgical Cutdown Technique for Limb Salvage in a Case of Critical Limb Ischemia With Severely Calcified Tibial Occlusive Disease.

    PubMed

    Shiraki, Tatsuya; Iida, Osamu; Suemitsu, Kotaro; Tsuji, Yoriko; Uematsu, Masaaki

    2016-05-01

    We here report a successful angioplasty for tibial artery occlusion using direct tibial puncture and subsequent retrograde approach under surgical cutdown technique. An 82-year-old man with ulcer/gangrene in first and second digits was referred to our hospital for endovascular therapy (EVT) of lower extremity ischemia. Diagnostic angiogram revealed anterior tibial artery (ATA) occlusion with severe calcification. Subintimal angioplasty was attempted using a 0.014-inch hydrophilic guidewire but was unsuccessful. A retrograde approach was subsequently attempted for ATA recanalization. However, because of severe calcification of dorsal pedis artery (DPA), percutaneous distal puncture was also unsuccessful. Direct puncture under surgical cutdown technique for DPA was subsequently performed and was successful. A 0.014-inch hydrophilic wire was advanced in retrograde fashion across the ATA occlusion and was used to access the microcatheter positioned at the proximal ATA via antegrade approach. Angioplasty of the ATA occlusion was performed using a 2.5-/3.0-mm tapered balloon. Completion angiogram revealed restoration of flow without dissection. Skin perfusion pressure was dramatically improved. Complete wound healing was achieved 5 months after EVT. PMID:27207678

  20. Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis.

    PubMed

    Al-Moraissi, E A; Elmansi, Y A; Al-Sharaee, Y A; Alrmali, A E; Alkhutari, A S

    2016-03-01

    A systematic review and meta-analysis was conducted to answer the clinical question "Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments?" A systematic and electronic search of several databases with specific key words, a reference search, and a manual search were performed from respective dates of inception through November 2014. The inclusion criteria were clinical human studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing the piezoelectric surgical osteotomy technique to the standard rotary instrument technique in lower third molar surgery. Postoperative sequelae (oedema, trismus, and pain), the total number of analgesics taken, and the duration of surgery were analyzed. A total of nine articles were included, six RCTs, two CCTs, and one retrospective study. Six studies had a low risk of bias and three had a moderate risk of bias. A statistically significant difference was found between piezoelectric surgery and conventional rotary instrument surgery for lower third molar extraction with regard to postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken (P=0.0001, P=0.0001, P<0.00001, and P<0.0001, respectively). However, a statistically significant increased surgery time was required in the piezoelectric osteotomy group (P<0.00001). The results of the meta-analysis showed that piezoelectric surgery significantly reduced the occurrence of postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken compared to the conventional rotary instrument technique in lower third molar surgery, but required a longer surgery time. PMID:26572830

  1. Comparison of the Outcomes and Recurrence with Three Surgical Techniques for Chronic Subdural Hematoma: Single, Double Burr Hole, and Double Burr Hole Drainage with Irrigation

    PubMed Central

    Jang, Kyoung-Min; Hwang, Sung-Nam; Park, Yong-Sook; Nam, Taek-Kyun

    2015-01-01

    Objective Chronic subdural hematoma (CSDH), a disease commonly encountered by neurosurgeons, is treated by burr hole drainage (BHD). However, the optimal surgical technique among the three types of BHD has not been determined. Methods We conducted a retrospective study on BHD performed on 93 patients who were diagnosed with CSDH. The subjects were divided into three groups based on the surgical technique performed: single BHD without irrigation (Group A, n=31), double BHD without irrigation (Group B, n=32), and double BHD with irrigation (Group C, n=30). The clinical factors, radiological factors and recurrences were compared between the three groups. Moreover, independent factors affecting the recurrence were analyzed. Results The change in hematoma thickness was 29.77±7.94%, 49.73±12.87%, and 75.29±4.32% for Group A, B, and C, respectively, while the change in midline shift was 40.81±15.47%, 51.78±10.94%, and 56.16±16.16%, respectively. Thus, Group C showed the most effective for resolution of hematoma and midline shift (p<0.05). Group A, B, and C had 12 cases (38.7%), 8 cases (25.0%), and 3 cases (10.0%) of recurrences, respectively. Group C had a statistically significantly fewer recurrence rate than Group A (p<0.05). Double burr hole, irrigation, and coagulopathy were each identified as independent factors that reduce recurrence (p<0.05). Conclusion Among the three techniques, the double BHD with saline irrigation resulted in the fewest recurrences. It is probably the most effective technique for preventing the recurrence of CSDH. PMID:27169069

  2. Pediatric liver transplantation - ethical dilemmas in a disabled patient.

    PubMed

    Toker, A; Salzer, L

    2012-09-01

    Allocation of medical resources, especially resources with absolute scarcity such as organs for transplant, is a difficult task. Medical, surgical, and ethical considerations should be evaluated. In solid organ transplantation, ethics committees are the gate keepers that deal with moral philosophy when moral values are in conflict. Often, no good solution to a dilemma in these medical ethics exists. Our case presents split living liver donation for retransplantation in a mentally disabled girl, with few medical ethics principles at stake. PMID:22081968

  3. Assessment of the influence of surgical technique on postoperative pain and wound tenderness in cats following ovariohysterectomy.

    PubMed

    Grint, Nicola J; Murison, Pamela J; Coe, Richard J; Waterman Pearson, Avril E

    2006-02-01

    Elective ovariohysterectomy was performed on 66 cats. Surgical approach was flank (group F) or midline (group M) allocated by block randomisation. Pre-anaesthetic medication was acepromazine (0.1 mg/kg) via intramuscular injection. Anaesthesia was induced with intravenous thiopentone, and maintained with halothane in 100% oxygen. Carprofen (4 mg/kg) was administered by the subcutaneous route immediately after induction of anaesthesia. Postoperative pain and wound tenderness were assessed at 1, 3, 6, 9, 11-12 and 20-24h after the end of surgery, and the assessment outcome marked on visual analogue scales (VAS). Intervention analgesia (if pain VAS was >40 mm) was pethidine 4 mg/kg via intramuscular injection. Area under the curve (AUC) for VAS for pain and VAS for wound tenderness for each cat were calculated. AUC for wound tenderness was significantly greater for group F (P = 0.007). There was no significant difference for AUC for pain between the groups. In conclusion, wounds after flank ovariohysterectomy are significantly more tender than after midline ovariohysterectomy in the cat. This indicates that interactive methods, including wound palpation, must be used to assess postoperative pain and the findings should be appropriately weighted in the overall assessment. PMID:16213762

  4. Central pancreatectomy: the Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach.

    PubMed

    Iacono, Calogero; Ruzzenente, Andrea; Bortolasi, Luca; Guglielmi, Alfredo

    2014-11-14

    Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection (SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot (1957) and Letton and Wilson (1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came. PMID:25400451

  5. Central pancreatectomy: The Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach

    PubMed Central

    Iacono, Calogero; Ruzzenente, Andrea; Bortolasi, Luca; Guglielmi, Alfredo

    2014-01-01

    Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection (SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot (1957) and Letton and Wilson (1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came. PMID:25400451

  6. Total Pancreatectomy and Islet Auto-Transplantation in Children for Chronic Pancreatitis. Indication, Surgical Techniques, Post Operative Management and Long-Term Outcomes

    PubMed Central

    Chinnakotla, Srinath; Bellin, Melena D.; Schwarzenberg, Sarah J.; Radosevich, David M.; Cook, Marie; Dunn, Ty B.; Beilman, Gregory J.; Freeman, Martin L.; Balamurugan, A.N.; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J.; Vickers, Selwyn M.; Pruett, Timothy L.; Sutherland, David E.R.

    2014-01-01

    Objective Describe the surgical technique, complications and long term outcomes of total pancreatectomy and islet auto transplantation (TP-IAT) in a large series of pediatric patients. Summary Background Data Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, while islet auto transplantation (IAT) potentially can prevent or minimize TP-related diabetes. Methods Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic or surgical treatment between 1989–2012. Results Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (p =<0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (p=0.032), lack of prior Puestow (p=0.018), lower body surface area (p=0.048), IEQ per Kg Body Weight (p=0.001) and total IEQ (100,000) (0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT:(1) male gender, (2) lower body surface area and the (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (OR = 2.62; p value < 0.001). Conclusions TP-IAT provides sustained pain relief and improved quality of life. The β cell function is dependent on islet yield. TP-IAT is an effective therapy for children with painful pancreatitis that fail medical and or endoscopic management PMID:24509206

  7. Evaluation of Functional Outcomes in Individuals 10 Years after Posterior Lumbar Interbody Fusion with Corundum Implants and Decompression: A Comparison of 2 Surgical Techniques

    PubMed Central

    Truszczyńska, Aleksandra; Rąpała, Kazimierz; Łukawski, Stanislaw; Trzaskoma, Zbigniew; Tarnowski, Adam; Drzal-Grabiec, Justyna; Cabak, Anna

    2014-01-01

    Background The purpose of this study was to evaluate lumbar spine-related functional disability in individuals 10 years after lumbar decompression and lumbar decompression with posterior lumbar interbody fusion (PLIF) with corundum implants surgery for degenerative stenosis and to compare the long-term outcome of these 2 surgical techniques. Material/Methods From 1998 to 2002, 100 patients with single-level lumbar stenosis were surgically treated. The patients were randomly divided into 2 groups that did not differ in terms of clinical or neurological symptoms. Group A consisted of 50 patients who were treated with PLIF and the use of porous ceramic corundum implants; the mean age was 57.74 and BMI was 27.34. Group B consisted of 50 patients treated with decompression by fenestration; mean age was 51.28 and the mean BMI was 28.84. Results There was no statistical significance regarding age, BMI, and sex. Both treatments revealed significant improvements. In group A, ODI decreased from 41.01% to 14.3% at 1 year and 16.3 at 10 years. In group B, ODI decreased from 63.8% to 18.36% at 1 year and 22.36% at 10 years. The difference between groups was statistically significant. There were no differences between the groups regarding the Rolland-Morris disability questionnaire and VAS at 1 and 10 years after surgery. Conclusions Long-term results evaluated according to the ODI, the Rolland-Morris disability questionnaire, and the VAS showed that the both methods significantly reduce patient disability, and this was maintained during next 10 years. The less invasive fenestration procedure was only slightly less favorable than surgical treatment of stenosis by both PLIF with corundum implants and decompression. PMID:25106708

  8. Temporalis Muscle Transfer for the Treatment of Lagophthalmos in Patients With Leprosy: Refinement in Surgical Techniques to Prevent Postoperative Ptosis.

    PubMed

    Ahn, Sung Yul; Park, Hyang Joon; Kim, Jong Pill; Park, Tae Hwan

    2016-01-01

    Facial paralysis resulting from leprosy has a serious impact on the entire face especially in the areas innervated by the facial nerves. In particular, lagophthalmos in patients with leprosy causes exposure keratitis, corneal, and conjunctival dryness, which can progress to blindness and disfigurement. Recently, we conducted 4 different temporalis muscle transfer (TMT) methods over the last 4 years to reduce ptosis. The methods used included Brown-McDowell, McCord-Codner, modified Gillies-Anderson, and modified Gillies. Seventy-five TMT operations in 60 patients were performed between 2011 and 2014. The mean age was 70.1. Fifteen patients had bilateral TMT procedures. As a result, ptosis appeared in 14(18.7%) of 75 TMT procedures for 4 years. To prevent or correct this complication, the following 4 technical refinements have simplified the surgery and yield better surgical outcomes. First, an increase in the length of the temporalis muscle flap to approximately 8 cm with a parallel course to the lateral canthus will reduce oblique pull. Second, the width of the fascia sling in the upper eyelid is narrowed (3-4 mm) to reduce weight on the eyelid. Third, the fascia sling in the upper lid should not be located along the full length of the upper lid but terminate 3.5 cm medial to lateral canthal tendon and in other words, should not be tied at the medial canthal tendon to reduce tension and weight. Lastly, the fascia sling in the eyelid should be located shallow (probably in subdermal layer) and as near as possible to the lid margin to prevent any functional disturbance in levator aponeurosis. PMID:26674897

  9. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures.

    PubMed

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    BACKGROUND This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. MATERIAL AND METHODS Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. RESULTS Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). CONCLUSIONS OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  10. Scrotal phalloplasty: A novel surgical technique for aphallia during infancy and childhood by pre-anal anterior coronal approach

    PubMed Central

    Bajpai, Minu

    2012-01-01

    All the currently known reconstructions for aphallia are carried out around puberty. We describe a novel technique as a temporizing procedure which would see the patient through childhood. This would not cause any hindrance while undertaking any of the other established procedures later on after puberty. PMID:23243368

  11. Overall Essen’s experience with the E-vita open hybrid stent graft system and evolution of the surgical technique

    PubMed Central

    Dohle, Daniel; Benedik, Jaroslav; Lieder, Helmut; Jakob, Heinz

    2013-01-01

    Background The hybrid stent graft prosthesis E-vita open was designed and introduced by us in 2005 to avoid a two-stage surgical approach in the surgical treatment of complex thoracic aortic disease. Experience in ascending aortic and arch replacement with simultaneous stent grafting of the descending aorta was accumulated over the past 8 years. Facilitation of surgical technique by moving the distal suture line from Zone 3 into Zone 2 took place in 2009. We report our mid-term single-center experience comparing both surgical periods. Methods Between January 2005 and July 2013 a total of 132 patients (mean age 59±11 years) underwent one stage surgery for acute (AAD, n=74), chronic aortic dissection (CAD, n=35) or an extensive thoracic aortic aneurysm (TAA, n=23). Patients were separated in two groups according to distal anastomosis level in Zone 2 (Z2, 41/132) and Zone 3 (Z3, 91/132). Outcome, ischemic and operative times as well as adverse events were monitored during follow up. Results Overall in-hospital mortality was 13% (17/132) without difference between the groups. However, Zone 2 anastomosis resulted in reduction of cardioplegic arrest (117±39 vs. 147±35 minutes; P<0.001), selective cerebral perfusion (52±15 vs. 68±18 minutes; P<0.001) and visceral ischemic time (51±19 vs. 72±23 minutes; P<0.001). The incidence of postoperative temporary hemodialysis decreased from 40% to 20% in Z2 (P=0.028), postoperative re-exploration rate from 15% to 2% (P=0.037). No difference was found in dissection with complete false lumen thrombosis in 83% (90/109) within 10 days, as well as in TAA, where 100% aneurysm exclusion was observed. Three-year survival, freedom from thoracoabdominal aortic surgery and endovascular repair was 93%, 88%, 88%, respectively. Overall 5-year survival was 76% in AAD, 85% in CAD and 79% in TAA patients. Conclusions The dimension of surgery could be successfully reduced, indicated by significantly shortened ischemic times and postoperative

  12. The results of anterior radical debridement and anterior instrumentation in Pott's disease and comparison with other surgical techniques.

