Noncontact microsurgery of cell membranes using femtosecond laser pulses for optoinjection of specified substances into cells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Il'ina, I V; Ovchinnikov, A V; Chefonov, O V

IR femtosecond laser pulses were used for microsurgery of a cell membrane aimed at local and short-duration change in its permeability and injection of specified extracellular substances into the cells. The possibility of noncontact laser delivery of the propidium iodide fluorescent dye and the pEGFP plasmid, encoding the green fluorescent protein, into the cells with preservation of the cell viability was demonstrated. (extreme light fields and their applications)

A laser unit for photodynamic therapy and robot-assisted microsurgery in dentistry

NASA Astrophysics Data System (ADS)

Chunikhin, A. A.; Bazikyan, E. A.; Pikhtin, N. A.

2017-06-01

Results are presented of photochemical experiments with an IR-laser unit for microsurgery and photodynamic therapy in dentistry. The efficiency of direct generation of singlet oxygen in model organic media in the continuous-wave and pulsed nanosecond modes is examined. The unit can serve both as an independent instrument and as a part of a complex for robot-assisted surgery and dentistry.

Smart surgical tool

NASA Astrophysics Data System (ADS)

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

2015-02-01

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

Plasma and Cavitation Dynamics during Pulsed Laser Microsurgery in vivo

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hutson, M. Shane; Ma Xiaoyan

We compare the plasma and cavitation dynamics underlying pulsed laser microsurgery in water and in fruit fly embryos (in vivo)--specifically for nanosecond pulses at 355 and 532 nm. We find two key differences. First, the plasma-formation thresholds are lower in vivo --especially at 355 nm--due to the presence of endogenous chromophores that serve as additional sources for plasma seed electrons. Second, the biological matrix constrains the growth of laser-induced cavitation bubbles. Both effects reduce the disrupted region in vivo when compared to extrapolations from measurements in water.

Revealing the micromechanics driving cellular division: optical manipulation of force-bearing substructure in mitotic cells

NASA Astrophysics Data System (ADS)

Ono, Matthew; Preece, Daryl; Duquette, Michelle; Forer, Arthur; Berns, Michael

2017-08-01

During the anaphase stage of mitosis, a motility force transports genetic material in the form of chromosomes to the poles of the cell. Chromosome deformations during anaphase transport have largely been attributed to viscous drag force, however LaFountain et. al. found that a physical tether connects separating chromosome ends in crane-fly spermatocytes such that a backwards tethering force elongates the separating chromosomes. In the presented study laser microsurgery was used to deduce the mechanistic basis of chromosome elongation in rat-kangaroo cells. In half of tested chromosome pairs, laser microsurgery between separating chromosome ends reduced elongation by 7+/-3% suggesting a source of chromosome strain independent of viscous drag. When microsurgery was used to sever chromosomes during transport, kinetochore attached fragments continued poleward travel while half of end fragments traveled towards the opposite pole and the remaining fragments either did not move or segregated to the proper pole. Microsurgery directed between chromosome ends always ceased cross-polar fragment travel suggesting the laser severed a physical tether transferring force to the fragment. Optical trapping of fragments moving towards the opposite pole estimates an upper boundary on the tethering force of 1.5 pN.

Toward robot-assisted neurosurgical lasers.

PubMed

Motkoski, Jason W; Yang, Fang Wei; Lwu, Shelly H H; Sutherland, Garnette R

2013-04-01

Despite the potential increase in precision and accuracy, laser technology is not widely used in neurological surgery. This in part relates to challenges associated with the early introduction of lasers into neurosurgery. Considerable advances in laser technology have occurred, which together with robotic technology could create an ideal platform for neurosurgical application. In this study, a 980-nm contact diode laser was integrated with neuroArm. Preclinical evaluation involved partial hepatectomy, bilateral nephrectomy, splenectomy, and bilateral submandibular gland excision in a Sprague-Dawley rat model (n = 50). Total surgical time, blood loss as weight of surgical gauze before and after the procedure, and the incidence of thermal, vascular, or lethal injury were recorded and converted to an overall performance score. Thermal damage was evaluated in the liver using tissue samples stained with hematoxylin and eosin. Clinical studies involved step-wise integration of the 980-nm laser system into four neurosurgical cases. Results demonstrate the successful integration of contact laser technology into microsurgery, with and without robotic assistance. In preclinical studies, the laser improved microsurgical performance and reduced thermal damage, while neuroArm decreased intra- and intersurgeon variability. Clinical studies demonstrate dutility in meningioma resection (n = 4). Together, laser and robotic technology offered a more consistent, expedient, and precise tool for microsurgery.

CO2-laser-assisted microsurgical anastomosis in reconstructive microsurgery

NASA Astrophysics Data System (ADS)

Kiyoshige, Yoshiro

1996-01-01

Since 1984, the author used a low output carbon dioxide laser for microsurgical anastomoses in the experimental investigation with rats. The series of experiments demonstrates the following characteristics, in comparison with conventional microsurgical anastomoses: ease in technique; less time consumption; equivalency of patency rate and bursting pressure; but only about 50% of the tensile strength of manual suture anastomosis. These findings suggested that low output carbon dioxide laser has the potential for clinical application. Then this technique has been applied in six clinical cases with digital replantations and free vascularized flap since 1988. The procedure offers increased safety and speed in reconstructive microsurgery.

Robot-assisted microsurgical forceps with haptic feedback for transoral laser microsurgery.

PubMed

Deshpande, Nikhil; Chauhan, Manish; Pacchierotti, Claudio; Prattichizzo, Domenico; Caldwell, Darwin G; Mattos, Leonardo S

2016-08-01

In this paper, a novel, motorized, multi-degrees-of-freedom (DoF), microsurgical forceps tool is presented, which is based on a master-slave teleoperation architecture. The slave device is a 7-DoF manipulator with: (i) 6-DoF positioning and orientation, (ii) 1 open/close gripper DoF; and (iii) an integrated force/torque sensor for tissue grip-force measurement. The master device is a 7-DoF haptic interface which teleoperates the slave device, and provides haptic feedback in its gripper interface. The combination of the device and the surgeon interface replaces the manual, hand-held device providing easy-to-use and ergonomic tissue control, simplifying the surgical tasks. This makes the system suitable to real surgical scenarios in the operating room (OR). The performance of the system was analysed through the evaluation of teleoperation control and characterization of gripping force. The new system offers an overall positioning error of less than 400 μm demonstrating its safety and accuracy. Improved system precision, usability, and ergonomics point to the potential suitability of the device for the OR and its ability to advance haptic-feedback-enhanced transoral laser microsurgeries.

Towards endoscopic ultrafast laser microsurgery of vocal folds

NASA Astrophysics Data System (ADS)

Hoy, Christopher L.; Everett, W. Neil; Yildirim, Murat; Kobler, James; Zeitels, Steven M.; Ben-Yakar, Adela

2012-03-01

Vocal fold scarring is a predominant cause of voice disorders yet lacks a reliable treatment method. The injection of soft biomaterials to improve mechanical compliance of the vocal folds has emerged as a promising treatment. Here, we study the use of precise femtosecond laser microsurgery to ablate subsurface voids, with a goal of eventually creating a plane in dense subepithelial scar tissue into which biomaterials can be injected for their improved localization. Specifically, we demonstrate the ablation of small subepithelial voids in porcine vocal fold tissue up to 120 µm below the surface such that larger voids in the active area of vocal fold mucosa (~3×10 mm2) can eventually be ablated in about 3 min. We use sub-µJ, 776-nm pulses from a compact femtosecond fiber laser system operating at a 500-kHz repetition rate. The use of relatively high repetition rates, with a small number of overlapping pulses, is critical to achieving ablation in a very short time while still avoiding significant heat deposition. Additionally, we use the same laser for nonlinear optical imaging to provide visual feedback of tissue structure and to confirm successful ablation. The ablation parameters, including pulse duration, pulse energy, spot size, and scanning speed, are comparable to the specifications in our recently developed miniaturized femtosecond laser surgery probes, illustrating the feasibility of developing an ultrafast laser surgical instrument.

JPRS Report, Science & Technology, USSR: Life Sciences

DTIC Science & Technology

1988-04-15

disease. Microsurgery and laser technology will be used more widely. The creation of cardiology dispensaries in all republic, kray, and oblast... microsurgery and dialysis will be used much more widely, and organ and tissue transplants and surgical interventions will be performed more often...be directed first of all to reconstruction and equipment renovation and to bringing treatment-and-prevention facilites up to speed with established

Laser Microsurgery in Caenorhabditis elegans

PubMed Central

Fang-Yen, Christopher; Gabel, Christopher V.; Samuel, Aravinthan D. T.; Bargmann, Cornelia I.; Avery, Leon

2013-01-01

Laser killing of cell nuclei has long been a powerful means of examining the roles of individual cells in C. elegans. Advances in genetics, laser technology, and imaging have further expanded the capabilities and usefulness of laser surgery. Here, we review the implementation and application of currently used methods for target edoptical disruption in C. elegans. PMID:22226524

Experimental study of CO/sub 2/-laser-induced histological effects on human fallopian tube: determination of CO/sub 2/ laser parameters to be used in microsurgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Foulot, H.; Lefebvre, G.; Jagueux, M.

This experiment investigates CO/sub 2/-laser-induced histological effects on fallopian tubes obtained during hysterectomies in women. Tubal transversal sections were performed at isthmic and ampullar sites. Forty strips were available for histological study of the cut section area. The role of different parameters such as radiation power and beam fractionation (continuous versus pulsed) on tissue lesions was assessed. In tubal microsurgery, the CO/sub 2/ laser can be used as a scalpel with the predominant advantage of minimal tissular alterations. As a result of this study, our recommended parameters are the following: radiation power, 7-10 W; beam focalization zone, 0.2 mm; energymore » density, 20,000-35,000 W/cm2; continuous operation; moving speed, 1 cm/s.« less

A vision-based system for fast and accurate laser scanning in robot-assisted phonomicrosurgery.

PubMed

Dagnino, Giulio; Mattos, Leonardo S; Caldwell, Darwin G

2015-02-01

Surgical quality in phonomicrosurgery can be improved by open-loop laser control (e.g., high-speed scanning capabilities) with a robust and accurate closed-loop visual servoing systems. A new vision-based system for laser scanning control during robot-assisted phonomicrosurgery was developed and tested. Laser scanning was accomplished with a dual control strategy, which adds a vision-based trajectory correction phase to a fast open-loop laser controller. The system is designed to eliminate open-loop aiming errors caused by system calibration limitations and by the unpredictable topology of real targets. Evaluation of the new system was performed using CO(2) laser cutting trials on artificial targets and ex-vivo tissue. This system produced accuracy values corresponding to pixel resolution even when smoke created by the laser-target interaction clutters the camera view. In realistic test scenarios, trajectory following RMS errors were reduced by almost 80 % with respect to open-loop system performances, reaching mean error values around 30 μ m and maximum observed errors in the order of 60 μ m. A new vision-based laser microsurgical control system was shown to be effective and promising with significant positive potential impact on the safety and quality of laser microsurgeries.

CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients.

PubMed

Matar, Nayla; Amoussa, Kassira; Verduyckt, Ingrid; Nollevaux, Marie-Cecile; Jamart, Jacques; Lawson, Georges; Remacle, Marc

2010-12-01

Microsurgery for intracordal cysts is a challenging procedure, because cysts are close to the vocal ligament and the risk of inducing a scar is high. In this retrospective study, our experience with the CO(2)-laser scanning system (Acublade(®)) is reported on 49 patients. There were 41% epidermoid cysts and 59% mucous retention cysts. A quarter of the patients presented with bilateral cystic lesions and 59% had a contralateral lesion other than a cyst. The cyst was removed after a minimicroflap. It was dissected away from the lamina propria and the epithelium. Collagen was injected intraoperatively if the glottal gap was considered important. The epithelium was redraped using Tissucol (Baxter, Vienna, Austria). The mean follow-up time was 160 days. We noted a statistically significant improvement in the grade of the dysphonia according to Hirano's perceptual scale (G pre = 2, G post = 1, p = 0.002); the Vocal Handicap Index (VHI pre = 51, VHI post = 28, p = 0.001) and the maximal phonation time in milliseconds (MPT pre = 11, 1 MPT post = 12.7, p = 0.033) in all the patients. In the professional voice subgroup (20/49 patients), there was a significant improvement in the frequency range (FR pre = 310 Hz, FR post = 434 Hz, p = 0.001). The CO(2)-laser scanning system is reliable in the treatment of intracordal cysts.

Outcomes after 1.9-microm diode laser-assisted anastomosis in reconstructive microsurgery: results in 27 patients.