    PubMed

    Benli, I T; Kiş, M; Akalin, S; Citak, M; Kanevetçi, S; Duman, E

    2000-04-01

    Classic procedure in the treatment of vertebral tuberculosis is drainage of the abscess, curettage of the devitalized vertebra and application of antituberculous chemotherapy regimen. Posterior instrumentation results are encouraging in the prevention or treatment of late kyphosis; however, a second stage operation is needed. Recently, posterolateral or transpedicular drainage without anterior drainage or posterior instrumentation following anterior drainage in the same session is preferred to avoid kyphotic deformity. Seventy-six patients with spinal tuberculosis were operated in the 1st Department of Orthopaedics and Traumatology, Ankara Social Security Hospital, between January 1987 and January 1997. There were four children in our series. Average follow-up period was 36.1 +/- 14.5 months and the average age at the time of operation was 40.8 +/- 15.2 years. This study reports the surgical results of 45 patients with Pott's disease who had anterior radical debridement with anterior fusion and anterior instrumentation [14 patients with Z-plate and 31 patients with Cotrel-Dubousset-Hopf (CDH system)]. The results are compared with those of 8 patients who had posterolateral drainage and posterior fusion, 12 patients who had only anterior drainage and anterior strut grafting and, 11 patients who had posterior instrumentation following anterior radical debridement in the same session in terms of fusion rates, correction of kyphotic deformity, recurrence rate and clinical results. All patients had one year consecutive triple drug therapy. Preoperative 23.2 degrees +/- 12.5 degrees local kyphosis angle was lowered to 6.1 degrees +/- 6.9 degrees with a correction rate of 77.4 +/- 22.3%. When the other three groups which had been instrumented were compared, the correction rates in the local kyphosis angle values were not statistically different and the variation in loss of correction at the last follow-up was also statistically insignificant. The sagittal contour of the

  13. Oncoplastic Surgical Techniques for Personalized Breast Conserving Surgery in Breast Cancer Patient with Small to Moderate Sized Breast

    PubMed Central

    Yang, Jung Dug; Lee, Jeong Woo; Kim, Wan Wook; Jung, Jin Hyang

    2011-01-01

    Oncoplastic surgery has revolutionized the field of breast conserving surgery (BCS). The final aims of this technique are to obtain an adequate resection margin that will reduce the rate of local recurrence while simultaneously improving cosmetic outcomes. To obtain successful results after oncoplastic surgery, it is imperative that patients be risk-stratified based on risk factors associated with positive margins, that relevant imaging studies be reviewed, and that the confirmation of negative margins be confirmed during the initial operation. Patients who had small- to moderate-sized breasts are the most likely to be dissatisfied with the cosmetic outcome of surgery, even if the defect is small; therefore, oncoplastic surgery in this population is warranted. Reconstruction of the remaining breast tissue is divided into volume displacement and volume replacement techniques. The use of the various oncoplastic surgeries is based on tumor location and excised breast volume. If the excised volume is less than 100 g, the tumor location is used to determine which technique should be used, with the most commonly used technique being volume displacement. However, if the excised volume is greater than 100 g, the volume replacement method is generally used, and in cases where more than 150 g is excised, the latissimus dorsi myocutaneous flap may be used to obtain a pleasing cosmetic result. The local recurrence rate after oncoplastic surgery was lower than that of conventional BCS, as oncoplastic surgery reduced the rate of positive resection margins by resecting a wider section of glandular tissue. If the surgeon understands the advantages and disadvantages of oncoplastic surgery, and the multidisciplinary breast team is able to successfully collaborate, then the success rate of BCS with partial breast reconstruction can be increased while also yielding a cosmetically appealing outcome. PMID:22323910

  14. Macroscopic optical imaging technique for wide-field estimation of fluorescence depth in optically turbid media for application in brain tumor surgical guidance

    NASA Astrophysics Data System (ADS)

    Kolste, Kolbein K.; Kanick, Stephen C.; Valdés, Pablo A.; Jermyn, Michael; Wilson, Brian C.; Roberts, David W.; Paulsen, Keith D.; Leblond, Frederic

    2015-02-01

    A diffuse imaging method is presented that enables wide-field estimation of the depth of fluorescent molecular markers in turbid media by quantifying the deformation of the detected fluorescence spectra due to the wavelength-dependent light attenuation by overlying tissue. This is achieved by measuring the ratio of the fluorescence at two wavelengths in combination with normalization techniques based on diffuse reflectance measurements to evaluate tissue attenuation variations for different depths. It is demonstrated that fluorescence topography can be achieved up to a 5 mm depth using a near-infrared dye with millimeter depth accuracy in turbid media having optical properties representative of normal brain tissue. Wide-field depth estimates are made using optical technology integrated onto a commercial surgical microscope, making this approach feasible for real-world applications.

  15. Macroscopic optical imaging technique for wide-field estimation of fluorescence depth in optically turbid media for application in brain tumor surgical guidance

    PubMed Central

    Kolste, Kolbein K.; Kanick, Stephen C.; Valdés, Pablo A.; Jermyn, Michael; Wilson, Brian C.; Roberts, David W.; Paulsen, Keith D.; Leblond, Frederic

    2015-01-01

    Abstract. A diffuse imaging method is presented that enables wide-field estimation of the depth of fluorescent molecular markers in turbid media by quantifying the deformation of the detected fluorescence spectra due to the wavelength-dependent light attenuation by overlying tissue. This is achieved by measuring the ratio of the fluorescence at two wavelengths in combination with normalization techniques based on diffuse reflectance measurements to evaluate tissue attenuation variations for different depths. It is demonstrated that fluorescence topography can be achieved up to a 5 mm depth using a near-infrared dye with millimeter depth accuracy in turbid media having optical properties representative of normal brain tissue. Wide-field depth estimates are made using optical technology integrated onto a commercial surgical microscope, making this approach feasible for real-world applications. PMID:25652704

  16. Occurrence and surgical repair of third degree perineal lacerations in adult female camels (Camelus dromedarius) by one-stage (Goetz) technique

    PubMed Central

    Anwar, S.; Purohit, G.N.

    2013-01-01

    Retrospective analysis of third degree perineal lacerations in 7 female camels (6-17 yrs of age) that were surgically corrected by one stage repair (Goetz technique) is presented. Majority (3/7) of the camels was primiparous and all parturitions had a history of calving assistance. Six (6/7) camels recovered by first intention of healing. Dehiscence of perineal structure occurred in only one camel due to infection and healed by second intention. Subsequent matings resulted in pregnancy in four camels and one camel died due to unrelated causes. We conclude that perineal lacerations can occur in primiparous camels with difficult assisted deliveries and that one stage repair of perineal lacerations in camels improves the perineal conformation and such camels may easily regain normal fertility. PMID:26623316

  17. A new surgical technique to facilitate osteochondral autograft transfer in osteochondral defects of the capitellum: a case report.

    PubMed

    Bilsel, Kerem; Demirhan, Mehmet; Atalar, Ata Can; Akkaya, Semih

    2010-01-01

    A 17-year-old boy who was engaged in amateur weightlifting and body building presented with complaints of right elbow pain and limitation in elbow range of motion. Plain x-rays and magnetic resonance imaging showed an osteochondral defect in the medial third of the capitellum. At surgery, as a new technique, the lateral collateral ligament was detached from the humeral attachment to provide access to the capitellum with a clear and perpendicular exposure. Following removal of loose fragments within the joint, an osteochondral graft harvested from the lateral femoral condyle was implanted to the defect area of the capitellum. Postoperative radiologic controls showed that the defect was entirely filled by the graft with appropriate graft height. On follow-up examination at 12 months, the patient did not have any complaint about his elbow, and had no limitation of movement compared to the left elbow. Magnetic resonance imaging showed that the graft was successfully adapted to the recipient site without any sign of loosening. At final follow-up 40 months after surgery, the surface of the articular cartilage appeared normal. The range of elbow motion was preserved and the patient had no restriction in daily and sports activities. Considering technical difficulties posed by the narrow and complex structure of the elbow joint, this new technique involving detachment of the lateral collateral ligament facilitates perpendicular implantation of the graft. In our opinion, utilization of this new technique will improve functional and radiological results of osteochondral autograft transfer. PMID:20513997

  18. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?

    PubMed Central

    Assietti, Roberto; Corbino, Leonardo; Olindo, Giuseppe; Foti, Pietro V.; Russo, Vittorio; Albanese, Vincenzo

    2009-01-01

    We report the clinical and radiological results on the safety and efficacy of an unusual surgical strategy coupling anterior cervical discectomy and fusion and total disc replacement in a single-stage procedure, in patients with symptomatic, multilevel cervical degenerative disc disease (DDD). The proposed hybrid, single-stage, fusion–nonfusion technique aims either at restoring or maintaining motion where appropriate or favouring bony fusion when indicated by degenerative changes. Twenty-four patients (mean age 46.7 years) with symptomatic, multilevel DDD, either soft disc hernia or different stage spondylosis per single level, with predominant anterior myeloradicular compression and absence of severe alterations of cervical spine sagittal alignment, have been operated using such hybrid technique. Fifteen patients underwent a two-level surgery, seven patients received a three-level surgery and two a four-level procedure, for a total of 59 implanted devices (27 disc prostheses and 32 cages). Follow-up ranged between 12 and 40 months (mean 23.8 months). In all but one patient clinical follow-up (neurological examination, Nurick scale, NDI, SF-36) demonstrated significant improvement; radiological evaluation showed functioning disc prostheses (total range of motion 3–15°) and fusion through cages. None of the patients needed revision surgery for persisting or recurring symptoms, procedure-related complications or devices dislocations. To the authors’ best knowledge, this is the first study with the longest available follow-up describing a different concept in the management of cervical multilevel DDD. Although larger series with longer follow-up are needed, in selected cases of symptomatic multilevel DDD, the proposed surgical strategy appears to be a safe and reliable application of combined arthroplasty and arthrodesis during a single surgical procedure. PMID:19415346

  19. Ethical Challenges

    ERIC Educational Resources Information Center

    Morris, Michael

    2004-01-01

    All evaluators face the challenge of striving to adhere to the highest possible standards of ethical conduct. Translating the AEA's Guiding Principles and the Joint Committee's Program Evaluation Standards into everyday practice, however, can be a complex, uncertain, and frustrating endeavor. Moreover, acting in an ethical fashion can require…

  20. Iconoclastic ethics.

    PubMed

    Black, D

    1984-12-01

    Arguments are advanced, on a pragmatic basis, for preferring a 'situational' approach to medical ethical problems, rather than an approach based on any one of the dogmatic formulations on offer. The consequences of such a preference are exemplified in relation to confidentiality; and in relation to the ethical dilemmas which surround the beginning and the end of terrestrial human life. PMID:6520850

  1. Use of a microdebrider for corporeal excavation and penile prosthesis implantation in men with severely fibrosed corpora cavernosa: a new minimal invasive surgical technique

    PubMed Central

    Bozkurt, İbrahim Halil; Yonguç, Tarık; Aydoğdu, Özgü; Değirmenci, Tansu; Arslan, Murat; Minareci, Süleyman

    2015-01-01

    Objective To propose a new minimal invasive surgical technique using a microdebrider (shaver) to excavate the fibrosed corpora cavernosa for penile prosthesis implantation in patients with severe fibrosis. Material and methods Two patients with severe corporeal fibrosis were implanted with a penile prosthesis using this technique. In the first patient, fibrosis was due to neglected idiopathic ischemic priapism and the second patient had his prosthesis extruded because of erosion in another center. Both patients were counseled about the procedure and the possible complications related to the experimental nature of the technique. A written informed consent was obtained from both patients. Excavation of the corpora was performed using microdebrider in both patients. Results Both operations were performed successfully without any intraoperative complications, including urethral injury or perforation of the tunica. The mean operation time was 57 min. The postoperative period was uneventful without any infection, migration, erosion, or mechanical failure. The penile length was increased nearly 2 cm in both patients, and the penile girth was increased around 30% in the patient who underwent inflatable penile prosthesis implantation. Conclusion The microdebrider potentially provides an important advance in patients with severe corporeal fibrosis to excavate the fibrosed corpora cavernosa for penile prosthesis implantation. The main advantages include fast, safe, and effective excavation of fibrous corpora cavernosa adequate for a satisfactory penile prosthesis implantation. PMID:26516594

  2. Multiscale Surgical Telerobots

    SciTech Connect

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

    2002-01-23

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

  3. Ethical dilemmas in perioperative nursing practice.

    PubMed

    Reeder, J M

    1989-12-01

    Ethical dilemmas in perioperative nursing practice occur during all phases and in every practice setting. Awareness of commonly experienced dilemmas and understanding of a model available to analyze and resolve these dilemmas can benefit patients and perioperative nurses. Patients will benefit from nurse advocates who recognize and act to resolve actual and potential ethical dilemmas. Nurses will benefit when they are empowered with the knowledge and ethical skills to enhance patient autonomy, to protect dignity and confidentiality, and human rights. Perioperative nurses should reflect on previous dilemmas and use them to assist with resolution of similar dilemmas. They should be knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas. The ANA code for Nurses and the AORN Statements of Competency in Perioperative Nursing are two resources available to perioperative nurses. In the increasingly complex, technologically laden surgical environment, patients who are sicker and living longer will require services of highly skilled and educated professionals. They are vulnerable in the surgical setting and need surgical teams to act on their behalf. Perioperative nurses with ethical skill are an asset to patients and other members of the surgical team when they seek to resolve ethical dilemmas in knowledgeable and systematic ways. PMID:2685781

  4. A Novel Surgical Technique for Right-Sided Interrupted Aortic Arch by Interposition of a Pulmonary Autograft Tube.

    PubMed

    Kato, Nobuyasu; Yamagishi, Masaaki; Miyazaki, Takako; Maeda, Yoshinobu; Asada, Satoshi; Hongu, Hisayuki; Yamashita, Eijiro; Yaku, Hitoshi

    2016-08-01

    Right-sided interrupted aortic arch (IAA) is a rare cardiac anomaly. In general, the right bronchus sits higher than the left bronchus, so aortic arch reconstruction with a direct anastomosis has a risk of tracheal and bronchial obstruction. This report describes the successful definitive repair of a right-sided IAA in a 2.5-kg neonate by aortic arch reconstruction with a pulmonary autograft tube (PA tube). Postoperative three-dimensional multidetector computed tomography showed the reconstructed aortic arch without airway obstruction or aortic stenosis. The use of a PA tube is a simple and useful technique for aortic arch reconstruction in patients with a high risk of tracheal andbronchial obstruction, such as right-sided IAA. PMID:27449446

  5. Increasing Effectiveness in Teaching Ethics to Undergraduate Business Students.

    ERIC Educational Resources Information Center

    Lampe, Marc

    1997-01-01

    Traditional approaches to teaching business ethics (philosophical analysis, moral quandaries, executive cases) may not be effective in persuading undergraduates of the importance of ethical behavior. Better techniques include values education, ethical decision-making models, analysis of ethical conflicts, and role modeling. (SK)

  6. Titanium anchors for the repair of distal Achilles tendon ruptures: preliminary report of a new surgical technique.

    PubMed

    Maniscalco, P; Bertone, C; Bonci, E; Donelli, L; Pagliantini, L

    1998-01-01

    From January 1995 to July 1996, the authors used Mitek GIV titanium anchors to treat seven patients with acute rupture of the Achilles tendon (four men, three women; average age 52.42 years; range, 33-62 years). All subjects had a total rupture of the most distal aspect of the tendon; none had an avulsion fracture. After dissection down to the paratenon, the reinsertion site was selected and a 2 to 3-cm-long trough carved through the cortex. Three holes were drilled at a distance of 0.5 cm one from the other and 1 cm parallel and distal to the trough. The anchors were then threaded, inserted into the holes, and engaged. Surgery was completed by resection of the frayed ends, reparation of the tendon, and insertion of the terminal end into the trough. At 6 months postoperative, a modified Mandelbaum and Pavanini clinical assessment indicated five excellent and two good outcomes. There were no cases of deep of superficial wound infection or skin necrosis. Despite the small number of patients and the short follow-up period, the authors believe this technique shows promise and that in selected cases the use of titanium anchors can facilitate the task of the surgeon and enable patients to return to normal and sports activities within 5 months after surgery. PMID:9571455

  7. Surgical excision of madelung disease using bilateral cervical lymphnode dissection technique-its effect and the influence of previous injection lipolysis.

    PubMed

    Andou, Erika; Komoto, Masakazu; Hasegawa, Toshio; Mizuno, Hiroshi; Hayashi, Ayato

    2015-04-01

    Madelung disease, also known as benign symmetrical lipomatosis, is a rare condition characterized by symmetrical diffuse adipose tissue in the neck, shoulders, and arms. The present report described the case of a 51-year-old man diagnosed with Madelung disease who presented with masses primarily in the neck. He had previously shown partial improvement after injection lipolysis and shoulder surgery. However, 4 years later, following corticosteroid administration for the treatment of acute deafness, cervical lipomatosis progressed to the extent that he was unable to fasten his shirt. The initial treatment plan involved bilateral surgical excision of the lipomatous masses of the neck and liposuction for those in the submental area. However, the lipomas were adherent to the surrounding tissue and were partially fibrosed, presumably due to the previous injection lipolysis; thus, liposuction was not possible, and all the masses around the neck were carefully excised using cervical lymph node dissection technique. Thirty-two months later, the patient showed good cosmetic results, with no recurrence of cervical lipomatosis. Radical resection of the lipomas using a cervical dissection technique is useful in the treatment of Madelung disease; however, clinicians must consider the potential for adhesions and plan a meticulous dissection in those who have undergone injection lipolysis before the surgery. PMID:25973353

  8. A modified vaginal wall patch sling technique as a first-line surgical approach for genuine stress incontinence with urethral hypermobility: long-term follow up.

    PubMed

    Mikhail, Magdy S; Rosa, Hector; Packer, Paul; Palan, Prabhudas; Lazarou, George

    2004-01-01

    We describe our long-term outcome for patients with genuine stress incontinence (GSI) and urethral hypermobility using a modified vaginal wall patch sling technique. Fifty-three patients were studied. Preoperatively, all patients had a positive standing stress test and urethral hypermobility on Q-tip testing. On urodynamics, all patients had absence of detrusor contractions on subtracted cystometry. The mean age of the patients was 45+10.2 years. Forty-four patients demonstrated complete symptomatic and urodynamic improvement. Five patients had a noticeable failure observed within the first 12 months of follow up and four patients developed later recurrence despite initial success. The overall success rate after 5 years of follow up was 83% (n=44/53). The modified vaginal wall patch sling technique appears to have a good long-term success rate with low operative morbidity and minimal postoperative voiding dysfunction. The patch sling can be used as a first-line surgical approach for GSI with urethral hypermobility and be combined with other vaginal surgery. PMID:15014942

  9. Use of Ilizarov Fixator for Grade III B Open Olecranon Fracture: a Case Report and Surgical Technique

    PubMed Central

    Sharad Nemade, Pradip; Dash, Kumar Kaushik; Patwardhan, Tanvi Yeshwant; Londhe, Pravin Vasant

    2015-01-01

    Introduction: External fixator application can be difficult for olecranon fractures in presence of large degloving injuries. We describe use of simple Ilizarov ring fixator construct for grade IIIB open olecranon fracture management. Case Report: A 45-year-old female with Grade III B open comminuted olecranon fracture (30*15cm degloving area) and ulnar nerve palsy was treated with a novel ring fixator construct. Two cut-end olive wires were passed from the proximal olecranon across the fracture site in intramedullary fashion exiting dorsally at mid-ulnar level through healthy skin and were attached to an Ilizarov half ring secured by perpendicular wires. The olive wires were tensioned, achieving compression and stability. Range of motion (ROM) exercises could be started quickly as the elbow was not spanned. Wound healed after skin grafting and at one-year follow-up the patient has good functional results (PRE 7, DASH 9.48), elbow ROM 10°-130°, 75° pronation and 85° supination. The patient returned to pre-injury occupational activities and had no pain. At three-year follow-up, the x-ray and CT showed union of olecranon fragment with well-maintained congruency. Conclusion: Internal fixation in most cases may be precluded by the soft tissue trauma and risk of infection. In addition, the small proximal fragment precludes a stable external fixation. In this technique, the hardware is kept away from the open wound allowing better wound inspection and care. The intramedullary olive wires provide compression and stability, and thus allow early ROM. Ilizarov half-ring and olive wire fixation can be an useful option for management of high grade open olecranon fractures because of its advantages, viz. stable fixation, minimal internal hardware, optimal wound care, immediate initiation of range of motion, and good outcome. PMID:27299012

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

    PubMed Central

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

    2013-01-01

    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

  11. Surgical revolutions.

    PubMed

    Toledo-Pereyra, Luis H

    2008-01-01

    Many surgical revolutions distinguish the history and evolution of surgery. They come in different sizes and exert a variable effect on the development and practice of the discipline. As science and technology rapidly evolve, so too does the creation of new paradigms, ideas and innovations or discoveries for the improvement of the surgical sciences. Surgical revolutions are not new, and have existed for centuries even though they have been more frequently recognized since the middle of the 19th century, 20th century and down to the present. Surgical revolutionaries are indispensable in the conception and completion of any surgical revolution. However, scientific and technological advances have supported the culmination of each revolution. PMID:18615311

  12. Small ethics.

    PubMed

    Chambers, David W

    2007-01-01

    Traditionally, ethics in the professions has focused on big problems that could be found on other peoples' back porches. Small, habitual, frequent, and personal lapses get little attention. In this essay, the literature on opportunism is applied to dentistry with a view toward bringing matters of "near ethics" within reach. Examples of small lapses are discussed under the headings of shirking, free riding, shrinkage, pressing, adverse selection, moral hazard, and risk shifting. The conditions that support opportunism include relationships with small numbers of transactions and uneven access to information. Practical limits on understanding all the consequences of agreements and the costs of supervising others and enforcing corrections of breaches are inescapable aspects of opportunism. Opportunism may not be accepted by all as the subject matter of ethical, but curbing it is a worthy goal and understanding the causes and management of opportunism casts some light on the ethical enterprise. Four suggestions are offered for addressing issue of opportunism. PMID:17691498

  13. Mitochondrial Replacement: Ethics and Identity.

    PubMed

    Wrigley, Anthony; Wilkinson, Stephen; Appleby, John B

    2015-11-01

    Mitochondrial replacement techniques (MRTs) have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer (PNT) and Maternal Spindle Transfer (MST). It examines how questions of identity impact on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. PMID:26481204

  14. Mitochondrial Replacement: Ethics and Identity

    PubMed Central

    Wilkinson, Stephen; Appleby, John B.

    2015-01-01

    Abstract Mitochondrial replacement techniques (MRTs) have the potential to allow prospective parents who are at risk of passing on debilitating or even life‐threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer (PNT) and Maternal Spindle Transfer (MST). It examines how questions of identity impact on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. PMID:26481204

  15. Ethical Orientations for Understanding Business Ethics.

    ERIC Educational Resources Information Center

    Lewis, Phillip V.; Speck, Henry E., III

    1990-01-01

    Argues that history provides the necessary framework in which both to discuss and to seek answers to the three necessary and sequential questions about business ethics: (1) What is ethics and what does it mean to be ethical? (2) Why be ethical?; and (3) How can one be ethical? (SG)

  16. Flexor Carpi Radialis to Palmaris Longus Tendon Transfer for Spontaneous Rupture of the Flexor Carpi Radialis Tendon-A Review of an Uncommon Finding and Surgical Technique for Operative Correction.

    PubMed

    Shearin, Jonathan Winkworth; Walters, Brian; Yang, S Steven

    2016-10-01

    Spontaneous ruptures of the flexor carpi radialis tendon (FCR) are rare and associated with systemic inflammatory diseases, localized tendinopathy related to scaphotrapezial-trapezoidal arthritis, or chronic immunosuppression from corticosteroids. While most cases do not require operative intervention, some patients develop weakness, impaired range of motion, and persistent pain. Previously reported surgical options include synovectomy, tendon stump resection, and osteophyte removal. We describe a surgical technique for patients with persistent symptomatology following FCR rupture in which the FCR is transposed end-to-side to the palmaris longus tendon. Three cases using this technique are presented with follow-up of 4-9 months that were collected at Lenox Hill Hospital. All three patients did well regarding specific outcome measures: grip strength, range of motion, and functional activity. FCR transfer to palmaris is an alternative to other surgical options for the spontaneous rupture of the FCR tendon in patients who remain symptomatic despite a course of non-operative therapy. PMID:27595965

  17. Surgical Mesh

    MedlinePlus

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

  18. An efficient technique for estimating the two-dimensional temperature distributions around multiple cryo-surgical probes based on combining contributions of unit circles.

    PubMed

    Magalov, Zaur; Shitzer, Avraham; Degani, David

    2016-10-01

    This study presents an efficient, fast and accurate method for estimating the two-dimensional temperature distributions around multiple cryo-surgical probes. The identical probes are inserted into the same depth and are operated simultaneously and uniformly. The first step in this method involves numerical derivation of the temporal performance data of a single probe, embedded in a semi-infinite, tissue-like medium. The results of this derivation are approximated by algebraic expressions that form the basis for computing the temperature distributions of multiple embedded probes by combining the data of a single probe. Comparison of isothermal contours derived by this method to those computed numerically for a variety of geometrical cases, up to 15 inserted probes and 2-10 min times of operation, yielded excellent results. Since this technique obviates the solution of the differential equations of multiple probes, the computational time required for a particular case is several orders of magnitude shorter than that needed for obtaining the full numerical solution. Blood perfusion and metabolic heat generation rates are demonstrated to inhibit the advancement of isothermal fronts. Application of this method will significantly shorten computational times without compromising the accuracy of the results. It may also facilitate expeditious consideration of the advantages of different modes of operation and the number of inserted probes at the early design stage. PMID:26963943

  19. Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion.

    PubMed

    Hwang, Shin; Ha, Tae-Yong; Ahn, Chul-Soo; Moon, Deok-Bog; Kim, Ki-Hun; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu

    2016-08-01

    After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases. PMID:27621745

  20. Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion

    PubMed Central

    Ha, Tae-Yong; Ahn, Chul-Soo; Moon, Deok-Bog; Kim, Ki-Hun; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu

    2016-01-01

    After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases. PMID:27621745

  1. Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance.

    PubMed

    Funasaki, Hiroki; Hayashi, Hiroteru; Sakamoto, Kanako; Tsuruga, Rei; Marumo, Keishi

    2015-12-01

    Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals. A 4.0-mm-diameter 30° arthroscope is used. Soft tissues around the talus are cleared with a motorized shaver and a radiofrequency device. The posterior aspects of the talus, os trigonum, and FHL tendon surrounded by the tendon sheath are visualized. The dynamic pathology of the FHL tendon is well observed on passive motion of the great toe. The prominent bone fragment of the talus is removed and the tendon sheath is cut with a retrograde knife and a motorized shaver from the superior border down to the entrance of the fibro-osseous tunnel. Arthroscopic release of the FHL tendon sheath is a useful and easy method to directly approach the dynamic pathology of FHL tenosynovitis in female ballet dancers. PMID:27284509

  2. Ethics in Distance Education: Developing Ethical Policies.

    ERIC Educational Resources Information Center

    Gearhart, Deb

    2001-01-01

    Examines the changing world of education through distance education and discusses the need for ethics in distance education. Explains how to ethically develop policy for distance education, including Internet ethics, good practices guidelines, and involving faculty. (LRW)

  3. Range of Hip Joint Motion in Developmental Dysplasia of the Hip Patients Following Total Hip Arthroplasty With the Surgical Technique Using the Concept of Combined Anteversion: A Study of Crowe I and II Patients.