PubMed

Leclère, Franck M P; Schoofs, Michel; Buys, Bruno; Mordon, Serge R

2010-04-01

Microvascular surgery has become an important method for reconstructing surgical defects resulting from trauma, tumors, or burns. The most important factor for successful free flap transfer is a well-executed anastomosis. This study was performed to review the authors' experience with a 1.9-microm diode laser in microsurgery, with special attention to outcomes and performance of the technique. Between January of 2005 and December of 2007, 27 patients underwent microsurgery with a 1.9-microm diode laser at the authors' institute. The patients had a mean age of 31 years (range, 2 to 59 years); 14 patients were women and 13 patients were men. This technique was used for digital replantations (n = 2) and for free flap transfer (n = 27). Causes of the defects were trauma (n = 14), tumor (n = 9), congenital (n = 2), burn (n = 1), infection (n = 1), arthritis (n = 1), and dog bite (n = 1). Laser-assisted microvascular anastomosis was performed with a 1.9-microm diode laser after placement of equidistant stitches. The following parameters were used: spot size, 400 microm; power, 125 mW; time depending on vessel size (0.8 to 1.8 mm); and fluence varying from 70 to 200 J/cm. Three surgical revisions following hematoma and one rupture of the arterial anastomosis leading to a free deep inferior epigastric perforator flap necrosis resulting from high-dose radiotherapy before surgery occurred after laser-assisted microvascular anastomosis, accounting for an overall success rate of 96.6 percent. This study reports the numerous benefits of the technique: easier performance of vascular anastomosis with difficult access, decrease of reperfusion bleeding and complications, and a short learning curve.

Rare Earth Doped IR Fiber Lasers For Medical Applications

NASA Astrophysics Data System (ADS)

Esterowitz, Leon; Allen, Roger

1989-06-01

Trivalent rare earth doped lasers in fluorozirconate glasses and fibers that lase between 2 and 3 μm are reviewed. There have been a large number of laser-fiber optic systems below 2pm developed for clinical microsurgery at a variety of sites. The required flexibility of the fiber optic waveguide varies with the clinical use, such as: intraocular (through a small diameter rigid tube), endoscopically accessible pulmonary and gastric mucosa (through a port of a fiber-optic endoscope of intermediate flexibility), and intra-arterial (as an integral part of a flexible catheter, which in the case of the coronaries must be very flexible so as to negotiate abrupt bends and bifurcations without damage to the vessels). Laser energy absorbed by tissue is capable of coagulation of tissue (denaturation of structural proteins), melting of fatty deposits or other structures (solid or gel to liquid phase transitions), as well as direct breakage of chemical bonds by high energy photons. It is of general interest to develop a pulsed laser system transmitted through flexible fiber optics that is capable of precise ablation of targeted tissue with minimal damage to the remaining tissue. Ideally, the device should be able to ablate any tissue because of the general absorptive properties of tissue, and not a specific chromophore such as melanin or hemoglobin, the concentration of which varies widely among tissues. Two obvious ubiquitous chromophores have been widely discussed: 1) proteins and nucleic acids whose high concentration and absorption coefficients lead to strong tissue absorption in the ultraviolet and 2) water whose strong infrared absorption bands have been widely utilized in CO2 laser surgery. Non-linear absorption occurring at very high power densities (~1 GW/cm2) has been shown to be very effective for non-invasive ocular (an optically transparent field) microsurgery at the image plane of a slit lamp, but this approach appears impractical in fiber optic systems because of similar non-linear damage mechanisms within the fiber.

High-throughput optofluidic system for the laser microsurgery of oocytes

NASA Astrophysics Data System (ADS)

Chandsawangbhuwana, Charlie; Shi, Linda Z.; Zhu, Qingyuan; Alliegro, Mark C.; Berns, Michael W.

2012-01-01

This study combines microfluidics with optical microablation in a microscopy system that allows for high-throughput manipulation of oocytes, automated media exchange, and long-term oocyte observation. The microfluidic component of the system transports oocytes from an inlet port into multiple flow channels. Within each channel, oocytes are confined against a microfluidic barrier using a steady fluid flow provided by an external computer-controlled syringe pump. This allows for easy media replacement without disturbing the oocyte location. The microfluidic and optical-laser microbeam ablation capabilities of the system were validated using surf clam (Spisula solidissima) oocytes that were immobilized in order to permit ablation of the 5 μm diameter nucleolinus within the oocyte nucleolus. Oocytes were the followed and assayed for polar body ejection.

Transoral laser microsurgery for laryngeal cancer: A primer and review of laser dosimetry

PubMed Central

Rubinstein, Marc

2010-01-01

Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. The basic approach and principles of performing TLM, the devices currently in use, and the associated dosimetry parameters will be discussed. The benefits of using TLM over conventional surgery, common complications and the different settings used depending on the location of the tumor will also be discussed. Although the CO2 laser is the most versatile and the best-suited laser for TLM applications, a variety of lasers and different parameters are used in the treatment of laryngeal cancer. Improved instrumentation has lead to an increased utilization of TLM by head and neck cancer surgeons and has resulted in improved outcomes. Laser energy levels and spot size are adjusted to vary the precision of cutting and amount of hemostasis obtained. PMID:20835840

Laser-ultrasonic technologies for medicine

NASA Astrophysics Data System (ADS)

Zharov, Vladimir P.; Latyshev, Alexei S.

1999-06-01

This review tackles the problem of further developing laser- ultrasonic medical technologies and gives the comparison of different laser and ultrasound combinations. The features of combined influence on biotissue are explicated with due regard for mechanic, ultrasonic (US), and thermal effects. The review present the effect of self-cleaning an optical fiber tip from the laser destruction products of biotissue, the result of research on the possibility of laser-US technology applications in endoscopy, and the ways of suppressing unwanted bending oscillations. Various spheres and peculiarities of applying laser-US technologies are discussed, including microsurgery, cosmetology, transcutaneous drug delivery, and the treatment of chronic prostatitis and infected wounds. Furthermore, the analysis of transcutaneous drug delivery methods employing a portable pulsed Er:YAG laser is presented. Drug diffusion has been shown to be enhanced under acoustic and US effects. The photo-vacuum drug injection mechanism recently suggested is discussed. It turned out that laser-US technology can be suitable for both impregnating the photosensitizer in local photodynamic therapy procedures and conducting microsurgery operations involving drug injection. Treatment of infectious processes based on the bactericidal action of photosensitizers and ultrasound due to the cavitation effect in solutions is described. An additional therapeutic effect can be achieved via the US intermingling of solutions with their simulations illumination by a matrix of red lasers or light diodes. An outlook on further developing laser-US technology and the ways of its apparatus realization are considered.

Review of intraoperative optical coherence tomography: technology and applications [Invited

PubMed Central

Carrasco-Zevallos, Oscar M.; Viehland, Christian; Keller, Brenton; Draelos, Mark; Kuo, Anthony N.; Toth, Cynthia A.; Izatt, Joseph A.

2017-01-01

During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon’s depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld OCT probes, microscope-integrated OCT systems, and OCT-guided laser treatment platforms designed for intraoperative use. Moreover, we discuss intraoperative OCT adjuncts and processing techniques currently under development to optimize the surgical feedback derivable from OCT data. Lastly, we survey salient clinical studies of intraoperative OCT for human surgery. PMID:28663853

Ten years of Nd:YAG Q-switched/mode-locked ophthalmic laser system clinical treatment

NASA Astrophysics Data System (ADS)

Jelinkova, Helena; Pasta, Jiri; Hamal, Karel; Cech, Miroslav; Prochazka, Ivan

1999-06-01

Plasma breakdown generated by high power lasers is used in ophthalmic microsurgery for perforation of the various membranes. We report on ten years of clinical experiences with the ophthalmic Nd:YAG laser system operating alternatively in both Q-switched or mode-locked regimes. This option gives the surgeon a possibility to compare the effect of treatments with nanosecond or picosecond pulses. The pulse duration in the picosecond regime is 25 ps, the length of a nanosecond pulse is 4 ns and the energy is variable up to 70 mJ. In the ten year period the laser system was used for more than 10 000 treatments. From the results is possible to conclude that in clinical practice the picosecond pulses are better for the posterior capsule opacification treatment and that there are not retinal complications. The nanosecond pulses are useful for iridectomies. Our constructed Nd:YAG laser system provides the surgeons with the possibility to use different photodisruptive regimes for special indications, which can be very useful for the ophthalmologists.

Optical workstation with concurrent, independent multiphoton imaging and experimental laser microbeam capabilities

PubMed Central

Wokosin, David L.; Squirrell, Jayne M.; Eliceiri, Kevin W.; White, John G.

2008-01-01

Experimental laser microbeam techniques have become established tools for studying living specimens. A steerable, focused laser beam may be used for a variety of experimental manipulations such as laser microsurgery, optical trapping, localized photolysis of caged bioactive probes, and patterned photobleaching. Typically, purpose-designed experimental systems have been constructed for each of these applications. In order to assess the consequences of such experimental optical interventions, long-term, microscopic observation of the specimen is often required. Multiphoton excitation, because of its ability to obtain high-contrast images from deep within a specimen with minimal phototoxic effects, is a preferred technique for in vivo imaging. An optical workstation is described that combines the functionality of an experimental optical microbeam apparatus with a sensitive multiphoton imaging system designed for use with living specimens. Design considerations are discussed and examples of ongoing biological applications are presented. The integrated optical workstation concept offers advantages in terms of flexibility and versatility relative to systems implemented with separate imaging and experimental components. PMID:18607511

Optical workstation with concurrent, independent multiphoton imaging and experimental laser microbeam capabilities

NASA Astrophysics Data System (ADS)

Wokosin, David L.; Squirrell, Jayne M.; Eliceiri, Kevin W.; White, John G.

2003-01-01

Experimental laser microbeam techniques have become established tools for studying living specimens. A steerable, focused laser beam may be used for a variety of experimental manipulations such as laser microsurgery, optical trapping, localized photolysis of caged bioactive probes, and patterned photobleaching. Typically, purpose-designed experimental systems have been constructed for each of these applications. In order to assess the consequences of such experimental optical interventions, long-term, microscopic observation of the specimen is often required. Multiphoton excitation, because of its ability to obtain high-contrast images from deep within a specimen with minimal phototoxic effects, is a preferred technique for in vivo imaging. An optical workstation is described that combines the functionality of an experimental optical microbeam apparatus with a sensitive multiphoton imaging system designed for use with living specimens. Design considerations are discussed and examples of ongoing biological applications are presented. The integrated optical workstation concept offers advantages in terms of flexibility and versatility relative to systems implemented with separate imaging and experimental components.

Cutting edge science: Laser surgery illuminates viscoelasticity of merotelic kinetochores

PubMed Central

Cabello, Simon

2016-01-01

Increasing evidence in eukaryotic cells suggests that mechanical forces are essential for building a robust mitotic apparatus and correcting inappropriate chromosome attachments. In this issue, Cojoc et al. (2016. J. Cell Biol., http://dx.doi.org/10.1083/jcb.201506011) use laser microsurgery in vivo to measure and study the viscoelastic properties of kinetochores. PMID:27002164

Cutting edge science: Laser surgery illuminates viscoelasticity of merotelic kinetochores.

PubMed

Cabello, Simon; Gachet, Yannick; Tournier, Sylvie

2016-03-28

Increasing evidence in eukaryotic cells suggests that mechanical forces are essential for building a robust mitotic apparatus and correcting inappropriate chromosome attachments. In this issue, Cojoc et al. (2016. J. Cell Biol., http://dx.doi.org/10.1083/jcb.201506011) use laser microsurgery in vivo to measure and study the viscoelastic properties of kinetochores. © 2016 Cabello.

A Comparison of Robotically Assisted Microsurgery versus Manual Microsurgery in Challenging Situations.

PubMed

Willems, Joost I P; Shin, Alexandra M; Shin, Delaney M; Bishop, Allen T; Shin, Alexander Y

2016-04-01

Microsurgery can be challenging secondary to orientation of the vessels, accessibility, or depth of the wound. Robotically assisted microsurgery reduces tremors and improves visualization and may improve the quality of anastomosis compared with traditional microsurgery. The purpose of this study was to compare robotically assisted microsurgery to traditional microsurgery in technically challenging situations with respect to time of anastomosis, quality of anastomosis, and Objective Structured Assessment of Technical Skills. Two investigators with no prior surgery or microsurgery experience performed 160 anastomoses on artificial microvessels after undergoing standardized traditional and robotically assisted microsurgery courses. Five different exposure groups were created with depths of 0, 10, and 20 cm and sidewall angles of 20 and 30 degrees. A comparison of 80 manual with 80 robotically assisted microsurgery anastomoses in different exposure groups was undertaken. The modified Objective Structured Assessment of Technical Skills scoring system, duration per anastomosis, and a subjective comfort scale were evaluated. In the most difficult exposure, Objective Structured Assessment of Technical Skills scores were similar in both groups (p = 0.98), the duration was higher in the manual group (p = 0.004), and the subjective comfort rating was higher in the robotically assisted microsurgery group (p < 0.001). In the easiest (0-cm depth, flat) exposure, Objective Structured Assessment of Technical Skills scores were higher in the manual group (p = 0.018) and the duration was longer in the robotically assisted microsurgery group (p = 0.008). Manual surgery was superior to robotically assisted microsurgery in technically easy exposures. In difficult exposures (greater depth and lower sidewall angles), however, robotically assisted microsurgery had a shorter surgery time and a higher comfort rating, with Objective Structured Assessment of Technical Skills scores similar to those assessing traditional microsurgery. Therapeutic, V.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery.

PubMed

Tan, Youri P A; Liverneaux, Philippe; Wong, Jason K F

2018-01-01

Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality.

Current Limitations of Surgical Robotics in Reconstructive Plastic Microsurgery

PubMed Central

Tan, Youri P. A.; Liverneaux, Philippe; Wong, Jason K. F.

2018-01-01

Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet  benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within  this surgical subspeciality. PMID:29740585

CO2 laser application in gynecology: experience in microsurgery of cervical lesions

NASA Astrophysics Data System (ADS)

Knapp, Piotr A.

1995-03-01

A CO2 laser device was used for treating cervical lesions in 1574 patients. Of the total, 163 were diagnosed as CIN. Patients were selected for the study as a result of mass screening during the period from 1988 to 1992 of Bialystok Province, Poland. Treatment of cervical lesions with laser proved to be effective. In the author's opinion it is an essential step in preventing cervical malignancy.

Preliminary clinical results with the ISL laser

NASA Astrophysics Data System (ADS)

Hoppeler, Thomas; Gloor, Balder

1992-08-01

The ISL laser (Intelligent Surgical Lasers, Inc.), a Nd:YLF picosecond pulse laser, is currently being used under investigational device exemption to perform microsurgery of the anterior segment of the eye. At different study sites procedures for cataract fragmentation and iridotomy, as well as for posterior capsulotomy after cataract surgery, are under evaluation. Other potential applications include: sclerostomy ab interno, the cutting of membranes in the anterior and posterior segment of the eye; corneal incisions; and corneal intrastromal effects. We discuss various clinically relevant aspects of the use of this picosecond laser. An overview of different computer controlled laser patterns is given.

Femtosecond lasers for microsurgery of cornea

NASA Astrophysics Data System (ADS)

Vartapetov, Sergei K.; Khudyakov, D. V.; Lapshin, Konstantin E.; Obidin, Aleksei Z.; Shcherbakov, Ivan A.

2012-03-01

The review of femtosecond laser installations for medical applications is given and a new femtosecond ophthalmologic system for creation of a flap of corneal tissue during the LASIK operation is described. An all-fibre femtosecond laser emitting ~400-fs pulses at 1067 nm is used. The pulse repetition rate can vary from 200 kHz up to 1 MHz. The output energy of the femtosecond system does not exceed 1 μJ. A specially developed objective with small spherical and chromatic aberrations is applied to focus laser radiation to an area of an eye cornea. The size of the focusing spot does not exceed 3 μm. To process the required area, scanning by a laser beam is applied with a speed no less than 5 m s-1. At a stage of preliminary tests of the system, the Κ8 glass, organic PMMA glass and specially prepared agarose gels are used as a phantom of an eye. The femtosecond system is successfully clinically tested on a plenty of eyes of a pig and on several human eyes. The duration of the procedure of creation of a corneal flap does not exceed 20 s.

Femtosecond lasers for microsurgery of cornea

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vartapetov, Sergei K; Khudyakov, D V; Lapshin, Konstantin E

The review of femtosecond laser installations for medical applications is given and a new femtosecond ophthalmologic system for creation of a flap of corneal tissue during the LASIK operation is described. An all-fibre femtosecond laser emitting {approx}400-fs pulses at 1067 nm is used. The pulse repetition rate can vary from 200 kHz up to 1 MHz. The output energy of the femtosecond system does not exceed 1 {mu}J. A specially developed objective with small spherical and chromatic aberrations is applied to focus laser radiation to an area of an eye cornea. The size of the focusing spot does not exceedmore » 3 {mu}m. To process the required area, scanning by a laser beam is applied with a speed no less than 5 m s{sup -1}. At a stage of preliminary tests of the system, the {Kappa}8 glass, organic PMMA glass and specially prepared agarose gels are used as a phantom of an eye. The femtosecond system is successfully clinically tested on a plenty of eyes of a pig and on several human eyes. The duration of the procedure of creation of a corneal flap does not exceed 20 s.« less

Comparison of tablet-based strategies for incision planning in laser microsurgery

NASA Astrophysics Data System (ADS)

Schoob, Andreas; Lekon, Stefan; Kundrat, Dennis; Kahrs, Lüder A.; Mattos, Leonardo S.; Ortmaier, Tobias

2015-03-01

Recent research has revealed that incision planning in laser surgery deploying stylus and tablet outperforms state-of-the-art micro-manipulator-based laser control. Providing more detailed quantitation regarding that approach, a comparative study of six tablet-based strategies for laser path planning is presented. Reference strategy is defined by monoscopic visualization and continuous path drawing on a graphics tablet. Further concepts deploying stereoscopic or a synthesized laser view, point-based path definition, real-time teleoperation or a pen display are compared with the reference scenario. Volunteers were asked to redraw and ablate stamped lines on a sample. Performance is assessed by measuring planning accuracy, completion time and ease of use. Results demonstrate that significant differences exist between proposed concepts. The reference strategy provides more accurate incision planning than the stereo or laser view scenario. Real-time teleoperation performs best with respect to completion time without indicating any significant deviation in accuracy and usability. Point-based planning as well as the pen display provide most accurate planning and increased ease of use compared to the reference strategy. As a result, combining the pen display approach with point-based planning has potential to become a powerful strategy because of benefiting from improved hand-eye-coordination on the one hand and from a simple but accurate technique for path definition on the other hand. These findings as well as the overall usability scale indicating high acceptance and consistence of proposed strategies motivate further advanced tablet-based planning in laser microsurgery.

Proposal of landmarks for clamping neurovascular elements during endoscopic surgery of the supraglottic region.

PubMed

Souvirón, R; Maranillo, E; Vázquez, T; Patel, N; McHanwell, S; Cobeta, I; Scola, B; Sañudo, J

2013-01-01

Bleeding within the supraglottic region can be a lethal complication after CO(2) laser microsurgery. Our aim was to propose endoluminal anatomical landmarks to locate the superior laryngeal vessels resulting in a safer microsurgery. Endoluminal dissections were made in 22 larynges without laryngeal disease. The neurovascular structures were in the superior third of a triangle defined by the vocal process, the anterior commissure, and the epiglottic attachment of the aryepiglottic fold. They overlapped in 4 different ways: pattern I (70.4%): superior laryngeal vein (SLV), superior laryngeal artery (SLA), and internal laryngeal nerve (ILN); pattern II (13.6%): SLA, SLV, ILN; pattern III (4.6%): SLV, ILN, and SLA; pattern IV (4.6%): SLA, ILN, and SLV. Microsurgery in the supraglottic region may be safer if surgeons are aware of the superior third of the above-defined triangle, "danger area", where the vascular elements of this region are located. Copyright © 2012 Wiley Periodicals, Inc.

Army Medical Robotics Research

DTIC Science & Technology

2007-01-01

environment. These advances in microsurgery would make possible procedures such as small vessel anastomosis, nerve reconstruction , and microdissection and...System, Intuitive Surgical, Inc. 3 b. Telepresence “ Microsurgery ” System for Uniformed Services University of the Health Sciences (USUHS) - Stanford

Kagome fiber based ultrafast laser microsurgery probe delivering micro-Joule pulse energies.

PubMed

Subramanian, Kaushik; Gabay, Ilan; Ferhanoğlu, Onur; Shadfan, Adam; Pawlowski, Michal; Wang, Ye; Tkaczyk, Tomasz; Ben-Yakar, Adela

2016-11-01

We present the development of a 5 mm, piezo-actuated, ultrafast laser scalpel for fast tissue microsurgery. Delivery of micro-Joules level energies to the tissue was made possible by a large, 31 μm, air-cored inhibited-coupling Kagome fiber. We overcome the fiber's low NA by using lenses made of high refractive index ZnS, which produced an optimal focusing condition with 0.23 NA objective. The optical design achieved a focused laser spot size of 4.5 μm diameter covering a 75 × 75 μm 2 scan area in a miniaturized setting. The probe could deliver the maximum available laser power, achieving an average fluence of 7.8 J/cm 2 on the tissue surface at 62% transmission efficiency. Such fluences could produce uninterrupted, 40 μm deep cuts at translational speeds of up to 5 mm/s along the tissue. We predicted that the best combination of speed and coverage exists at 8 mm/s for our conditions. The onset of nonlinear absorption in ZnS, however, limited the probe's energy delivery capabilities to 1.4 μJ for linear operation at 1.5 picosecond pulse-widths of our fiber laser. Alternatives like broadband CaF 2 crystals should mitigate such nonlinear limiting behavior. Improved opto-mechanical design and appropriate material selection should allow substantially higher fluence delivery and propel such Kagome fiber-based scalpels towards clinical translation.

Transoral robotic surgery vs transoral laser microsurgery for resection of supraglottic cancer: a pilot surgery.

PubMed

Ansarin, Mohssen; Zorzi, Stefano; Massaro, Maria Angela; Tagliabue, Marta; Proh, Michele; Giugliano, Gioacchino; Calabrese, Luca; Chiesa, Fausto

2014-03-01

Transoral laser microsurgery (TLM) is a mature approach to supraglottic cancer, while transoral robotic surgery (TORS) is emerging. The present study compared these approaches. The first 10 patients (2002-2005) given TLM were compared with the first 10 (2007-2011) given TORS for cT1-3 cN0-cN2c supraglottic cancer. A feeding tube was used in four TLM and seven TORS patients. Margins were more often positive, but operating times shorter, in TORS. All 10 TORS patients are without evidence of disease, but only six TLM patients remain disease-free after much longer follow-up. TORS was considerably less uncomfortable and fatiguing for the surgeon. TORS seems as safe and effective as TLM. Shorter TORS operating times are probably attributable to prior experience with TLM. For laryngeal exposure, length of tube placement and margin evaluability, TLM was superior; however, this may change as TORS develops and transoral robotic instruments are optimized. Copyright © 2013 John Wiley & Sons, Ltd.

Transoral Laser Microsurgery in Early Glottic Lesions.

PubMed

Sjögren, E V

2017-01-01

To give an overview of the evolvement of transoral laser microsurgery (TLM) in the treatment of early glottic carcinoma and highlight the contribution of recent literature. The indications and limits of TLM have been well specified. Effects on swallowing have been well documented. Introduction of narrow-band imaging (NBI) and diffusion-weighted magnetic resonance has been shown of additional value for outcome. The first reports on transoral robotic surgery show that it may be of added value in the future. TLM for early glottic carcinoma (Tis-T2) has very good oncological outcomes with indications of higher larynx preservation in TLM than that in radiotherapy. The anterior commissure is a risk factor if involved in the cranio-caudal plane, and reduced vocal fold mobility is a risk factor when this is due to arytenoid involvement. The best voice results are achieved when the anterior commissure can be left intact along with part of the vocal fold muscle although even in larger resections, patient self-reported voice handicap is still limited.

Clinical feasibility test on a minimally invasive laser therapy system in microsurgery of nerves.

PubMed

Mack, K F; Leinung, M; Stieve, M; Lenarz, T; Schwab, B

2008-01-01

The clinical feasibility test described here evaluates the basis for a laser therapy system that enables tumour tissue to be separated from nerves in a minimally invasive manner. It was first investigated whether, using an Er:YAG laser, laser-induced nerve (specifically, facial nerve) responses in the rabbit in vivo can be reliably detected with the hitherto standard monitoring techniques. Peripherally recordable neuromuscular signals (i.e. compound action potentials, CAPs) were used to monitor nerve function and to establish a feedback loop. The first occurrence of laser-evoked CAPs was taken as the criterion for deciding when to switch off the laser. When drawing up criteria governing the control and termination of the laser application, the priority was the maintenance of nerve function. Five needle-electrode arrays specially developed for this purpose, each with a miniature preamplifier, were then placed into the facial musculature instead of single-needle electrodes. The system was tested in vivo under realistic surgical conditions (i.e. facial-nerve surgery in the rabbit). This modified multi-channel electromyography (EMG) system enabled laser-evoked CAPs to be detected that have amplitudes 10 times smaller than those picked up by commercially available systems. This optimization, and the connection of the neuromuscular unit with the Er:YAG laser via the electrode array to create a feedback loop, were designed to make it possible to maintain online control of the laser ablation process in the vicinity of neuronal tissue, thus ensuring that tissue excision is both reliable and does not affect function. Our results open up new possibilities in minimally invasive surgery near neural structures.