    PubMed

    Zhang, Jingwei; Wei, Jianhe; Mao, Yuanqing; Li, Huiwu; Xie, Youzhuan; Zhu, Zhenan

    2015-12-01

    The combined anteversion surgical technique has been proposed and used in clinical practice. To more objectively evaluate the feasibility of this surgical technique using combined anteversion concept for DDH patients, we studied 34 DDH patients (40 hips) in this research. Every patient underwent pelvic CT scans before and after surgery and the HHSs were recorded. Optimal range of joint motion was measured using a three-dimensional reconstruction technique and a dynamic measurement technique. The results revealed that joint function met the requirements of daily life and the range of motion was not over-limited by impingement between the prosthesis and the skeleton. Moreover, the combined anteversion was found to be the most critical parameter in this study. PMID:26228491

  4. Modified surgical techniques of free vascularized fibular grafting for treatment of the osteonecrosis of femoral head: results from a series of 407 cases.

    PubMed

    Gao, You-Shui; Chen, Sheng-Bao; Jin, Dong-Xu; Sheng, Jia-Gen; Cheng, Xiang-Guo; Zhang, Chang-Qing

    2013-11-01

    The goal for treatment of osteonecrosis of the femoral head (ONFH) is to relieve pain, preserve the contour of the femoral head, and delay the need for total hip arthroplasty. The free vascularized fibular grafting (FVFG) has been shown to support the subchondral architecture as well as restore local circulation for the necrotic femoral head in treatment of ONFH. This report aimed to present the clinical results of the use of a modified surgical technique of FVFG for treatment of ONFH. Four hundred and seven patients with 578 hips of ONFH were included. The patients' average age was 36.7 years old (ranging 19-55 years old). The disease was staged from II to V based on the Steinberg classification system. By the modified procedure, the vascularized fibular graft was harvested via a lateral incision with fibular osteotomy prior to the exposure of the vascular pedicle, and the removal of necrotic tissue and inset of graft were performed through an anterior approach. The operative time averaged 90 min for unilateral ONFH (ranging 75-110 min) and 190 min for simultaneous treatment of bilateral ONFH (ranging 160-230 min). The average length of follow-up was 5.0 years (ranging 3-10 years). The complications included one infection in one case, temporary loss of sensation of the thigh in eleven cases, and restricted motion of the great toe in nine cases. The Harris hip score of patients improved from 65.0 to 86.9 on average. Radiographic evaluation showed no changes in 331 hips (57.3%), improvement in 195 hips (33.7%) and necrosis progression in 52 hips (9.0%). Twenty-three hips (4.0%) in 20 patients had total hip arthroplasty during the period. These results show that the modified technique of the use of FVFG for treatment of ONFH yields similar postoperative results in comparison to the traditional method. PMID:23907776

  5. Ethical considerations in targeted pediatric neurosurgery missions

    PubMed Central

    Hughes, SA; Jandial, R

    2013-01-01

    Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique logistical needs of delivering operative care surgical missions are often described solely in terms of cases performed, with a paucity of discourse on medical ethics. Within surgery, subspecialties that serve patients on a non-elective basis should, it could be argued, create mission strategies that involve a didactic approach and the propagation of sustainable surgical care. The ethical considerations have yet to be described for pediatric neurosurgical outreach missions. We present here the perspectives of neurosurgeons who have participated in surgical outreach missions in Central America, South America, Eastern Europe, and Sub-Saharan Africa from the vantage point of both the visiting mission team and the host team that accommodates the mission efforts. PMID:23001919

  6. Ethics fundamentals.

    PubMed

    Chambers, David W

    2011-01-01

    Ethics is about studying the right and the good; morality is about acting as one should. Although there are differences among what is legal, charitable, professional, ethical, and moral, these desirable characteristics tend to cluster and are treasured in dentistry. The traditional approach to professionalism in dentistry is based on a theory of biomedical ethics advanced 30 years ago. Known as the principles approach, general ideals such as respect for autonomy, nonmaleficence, beneficence, justice, and veracity, are offered as guides. Growth in professionalism consists in learning to interpret the application of these principles as one's peers do. Moral behavior is conceived as a continuous cycle of sensitivity to situations requiring moral response, moral reasoning, the moral courage to take action when necessary, and integration of habits of moral behavior into one's character. This essay is the first of two papers that provide the backbone for the IDEA Project of the College--an online, multiformat, interactive "textbook" of ethics for the profession. PMID:22263371

  7. [Surgical treatment of eyelid tumors].

    PubMed

    Serra, J M; Valiente, E; Paloma, V; Samayoa, V; Ordiales, G; Mesa, F

    1989-01-01

    Our surgical protocol for reconstruction of eyelid's defects after tumor excision is presented. Each technique is applied depending on the site and extension of the lesion and also on the pathologic characteristics of the tumor. PMID:2490181

  8. Ethical issues in the psychosocial assessment of bariatric surgery candidates.

    PubMed

    Rouleau, Codie R; Rash, Joshua A; Mothersill, Kerry J

    2016-07-01

    Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments. PMID:25411197

  9. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  10. Do Ethics Classes Teach Ethics?

    ERIC Educational Resources Information Center

    Curzer, Howard J.; Sattler, Sabrina; DuPree, Devin G.; Smith-Genthôs, K. Rachelle

    2014-01-01

    The ethics assessment industry is currently dominated by the second version of the Defining Issues Test (DIT2). In this article, we describe an alternative assessment instrument called the Sphere-Specific Moral Reasoning and Theory Survey (SMARTS), which measures the respondent's level of moral development in several respects. We describe…

  11. [The biologization of ethics].

    PubMed

    Moreno Lax, Alejandro

    2010-01-01

    Three ethics exist as a condition of possibility of any possible ethics, following a material and biological foundation. This content argument (not logical-formal) supposes a refutation of the naturalistic fallacy that the analytical philosophy attributes to Hume, in three areas of the ethical human experience: body, society and nature. These are: the ethics of the species [J. Habermas], the ethics of liberation [E. Dussel] and the ethics of the responsibility [H. Jonas]. This material argument is a philosophical foundation to considering for three types of applied ethics: medical bioethics, development ethics and environmental ethics. PMID:20405971

  12. Some Basics about Ethics.

    ERIC Educational Resources Information Center

    Dean, Peter J.

    1994-01-01

    Discussion of ethics focuses on the role of human performance technology professionals in helping corporate ethicists. Highlights include definitions of ethics, morals, values, and business ethics; ethics in academia and in business; and application of the knowledge of ethics to decision-making. (Contains 18 references.) (LRW)

  13. The Ethic of Community

    ERIC Educational Resources Information Center

    Furman, Gail C.

    2004-01-01

    This article proposes the concept of an ethic of community to complement and extend other ethical frames used in education e.g. the ethics of justice, critique, and care. Proceeding from the traditional definition of ethics as the study of moral duty and obligation, ethic of community is defined as the moral responsibility to engage in communal…

  14. Eer ethics

    SciTech Connect

    Orwant, C.J.

    1994-12-31

    Intelligent agents are personified as epers, electronic personas. Epers can take on various roles as business representatives, financial agents, game players, teachers or civil servants. The ethical deployment of epers requires that they be accountable to their originators, who, in turn, are responsible to the cyberspace communities in which they are involved. Epers must maintain integrity of information, carry out tasks as directed and report accurately on task status. Epers can be custodians of the truth, responsible for certifying that data has not been altered. Public service epers could chair electronic meetings, collect and validate votes on local issues and referee online {open_quotes}flame{close_quotes} wars. Epers` rights include those of privacy, autonomy and anonymity. They could decline to produce information aside from key identifiers and have the right to be protected from arbitrary deletion. Ethical issues include privacy protections, maintenance of appropriate access restrictions, and carrying out business in a secure and trustworthy manner.

  15. Ethics in perioperative practice--values, integrity, and social policy.

    PubMed

    King, Cecil A; Broom, Catherine

    2002-12-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this final article of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the ninth provision, which emphasizes the responsibility of professional nursing associations to maintain the value and integrity of the profession. PMID:12528493

  16. Values and Ethics in Family Therapy.

    ERIC Educational Resources Information Center

    Doherty, William J.

    1985-01-01

    Discusses the historical context for rising interest in values and ethical issues in family therapy, and presents framework for analyzing core values of prominent models of family therapy. Uses ethical debate over use of paradoxical techniques in family therapy to illustrate values clash between different models of family therapy. (Author)

  17. The Teaching of Life-Line Ethics

    ERIC Educational Resources Information Center

    Bridger, James A.

    1977-01-01

    Outlines techniques used in teaching a course in "life-line" ethics, in which the events of conception, birth and death are related to ethical issues of abortion, suicide, euthanasia, etc. Several modes of actively involving students are described. Lists seven reference for information on bioethical issues. (CS)

  18. Medical ethics in the media.

    PubMed

    Raman, Usha

    2009-01-01

    The mass media function both as reflector and a shaper of a society's attitudes and values and as such represent a forum within which one may understand and influence public opinion. While questions of medical ethics may be largely confined to academic and scientific spaces, their importance to society at large cannot be denied, and how issues of medical ethics play out--if at all--in the media could tell us how society understands and processes these questions. This paper uses the techniques of framing analysis and textual analysis to examine how the print media, represented by two major Indian newspapers, cover medical ethics. The study looked at all articles related to medical research over a three-month period (January-March 2007) and considered how the story was framed, what were the key threads followed, and the dominant themes focused on. The ethical frame is notable by its absence, even in articles related to controversial themes such as drug research and genetics. Discussion of ethics appears to be problematic given the adherence to traditional "news values" when covering science and medicine. The research community and the media need to pay more attention to explicitly focusing on ethics in their interactions. PMID:19241950

  19. Ethical stockmanship.

    PubMed

    Hemsworth, P H

    2007-05-01

    The objective of this review is to consider the ethics of stockmanship, particularly from the perspective of the nature and extent of the duties of stockpeople to their farm animals. It will consider what science tells us about the impact of stockmanship on the animal, particularly the welfare of the farm animal. The effects of human-animal interactions on the stockperson will also be considered, since these interactions affect the work performance and job satisfaction of the stockperson and thus indirectly affect animal welfare. Animal ethics is broader than animal welfare and includes economic as well as philosophical, social, cultural and religious aspects. This paper is predicated on the view that farm animals can suffer, and that animal suffering is a key consideration in our moral obligations to animals. Housing and husbandry practices affect farm animal welfare and thus farmers and stockpeople have a responsibility to provide, at minimum, community-acceptable animal housing and husbandry standards for their animals. The farmer's or stockperson's attitudes and behaviour can directly affect the animal's welfare and thus they also have a responsibility to provide specific standards of stockmanship for these animals. However, research suggests that the behaviour of some stockpeople is not as correct as it might be. Such situations exemplify the inevitably unequal human - domestic animal relationship, and this inequality should be considered in analysing the boundary between right and wrong behaviour of humans. Thus ethical discussion, using science and other considerations and involving stockpeople, livestock industries, government and the general public, should be used to establish and assure acceptable stockperson competencies across the livestock industries. Training programs targeting the key attitudes and behaviour of stockpeople presently offer the livestock industries good opportunities to improve human-animal interactions. PMID:17470069

  20. Surgical procedures for voice restoration

    PubMed Central

    Nawka, Tadeus; Hosemann, Werner

    2005-01-01

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

  1. Teaching Business Ethics or Teaching Business Ethically?

    ERIC Educational Resources Information Center

    Stablein, Ralph

    2003-01-01

    Notes that one of the most important contexts for ethical decision-making is the nature and operation of "contemporary capitalisms." Suggests that rather than issuing a call for teaching business ethics, the author emphasizes the need for more ethical business teaching. (SG)

  2. Behavioral Ethics and Teaching Ethical Decision Making

    ERIC Educational Resources Information Center

    Drumwright, Minette; Prentice, Robert; Biasucci, Cara

    2015-01-01

    Business education often renders students less likely to act ethically. An infusion of liberal learning in the form of behavioral ethics could improve this situation by prompting students to develop higher levels of professionalism that encompass ethics, social responsibility, self-critical reflection, and personal accountability. More…

  3. Ethics, Ricoeur And Philosophy: Ethical Teacher Workshops

    ERIC Educational Resources Information Center

    Scott-Baumann, Alison

    2006-01-01

    This work is about the ethics of education, and about philosophy as a discipline that can help us to help children look at ethics afresh. The study and practice of ethics is about morals and uncertainties and, as such, poses problems for the research community. The philosopher Ricoeur challenges research as only one way to find meaning in the…

  4. Ethical breakdowns.

    PubMed

    Bazerman, Max H; Tenbrunsel, Ann E

    2011-04-01

    Companies are spending a great deal of time and money to install codes of ethics, ethics training, compliance programs, and in-house watchdogs. If these efforts worked, the money would be well spent. But unethical behavior appears to be on the rise. The authors observe that even the best-intentioned executives may be unaware of their own or their employees' unethical behavior. Drawing from extensive research on cognitive biases, they offer five reasons for this blindness and suggest what to do about them. Ill-conceived goals may actually encourage negative behavior. Brainstorm unintended consequences when devising your targets. Motivated blindness makes us overlook unethical behavior when remaining ignorant would benefit us. Root out conflicts of interest. Indirect blindness softens our assessment of unethical behavior when it's carried out by third parties. Take ownership of the implications when you outsource work. The slippery slope mutes our awareness when unethical behavior develops gradually. Be alert for even trivial infractions and investigate them immediately. Overvaluing outcomes may lead us to give a pass to unethical behavior. Examine good outcomes to ensure they're not driven by unethical tactics. PMID:21510519

  5. Training of breast surgical oncologists.

    PubMed

    Teshome, Mediget; Kuerer, Henry M

    2016-06-01

    Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education. PMID:27197510

  6. Intermittent exotropia: Surgical treatment strategies

    PubMed Central

    Kelkar, Jai Aditya; Gopal, Santhan; Shah, Rachana B; Kelkar, Aditya S

    2015-01-01

    Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered. PMID:26458472

  7. Character-Based Ethics.

    ERIC Educational Resources Information Center

    Hunt, Jasper

    1996-01-01

    In the ethical arena, our society offers the choice of an ethics of emotion versus an ethics of rules, inadequate choices when compared to ethics based in strong moral character. Moral education and character development are basic elements of adventure and experiential education, and practitioners achieve excellence in practice only when they…

  8. Setting Ethical Standards.

    ERIC Educational Resources Information Center

    Kalish, Judith; Perry, David

    1992-01-01

    School systems are advised to take a lesson from corporations who have created a code of ethical conduct for their employees and have implemented ethics training programs. Outlines steps to create a code of ethical conduct and cites five examples of corporations' ethical codes on the topic of nepotism. (MLF)

  9. [Ethics in medical journals.