A 5-mm piezo-scanning fiber device for high speed ultrafast laser microsurgery

PubMed Central

Ferhanoglu, Onur; Yildirim, Murat; Subramanian, Kaushik; Ben-Yakar, Adela

2014-01-01

Towards developing precise microsurgery tools for the clinic, we previously developed image-guided miniaturized devices using low repetition rate amplified ultrafast lasers for surgery. To improve the speed of tissue removal while reducing device diameter, here we present a new 5-mm diameter device that delivers high-repetition rate laser pulses for high speed ultrafast laser microsurgery. The device consists of an air-core photonic bandgap fiber (PBF) for the delivery of high energy pulses, a piezoelectric tube actuator for fiber scanning, and two aspheric lenses for focusing the light. Its inline optical architecture provides easy alignment and substantial size reduction to 5 mm diameter as compared to our previous MEMS-scanning devices while realizing improved intensity squared (two-photon) lateral and axial resolutions of 1.16 μm and 11.46 μm, respectively. Our study also sheds light on the maximum pulse energies that can be delivered through the air-core PBF and identifies cladding damage at the input facet of the fiber as the limiting factor. We have achieved a maximum energy delivery larger than 700 nJ at 92% coupling efficiency. An in depth analysis reveals how this value is greatly affected by possible slight misalignments of the beam during coupling and the measured small beam pointing fluctuations. In the absence of these imperfections, self-phase modulation becomes the limiting factor for the maximum energy delivery, setting the theoretical upper bound to near 2 μJ for a 1-m long, 7-μm, air-core PBF. Finally, the use of a 300 kHz repetition rate fiber laser enabled rapid ablation of 150 µm x 150 µm area within only 50 ms. Such ablation speeds can now allow the surgeons to translate the surgery device as fast as ~4 mm/s to continuously remove a thin layer of a 150 µm wide tissue. Thanks to a high optical transmission efficiency of the in-line optical architecture of the device and improved resolution, we could successfully perform ablation of scarred cheek pouch tissue, drilling through a thin slice. With further development, this device can serve as a precise and high speed ultrafast laser scalpel in the clinic. PMID:25071946

Carbon dioxide laser microsurgery of the uterine tube.

PubMed

Baggish, M S; Chong, A P

1981-07-01

The carbon dioxide (CO2) laser was used to perform microsurgical excision of obstructed tubal segments in rabbit and human subjects. Approximation of the freshly severed tubes by means of laser "welding" was evaluated in both groups investigated. More important, the laser beam cuts accurately and atraumatically while sealing small vascular channels. Scanning electron microscopic studies of the human fallopian tube following laser surgery were done to determine the extent of tissue injury. At a distance of 1 mm distal to the vaporization and necrotic impact zone, normal tubal anatomy was observed. Follow-up data are presented for 7 women who underwent laser beam tuboplasty between 1979 and 1980. The principle advantages of the CO2 laser are its precise control, minimal tissue injury, and hemostatic properties.

Kagome fiber based ultrafast laser microsurgery probe delivering micro-Joule pulse energies

PubMed Central

Subramanian, Kaushik; Gabay, Ilan; Ferhanoğlu, Onur; Shadfan, Adam; Pawlowski, Michal; Wang, Ye; Tkaczyk, Tomasz; Ben-Yakar, Adela

2016-01-01

We present the development of a 5 mm, piezo-actuated, ultrafast laser scalpel for fast tissue microsurgery. Delivery of micro-Joules level energies to the tissue was made possible by a large, 31 μm, air-cored inhibited-coupling Kagome fiber. We overcome the fiber’s low NA by using lenses made of high refractive index ZnS, which produced an optimal focusing condition with 0.23 NA objective. The optical design achieved a focused laser spot size of 4.5 μm diameter covering a 75 × 75 μm2 scan area in a miniaturized setting. The probe could deliver the maximum available laser power, achieving an average fluence of 7.8 J/cm2 on the tissue surface at 62% transmission efficiency. Such fluences could produce uninterrupted, 40 μm deep cuts at translational speeds of up to 5 mm/s along the tissue. We predicted that the best combination of speed and coverage exists at 8 mm/s for our conditions. The onset of nonlinear absorption in ZnS, however, limited the probe’s energy delivery capabilities to 1.4 μJ for linear operation at 1.5 picosecond pulse-widths of our fiber laser. Alternatives like broadband CaF2 crystals should mitigate such nonlinear limiting behavior. Improved opto-mechanical design and appropriate material selection should allow substantially higher fluence delivery and propel such Kagome fiber-based scalpels towards clinical translation. PMID:27896003

Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery.

PubMed

Yang, Shih-Wei; Chao, Wei-Chieh; Lee, Yun-Shien; Chang, Liang-Che; Hsieh, Tsan-Yu; Chen, Tai-An; Luo, Cheng-Ming

2017-01-01

The aim of this study is to evaluate the treatment outcome and analyze the associated factors of postoperative recurrence in patients who received transoral laser microsurgery for vocal cord leukoplakia. The demographic, histopathological data were retrospectively reviewed and the factors associated with recurrence of vocal leukoplakia after surgery were analyzed statistically. A total of 44 patients, including 36 males and 8 females, with a mean age of 50.4 ± 13.4 years, were enrolled. All the patients received excision of the vocal leukoplakia by carbon dioxide laser (2-4 Watt, ultrapulse mode) under general anesthesia. No patients had malignant transformation after surgery. Postoperative recurrence occurred in 10 patients (22.7 %). Univariate analysis showed that patients who had the habit of cigarette smoking, alcohol drinking, and presence of gastroesophageal reflux disease tended to recur. Among these risk factors, presence of gastroesophageal reflux disease (odds ratio 8.43) was the independent prognostic factor for recurrence using multivariate logistic regression analysis. Carbon dioxide laser excision is effective for treating vocal leukoplakia that is still confined to dysplasia of any degree, with acceptable morbidity. This study suggests that the presence of gastroesophageal reflux disease is the prognostic indicator for postoperative recurrence of vocal leukoplakia. Aggressive treatment of reflux disease for those who have received surgical excision for vocal leukoplakia is indicated.

Transoral laser microsurgery for managing laryngeal stenosis after reconstructive partial laryngectomies.

PubMed

Lucioni, Marco; Bertolin, Andy; Lionello, Marco; Giacomelli, Luciano; Ghirardo, Guido; Rizzotto, Giuseppe; Marioni, Gino

2017-02-01

To retrospectively analyze our experience of transoral laser microsurgery (TLM) for treating postoperative laryngeal obstruction (POLO) after supracricoid and supratracheal laryngectomy (open partial horizontal laryngectomy [OPHL]) types 2 and 3, and to investigate potential relationships between patients' clinical features and their functional outcomes. A retrospective cohort study. The prognostic influence of clinical and surgical parameters on functional outcomes was investigated in a univariate statistical setting in terms of decannulation rate (DR), time to tracheostomy closure (TTC), and number of laser procedures required (NLP). OPHL type 2 was associated with a better functional outcome than OPHL type 3 in terms of DR, TTC, and NLP (P = .03, P = .02, and P = .02, respectively). Annular and semicircumferential stenoses developed more frequently after OPHL type 3, and were particularly difficult to manage with TLM. Fixation of the residual arytenoid was a negative prognostic factor in terms of functional outcome in terms of DR, TTC, and NLP (P = .0002, P = .08, and P = .08, respectively). There is no standardized laser treatment for POLO; it must be tailored to individual patients. Identifying prognostic factors influencing functional outcome could help surgeons to earmark patients less likely to benefit from TLM for the treatment of POLO, and enable an adequate preoperative counseling, given the high probability of repeat postoperative TLM procedures. 4 Laryngoscope, 2016 127:359-365, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Diode-laser-based therapy device

NASA Astrophysics Data System (ADS)

Udrea, Mircea V.; Nica, Adriana S.; Florian, Mariana; Poenaru, Daniela; Udrea, Gabriela; Lungeanu, Mihaela; Sporea, Dan G.; Vasiliu, Virgil V.; Vieru, Roxana

2004-10-01

A new therapy laser device is presented. The device consists of a central unit and different types of laser probes. The laser probe model SL7-650 delivers seven red (650 nm), 5 mW diode lasers convergent beams. The beams converge at about 30 cm in front of the laser probe and the irradiated area might be varied by simple displacement of the laser probe with respect to the target. The laser probe SL1-808 emits single infrared laser beam up to 500 mW. The efficiency of the use of this device in physiotherapy, and rheumatology, has been put into evidence after years of testing. Dermatology and microsurgery are users of infrared powerful laser probes. The device has successfully passed technical and clinical tests in order to be certified. The laser device design and some medical results are given.

[Clinical study on vocal cords spontaneous rehabilitation after CO2 laser surgery].

PubMed

Zhang, Qingxiang; Hu, Huiying; Sun, Guoyan; Yu, Zhenkun

2014-10-01

To study the spontaneous rehabilitation and phonation quality of vocal cords after different types of CO2 laser microsurgery. Surgical procedures based on Remacle system Type I, Type II, Type III, Type IV and Type V a respectively. Three hundred and fifteen cases with hoarseness based on strobe laryngoscopy results were prospectively assigned to different group according to vocal lesions apperence,vocal vibration and imaging of larynx CT/MRI. Each group holded 63 cases. The investigation included the vocal cords morphological features,the patients' subjective feelings and objective results of vocal cords. There are no severe complications for all patients in perioperative period. Vocal scar found in Type I ,1 case; Type II, 9 cases ;Type III, 47 cases; Type IV, 61 cases and Type Va 63 cases respectively after surgery. The difference of Vocal scar formation after surgery between surgical procedures are statistical significance (χ2 = 222.24, P < 0.05). Hoarseness improved after the surgery in 59 cases of Type I , 51 cases of Type II, 43 cases of Type III, 21 cases of Type IV and 17 cases of Type Va. There are statistically significance (χ2 = 89.46, P < 0.05) between different surgical procedures. The parameters of strobe laryngoscope: there are statistical significance on jitter between procedures (F 44.51, P < 0.05), but without difference within Type I and Type II (P > 0.05). This happened in shimmer parameter and the maximum phonation time (MPT) as jitter. There are no statistical significance between Type IV and Type Va on MPT (P > 0.05). Morphological and functional rehabilitation of vocal cord will be affected obviously when the body layer is injured. The depth and range of the CO2 laser microsurgery are the key factors affecting the vocal rehabilitation.

Optical Coherence Tomography Guided Laser Cochleostomy: Towards the Accuracy on Tens of Micrometer Scale

PubMed Central

Weller, Marcel; Wieser, Wolfgang; Huber, Robert; Raczkowsky, Jörg; Schipper, Jörg; Wörn, Heinz; Klenzner, Thomas

2014-01-01

Lasers have been proven to be precise tools for bone ablation. Applying no mechanical stress to the patient, they are potentially very suitable for microsurgery on fragile structures such as the inner ear. However, it remains challenging to control the laser-bone ablation without injuring embedded soft tissue. In this work, we demonstrate a closed-loop control of a short-pulsed CO2 laser to perform laser cochleostomy under the monitoring of an optical coherence tomography (OCT) system. A foresighted detection of the bone-endosteum-perilymph boundary several hundred micrometers before its exposure has been realized. Position and duration of the laser pulses are planned based on the residual bone thickness distribution. OCT itself is also used as a highly accurate tracking system for motion compensation between the target area and the optics. During ex vivo experimental evaluation on fresh porcine cochleae, the ablation process terminated automatically when the thickness of the residual tissue layer uniformly reached a predefined value. The shape of the resulting channel bottom converged to the natural curvature of the endosteal layer without injuring the critical structure. Preliminary measurements in OCT scans indicated that the mean absolute accuracy of the shape approximation was only around 20 μm. PMID:25295253

A novel computerized surgeon-machine interface for robot-assisted laser phonomicrosurgery.

PubMed

Mattos, Leonardo S; Deshpande, Nikhil; Barresi, Giacinto; Guastini, Luca; Peretti, Giorgio

2014-08-01

To introduce a novel computerized surgical system for improved usability, intuitiveness, accuracy, and controllability in robot-assisted laser phonomicrosurgery. Pilot technology assessment. The novel system was developed involving a newly designed motorized laser micromanipulator, a touch-screen display, and a graphics stylus. The system allows the control of a CO2 laser through interaction between the stylus and the live video of the surgical area. This empowers the stylus with the ability to have actual effect on the surgical site. Surgical enhancements afforded by this system were established through a pilot technology assessment using randomized trials comparing its performance with a state-of-the-art laser microsurgery system. Resident surgeons and medical students were chosen as subjects in performing sets of trajectory-following exercises. Image processing-based techniques were used for an objective performance assessment. A System Usability Scale-based questionnaire was used for the qualitative assessment. The computerized interface demonstrated superiority in usability, accuracy, and controllability over the state-of-the-art system. Significant ease of use and learning experienced by the subjects were demonstrated by the usability score assigned to the two compared interfaces: computerized interface = 83.96% versus state-of-the-art = 68.02%. The objective analysis showed a significant enhancement in accuracy and controllability: computerized interface = 90.02% versus state-of-the-art = 75.59%. The novel system significantly enhances the accuracy, usability, and controllability in laser phonomicrosurgery. The design provides an opportunity to improve the ergonomics and safety of current surgical setups. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer.

PubMed

Klimza, Hanna; Jackowska, Joanna; Piazza, Cesare; Banaszewski, Jacek; Wierzbicka, Malgorzata

2018-03-01

Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Structured assessment of microsurgery skills in the clinical setting.