    PubMed

    Lifshitz, Alberto

    2013-01-01

    The title of this reflection evokes several contents that may encompass from ethics in research; fraud in science; ethics in medical advertising and relations between sponsors and science; and, finally, papers related to ethic content. This paper is limited to the ethic responsibilities of the medical writers or "scriptwriters." PMID:24290007

  10. Seamless Integration of Ethics

    ERIC Educational Resources Information Center

    Beggs, Jeri Mullins

    2011-01-01

    The ineffectiveness of business ethics education has received attention from the popular press and the Association to Advance Collegiate Schools of Business after repeated ethics scandals. One possibility is that teaching ethics is different from other content areas because ethics is best learned when the student does not know it is being taught.…

  11. [Our surgical heritage. Surgery in ancient Egypt].

    PubMed

    Oelschlegel, F F; Luther, B; Arnst, C B

    1986-01-01

    In its 3,000 years History the surgery of the Old Egypt came on to an important development. Some of the antique instruments used in traumatology, the general surgery and in cosmetic-plastic operations, are in a scarcely modified manner employed for the same purposes in modern surgical interventions nowadays. The surgical diagnostics and therapy of that time is demonstrated by the surgical instruments stock being in the possession of the "Agyptisches Museum" of the "Staatlichen Museen zu Berlin". The surgery of Egypt transferred its leading part to the prosperous medical schools of Greece at the late period of the Old Egyptian empire (1085-332 B.C.). Its surgical diagnostics and therapy depending on an empirical rationalism, the applied instruments but also its ethical attitude towards the patients have been one of the dedisive bases influencing the development of the surgery in the antiquity. PMID:3532623

  12. Surgical management of presbyopia

    PubMed Central

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

    2012-01-01

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

  13. [The process of the acceptance of modern medical techniques in Japan at the beginning of the Meiji Era: with a focus on the surgical instruments, "écraseur" and "galvanic cautery"].

    PubMed

    Tsukisawa, Miyoko

    2009-09-01

    In this paper, I focus on the historical analysis of the process of the introduction and acceptance of modem medical techniques in Japan from the standpoints of medical assessments by Japanese doctors at that time. The "écraseur" and "galvanic cautery" are surgical instruments which were introduced into Japan from Prussia in 1873-74. These two surgical instruments have almost the same utility, such as the removal of tumors, polypi, and other growths without the effusion of the blood. At the beginning of the Meiji era, many social facilities, for example, European style hospitals and medical schools, academic journals, industrial expositions and catalog sales of medical devices, were introduced in Japan. These social facilities were related to the transfer of the medical practices in which these surgical instruments were used. Although this transfer was achieved in a short time, it involved technology assessments by Japanese doctors from many practical standpoints, including economic viewpoints. In particular, the "galvanic cautery" served as a medical device that had significant mutual effects in the surrounding areas. PMID:20509528

  14. Surgical correction of gynecomastia: a geometric approach.

    PubMed

    Martin, Antony E; Olinger, Thomas A; Yu, Jack C

    2015-05-01

    Many techniques are available for surgical correction of gynecomastia. In this article, we describe a technique based on geometrical principles that is simple to execute, effective, highly reproducible, and relies less on intuition of the surgeon. PMID:25919255

  15. Ethical issues in neuroprosthetics

    NASA Astrophysics Data System (ADS)

    Glannon, Walter

    2016-04-01

    re-establish their identity. Neuroprosthetics can maximize benefit and minimize harm for people affected by damaged or dysfunctional brains and improve the quality of their lives. Significance. Provided that adequate protections are in place for research subjects and patients, the probable benefit of research into and therapeutic applications of neuroprosthetics outweighs the risk and therefore can be ethically justified. Depending on their neurogenerative potential, there may be an ethical obligation to conduct this research. Advances in neuroscience will generate new ethical and philosophical questions about people and their brains. These questions should shape the evolution and application of novel techniques to better understand and treat brain disorders.

  16. Beyond Ethical Frameworks: Using Moral Experimentation in the Engineering Ethics Classroom.

    PubMed

    Walling, Olivia

    2015-12-01

    Although undergraduate engineering ethics courses often include the development of moral sensitivity as a learning objective and the use of active learning techniques, teaching centers on the transmission of cognitive knowledge. This article describes a complementary assignment asking students to perform an ethics "experiment" on themselves that has a potential to enhance affective learning and moral imagination. The article argues that the focus on cognitive learning may not promote, and may even impair, our efforts to foster moral sensitivity. In contrast, the active learning assignments and exercises, like the ethics "experiment" discussed, offer great potential to expand the scope of instruction in engineering ethics to include ethical behavior as well as knowledge. Engineering ethics education needs to extend beyond the narrow range of human action associated with the technical work of the engineer and explore ways to draw on broader lifeworld experiences to enrich professional practice and identity. PMID:25431220

  17. Correction of a severe facial asymmetry with computerized planning and with the use of a rapid prototyped surgical template: a case report/technique article

    PubMed Central

    2014-01-01

    Management of significant facial asymmetry presents a challenge due to the geometric complexity of the bony and other facial structures. Manual model surgery is an essential part of treatment planning but it can be complicated, time-consuming and may contain potential errors. Computer-aided surgery has revolutionized the correction of maxillofacial deformities. The aim of this study was to report a case of facial asymmetry when computerised simulation surgery was performed instead of manual model surgery and a virtually planned wafer splint was fabricated. A 26-year-old male was presented with a severe right-sided hemimandibular elongation. Following presurgical orthodontics high-resolution computer tomography scan was performed. The stack images were reformatted into a three-dimensional structure. Virtual Le Fort-I osteotomy was performed and the symmetry of the maxilla was corrected with the help of a three-dimensional planning software. A virtual intermediate surgical wafer was designed and produced with three-dimensional rapid prototyping technology. The mandible was rotated into the correct position following virtual bilateral sagittal split osteotomy to visualize the movements of the osteotomised mandibular segments. The two-jaw procedure was performed according to the virtual plan. The facial symmetry was improved significantly and stable occlusion was achieved. This complex case shows the advantages of computer-aided surgical planning and three-dimensional rapid prototyping for the correction of facial asymmetries. PMID:25014992

  18. Surgical approaches of endobronchial neoplasms

    PubMed Central

    Li, Zhigang; Kougioumtzi, Ioanna; Darwiche, Kaid; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Stylianaki, Aikaterini; Kesisis, Georgios; Machairiotis, Nikolaos; Zarogoulidis, Konstantinos

    2013-01-01

    Endobronchial tumors are a rare entity that presents with different pathological findings. The interventional pulmonologist, but also the thoracic surgeon have at their disposal the same techniques for diagnosis, however; the two modalities differentiate in the treatment approach. Diagnosis evaluation should include lymph node evaluation. Minimal invasive techniques under local or general anesthesia are usually preferred by the interventional pulmonologists, whereas in the surgical approach of the thoracic surgeons the general anesthesia is necessary. A more extensive surgical approach either lobotomy or pneumonectomy should be performed in cases with positive intrapulmonary lymph nodes. Carinal reconstruction should be performed skillfully to get a negative proximal margin whenever needed. In the current manuscript we will present the methods of patient evaluation and surgical techniques for the management of these lesions. PMID:24102010

  19. Strategies for promoting ethical decision-making.

    PubMed

    Mysak, S

    1997-01-01

    The structured controversy as a strategy for helping the non-licensed caregiver make ethical decisions as well as develop critical thinking skills was an innovative teaching technique. Students in the Homecare/Special care aide program are essential providers of care to residents or clients in a special care facility or in a homecare setting. Theory and practice of ethical decision-making is not usually dealt with in the curriculum of the non-licensed caregiver. Implementation of this approach helped students learn theory and skills necessary when dealing with controversial issues in making ethical decisions. Thompson and Thompson's (1985) ten steps of bioethical decision-making were implemented to assist in the process. Structured controversy was defined and the process of implementing structured controversy outlined. A variety of ethical issues were presented based on the ethical principles of beneficence, justice, autonomy, truthfulness, confidentiality, and integrity (Yeo, 1991). Several definitions of critical thinking are presented. PMID:9136367

  20. Keeping it Ethically Real.

    PubMed

    Ho, Dien

    2016-08-01

    Many clinical ethicists have argued that ethics expertise is impossible. Their skeptical argument usually rests on the assumptions that to be an ethics expert is to know the correct moral conclusions, which can only be arrived at by having the correct ethical theories. In this paper, I argue that this skeptical argument is unsound. To wit, ordinary ethical deliberations do not require the appeal to ethical or meta-ethical theories. Instead, by agreeing to resolve moral differences by appealing to reasons, the participants agree to the Default Principle-a substantive rule that tells us how to adjudicate an ethical disagreement. The Default Principle also entails a commitment to arguments by parity, and together these two methodological approaches allow us to make genuine moral progress without assuming any deep ethical principles. Ethical expertise, in one sense, is thus the ability and knowledge to deploy the Default Principle and arguments by parity. PMID:27256847

  1. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique.

    PubMed

    Berger, Richard A; Cooney, William P

    2005-11-01

    Resection of the distal ulna for post-traumatic arthritis can lead to an unstable forearm joint through loss of the normal articular contact through the distal radioulnar joint and loss of soft tissue constraint. The resulting convergence instability can lead to residual pain, weakness, and loss of function. Restabilization of the forearm joint with implantation of an ulnar head endoprosthesis can re-establish the mechanical continuity of the forearm, reducing pain and improving strength and function. The anatomy, mechanics,rationale, and indications for surgical replacement of the distal ulna are presented. Important tenets of proper ulnar head implant insertion are given to provide a guide for use of the implant. Preliminary results after 2 years of clinical experience are encouraging. PMID:16274870

  2. Imperfect twinning: a clinical and ethical dilemma

    PubMed Central

    Denardin, Daniela; Telles, Jorge Alberto B.; Betat, Rosilene da Silveira; Fell, Paulo Renato K.; da Cunha, André Campos; Targa, Luciano Vieira; Zen, Paulo Ricardo G.; Rosa, Rafael Fabiano M.

    2013-01-01

    OBJECTIVE To review the history, epidemiology, etiology, gestational aspects, diagnosis and prognosis of imperfect twinning. DATA SOURCES Scientific articles were searched in PubMed, SciELO and Lilacs databases, using the descriptors "conjoined twins", "multiple pregnancy", "ultrasound", "magnetic resonance imaging" and "prognosis". The research was not delimited to a specific period of time and was supplemented with bibliographic data from books. DATA SYNTHESIS: The description of conjoined twins is legendary. The estimated frequency is 1/45,000-200,000 births. These twins are monozygotic, monochorionic and usually monoamniotic. They can be classified by the most prominent fusion site, by the symmetry between the conjoined twins or by the sharing structure. The diagnosis can be performed in the prenatal period or after birth by different techniques, such as ultrasound, magnetic resonance imaging and echocardiography. These tests are of paramount importance for understanding the anatomy of both fetuses/children, as well as for prognosis and surgical plan determination. CONCLUSIONS Although imperfect twinning is a rare condition, the prenatal diagnosis is very important in order to evaluate the fusion site and its complexity. Hence, the evaluation of these children should be multidisciplinary, involving mainly obstetricians, pediatricians and pediatric surgeons. However, some decisions may constitute real ethical dilemmas, in which different points should be discussed and analyzed with the health team and the family. PMID:24142323

  3. A new primary cleft lip repair technique tailored for Asian patients that combines three surgical concepts: Comparison with rotation--advancement and straight-line methods.

    PubMed

    Funayama, Emi; Yamamoto, Yuhei; Furukawa, Hiroshi; Murao, Naoki; Shichinohe, Ryuji; Hayashi, Toshihiko; Oyama, Akihiko

    2016-01-01

    Various techniques have been described for unilateral cleft lip repair. These may be broadly classified into three types of procedure/concept: the straight-line method (SL; Rose-Thompson effect); rotation-advancement (RA; upper-lip Z-plasty); and the triangular flap method (TA; lower-lip Z-plasty). Based on these procedures, cleft lip repair has evolved in recent decades. The cleft lip repair method in our institution has also undergone several changes. However, we have found that further modifications are needed for Asian patients who have wider philtral dimples and columns than Caucasians, while following the principles of the original techniques mentioned above. Here, we have incorporated the advantages of each procedure and propose a refined hybrid operating technique, seeking a more appropriate procedure for Asian patients. To evaluate our new technique, a comparison study was performed to evaluate RA, SL, and our technique. We have used our new technique to treat 137 consecutive cleft lip cases of all types and degrees of severity, with or without a cleft palate, since 2009. In the time since we adopted the hybrid technique, we have observed improved esthetics of the repaired lip. Our technique demonstrated higher glance impression average scores than RA/SL. PMID:26653337

  4. Ethical Issues Related to Restructuring.

    ERIC Educational Resources Information Center

    Mielke, Patricia L.; Schuh, John H.

    1995-01-01

    Offers a framework for thinking about ethical principles through the use of codes of ethics. Examines the ethical issues of restructuring and discusses specific ethical dilemmas. Specifically outlines ethics related to resources allocation and management, and details critical points in restructuring. Argues that ethical guidelines help shape…

  5. Is There a Cosmetic Advantage to Single-Incision Laparoscopic Surgical Techniques Over Standard Laparoscopic Surgery? A Systematic Review and Meta-analysis.

    PubMed

    Evans, Luke; Manley, Kate

    2016-06-01

    Single-incision laparoscopic surgery represents an evolution of minimally invasive techniques, but has been a controversial development. A cosmetic advantage is stated by many authors, but has not been found to be universally present or even of considerable importance by patients. This systematic review and meta-analysis demonstrates that there is a cosmetic advantage of the technique regardless of the operation type. The treatment effect in terms of cosmetic improvement is of the order of 0.63. PMID:27213788

  6. High-speed extra-intracranial bypass combined with an assisting low-speed anastomosis: surgical technique and a clinical example.

    PubMed

    Byval'tsev, V A; Belykh, E G; Kikuta, K; Sorokovikov, V A; Grigor'ev, E G

    2015-01-01

    Described herein is the technique of performing assisting low-speed and high-speed extra-intracranial bypass, followed by a clinical case report concerning successful application of this technique in trapping of a giant aneurysm of the cavernous portion of the internal carotid artery in a female patient after endured transitory ischaemic attack during the test with temporary balloon-mediated occlusion of the internal carotid artery. PMID:26673311

  7. The role of the surgical care practitioner within the surgical team.

    PubMed

    Quick, Julie

    Changes to the surgical workforce and the continued development of health policy have perpetuated the requirement for innovative perioperative roles. The surgical care practitioner is a nurse or allied health professional who works within a surgical team and has advanced perioperative skills, including the ability to undertake surgical interventions.With only limited literature evaluating this role, any benefits of their inclusion to a surgical team are largely anecdotal. This article presents the findings of an autoethnographic inquiry that explored the experiences of surgical team members who worked with the nurse researcher in her role as surgical care practitioner. Surgeons identified the provision of a knowledgeable, competent assistant and operator who enhanced patient care, helped maintain surgical services and supported the training of junior doctors. The professional, ethical and legal obligations of advanced perioperative practice were upheld. Interprofessional collaboration was improved, as was service provision. This further enhanced the patient experience. The traditional viewpoint that nurses who undertake tasks previously associated with medicine should be working to the standard of a doctor is challenged but requires further examination. PMID:24261091

  8. Persuasion as Ethical Argument.

    ERIC Educational Resources Information Center

    Hashimoto, I.

    1985-01-01

    States that teachers should help students understand in practical terms how to recognize good ethical persuasion and to understand when even distinguished, honest, and moral writers might need to resort to "unfair ethical persuasion." (EL)

  9. Technical Note: Ethical Economics

    NASA Astrophysics Data System (ADS)

    Blodgett, J.

    Ethical economics is inspirational, expanding our vision beyond the narrow self-interest of the theoretical economic man. Ethical economics sees more value in space settlement than conventional economic calculations that can inappropriately discount the value of the future.

  10. Institutionalizing Ethics in Government.

    ERIC Educational Resources Information Center

    Brumback, Gary B.

    1992-01-01

    Ways to institutionalize ethics in government agencies include demonstrating moral leadership, making it a job qualification, training, establishing and enforcing a code, and including ethics in personnel management and performance appraisal. (SK)

  11. Ethics for Management.

    ERIC Educational Resources Information Center

    Jaques, Elliott

    2003-01-01

    Notes that it is essential that business organizations establish organizational systems that require satisfactory ethical business behaviors from everyone concerned, regardless of differences in personal outlooks. Outlines what needs to be done in order to effectively teach business ethics. (SG)

  12. [Toward a practical ethic].

    PubMed

    Vanbelle, Guido

    2007-01-01

    The relationship between ethics and philosophy and jurisdiction is described; different kinds of ethics are presented. The increasing pressure of liberal points of view has boosted the ethics of utility. The ethics of care oppose a too rational utilitarianism, taking into consideration relationships such as the caregiver-patient relationship. In the multicultural society ethics of care and virtue ethics are being criticised for not giving universal answers to ethical dilemmas. Can one still define "doing good"? Is "doing good" so culturally biased that it no longer provides the basis for ethical conduct? An accurate procedural assessment of values, sometimes interpreted quite differently in different cultures, could be a tool to judge values in a less relativistic way. PMID:18506970

  13. Influence of tooth sectioning technique and various risk factors in reducing the IAN injury following surgical removal of an impacted mandibular third molar.

    PubMed

    Jain, Neha; Thomas, Shaji; Prabhu, S; Jain, Sumant; Pathak, Ashutosh Dutt; Pillai, Ajay; Satpathy, Mrinal

    2016-06-01

    A prospective study on 100 patients presented with a mesioangular impacted mandibular third molar in close proximity to the inferior alveolar nerve canal (IANC) was done to evaluate the efficacy of tooth sectioning in reducing the incidence of inferior alveolar nerve (IAN) injury during their surgical removal. The patients were divided into two groups: group A, where tooth sectioning was not performed, and group B, where tooth sectioning was performed. Patients were recalled 7 days, 15 days, 30 days, 3 months, and 6 months postoperatively for evaluation of nerve injury and its recovery. A total of 13 patients suffered from nerve damage out of which 10 patients (10/50 or 20 %) belonged to group A and 3 patients (3/50 or 6 %) belonged to group B. All patients showed complete recovery from nerve damage within 6 months except 1 patient. The result of the study showed that tooth sectioning significantly reduces the incidence of nerve damage by 14 %. Deviation of the IANC, increased depth of the impacted tooth, intraoperative hemorrhage within socket/nerve exposure, and increased duration of procedure were found to be the significant risk factors associated with nerve injury. PMID:26711938

  14. Cervical Deuk Laser Disc Repair®: A novel, full-endoscopic surgical technique for the treatment of symptomatic cervical disc disease

    PubMed Central

    Deukmedjian, Ara J.; Cianciabella, Augusto; Cutright, Jason; Deukmedjian, Arias

    2012-01-01

    Background: Cervical Deuk Laser Disc Repair® is a novel full-endoscopic, anterior cervical, trans-discal, motion preserving, laser assisted, nonfusion, outpatient surgical procedure to safely treat symptomatic cervical disc diseases including herniation, spondylosis, stenosis, and annular tears. Here we describe a new endoscopic approach to cervical disc disease that allows direct visualization of the posterior longitudinal ligament, posterior vertebral endplates, annulus, neuroforamina, and herniated disc fragments. All patients treated with Deuk Laser Disc Repair were also candidates for anterior cervical discectomy and fusion (ACDF). Methods: A total of 142 consecutive adult patients with symptomatic cervical disc disease underwent Deuk Laser Disc Repair during a 4-year period. This novel procedure incorporates a full-endoscopic selective partial decompressive discectomy, foraminoplasty, and posterior annular debridement. Postoperative complications and average volume of herniated disc fragments removed are reported. Results: All patients were successfully treated with cervical Deuk Laser Disc Repair. There were no postoperative complications. Average volume of herniated disc material removed was 0.09 ml. Conclusions: Potential benefits of Deuk Laser Disc Repair for symptomatic cervical disc disease include lower cost, smaller incision, nonfusion, preservation of segmental motion, outpatient, faster recovery, less postoperative analgesic use, fewer complications, no hardware failure, no pseudoarthrosis, no postoperative dysphagia, and no increased risk of adjacent segment disease as seen with fusion. PMID:23230523

  15. Surgical extraction of lower third molars: diagnostic tests and operative technique in the prevention of inferior alveolar nerve injury. Case study

    PubMed Central

    MELEO, D.; PACIFICI, L.

    2009-01-01

    SUMMARY Increased knowledge and technical refinement have broadened the limits of outpatient oral surgery; however, these changes have at the same time led to a greater number of complications and poor outcomes and, accordingly, to legal action for professional responsibility. Oral surgery represents 10% of all actions, and almost all of these are attributable to exodontic surgery, of which around a third are related to inferior alveolar nerve injury following the extraction of lower third molars. The aim of this case study is to suggest operative technical strategies in accordance with a correct clinical-diagnostic pathway in order to prevent neurological complications involving the inferior alveolar nerve subsequent to lower third molar extraction. Cases should be carefully selected and surgical intervention undertaken solely when genuinely necessary. The patient should be informed of the risks, the methods and the possible results of the treatment. These are the bases for correct indication, along with a sufficient diagnostic path and a good level of communication between operator and patient. PMID:23285341

  16. Ethics and Law

    NASA Astrophysics Data System (ADS)

    Vilacoba Ramos, Andrés

    2007-04-01

    Ethics are the set of moral rules that govern human conduct. Hegel, for his part, asserted that ethicity implied the full realization of freedom, as well as the suppression of it as arbitrariness. In this paper, we point out that, through the relation between Law and Ethics, we can discover how high are the Ethics of a society, as well as the adherence of its members to it.

  17. Giftedness and Ethics

    ERIC Educational Resources Information Center

    Sternberg, Robert J.

    2012-01-01

    What is, or should be, the role of ethics in giftedness? In this article, I consider why ethical behavior is much harder to come by than one would expect. Ethical behavior requires completion of a series of eight steps to action, the failure of any one of which may result in a person, even one who is ethically well trained, to act in a manner that…

  18. The "Ethics" Expertise in Clinical Ethics Consultation.

    PubMed

    Iltis, Ana S; Rasmussen, Lisa M

    2016-08-01

    The nature, possibility, and implications of ethics expertise (or moral expertise) in general and of bioethics expertise in particular has been the focus of extensive debate for over thirty years. What is ethics expertise and what does it enable experts to do? Knowing what ethics expertise is can help answer another important question: What, if anything, makes a claim of expertise legitimate? In other words, how does someone earn the appellation "ethics expert?" There remains deep disagreement on whether ethics expertise is possible, and if so, what constitutes such expertise and what it entails and legitimates. Discussion of bioethics expertise has become particularly important given the growing presence of bioethicists in the clinical setting as well as efforts to professionalize bioethics through codes of ethics and certification (or quasi-certification) efforts. Unlike in the law or in engineering, where there may be a body of knowledge that professional organizations or others have articulated as important for education and training of experts, ethics expertise admits of no such body of knowledge or required experience. Nor is there an entity seen as having the authority to articulate the necessary scope of knowledge. Questions about whether there is such a body of knowledge for particular areas within bioethics have emerged and played a central role in professionalization efforts in recent years, especially in the area of clinical ethics. PMID:27261069

  19. The Ethics and Politics of Ethics Approval

    ERIC Educational Resources Information Center

    Battin, Tim; Riley, Dan; Avery, Alan

    2014-01-01

    The regulatory scope of Human Research Ethics Committees can be problematic for a variety of reasons. Some scholars have argued the ethics approval process, for example, is antithetical to certain disciplines in the humanities and social sciences, while others are willing to give it qualified support. This article uses a case study to cast the…

  20. Ethical Issues in Teaching about Research Ethics.

    ERIC Educational Resources Information Center

    Lucas, Keith B.; Lidstone, John G.

    2000-01-01

    Describes experiences teaching ethical issues in the conduct of research over several semesters using a simulation of research into obedience by S. Milgram in the early 1960s. Describes students' reactions to the simulation at emotional and intellectual levels and discusses the ethical dilemma these reactions have created for teachers…

  1. Improving Ethical Attitudes or Simply Teaching Ethical Codes? The Reality of Accounting Ethics Education

    ERIC Educational Resources Information Center

    Cameron, Robyn Ann; O'Leary, Conor

    2015-01-01

    Ethical instruction is critical in accounting education. However, does accounting ethics teaching actually instil core ethical values or simply catalogue how students should act when confronted with typical accounting ethical dilemmas? This study extends current literature by distinguishing between moral/ethical and legal/ethical matters and then…

  2. Ethics in Academia.

    ERIC Educational Resources Information Center

    Kunkel, H. O.

    The definition and role of ethics in higher education in agriculture are discussed. The ethical dimensions of recent events in agricultural education and agricultural science are discussed, including the ethics implicit in federal regulations and court decisions, changes in the backgrounds, experiences and values of students choosing agriculture,…

  3. Ethics and Reference Services.

    ERIC Educational Resources Information Center

    Danielson, Elena S.

    1997-01-01

    While revised ethical codes provide helpful guidelines, reference archivists face many ethical questions raised by rapidly evolving technology, changing expectations, and inconsistent privacy laws that have no clear answers. Discusses issues related to reference searching, codification of ethics, cultural property and the responsibility of…

  4. Ethics in Practice

    ERIC Educational Resources Information Center

    Medlin, E. Lander

    2010-01-01

    Ethics is defined as a set of guidelines and/or rules for the conduct of individual behavior in an organization or civil society. This ethical code of conduct is intended to guide policies, practices, and decision-making for employees on behalf of the organization. This article explores the importance of ethics, the basis for making ethical…

  5. Ethics for Fundraisers.

    ERIC Educational Resources Information Center

    Anderson, Albert

    Intended for professionals and others in the field of philanthropy, this book applies ethics and ethical decision-making to fund raising. Its primary aim is to enhance the level of ethical fund raising throughout the nonprofit sector by equipping those involved with frameworks for understanding and taking principled actions and preventing…

  6. Professional Ethics in Education.

    ERIC Educational Resources Information Center

    Rich, John Martin

    Major problems and issues of ethics in elementary, secondary, and higher education are examined. The function and present status of professional ethics are considered, along with specific codes of ethics, including those of the National Education Association, American Association of University Professors, and the American Association of School…

  7. Making Ethics Come Alive

    ERIC Educational Resources Information Center

    McQueeney, Edward

    2006-01-01

    Making ethics relevant to students in a business communications course continues to be a challenge. Classroom practitioners have long noted the difficulties in surmounting the contradictions students sense in business ethics instruction. Furthermore, students often perceive ethics to be largely irrelevant to the skills necessary for success in…

  8. Ethics across the Curriculum

    ERIC Educational Resources Information Center

    Matchett, Nancy J.

    2008-01-01

    All colleges teach ethics across their undergraduate curricula, yet relatively few institutions do so deliberately. That is, few colleges make explicit attempts to coordinate or integrate the various ethical lessons their students might be learning. This does not mean that most colleges are bad for students' ethical development; research shows…

  9. Ethics in the Marketplace.

    ERIC Educational Resources Information Center

    Sugnet, Chris, Ed.