PubMed

Chan, WoanYi; Niranjan, Niri; Ramakrishnan, Venkat

2010-08-01

Microsurgery is an essential component in plastic surgery training. Competence has become an important issue in current surgical practice and training. The complexity of microsurgery requires detailed assessment and feedback on skills components. This article proposes a method of Structured Assessment of Microsurgery Skills (SAMS) in a clinical setting. Three types of assessment (i.e., modified Global Rating Score, errors list and summative rating) were incorporated to develop the SAMS method. Clinical anastomoses were recorded on videos using a digital microscope system and were rated by three consultants independently and in a blinded fashion. Fifteen clinical cases of microvascular anastomoses performed by trainees and a consultant microsurgeon were assessed using SAMS. The consultant had consistently the highest scores. Construct validity was also demonstrated by improvement of SAMS scores of microsurgery trainees. The overall inter-rater reliability was strong (alpha=0.78). The SAMS method provides both formative and summative assessment of microsurgery skills. It is demonstrated to be a valid, reliable and feasible assessment tool of operating room performance to provide systematic and comprehensive feedback as part of the learning cycle. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Optical transfection using an endoscope-like system.

PubMed

Ma, Nan; Gunn-Moore, Frank; Dholakia, Kishan

2011-02-01

Optical transfection is a powerful method for targeted delivery of therapeutic agents to biological cells. A tightly focused pulsed laser beam may transiently change the permeability of a cell membrane to facilitate the delivery of foreign genetic material into cells. We report the first realization of an endoscope-like integrated system for optical transfection. An imaging fiber (coherent optical fiber bundle) with ∼ 6000 cores (pixels) embedded in a fiber cladding of ∼ 300 μm in diameter, produces an image circle (area) of ∼ 270 μm diam. This imaging fiber, with an ordered axicon lens array chemically etched at its exit face, is used for the delivery of a femtosecond laser to the cell membrane for optical transfection along with subcellular resolution imaging. A microcapillary-based microfluidic system for localized drug delivery was also combined in this miniature, flexible system. Using this novel system, a plasmid transfection efficiency up to ∼ 72% was obtained for CHO-K1 cells. This endoscope-like system opens a range of exciting applications, in particular, in the targeted in vivo optical microsurgery area.

Investigation of ultrashort pulse laser ablation of the cornea and hydrogels for eye microsurgery

NASA Astrophysics Data System (ADS)

Girard, Guillaume; Zhou, Sheng; Bigaouette, Nicolas; Brunette, Isabelle; Chaker, Mohamed; Germain, Lucie; Lavertu, Pierre-Luc; Martin, François; Olivié, Gilles; Ozaki, Tsuneyuki; Parent, Mireille; Vidal, François; Kieffer, Jean-Claude

2004-10-01

The Femtosecond laser is a very promising tool for performing accurate dissection in various cornea layers. Clearly, the development of this application requires basic knowledge about laser-tissue interaction. One of the most significant parameter in laser applications is the ablation threshold, defined as the minimal laser energy per unit surface required for ablation. This paper investigates the ablation threshold as a function of the laser pulse duration for two corneal layers (endothelium and epithelium) as well as for hydrogel with different hydration degrees. The measured ablation thresholds prove to behave very differently as a function of the pulse duration for the various materials investigated, although the values obtained for the shortest laser pulses are quite similar. Our experimental results are fitted with a simple model for laser-matter interaction in order to determine some intrinsic physical parameters characterizing each target.

Transoral laser microsurgery for oral squamous cell carcinoma: Oncologic outcomes and prognostic factors

PubMed Central

Sinha, Parul; Hackman, Trevor; Nussenbaum, Brian; Wu, Ningying; Lewis, James S.; Haughey, Bruce H.

2014-01-01

Background Modest survival rates are published for treatment of oral squamous cell carcinoma (OSCC) using conventional approaches. Few cohort studies are available for transoral resection of OSCC. Methods Analysis for recurrence, survival, and prognosis of patients with OSCC treated with transoral laser microsurgery (TLM) ± neck dissection was obtained from a prospective database. Results Ninety-five patients (71 patients had stages T1–T2 and 24 had stages T3–T4 disease) with minimum follow-up of 24 months met criteria and demonstrated negative margins in 95%. Five-year local control (LC) and disease-specific survival (DSS) were 78% and 76%, respectively. Surgical salvage achieved an absolute final locoregional control of 92%. Immune compromise and final margins were prognostic for LC, whereas T classification, N classification, TNM stage, comorbidity, and perineural invasion were also significant for DSS. Conclusion We document a large series of patients with OSCC treated with TLM, incorporating T1 to T4 primaries. A significant proportion of stage III/IV cases demonstrates feasibility of TLM in higher stages, with final margin positivity of 5%, LC greater than 90%, and comparable survival outcomes. PMID:23729304

Mechanism and applications of new fluorescent compounds produced by femtosecond laser surgery in biological tissue (Conference Presentation)

NASA Astrophysics Data System (ADS)

Qu, Jianan Y.; Sun, Qiqi

2017-02-01

The single or multi-photon microscopy based on fluorescent labelling and staining is a sensitive and quantitative method that is widely used in molecular biology and medical research for a variety of experimental, analytical, and quality control applications. However, label-free method is highly desirable in biology and medicine when performing long term live imaging of biological system and obtaining instant tissue examination during surgery procedures. Recently, our group found that femtosecond laser surgery turned a variety of biological tissues and protein samples into highly fluorescent substances. The newly formed fluorescent compounds produced during the laser surgery can be excited via single- and two-photon processes over broad wavelength ranges. We developed a combined confocal and two-photon spectroscopic microscope to characterize the fluorescence from the new compound systematically. The structures of the femtosecond laser treated tissue were studied using Raman spectroscopy and transmission electron microscopy. Our study revealed the mechanisms of the fluorescence emission form the new compound. Furthermore, we demonstrated the applications of the fluorescent compounds for instant evaluation of femtosecond laser microsurgery, study of stem cell responses to muscle injury and neuro-regeneration after spinal cord injury.

[Contribution of French surgeons to reconstructive microsurgery].

PubMed

Grinfeder, C; Pinsolle, V; Pelissier, P; Martin, D; Baudet, J

2005-02-01

The authors report the contribution of French surgeons and particularly the plastic surgeons to the reconstructive microsurgery since 1972. Different domains are reviewed: animal experimentation, anatomical studies, reimplantations, free tissular transfer, free bone transfer, strategic original concept of transfer, free toes transfer, microsurgical reconstruction of malformative hand, free lymphatic transfer, nervous microsurgery, flap prefabrication, allotransplantations and the future of microsurgery. Three societies have the place of honour: the French Society of Plastic Reconstructive and Aesthetic Surgery, the Group for Advancement of Microsurgery and the World Society for Reconstructive Microsurgery.

Survey of reconstructive microsurgery training in Korea.

PubMed

Moon, Seong June; Hong, Joon Pio; Kang, So Ra; Suh, Hyun Suk

2015-01-01

Microsurgical technique in reconstructive surgery is important. Despite recognizing this fact, there are no systematized microsurgery training programs in Korea. The purpose of this study was to diagnose the current training programs and discuss the direction that is needed to improve them. The authors conducted a survey of graduates of a plastic surgery residency program. The questionnaire included the volume of microsurgery, training environment, area of microsurgery, department(s) performing microsurgery, and the frequency with which flaps were used. Many specialties other than plastic surgery involved microsurgical procedures. The volume of microsurgery cases was disproportionate between large and small hospitals, creating an imbalance of residents' experience with microsurgical procedures. The increase in microsurgical procedures being performed has increased the number of surgeons who want to train in microsurgery. Increasing the number of microsurgery training programs will create more microsurgeons in Korea. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgery robots: addressing the needs of high-precision surgical interventions.

PubMed

Mattos, Leonardo S; Caldwell, Darwin G; Peretti, Giorgio; Mora, Francesco; Guastini, Luca; Cingolani, Roberto

2016-01-01

Robotics has a significant potential to enhance the overall capacity and efficiency of healthcare systems. Robots can help surgeons perform better quality operations, leading to reductions in the hospitalisation time of patients and in the impact of surgery on their postoperative quality of life. In particular, robotics can have a significant impact on microsurgery, which presents stringent requirements for superhuman precision and control of the surgical tools. Microsurgery is, in fact, expected to gain importance in a growing range of surgical specialties as novel technologies progressively enable the detection, diagnosis and treatment of diseases at earlier stages. Within such scenarios, robotic microsurgery emerges as one of the key components of future surgical interventions, and will be a vital technology for addressing major surgical challenges. Nonetheless, several issues have yet to be overcome in terms of mechatronics, perception and surgeon-robot interfaces before microsurgical robots can achieve their full potential in operating rooms. Research in this direction is progressing quickly and microsurgery robot prototypes are gradually demonstrating significant clinical benefits in challenging applications such as reconstructive plastic surgery, ophthalmology, otology and laryngology. These are reassuring results offering confidence in a brighter future for high-precision surgical interventions.

Functional organ preservation in laryngeal and hypopharyngeal cancer

PubMed Central

Ambrosch, Petra; Fazel, Asita

2012-01-01

The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications. PMID:22558052

Design and implementation of a magnetically suspended microrobotic pick-and-place system

NASA Astrophysics Data System (ADS)

Shameli, Ehsan; Craig, David G.; Khamesee, Mir Behrad

2006-04-01

Micromanipulation is an emerging technology in such diverse areas as precision engineering, microfabrication, and microsurgery. Each of these areas impose certain technological constraints and requirements in fabrication, actuation, and control. This paper performs a review on the latest technologies of microrobotic actuation techniques and suggests a suitable technique for the actuation of a magnetically levitated microrobot. The microrobot, suspended in an externally produced magnetic field, consists of a gripper attached to a series of permanent magnets and is capable of simple pick and place tasks. A number of electromagnets produce the external magnetic field and three laser sensors feedback the position of the levitated microrobot. Through finite element analysis, performance of the levitation system was investigated, and simulations and experiments were carried out to demonstrate the practical capabilities of the proposed system.

Flash scanning the CO2 laser: a revival of the CO2 laser in plastic surgery

NASA Astrophysics Data System (ADS)

Lach, Elliot

1994-09-01

The CO2 laser has broad clinical application yet also presents a number of practical disadvantages. These drawbacks have limited the success and utilization of this laser in plastic surgery. Flashscanner technology has recently been used for char-free CO2 laser surgery of the oropharynx, the external female genital tract, and perirectal mucosa. A commercially available optomechanical flashscanner unit `Swiftlase,' was adapted to a CO2 laser and used for treatment in numerous plastic surgical applications. Conditions and situations that were treated in this study included generalized neurofibromatosis, tuberous sclerosis, rhinophyma, viral warts, breast reconstruction, and deepithelialization prior to microsurgery or local flap transfer and/or skin graft placement. There were no significant wound healing complications. Some patients previously sustained undue scarring from conventional CO2 laser surgery. Conservative, primarily ablative CO2 laser surgery with the Swiftlase has usefulness for treatment of patients in plastic surgery including those that were previously unsuccessfully treated.

CO2 laser versus cold steel margin analysis following endoscopic excision of glottic cancer

PubMed Central

2014-01-01

Objective To compare the suitability of CO2 laser with steel instruments for margin excision in transoral laser microsurgery. Methods Prospective randomized blinded study. Patients with glottic cancer undergoing laser resection were randomized to margin excision by either steel instruments or CO2 laser. Margins were analyzed for size, interpretability and degree of artifact by a pathologist who was blinded to technique. Results 45 patients were enrolled in the study with 226 total margins taken. 39 margins taken by laser had marked artifact and 0 were uninterpretable. 20 margins taken by steel instruments had marked artifact, and 2 were uninterpretable. Controlling for margin size, the laser technique was associated with increasing degrees of margin artifact (p = 0.210), but there was no difference in crude rates of uninterpretability (p = 0.24). Conclusion Laser margin excision is associated with a greater degree of artifact than steel instrument excision, but was not associated with higher rate of uninterpretability. PMID:24502856

Image-guided feedback for ophthalmic microsurgery using multimodal intraoperative swept-source spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography

NASA Astrophysics Data System (ADS)

Li, Jianwei D.; Malone, Joseph D.; El-Haddad, Mohamed T.; Arquitola, Amber M.; Joos, Karen M.; Patel, Shriji N.; Tao, Yuankai K.

2017-02-01

Surgical interventions for ocular diseases involve manipulations of semi-transparent structures in the eye, but limited visualization of these tissue layers remains a critical barrier to developing novel surgical techniques and improving clinical outcomes. We addressed limitations in image-guided ophthalmic microsurgery by using microscope-integrated multimodal intraoperative swept-source spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography (iSS-SESLO-OCT). We previously demonstrated in vivo human ophthalmic imaging using SS-SESLO-OCT, which enabled simultaneous acquisition of en face SESLO images with every OCT cross-section. Here, we integrated our new 400 kHz iSS-SESLO-OCT, which used a buffered Axsun 1060 nm swept-source, with a surgical microscope and TrueVision stereoscopic viewing system to provide image-based feedback. In vivo human imaging performance was demonstrated on a healthy volunteer, and simulated surgical maneuvers were performed in ex vivo porcine eyes. Denselysampled static volumes and volumes subsampled at 10 volumes-per-second were used to visualize tissue deformations and surgical dynamics during corneal sweeps, compressions, and dissections, and retinal sweeps, compressions, and elevations. En face SESLO images enabled orientation and co-registration with the widefield surgical microscope view while OCT imaging enabled depth-resolved visualization of surgical instrument positions relative to anatomic structures-of-interest. TrueVision heads-up display allowed for side-by-side viewing of the surgical field with SESLO and OCT previews for real-time feedback, and we demonstrated novel integrated segmentation overlays for augmented-reality surgical guidance. Integration of these complementary imaging modalities may benefit surgical outcomes by enabling real-time intraoperative visualization of surgical plans, instrument positions, tissue deformations, and image-based surrogate biomarkers correlated with completion of surgical goals.