    1986-01-01

    Representatives of five library integrated system vendors express their views on ethics and the marketplace, emphasizing the need for ethical behavior by librarians, consultants, and vendors. Four sidebars are included: one on the need for customer data rights standards; others containing the codes of ethics of three professional consultants'…

  10. Ethical Issues in Gerocounseling.

    ERIC Educational Resources Information Center

    Cavallaro, Marion L.; Ramsey, Marylou

    1988-01-01

    Combines areas of counseling older adults and maintaining sound ethical practices in professional counseling by enumerating some ethical dilemmas encountered in gerocounseling, examining the American Association for Counseling and Development Ethical Standards (1981), and suggesting options for handling conflicts that may arise. (Author/NB)

  11. The Evolution of Ethics.

    PubMed

    Powell, Suzanne K

    2016-01-01

    Ethical issues and dilemmas span from conception to the grave. The interconnectedness of advocacy, ethics, and end of life/death with dignity are woven into this issue of the Professional Case Management journal. Case management is a critical member of the team when these discussions arise. And knowledge of the issues, along with legal, ethical, and professional codes, is highlighted. PMID:27231955

  12. Ethics and Special Education.

    ERIC Educational Resources Information Center

    Paul, James; French, Peter; Cranston-Gingras, Ann

    2001-01-01

    Discussion of ethics in special education focuses on four challenges: (1) examination of special education's history within an ethical framework; (2) articulation of character morality as well as choice morality in special education ethical dilemmas; (3) examination of special education in a liberal democracy; and (4) development of an ethical…

  13. Ethics-R-Us.

    ERIC Educational Resources Information Center

    Witkin, Stanley L.

    2000-01-01

    Outlines this issue of "Social Work," which addresses ethical issues relevant to the profession, including how to prepare students for the complex task of ethical decision-making; attitudes about sexual contact with clients; legal concerns regarding sexual harassment and confidentiality; the nature of ethics violations; approaches to new and…

  14. Designing an Ethics Class.

    ERIC Educational Resources Information Center

    Prager, Richard

    1993-01-01

    Describes a required ethics course designed for juniors and seniors at a small Connecticut boarding school. Students explore the ethics of care and justice, examine ethical assumptions behind the school's disciplinary system, consider a series of dilemmas, and discuss complex topics such as abortion, euthanasia, and racism. A sidebar outlines…

  15. Targeted Endovascular Temporary Vessel Occlusion with a Reverse Thermosensitive Polymer for Near-Bloodless Partial Nephrectomy: Comparison to Standard Surgical Clamping Techniques

    SciTech Connect

    Flacke, Sebastian; Harty, Niall J.; Laskey, Daniel H.; Moinzadeh, Alireza; Benn, James A.; Villani, Rosanna; Kalra, Aarti; Libertino, John A.; Madras, Peter N.

    2012-10-15

    Purpose: To determine whether reversible blood flow interruption to a randomly chosen target region of the kidney may be achieved with the injection of a reverse thermoplastic polymer through an angiographic catheter, thereby facilitating partial nephrectomy without compromising blood flow to the remaining kidney or adding risks beyond those encountered by the use of hilar clamping. Methods: Fifteen pigs underwent partial nephrectomy after blood flow interruption by vascular cross-clamping or injection of polymer (Lumagel Trade-Mark-Sign ) into a segmental artery. Five animals were euthanized after surgery (three open and two laparoscopic resection, cross-clamping n = 2), and 10 (open resection, cross-clamping n = 4) were euthanized after 6 weeks' survival. Blood specimens were obtained periodically, and angiogram and necropsy were performed at 6 weeks. Results: Selective renal ischemia was achieved in all cases. Surgical resection time averaged 9 and 24.5 min in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of one case where an accessory renal artery was originally overlooked. Reversal of the polymer to a liquid state was consistent angiographically and visually in all cases. Time to complete flow return averaged 7.4 and 2 min for polymer and clamping, respectively. Angiography at 6 weeks revealed no evidence of vascular injury. Laboratory data and necropsies revealed no differences between animals undergoing vascular clamping or polymer injection. Conclusion: Lumagel was as effective as vascular clamping in producing a near bloodless operative field for partial nephrectomy while maintaining flow to the uninvolved portion of the affected kidney.

  16. Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases).

    PubMed

    Boussakri, Hassan; Elidrissi, Mohamad; Azarkane, Mohamad; Bensaad, Soufiane; Bachiri, Mohammed; Shimi, Mohamed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

    2014-01-01

    This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture (boxers' fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity. PMID:25419314

  17. Simulation in Surgical Education

    PubMed Central

    de Montbrun, Sandra L.; MacRae, Helen

    2012-01-01

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

  18. Ethical considerations in sex selection.

    PubMed

    Eftekhaari, Tasnim Eghbal; Nejatizadeh, Abdol Azim; Rajaei, Minoo; Soleimanian, Saeede; Fallahi, Soghra; Ghaffarzadegan, Rahman; Mahmoudi, Forough

    2015-01-01

    Advances in modern medicine are resulted from unrestricted and unlimited research disregarding many essentials of a research including ethical issues. Following ethical issues, many of unwanted pregnancies and abortions can be avoided. Several factors such as medical issues including X linked disease, has encouraged couples to select traditional or modern techniques in selecting the gender of their children. Some of these methods are corrected Swim-up method or washing of spermatozoa, Percoll gradient sperm separation method, grass wool column filter method method, albumin separation method, microsort method using FISH (Fluorescence in situ hybridization), free electrophoresis method, Ph adjustment method, pre implantation genetic diagnosis (PGD)/fluorescence in situ hybridization. This technology is confronted with many ethical issues. Ethical considerations PGD in the SEX SELECTION differ in different religions and their perspectives on this issue. In this this review, electronic databases, books and Internet sites were completely searched and full articles including required keywords and techniques were obtained and reviewed. The rites and religions, were different and had legal perspectives and opinions about PGD. In some non-Islamic countries there are strict rules to control the use of technology. Some of these methods are costly and even risky. They also involve ethical issues such as legitimacy of the conceived fetus; recommending final touches in sex selection is still considered a taboo and a big issue in some cultures or mono-sexual families. Islamic views and beliefs are more flexible and the use of these technologies are allowed to preserve the health and lives permit. Islam strongly favors humanity and supports different issues if they are not in conflict with the primary concept of legitimate reproduction and are beneficial to human beings. PMID:26097846

  19. Ethical considerations in sex selection

    PubMed Central

    Eftekhaari, Tasnim Eghbal; Nejatizadeh, Abdol Azim; Rajaei, Minoo; Soleimanian, Saeede; Fallahi, Soghra; Ghaffarzadegan, Rahman; Mahmoudi, Forough

    2015-01-01

    Advances in modern medicine are resulted from unrestricted and unlimited research disregarding many essentials of a research including ethical issues. Following ethical issues, many of unwanted pregnancies and abortions can be avoided. Several factors such as medical issues including X linked disease, has encouraged couples to select traditional or modern techniques in selecting the gender of their children. Some of these methods are corrected Swim-up method or washing of spermatozoa, Percoll gradient sperm separation method, grass wool column filter method method, albumin separation method, microsort method using FISH (Fluorescence in situ hybridization), free electrophoresis method, Ph adjustment method, pre implantation genetic diagnosis (PGD)/fluorescence in situ hybridization. This technology is confronted with many ethical issues. Ethical considerations PGD in the SEX SELECTION differ in different religions and their perspectives on this issue. In this this review, electronic databases, books and Internet sites were completely searched and full articles including required keywords and techniques were obtained and reviewed. The rites and religions, were different and had legal perspectives and opinions about PGD. In some non-Islamic countries there are strict rules to control the use of technology. Some of these methods are costly and even risky. They also involve ethical issues such as legitimacy of the conceived fetus; recommending final touches in sex selection is still considered a taboo and a big issue in some cultures or mono-sexual families. Islamic views and beliefs are more flexible and the use of these technologies are allowed to preserve the health and lives permit. Islam strongly favors humanity and supports different issues if they are not in conflict with the primary concept of legitimate reproduction and are beneficial to human beings. PMID:26097846

  20. Electronic surgical record management.

    PubMed

    Rockman, Justin

    2010-01-01

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

  1. [Surgical laboratory in pregraduate medicine.

    PubMed

    Tapia-Jurado, Jesús

    2011-01-01

    Surgical laboratory in pregraduate students in medicine is beneficial and improves learning processes in cognitive aspects and skills acquisition. It is also an early initiation into scientific research. The laboratory is the introductory pathway into basic concepts of medical science (meaningful learning). It is also where students gain knowledge in procedures and abilities to obtain professional skills, an interactive teacher-student process. Medicine works rapidly to change from an art to a science. This fact compromises all schools and medical faculties to analyze their actual lesson plans. Simulators give students confidence and ability and save time, money and resources, eliminating at the same time the ethical factor of using live animals and the fear of patient safety. Multimedia programs may give a cognitive context evolving logically with an explanation based on written and visual animation followed by a clinical problem and its demonstration in a simulator, all before applying knowledge to the patient. PMID:21477522

  2. Ethical Expert Systems

    PubMed Central

    Victoroff, Michael S.

    1985-01-01

    The title is a double entendre. The discussion approaches expert systems from two directions: “What ethical hazards are created by expert systems in medicine?” and “Would it be ethical to design an expert system for solving problems in bioethics?” Computers present new ethical problems to society, some of which are unprecedented. These can be categorized under several rubrics. The paper describes a rudimentary scheme for understanding ethical issues raised by computers, in general, and medical expert systems, in particular. It focuses on bioethical implications of AI in medicine; explores norms, assumptions and taboos; and highlights certain ethical pitfalls. Principles are elucidated, for building ethically sound systems. Finally, a proposal is discussed, for the design of an expert system for moral problem solving, and the ethical implications of this notion are analyzed.

  3. Clinical ethics and happiness.

    PubMed

    Devettere, R J

    1993-02-01

    Most contemporary accounts of clinical ethics do not explain why clinicians should be ethical. Those few that do attempt an explanation usually claim that clinicians should be ethical because ethical behavior provides an important good for the patient--better care. Both these approaches ignore the customary traditional reason for being ethical, namely, the good of the moral agent. This good was commonly called 'happiness'. The following article shows how the personal happiness of the moral agent provided a major reason for being ethical in the ancient philosophical and biblical traditions and how it continues to play a role in the more modern rights-based, Kantian and utilitarian theories. This history suggests that the personal happiness of the clinician, rightly understood, is a legitimate and important goal of clinical ethics. PMID:8433049

  4. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

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

    2003-01-01

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

  5. Stereolithographic Surgical Template: A Review

    PubMed Central

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

    2013-01-01

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

  6. Surgical management of fecal incontinence.

    PubMed

    Bleier, Joshua I S; Kann, Brian R

    2013-12-01

    The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches. PMID:24280402

  7. Stereolithographic surgical template: a review.

    PubMed

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

    2013-09-01

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

  8. Surgical management of ectopic pregnancy.

    PubMed

    Stock, Laura; Milad, Magdy

    2012-06-01

    Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed. PMID:22510627

  9. Ethical Grand Rounds: Teaching Ethics at the Point of Care.

    PubMed

    Airth-Kindree, Norah M M; Kirkhorn, Lee-Ellen C

    2016-01-01

    We offer an educational innovation called Ethical Grand Rounds (EGR) as a teaching strategy to enhance ethical decision-making. Nursing students participate in EGR-flexible ethical laboratories, where they take stands on ethical dilemmas, arguing for--or against--an ethical principle. This process provides the opportunity to move past normative ethics, that is, an ideal ethical stance in accord with ethical conduct codes, to applied ethics, what professional nurses would do in actual clinical practice, given the constraints that exist in contemporary care settings. EGR serves as a vehicle to translate "what ought to be" into "what is." PMID:27164779

  10. Empirical ethics and its alleged meta-ethical fallacies.

    PubMed

    de Vries, Rob; Gordijn, Bert

    2009-05-01

    This paper analyses the concept of empirical ethics as well as three meta-ethical fallacies that empirical ethics is said to face: the is-ought problem, the naturalistic fallacy and violation of the fact-value distinction. Moreover, it answers the question of whether empirical ethics (necessarily) commits these three basic meta-ethical fallacies. PMID:19338520

  11. The Manchester Siamese twins case--a French ethical analysis.

    PubMed

    Gold, F

    2001-12-01

    Conjoined twins were born on 8th August 2000 in Manchester. After a 2-month period of legal fighting between their parents and the medical team, which was widely reported in the media, the twins were surgically separated on 7th November 2000. This case-report scrutinises the ethical dilemma from a fresh perspective. PMID:11788164

  12. Experimental trial on surgical treatment for transverse fractures of the proximal phalanx: technique using intramedullary conical compression screw versus lateral compression plate☆

    PubMed Central

    Ibanez, Daniel Schneider; Rodrigues, Fabio Lucas; Salviani, Rafael Salmeron; Roberto, Fernando Augusto Reginatto; Pengo Junior, Jose Roberto; Aita, Marcio Aurelio

    2015-01-01

    Objective To compare the mechanical parameters between two methods for stabilization through compression: 1.5 mm axial compression plate versus conical compression screw used as an intramedullary tutor. Methods Polyurethane models (Sawbone®) that simulated transverse fractures of the proximal phalanx were used. The models were divided into three groups: lateral plate, conical screw and no implant. Results Greater force was needed to result in fatigue in the synthesis using an intramedullary plate. Thus, this model was proven to be mechanically superior to the model with the lateral plate. Conclusion Stabilization using the Acutrak® screw for treating fractures in the model used in this trial presents mechanical results that are statistically significantly superior to those from the axial compression technique using the lateral plate (Aptus Hand®). PMID:26535195

  13. Law, ethics and research ethics committees.

    PubMed

    Beyleveld, Deryck

    2002-01-01

    This paper examines the view of the operational management of the UK Research Ethics Committee (REC) system that RECs may not reject applications on purely legal grounds. Two arguments are offered for this view: the first rests on the contention that being lawful and being ethical are not the same thing; the second is that RECs lack expertise and authority to base their decisions on legal considerations. However, whatever the philosophical standing of the first argument, it is contrary to published guidance, the basis of RECs' official authority, unethical, and politically imprudent to permit RECs not to consider conformity with the law to be at least a necessary condition for REC approval. In any event, RECs can obtain competent and authoritative advice on the law (though the Department of Health has been remiss in this regard), and they do not exceed their authority by applying the law, because this is within their ethical remit. When current guidance to RECs about advising researchers on whether or not breaches of confidence are permissible in the public interest is linked to the view of the REC management that the role of RECs is to facilitate research (albeit ethical research), this raises serious doubts about the integrity of the system of ethical review currently in place, which is illustrated by a recent "agreement" of the Chairmen of the MRECs not to consider the Data Protection Act 1998 in their ethical review. PMID:12017445

  14. Spinal meningiomas: surgical management and outcome.

    PubMed

    Gottfried, Oren N; Gluf, Wayne; Quinones-Hinojosa, Alfredo; Kan, Peter; Schmidt, Meic H

    2003-06-15

    Advances in imaging and surgical technique have improved the treatment of spinal meningiomas; these include magnetic resonance imaging, intraoperative ultrasonography, neuromonitoring, the operative microscope, and ultrasonic cavitation aspirators. This study is a retrospective review of all patients treated at a single institution and with a pathologically confirmed diagnosis of spinal meningioma. Additionally the authors analyze data obtained in 556 patients reported in six large series in the literature, evaluating surgical techniques, results, and functional outcomes. Overall, surgical treatment of spinal meningiomas is associated with favorable outcomes. Spinal meningiomas can be completely resected, are associated with postoperative functional improvement, and the rate of recurrence is low. PMID:15669787

  15. Eye-gaze driven surgical workflow segmentation.

    PubMed

    James, A; Vieira, D; Lo, B; Darzi, A; Yang, G Z

    2007-01-01

    In today's climate of clinical governance there is growing pressure on surgeons to demonstrate their competence, improve standards and reduce surgical errors. This paper presents a study on developing a novel eye-gaze driven technique for surgical assessment and workflow recovery. The proposed technique investigates the use of a Parallel Layer Perceptor (PLP) to automate the recognition of a key surgical step in a porcine laparoscopic cholecystectomy model. The classifier is eye-gaze contingent but combined with image based visual feature detection for improved system performance. Experimental results show that by fusing image instrument likelihood measures, an overall classification accuracy of 75% is achieved. PMID:18044559

  16. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  17. Ethics manual: fifth edition.