Intraoperative narrow band imaging better delineates superficial resection margins during transoral laser microsurgery for early glottic cancer.

PubMed

Garofolo, Sabrina; Piazza, Cesare; Del Bon, Francesca; Mangili, Stefano; Guastini, Luca; Mora, Francesco; Nicolai, Piero; Peretti, Giorgio

2015-04-01

The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM. Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test. At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort (P<.001). Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer. © The Author(s) 2014.

Improvements in High Resolution Laryngeal Magnetic Resonance Imaging for Preoperative Transoral Laser Microsurgery and Radiotherapy Considerations in Early Lesions

PubMed Central

Ruytenberg, Thomas; Verbist, Berit M.; Vonk-Van Oosten, Jordi; Astreinidou, Eleftheria; Sjögren, Elisabeth V.; Webb, Andrew G.

2018-01-01

As the benefits, limitations, and contraindications of transoral laser microsurgery (TLM) in glottic carcinoma treatments become better defined, pretreatment imaging has become more important to assess the case-specific suitability of TLM and to predict functional outcomes both for treatment consideration and patient counseling. Magnetic resonance imaging (MRI) is the preferred modality to image such laryngeal tumors, even though imaging the larynx using MRI can be difficult. The first challenge is that there are no commercial radiofrequency (RF) coils that are specifically designed for imaging the larynx, and performance in terms of coverage and signal-to-noise ratio is compromised using general-purpose RF coils. Second, motion in the neck region induced by breathing, swallowing, and vessel pulsation can induce severe image artifacts, sometimes rendering the images unusable. In this paper, we design a dedicated RF coil array, which allows high quality high-resolution imaging of the larynx. In addition, we show that introducing respiratory-triggered acquisition improves the diagnostic quality of the images by minimizing breathing and swallowing artifacts. Together, these developments enable robust, essentially artifact-free images of the full larynx with an isotropic resolution of 1 mm to be acquired within a few minutes. PMID:29928638

An Island Flap Technique for Laryngeal Intracordal Mucous Retention Cysts.

PubMed

Izadi, Farzad; Ghanbari, Hadi; Zahedi, Sahar; Pousti, Behzad; Maleki Delarestaghi, Mojtaba; Salehi, Abolfazl

2015-09-01

Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes. In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament. There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002) and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071) (P=0.622). In the follow-up period (median, 150 days), there was no report of recurrence or mucosal stiffness. The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods.

An Island Flap Technique for Laryngeal Intracordal Mucous Retention Cysts

PubMed Central

Izadi, Farzad; Ghanbari, Hadi; Zahedi, Sahar; Pousti, Behzad; Maleki Delarestaghi, Mojtaba; Salehi, Abolfazl

2015-01-01

Introduction: Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes. Materials and Methods: In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament. Results: There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002) and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071) (P=0.622). In the follow-up period (median, 150 days), there was no report of recurrence or mucosal stiffness. Conclusion: The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods. PMID:26568936

High-speed laser microsurgery of alert fruit flies for fluorescence imaging of neural activity

PubMed Central

Sinha, Supriyo; Liang, Liang; Ho, Eric T. W.; Urbanek, Karel E.; Luo, Liqun; Baer, Thomas M.; Schnitzer, Mark J.

2013-01-01

Intravital microscopy is a key means of monitoring cellular function in live organisms, but surgical preparation of a live animal for microscopy often is time-consuming, requires considerable skill, and limits experimental throughput. Here we introduce a spatially precise (<1-µm edge precision), high-speed (<1 s), largely automated, and economical protocol for microsurgical preparation of live animals for optical imaging. Using a 193-nm pulsed excimer laser and the fruit fly as a model, we created observation windows (12- to 350-µm diameters) in the exoskeleton. Through these windows we used two-photon microscopy to image odor-evoked Ca2+ signaling in projection neuron dendrites of the antennal lobe and Kenyon cells of the mushroom body. The impact of a laser-cut window on fly health appears to be substantially less than that of conventional manual dissection, for our imaging durations of up to 18 h were ∼5–20 times longer than prior in vivo microscopy studies of hand-dissected flies. This improvement will facilitate studies of numerous questions in neuroscience, such as those regarding neuronal plasticity or learning and memory. As a control, we used phototaxis as an exemplary complex behavior in flies and found that laser microsurgery is sufficiently gentle to leave it intact. To demonstrate that our techniques are applicable to other species, we created microsurgical openings in nematodes, ants, and the mouse cranium. In conjunction with emerging robotic methods for handling and mounting flies or other small organisms, our rapid, precisely controllable, and highly repeatable microsurgical techniques should enable automated, high-throughput preparation of live animals for optical experimentation. PMID:24167298

Reconstructive transoral laser microsurgery for posterior glottic web with stenosis.

PubMed

Atallah, Ihab; Manjunath, M Krishniah; Omari, Ahmad Al; Righini, Christian Adrien; Castellanos, Paul F

2017-03-01

To demonstrate that reconstructive transoral laser microsurgical (R-TLM) techniques can be used for the treatment of symptomatic laryngeal posterior glottic web-based stenosis (PGWS) in a large cohort of patients utilizing a postcricoid mucosal advancement flap (PCMAF). Retrospective cohort review. A consecutive series of patients with PGWS who underwent R-TLM using a PCMAF were reviewed for outcomes. After laser excision of the PGWS scar and mobilization of fixed cricoarytenoid joints, a PCMAF was raised using microinstruments and a scanning free-beam CO 2 laser. The flap was advanced and attached over the scar bed using a technique with multiple novel features that make it easy to adopt. Fifty-two patients were treated. Of the cases, 42.3% had a tracheostomy at presentation with grade II to IV PGWS, and 46% of cases had grade III to IV PGWS. In all cases, R-TLM was the only treatment approach. No open reconstructions were performed. No airway stents were used. Patients without tracheostomy, regardless of the grade of stenosis, did not require a tracheostomy to undergo this operation. All tracheostomy patients were successfully decannulated. All patients without a tracheostomy had significant improvement of their respiratory symptoms on the Dyspnea Index (mean Δ = 14.75, P value <.01). RTLM using the PCMAF is a feasible, safe, and effective alternative to open approaches for airway reconstruction for PGWS. This novel transoral technique includes a much simpler endoscopic suturing alternative to knot tying among other new features. It is reproducible and reliable for laryngologists familiar with laryngeal microsurgery. 4. Laryngoscope, 127:685-690, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pradier, Olivier; Christiansen, Hans; Schmidberger, Heinz

Purpose: To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment. Patients and Methods: Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO{sub 2} laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients.more » Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B). Results: Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054). Conclusion: In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy.« less

Advances in laser and tissue interactions: laser microbeams and optical trapping (Invited Paper)

NASA Astrophysics Data System (ADS)

Serafetinides, Alexander A.; Makropoulou, Mersini; Papadopoulos, Dimitris; Papagiakoumou, Eirini; Pietreanu, D.

2005-04-01

The increasing use of lasers in biomedical research and clinical praxis leads to the development and application of new, non-invasive, therapeutic, surgical and diagnostic techniques. In laser surgery, the theory of ablation dictates that pulsed mid-infrared laser beams exhibit strong absorption by soft and hard tissues, restricting residual thermal damage to a minimum zone. Therefore, the development of high quality 3 μm lasers is considered to be an alternative for precise laser ablation of tissue. Among them are the high quality oscillator-two stages amplifier lasers developed, which will be described in this article. The beam quality delivered by these lasers to the biological tissue is of great importance in cutting and ablating operations. As the precision of the ablation is increased, the cutting laser interventions could well move to the microsurgery field. Recently, the combination of a laser scalpel with an optical trapping device, under microscopy control, is becoming increasingly important. Optical manipulation of microscopic particles by focused laser beams, is now widely used as a powerful tool for 'non-contact' micromanipulation of cells and organelles. Several laser sources are employed for trapping and varying laser powers are used in a broad range of applications of optical tweezers. For most of the lasers used, the focal spot of the trapping beam is of the order of a micron. As the trapped objects can vary in size from hundreds of nanometres to hundreds of microns, the technique has recently invaded in to the nanocosomos of genes and molecules. However, the use of optical trapping for quantitative research into biophysical processes requires accurate calculation of the optical forces and torques acting within the trap. The research and development efforts towards a mid-IR microbeam laser system, the design and realization efforts towards a visible laser trapping system and the first results obtained using a relatively new calibration method to calculate the forces experienced in the optical trap are discussed in detail in the following.

[Microsurgery].

PubMed

Binder, J-P

2010-10-01

This article traces some of the developments in the innovation of microsurgery since the first free flaps in the 1970s. French reconstructive surgeons contribution to microsurgery and composite tissue allotransplantation was particularly important. Robotic assisted microsurgery and microgravity represent some of the latest innovations. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

[Microsurgery, a 'small' surgical revolution in the medical history of the 20th century].

PubMed

Haeseker, B

1999-04-17

Microsurgery in the twentieth century enabled surgeons to operate on very fine structures, which was impossible before the advent of the microscope. Since 1860 loupe magnification was employed in rare cases. In 1921 Nylén from Sweden transformed an ordinary laboratory microscope into an operation microscope for ear interventions. The eye specialists were the second group of doctors who employed the microscope in the operating theatre during the years 40-50 of this century. Since 1953 Zeiss in Germany has produced highly professional operation microscopes. In the sixties experimental laboratory studies were taken up to develop microsurgical techniques, microinstruments and suture material. Both plastic and reconstructive surgeons and neurosurgeons continued to develop microsurgery and indeed transformed their disciplines a great deal. Microsurgery is here to stay and still experiments are going on with video-assisted systems in order to further miniaturize the instruments for magnification and to gain a more comfortable working position for the surgeon.

Evidence to support controversy in microsurgery.

PubMed

Fan, Kenneth L; Patel, Ketan M; Mardini, Samir; Attinger, Christopher; Levin, L Scott; Evans, Karen K

2015-03-01

Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

Robotic transanal endoscopic microsurgery: technical details for the lateral approach.

PubMed

Buchs, Nicolas C; Pugin, François; Volonte, Francesco; Hagen, Monika E; Morel, Philippe; Ris, Frederic

2013-10-01

Transanal endoscopic microsurgery is a minimally invasive approach reserved for the resection of selected rectal tumors. However, this approach is technically demanding. Although robotic technology may overcome the limitations of this approach, the system can be difficult to dock, especially in the lithotomy position. The study aim is thus to report the technical details of robotic transanal endoscopic microsurgery with the use of a lateral approach. This study is a prospective evaluation of robotic transanal endoscopic microsurgery in a single tertiary institution, under a protocol approved by our local ethics committee. Patients underwent a routine mechanical bowel preparation and were placed in the left or right lateral position according to the tumor location. A circular anal dilatator was used together with the glove port technique. The robotic system was then docked over the hip. A 30° optic and 2 articulated instruments were used with an additional assistant trocar. The tumor excision was realized with an atraumatic grasper and an articulated cautery hook, and the defect was closed with barbed continuous stiches in each case. The primary outcome was the safety and feasibility of the procedure. Three patients underwent a robotic transanal endoscopic microsurgery with the use of the lateral approach. Mean operative time was 110 minutes, including 20 minutes for the docking of the robot. There was 1 intraoperative complication (a pneumoperitoneum without intraabdominal lesion) and no postoperative complications. Mean hospital stay was 3 days. Margins were negative in all the cases. The study was limited by the small number of patients. Robotic transanal endoscopic microsurgery with use of the lateral approach is feasible and may facilitate the local resection of small lesions of the mid and lower rectum. It might assume an important place in sphincter-preserving surgery, especially for selected and early rectal cancer (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A114).

Resolution and throughput optimized intraoperative spectrally encoded coherence tomography and reflectometry (iSECTR) for multimodal imaging during ophthalmic microsurgery

NASA Astrophysics Data System (ADS)

Malone, Joseph D.; El-Haddad, Mohamed T.; Leeburg, Kelsey C.; Terrones, Benjamin D.; Tao, Yuankai K.

2018-02-01

Limited visualization of semi-transparent structures in the eye remains a critical barrier to improving clinical outcomes and developing novel surgical techniques. While increases in imaging speed has enabled intraoperative optical coherence tomography (iOCT) imaging of surgical dynamics, several critical barriers to clinical adoption remain. Specifically, these include (1) static field-of-views (FOVs) requiring manual instrument-tracking; (2) high frame-rates require sparse sampling, which limits FOV; and (3) small iOCT FOV also limits the ability to co-register data with surgical microscopy. We previously addressed these limitations in image-guided ophthalmic microsurgery by developing microscope-integrated multimodal intraoperative swept-source spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography. Complementary en face images enabled orientation and coregistration with the widefield surgical microscope view while OCT imaging enabled depth-resolved visualization of surgical instrument positions relative to anatomic structures-of-interest. In addition, we demonstrated novel integrated segmentation overlays for augmented-reality surgical guidance. Unfortunately, our previous system lacked the resolution and optical throughput for in vivo retinal imaging and necessitated removal of cornea and lens. These limitations were predominately a result of optical aberrations from imaging through a shared surgical microscope objective lens, which was modeled as a paraxial surface. Here, we present an optimized intraoperative spectrally encoded coherence tomography and reflectometry (iSECTR) system. We use a novel lens characterization method to develop an accurate model of surgical microscope objective performance and balance out inherent aberrations using iSECTR relay optics. Using this system, we demonstrate in vivo multimodal ophthalmic imaging through a surgical microscope

Highlights of Thirty-Year Experience of CO2 Laser Use at the Florence (Italy) Department of Dermatology

PubMed Central

Campolmi, Piero; Bonan, Paolo; Cannarozzo, Giovanni; Bassi, Andrea; Bruscino, Nicola; Arunachalam, Meena; Troiano, Michela; Lotti, Torello; Moretti, Silvia

2012-01-01

The CO2 laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO2 laser delivery system and the newer “superpulsed” and scanned CO2 systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO2 laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital. PMID:22593693

[A retrospective study of 180 cases of apical microsurgery].

PubMed

Wang, Hanguo; Li, Dan; Tian, Yu; Yu, Qing

2014-07-01

To evaluate the outcome and the potential prognostic factors of apical microsurgery. The teeth with persistent periapical diseases were treated by microsurgery using micro instruments, ultrasonic retrotips and mineral trioxide aggregate (MTA) under dental operate microscope. The procedure includes incision and flap retraction, osteotomy, apicoectomy, retro- preparation and retro- filling of root canal. Patients were recalled at 1, 3, 6, and 12- month intervals. The outcome was evaluated by clinical and radiographic examinations, and the potential prognostic factors were analyzed. One hundred and eighty cases (240 teeth), including 132 upper anterior teeth, 22 lower anterior teeth, 31 upper premolars, 18 lower premolars, 19 upper molars and 18 lower molars, were treated by microsurgery between July 2010 and December 2012. A total of 152 cases (207 teeth) were recalled. The application of the apical microsurgery included failure of previous endodontic treatment, periapical lesion with post, periapical cyst, calcified canals, separated instruments, overfilling, open apex, root facture, failure of previous apical surgery, apical fenestration, and special root canal system. The success rate was 90.8% (188/207). Age, sex, tooth position, type of periapical radiolucency, fistula and clinical application type appeared to have a negative effect on the outcome. Endo-perio lesion was a significant factor. Eighteen cases (19 teeth) failed mainly because of periodontally involved lesion and vertical root fracture. Apical microsurgery, which combines the magnification and illumination provided by the microscope with the proper use of micro instruments, can treat the teeth with persistent periapical diseases precisely and less traumatically with high success rate. Case selection and standardized operations play a key role for success.

Simulated microsurgery monitoring using intraoperative multimodal surgical microscopy

NASA Astrophysics Data System (ADS)

Lee, Donghyun; Lee, Changho; Kim, Sehui; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

2016-03-01

We have developed an intraoperative multimodal surgical microscopy system that provides simultaneous real-time enlarged surface views and subsurface anatomic information during surgeries by integrating spectral domain optical coherence tomography (SD-OCT), optical-resolution photoacoustic microscopy (OR-PAM), and conventional surgical microscopy. By sharing the same optical path, both OCT and PAM images were simultaneously acquired. Additionally, the custom-made needle-type transducer received the generated PA signals enabling convenient surgical operation without using a water bath. Using a simple augmented device, the OCT and PAM images were projected on the view plane of the surgical microscope. To quantify the performance of our system, we measured spatial resolutions of our system. Then, three microsurgery simulation and analysis were processed: (1) ex vivo needle tracking and monitoring injection of carbon particles in biological tissues, (2) in vivo needle tracking and monitoring injection of carbon particles in tumor-bearing mice, and (3) in vivo guiding of melanoma removal in melanoma-bearing mice. The results indicate that this triple modal system is useful for intraoperative purposes, and can potentially be a vital tool in microsurgeries.

Optical coherence tomography monitoring of vocal fold femtosecond laser microsurgery

NASA Astrophysics Data System (ADS)

Wisweh, Henning; Merkel, Ulrich; Hüller, Ann-Kristin; Lüerßen, Kathrin; Lubatschowski, Holger

2007-07-01

Surgery of benign pathological alterations of the vocal folds results in permanent disphonia if the bounderies of the vocal fold layers are disregarded. Precise cutting with a femtosecond laser (fs-laser) combined with simultanous imaging of the layered structure enables accurate resections with respect to the layer boundaries. Earlier works demonstrated the capability of optical coherence tomography (OCT) for utilization on vocal folds. The layered structure can be imaged with a spatial resolution of 10-20μm up to a depth of 1.5mm. The performance of fs-laser cutting was analyzed on extracted porcine vocal folds with OCT monitoring. Histopathological sections of the same processed samples could be well correlated with the OCT images. With adequate laser parameters thermal effects induced only negligable damage to the processed tissue. The dimensions of the thermal necrosis were determined to be smaller than 1μm. OCT contolled fs-laser cutting of porcine vocal fold tissue in the μm range with minimal tissue damage is presented.

Diode end-pumped passively Q-switched Tm:YAP laser with 1.85-mJ pulse energy.

PubMed

Sebbag, Daniel; Korenfeld, Arik; Ben-Ami, Udi; Elooz, David; Shalom, Eran; Noach, Salman

2015-04-01

Passive Q switching of a Tm:YAP solid-state laser at 1935 nm with Cr:ZnSe and Cr:ZnS polycrystalline saturable absorbers is demonstrated for the first time, to the best of our knowledge. With Cr:ZnS, a maximum pulse energy of 1.85 mJ is obtained for a pulse duration of 35.8 ns, resulting in a peak power of 51.7 kW. With Cr:ZnSe, the achieved pulse energy of 1.55 mJ with a pulse duration of 42.2 ns leads to 36.7-kW peak power. These high pulse energies, together with the unique lasing wavelength at 1935 nm, make this laser a promising tool for biomedical and microsurgery applications.

Light and ultrasound activated microbubbles around gold nanorods for photoacoustic microsurgery

NASA Astrophysics Data System (ADS)

Cavigli, Lucia; Centi, Sonia; Lai, Sarah; Borri, Claudia; Micheletti, Filippo; Tortoli, Paolo; Panettieri, Ilaria; Streit, Ingolf; Rossi, Francesca; Ratto, Fulvio; Pini, Roberto

2017-07-01

Photoacoustic imaging and microsurgery have recently attracted attention for applications in oncology. Here, we present a versatile set-up to trigger vapor microbubbles around plasmonic nanoparticles by a combined light-ultrasound excitation. This system enables the detection and parametrization of bubbles as a function of several variables, such us optical fluence, ultrasound intensity, nanoparticles concentration, thus providing useful directions to the development of new strategies for treatments based on optical cavitation.

Transoral laser microsurgery for locally advanced (T3-T4a) supraglottic squamous cell carcinoma: Sixteen years of experience.

PubMed

Vilaseca, Isabel; Blanch, José Luis; Berenguer, Joan; Grau, Juan José; Verger, Eugenia; Muxí, África; Bernal-Sprekelsen, Manuel

2016-07-01

Controversy exists regarding treatment of advanced laryngeal cancer. The purpose of this study was to evaluate the oncologic and functional outcomes of T3 to T4a supraglottic squamous carcinomas treated with transoral laser microsurgery (TLM). We conducted a retrospective analysis from an SPSS database. Primary outcomes were: locoregional control, overall survival (OS), disease-specific survival (DSS), laryngectomy-free survival, and function-preservation rates. Secondary objectives were: rate of tracheostomies and gastrostomies according to age. Risk factors for local control and larynx preservation were also evaluated. One hundred fifty-four consecutive patients were chosen for this study. Median follow-up was 40.7 + /- 32.8 months. Five and 10-year OS, DSS, and laryngectomy-free survival were 55.6% and 47%, 67.6% and 58.6%, and 75.2% and 59.5%, respectively. Paraglottic involvement was an independent factor for larynx preservation. Six patients (3.9%) needed a definitive tracheostomy, a gastrostomy, or both. The gastrostomy rate was higher in the group of patients above 65 years of age (p = .03). Five-year laryngectomy-free survival with preserved function was 74.5%. TLM constitutes a true alternative for organ preservation in locally advanced supraglottic carcinomas with good oncologic and functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1050-1057, 2016. © 2016 Wiley Periodicals, Inc.

[Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review].

PubMed

Knobloch, K; Gohritz, A; Busch, K; Spies, M; Vogt, P M

2007-04-01

Medical leech therapy has enjoyed a renaissance in the world of reconstructive microsurgery during recent years. Especially venous congestion is decreased using hirudo medicinalis application such as following replantation of amputated fingers or congested flaps. They provide a temporary relief to venous engorgement whilst venous drainage is re-established. Living in symbiosis with Aeromonas hydrophila, who can digest the sixfold blood meal related to their body weight, and a broad number of anticoagulant agents such as the thrombin inhibitor hirudin, apyrase as well as collagenase, hyaluronidase, Factor Xa inhibitor and fibrinase I and II, leeches decrease venous congestion. Laser Doppler flowmetry could demonstrate a significant increase in superficial skin perfusion following leech application 16 mm around the biting zone. Following the initial blood meal accounting for about 2.5 ml, the anticoagulant effect of the various leeches enzymes follows within the next 5-6 hours, which both account for the beneficial effects. Infection associated with leech therapy is a documented complication of leech application, with reported incidences ranging from 2.4 to 20 % and a chinolone antibiotic is currently recommended to face the potential Aeromonas hydrophila infection. Anemia is a second adverse effect during medicinal leech application which has to be taken account with repetitive blood samples. Besides the successful applications of leeches in various applications in plastic and reconstructive microsurgery, randomized-controlled trials are pending to elucidate the value of hirudo medicinalis according to evidence-based criteria above from case series and case studies.

Histologic effects of different technologies for dissection in endoscopic surgery: Nd:YAG laser, high frequency and water-jet.

PubMed

Schurr, M O; Wehrmann, M; Kunert, W; Melzer, A; Lirici, M M; Trapp, R; Kanehira, E; Buess, G

1994-01-01

Precise cutting combined with reliable coagulation of the margins of the lesion is an important requirement for dissection techniques in endoscopic surgery. These requirements are met by the two most common ancillary energy sources applied for endoscopic dissection today, electrosurgery and "thermal lasers", mostly the Nd:YAG. For the comparison of the histological effects of monopolar and bipolar high frequency with the Nd:YAG laser an experimental in vitro and in vivo study has been performed. In order to evaluate the advantages of non thermal dissection for endoscopic procedures, a water jet cutting system was included in the in vitro study. In parenchymatous tissue the water jet was found to be the least traumatic technique, followed by bipolar high frequency, laser and monopolar high frequency. The water jet was not applicable for intestinal dissection since uncontrolled bloating of the rectal wall with uncontrolled disruption of the tissue layers occurred. A general disadvantage is that secure haemostasis in the line of incision is hard to achieve. In the microscopic comparison of the shape of the incision, the Nd:YAG laser produced the smoothest lesions with well-defined margins. The monopolar technique was more often associated with irregular and sometimes fissured margins. These results were confirmed in the in vivo part of the study (Transanal Endoscopic Microsurgery).

Applications of optical manipulation in plant biology

NASA Astrophysics Data System (ADS)

Buer, Charles S.

Measuring small forces in biology is important for determining basic physiological parameters of a cell. The plant cell wall provides a primary defense and presents a barrier to research. Magnitudes of small forces are impossible to measure with mechanical transducers, glass needles, atomic force microscopy, or micropipet-based force transduction due to the cell wall. Therefore, a noninvasive method of breaching the plant cell wall to access the symplastic region of the cell is required. Laser light provides sub-micrometer positioning, particle manipulation without mechanical contact, and piconewton force determination. Consequently, the extension of laser microsurgery to expand an experimental tool for plant biology encompassed the overall objective. A protocol was developed for precisely inserting microscopic objects into the periplasmic region of plant callus cells using laser microsurgery. Ginkgo biloba and Agrobacterium rhizogenes were used as the model system for developing the optical tweezers and scalpel techniques. Better than 95% survival was achieved after plasmolyzing G. biloba cells, ablating a 2-4 μm hole through the cell wall using a pulsed UV laser beam, trapping and manipulating bacteria into the periplasmic region, and deplasmolyzing the cells. Optical trapping experiments implied a difference existed between the bacteria models. Determining the optical trapping efficiency of Agrobacterium rhizogenes and A. tumefaciens strains indicated the A. rhizogenes strain, ATCC 11325, was significantly less efficiently trapped than strains A4 and ATCC 15834 and the A. tumefaciens strain LBA4404. Differences were also found in capsule generation, growth media viscosity, and transmission electron microscopy negative staining implying that a difference in surface structure exists. Calcofluor fluorescence suggests the difference involves an exopolysaccharide. Callus cell plasmolysis revealed Hechtian strands interconnecting the plasma membrane and the cell wall. The spring tension of these strands was measured in normal and cold-hardened G. biloba and N. tabacum callus cells. There was little change in flexibility between the groups of cultured cells in either species studied. Microspheres were attached to Hechtian strands in normal cultured Nicotiana tabacum and the cells were deplasmolyzed and replasmolyzed to determine the fate of Hechtian strands. The microspheres either moved to the plasma membrane and adhered or moved to the cell wall and adhered. The attached microspheres occasionally moved independently on the same strand. Inserted microspheres provided a visual probe to follow physiological events within a plant cell.