    PubMed

    Snyder, Lois; Leffler, Cathy

    2005-04-01

    Medicine, law, and social values are not static. Reexamining the ethical tenets of medical practice and their application in new circumstances is a necessary exercise. The fifth edition of the College's Ethics Manual covers emerging issues in medical ethics and revisits old ones. It reflects on many of the ethical tensions faced by internists and their patients and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared obligations and duties of the medical profession. PMID:15809467

  18. Ethical considerations in hibernation research.

    PubMed

    Jinka, Tulasi R; Duffy, Lawrence K

    2013-07-01

    Ethical research practices are a key component of scientific integrity and of public support for research. Hibernation research presents specific ethical issues in regard to animal welfare. In this article, the authors apply the '3Rs' principles of humane experimental technique (replacement, reduction and refinement) to hibernation research. They provide recommendations for hibernation researchers and suggest future directions for addressing issues specific to hibernation research. They discuss the use of appropriate behavioral and physiological monitoring procedures, the development of species-specific brain atlases for placement of brain probes, the provision of environmental enrichment and the management of studies involving pharmacological induction of torpor. Addressing these issues in hibernation research will lead to improvements in research outcomes and in welfare of hibernating species. PMID:23783315

  19. Ethics of community psychiatry.

    PubMed

    Adshead, G

    1999-09-01

    Psychiatric care in the community gives rise to ethical dilemmas which resemble those associated with predominantly institutional care. However, there are also dilemmas specifically associated with community care, many of which are conceptual as well as practical. Papers addressing both conceptual and practical ethical dilemmas are reviewed including some papers which deal with the ethical issues associated with violence in the community by the mentally ill. PMID:15719521

  20. [Population, ethics and equity].

    PubMed

    Berlinguer, G

    1997-01-01

    "Demography is, explicitly and not, imbued with an [ethical] content.... As demography involves both public policies and individual choices, the [ethical] slant should be [examined]. Thus, what we have on the one hand is an [ethical] state, which dictates its citizens' personal behaviour and, on the other, a state based on liberty, backed up by three shared values: human rights, pluralism and equality. This article looks at how today these may be reinterpreted when making decisions regarding the population." (EXCERPT) PMID:12293335

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

    PubMed Central

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

    2014-01-01

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

  2. Laparoscopic nephroureterectomy with transvesical single-port distal ureter and bladder cuff dissection: points of technique and initial surgical outcomes with five patients

    PubMed Central

    Markuszewski, Marcin; Kłącz, Jakub; Sieczkowski, Marcin; Połom, Wojciech; Piaskowski, Wojciech; Krajka, Kazimierz; Matuszewski, Marcin

    2014-01-01

    Although a variety of techniques have been used to manage the distal ureter during laparoscopic radical nephroureterectomy (LNU), a consensus has not yet been established. Recently, some authors have used a single-port transvesical approach to excise the distal ureter and bladder cuff following LNU. The aim of the study was to present our initial experience in „en bloc” dissection of the distal ureter and bladder cuff during LNU, using a transvesical single-port approach (T-LESS) and standard laparoscopic instruments. From April to October 2012, 5 patients aged 45 to 73 years with upper urinary tract urothelial tumors were subjected to LNU/T-LESS. After a standard LNU was performed, a TriPort+® device was introduced into the bladder and the pneumovesicum was established. A bladder cuff with a distal ureter was dissected and put in the paravesical tissue. The bladder wall defect was closed with the V-loc® 3/0 suture. The LNU was then completed in the flank position. All procedures were completed successfully. No significant blood loss or complications were observed. The mean operative time was 250 min (range: 200–370) for a total procedure and 59 min (range: 42–80) for the T-LESS stage. The postoperative hospital stay was 5.2 days (range: 4–9). Pathologic examination revealed no positive margin in any of the cases. The LNU/T-LESS approach is an efficient and safe procedure. A well-visualized dissection of the distal ureter, closing the defect of the bladder, the use of standard laparoscopic instruments and a good cosmesis are advantages of the method. PMID:25097698

  3. Ethical and Unethical Methods of Plagiarism Prevention in Academic Writing

    ERIC Educational Resources Information Center

    Bakhtiyari, Kaveh; Salehi, Hadi; Embi, Mohamed Amin; Shakiba, Masoud; Zavvari, Azam; Shahbazi-Moghadam, Masoomeh; Ebrahim, Nader Ale; Mohammadjafari, Marjan

    2014-01-01

    This paper discusses plagiarism origins, and the ethical solutions to prevent it. It also reviews some unethical approaches, which may be used to decrease the plagiarism rate in academic writings. We propose eight ethical techniques to avoid unconscious and accidental plagiarism in manuscripts without using online systems such as Turnitin and/or…

  4. Ethical Dilemmas of Turkish Counsellors: A Critical Incidents Study

    ERIC Educational Resources Information Center

    Sivis-Cetinkaya, Rahsan

    2015-01-01

    Ethical dilemmas from a national purposive sample of Turkish counsellors (N = 172) were collected using critical incidents technique. Content analysis was performed with open coding guided by the classification of American Counseling Association code of ethics. Incidents regarding confidentiality and privacy (56.4%), with 37.1% involving incidents…

  5. Evolving Ethical Concepts

    ERIC Educational Resources Information Center

    Potter, Van Rensselaer

    1977-01-01

    Discusses the role of the scientist in changing ethical concepts from simple interpersonal and theological imperatives towards "survival imperatives that must form the core of environmental bioethics." (CS)

  6. Professional Ethics: Caught and Taught.

    ERIC Educational Resources Information Center

    Nickols, Sharon Y.; Belliston, Lisa M.

    2001-01-01

    Compares codes of professional ethics of several professional associations in light of rapidly changing technology. Explores the relation between academic honesty and ethical practice and provides a summary of approaches to teaching ethics. (Contains 34 references.) (JOW)

  7. Surgical Adhesive Drape (IO-ban) as Postoperative Surgical Site Dressing

    PubMed Central

    Syed, Hasan R; Snyder, Rita; McGowan, Jason E; Jha, Ribhu T; Nair, Mani N

    2015-01-01

    Study Design: Retrospective chart analysis. Objective: The objective of this study is to describe the senior author’s (MNN) experience applying a widely available surgical drape as a postoperative sterile surgical site dressing for both cranial and spinal procedures. Summary of Background Data: Surgical site infection (SSI) is an important complication of spine surgery that can result in significant morbidity. There is wide variation in wound care management in practice, including dressing type. Given the known bactericidal properties of the surgical drape, there may be a benefit of continuing its use immediately postoperatively. Methods: All of the senior author’s cases from September 2014 through September 2015 were reviewed. These were contrasted to the previous year prior to the institution of a sterile surgical drape as a postoperative dressing. Results: Only one surgical case out of 157 operative interventions (35 cranial, 124 spinal) required operative debridement due to infection. From September 2013 to September 2014, prior to the institution of a sterile surgical drape as dressing, the author had five infections out of 143 operations (46 cranial, 97 spinal) requiring intervention. Conclusion: The implementation of a sterile surgical drape as a closed postoperative surgical site dressing has led to a decrease in surgical site infections. The technique is simple and widely available, and should be considered for use to diminish surgical site infections. PMID:26798570

  8. Leave No Trace! Land Ethics [and] Tread Lightly! On Public and Private Land. A National Land Use Ethics Program.

    ERIC Educational Resources Information Center

    Forest Service (USDA), Washington, DC.

    This document consists of two brochures that provide land ethics guidelines for outdoor recreationists. The brochures provide techniques that visitors can use to help reduce evidence of their presence in the back country, designated "Wilderness" areas. The first brochure, titled "Leave no Trace! Land Ethics," provides guidelines for planning back…

  9. Systems ethics and the history of medical ethics.

    PubMed

    Clements, C D

    1992-01-01

    This paper reviews the current conclusions in medical ethics which have followed the 1969-1970 Medical Ethics Discontinuity, a break that challenged the Hippocratic way of thinking about ethics. The resulting dislocations in quality of care and the medical value system are discussed, and an alternative medical ethics is offered: Systems Ethics. A methodology for a Systems Ethics analysis of cases is presented and illustrated by the case of a physician-assisted suicide. The advantages, both theoretical and clinical, of a Systems Ethics approach to medicine, which is an expansion of the Hippocratic tradition in medical ethics, are developed. Using Systems Ethics, it is possible to avoid the dangers of legalism, bureaucratic ethics, utilitarian cost cutting, and "political correctness" in medical ethics. PMID:1475330

  10. Ethics, Ethical Human Research and Human Research Ethics Committees

    ERIC Educational Resources Information Center

    Lindorff, Margaret

    2010-01-01

    Non-medical research involves the same issues of justice, beneficence, and respect for persons that apply to non-medical research. It also may involve risk of harm to participants, and conflicts of interest for researchers. It is therefore not possible to argue that such research should be exempt from ethical review. This paper argues that…

  11. [Surgical anatomy of the nose].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Jallut, Y; Aiach, G

    2014-12-01

    Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty. PMID:25159815

  12. Ethics of Reproductive Engineering

    ERIC Educational Resources Information Center

    Buuck, R. John

    1977-01-01

    Artificial insemination, in vitro fertilization, artificial placentas, and cloning are examined from a ethical viewpoint. The moral, social, and legal implications of reproductive engineering are considered important to biology as well as medicine. The author suggests that these ethical issues should be included in the biology curriculum and lists…

  13. Ethics and Engineering Education

    ERIC Educational Resources Information Center

    Bucciarelli, L. L.

    2008-01-01

    In the US, Accreditation Board for Engineering and Technology (ABET) recommends the study of ethics so that students acquire "an understanding of professional and ethical responsibility". For the most part, teaching of the subject relies upon the use of scenarios--both hypothetical and "real"--and open discussion framed by the codes. These…

  14. Ethics of Information Supply.

    ERIC Educational Resources Information Center

    Oppenheim, Charles

    This discussion of the ethics of the information process provides a brief review of the process of information supply and flow, primarily in science and technology; looks at various points in the flow of information; and highlights particular ethical concerns. Facets of the process discussed in more detail include ways in which some scientists…

  15. Code of Ethics.

    ERIC Educational Resources Information Center

    American Sociological Association, Washington, DC.

    The American Sociological Association's code of ethics for sociologists is presented. For sociological research and practice, 10 requirements for ethical behavior are identified, including: maintaining objectivity and integrity; fully reporting findings and research methods, without omission of significant data; reporting fully all sources of…

  16. Cultivating an Ethical School

    ERIC Educational Resources Information Center

    Starratt, Robert J.

    2012-01-01

    Often the school is left as an institution seemingly ethically neutral, leaving untouched questions about whether the school itself is a site of injustice toward both educators and children. Springing from his well-known "Building an Ethical School", Robert J. Starratt now looks more closely at the educational leader's responsibility to ensure…

  17. Code of Ethics

    ERIC Educational Resources Information Center

    Division for Early Childhood, Council for Exceptional Children, 2009

    2009-01-01

    The Code of Ethics of the Division for Early Childhood (DEC) of the Council for Exceptional Children is a public statement of principles and practice guidelines supported by the mission of DEC. The foundation of this Code is based on sound ethical reasoning related to professional practice with young children with disabilities and their families…

  18. Ethics in Government.

    ERIC Educational Resources Information Center

    Update on Law-Related Education, 1990

    1990-01-01

    Presents a lesson developed by the Center for Civic Education giving secondary students the opportunity to explore ethical issues in government from the perspective of corrective justice. Outlines role plays and other class activities based on a fictitious ethics scandal involving bribery. Identifies specific questions to be asked on issues of…

  19. Code of Ethics.

    ERIC Educational Resources Information Center

    Association of College Unions-International, Bloomington, IN.

    The code of ethics for the college union and student activities professional is presented by the Association of College Unions-International. The preamble identifies the objectives of the college union as providing campus community centers and social programs that enhance the quality of life for members of the academic community. Ethics for…

  20. Teaching Ethics: Telling Stories.

    ERIC Educational Resources Information Center

    Bowman, Ann

    1995-01-01

    In order to develop moral literacy, nursing students should be exposed to both rules- and justice-based ethics and to a feminist care perspective. They can learn to analyze and understand ethical dilemmas and to tell their own stories in order to identify the influences on their decision making. (SK)