Picosecond lasers: the next generation of short-pulsed lasers.

PubMed

Freedman, Joshua R; Kaufman, Joely; Metelitsa, Andrea I; Green, Jeremy B

2014-12-01

Selective photothermolysis, first discussed in the context of targeted microsurgery in 1983, proposed that the optimal parameters for specific thermal damage rely critically on the duration over which energy is delivered to the tissue. At that time, nonspecific thermal damage had been an intrinsic limitation of all commercially available lasers, despite efforts to mitigate this by a variety of compensatory cooling mechanisms. Fifteen years later, experimental picosecond lasers were first reported in the dermatological literature to demonstrate greater efficacy over their nanosecond predecessors in the context of targeted destruction of tattoo ink. Within the last 4 years, more than a decade after those experiments, the first commercially available cutaneous picosecond laser unit became available (Cynosure, Westford, Massachusetts), and several pilot studies have demonstrated its utility in tattoo removal. An experimental picosecond infrared laser has also recently demonstrated a nonthermal tissue ablative capability in soft tissue, bone, and dentin. In this article, we review the published data pertaining to dermatology on picosecond lasers from their initial reports to the present as well as discuss forthcoming technology.

Contact laser microsurgery.

PubMed

Jallo, George I; Kothbauer, Karl F; Epstein, Fred J

2002-07-01

Lasers are commonly understood as instruments that produce a freestanding light beam that can cut or vaporize tissue. In contrast, a contact laser is an instrument where the laser beam resides entirely within a coated sapphire crystal probe tip. The authors describe the use of the contact laser for a variety of intraspinal procedures. The probe is mounted on a curved handpiece and can be used in the same way as any microsurgical instrument. The laser energy is delivered only at the probe tip and only on contact of the tip with tissue. Different probe sizes and shapes allow for sharp cutting or tissue vaporization with minimal tissue penetration. We have used this laser in 95 operations for dysraphic conditions, and intradural (both intra- and extramedullary) spinal tumors. It was easy to use for the microsurgically trained neurosurgeon. It is safer than a freestanding, noncontact, laser beam. To lyse scar tissue, evaporate lipomatous tissue, perform a precise myelotomy, and dissect, cut and debulk firm and fibrous intradural spinal lesions this instrument is superior to microscissors, suction, or the ultrasonic aspirator. The contact laser is a useful microsurgical instrument for use in neurosurgery. It combines the advantages of lasers with those of microinstruments and avoids most shortcomings of both.

Morphological effects of nanosecond- and femtosecond-pulsed laser ablation on human middle ear ossicles

NASA Astrophysics Data System (ADS)

Ilgner, Justus F.; Wehner, Martin; Lorenzen, Johann; Bovi, Manfred; Westhofen, Martin

2004-07-01

Introduction: Since the early 1980's, a considerable number of different laser systems have been introduced into reconstructive middle ear surgery. Depending on the ablation mode, however, pressure transients or thermal load to inner ear structures continue to be subject to discussion. Material and methods: We examined single spot ablations by a nanosecond-pulsed, frequency-tripled Nd:YAG-Laser (355 nm, beam diameter 10 μm, pulse rate 2 kHz, power 250 mW) on isolated human mallei. In a second set-up, a similar system (355 nm, beam diameter 20 μm, pulse rate 10 kHz, power 160-1500 mW) was coupled to a scanner to examine the morphology of bone surface ablation over an area of 1mm2. A third set-up employed a femtosecond-pulsed CrLiSAF-Oscillator (850 nm, pulse duration 100 fs, pulse energy 40μJ, beam diameter 36 μm, pulse rate 1 kHz) to compare these results with the former and with those obtained from a commercially available Er:YAG laser for ear surgery (Zeiss ORL E, 2940 nm, single pulse, energy 10-25 mJ). Results: In set-up 1 and 2, thermal effects in terms of marginal carbonization were visible in all single spot ablations of 1 s and longer. With ablations of 0.5 seconds, precise cutting margins with preservation of surrounding tissue could be observed. Cooling with saline solution resulted in no carbonization at 1500 mW and a scan speed of 500 mm/s. Set-up 3 equally showed no carbonization, although scanning times were longer and ablation less pronounced. Conclusion: Ultrashort pulsed laser systems could potentially aid further refinement of reconstructive microsurgery of the middle ear.

Nurse training with simulation: an innovative approach to teach complex microsurgery patient care.

PubMed

Flurry, Mitchell; Brooke, Sebastian; Micholetti, Brett; Natoli, Noel; Moyer, Kurtis; Mnich, Stephanie; Potochny, John

2012-10-01

Simulation has become an integral part of education at all levels within the medical field. The ability to allow personnel to practice and learn in a safe and controlled environment makes it a valuable tool for initial training and continued competence verification. An area of specific interest to the reconstructive microsurgeon is assurance that the nursing staff has adequate training and experience to provide optimum care for microsurgery patients. Plastic surgeons in institutions where few microsurgeries are performed face challenges teaching nurses how to care for these complex patients. Because no standard exists to educate microsurgery nurses, learning often happens by chance on-the-job encounters. Outcomes, therefore, may be affected by poor handoffs between inexperienced personnel. Our objective is to create a course that augments such random clinical experience and teaches the knowledge and skills necessary for successful microsurgery through simulated patient scenarios. Quality care reviews at our institution served as the foundation to develop an accredited nursing course providing clinical training for the care of microsurgery patients. The course combined lectures on microsurgery, pharmacology, and flap monitoring as well as simulated operating room, surgical intensive care unit, postanesthesia care unit, Trauma Bay, and Floor scenarios. Evaluation of participants included precourse examination, postcourse examination, and a 6-month follow-up. Average test scores were 72% precourse and 92% postcourse. Educational value, effectiveness of lectures and simulation, and overall course quality was rated very high or high by 86% of respondents; 0% respondents rated it as low. Six-month follow-up test score average was 88%. Learning to care for microsurgery patients should not be left to chance patient encounters on the job. Simulation provides a safe, reproducible, and controlled clinical experience. Our results show that simulation is a highly rated and effective way to teach nurses microsurgery patient care. Simulated patient care training should be considered to augment the clinical experience in hospitals where microsurgery is performed.

Robotic Assisted Microsurgery - RAMS FY'97

NASA Technical Reports Server (NTRS)

1997-01-01

JPL and Microdexterity Systems collaborated to develop new surgical capabilities. They developed a Robot Assisted Microsurgery (RAM) tool for surgeons to use for operating on the eye, ear, brain, and blood vessels with unprecedented dexterity. A surgeon can hold the surgical instrument with motions of 6 degrees of freedom with an accuracy of 25 microns in a 70 cu cm workspace. In 1996 a demonstration was performed to remove a microscopic particle from a simulated eyeball. In 1997, tests were performed at UCLA to compare telerobotics with mechanical operations. In 5 out of 7 tests, the RAM tool performed with a significant improvement of preciseness over mechanical operation. New design features include: (1) amplified forced feedback; (2) simultaneous slave robot instrumentation; (3) index control switch on master handle; and (4) tool control switches. Upgrades include: (1) increase in computational power; and (2) installation of hard disk memory storage device for independent operation and independent operation of forceps. In 1997 a final demonstration was performed using 2 telerobotics simultaneously in a microsurgery suture procedure to close a slit in a thin sheet of latex rubber which extended the capabilities of microsurgery procedures. After completing trials and demonstrations for the FDA the potential benefits for thousands of operations will be exposed.

Tool actuation and force feedback on robot-assisted microsurgery system

NASA Technical Reports Server (NTRS)

Das, Hari (Inventor); Ohm, Tim R. (Inventor); Boswell, Curtis D. (Inventor); Steele, Robert D. (Inventor)

2002-01-01

An input control device with force sensors is configured to sense hand movements of a surgeon performing a robot-assisted microsurgery. The sensed hand movements actuate a mechanically decoupled robot manipulator. A microsurgical manipulator, attached to the robot manipulator, is activated to move small objects and perform microsurgical tasks. A force-feedback element coupled to the robot manipulator and the input control device provides the input control device with an amplified sense of touch in the microsurgical manipulator.

Robotic microsurgery in male infertility and urology-taking robotics to the next level.

PubMed

Gudeloglu, Ahmet; Brahmbhatt, Jamin V; Parekattil, Sijo J

2014-03-01

The initial reports of robotic assisted microsurgery began to appear in the early 1990s. Animal and early human studies were the initial publications. Larger series papers have recently been published from a few institutions. The field of robotic assisted microsurgery is still in evolution and so are adjunctive tools and instruments. It is clearly a different and unique skill set-is it microsurgery or is it robotic surgery, or both. It is clear from history that the art of surgery evolves over time to encompass new technology as long as the outcomes are better for the patient. Our current robotic platforms may not be ideal for microsurgery, however, the use of adjunctive tools and instrument refinement will further its future potential. This review article presents the current state of the art in various robotic assisted microsurgical procedures in male infertility and urology. Some novel applications of taking microsurgery to areas not classically accessible (intra-abdominal vasovasostomy) and adjunctive tools will also be presented.

Prior experience in micro-surgery may improve the surgeon's performance in robotic surgical training.

PubMed

Perez, Manuela; Perrenot, Cyril; Tran, Nguyen; Hossu, Gabriela; Felblinger, Jacques; Hubert, Jacques

2013-09-01

Robotic surgery has witnessed a huge expansion. Robotic simulators have proved to be of major interest in training. Some authors have suggested that prior experience in micro-surgery could improve robotic surgery training. To test micro-surgery as a new approach in training, we proposed a prospective study comparing the surgical performance of micro-surgeons with that of general surgeons on a robotic simulator. 49 surgeons were enrolled; 11 in the micro-surgery group (MSG); 38 n the control group (CG). Performance was evaluated based on five dV-Trainer® exercises. MSG achieved better results for all exercises including exercises requiring visual evaluation of force feed-back, economy of motion, instrument force and position. These results show that experience in micro-surgery could significantly improve surgeons' abilities and their performance in robotic training. So, as micro-surgery practice is relatively cheap, it could be easily included in basic robotic surgery training. Copyright © 2013 John Wiley & Sons, Ltd.

Micro-telerobotic applications for microsurgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ford, W.E.; Morimoto, A.K.; Kozlowski, D.M.

MicroDexterity Systems Inc. and Sandia National Laboratories are collaborating on the design of a six degree-of-freedom surgeon-controlled micropositioner and a six degree-of-freedom surgeon-controlled master for use in microsurgery. A control system will provide the linkage between the force-reflecting master and micropositioner for force scaling, position scaling, and tremor filtering. The technologies developed by this project are expected to enhance the skills of surgeons, improve the success rates for existing microsurgical procedures, make new high-dexterity procedures possible, and ultimately reduce surgical costs by increasing the precision and speed of operations. This paper discusses the motivation, approach, and accomplishments to date.

Glottic and supraglottic pT3 squamous cell carcinoma: outcomes with transoral laser microsurgery.

PubMed

Pantazis, Dimitrios; Liapi, Georgia; Kostarelos, Dimitrios; Kyriazis, Georgios; Pantazis, Theodoros-Leonidas; Riga, Maria

2015-08-01

Patients diagnosed with T3 squamous cell laryngeal carcinomas are nowadays offered either organ-preserving surgical or non-surgical treatment, with the optimum approach remaining undefined. No direct comparison of organ-preserving therapeutical options, stratified by anatomical subsites is available in the literature. The aim of this study is to present institutional treatment outcomes for laser-assisted microsurgery (TLM) of laryngeal T3 squamous cell carcinomas and review the relevant literature. Sixty-four consecutive, previously untreated patients were evaluated. Twenty-four supraglottic and 19 glottic patients were treated with TLM and neck dissection, tumor exposure and postoperative upstaging of the tumors through pathology evaluation of the specimens being the only exclusion criteria. Five-year disease-specific survival and organ preservation rates for supraglottic carcinomas were both 91.7 %. The respective values for glottic carcinomas were 63.2 and 73.3 %. TLM-treated T3 supraglottic tumors seem to attribute better outcomes than T3 glottic tumors in terms of recurrence-free survival, organ preservation and local control (p = 0.01, <0.0001 and 0.01, respectively). The results of this study suggest that TLM-treated T3 supraglottic tumors have a good prognosis, substantially better than that of glottic tumors. A literature review, on the other hand, attributes to chemo-radiation-treated T3 supraglottic tumors a considerably poorer prognosis. Further studies of homogenous populations in terms of anatomical subsites are needed in order to reach a consensus regarding treatment of T3 laryngeal tumors.

Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies.

PubMed

Dombrée, Manon; Crott, Ralph; Lawson, Georges; Janne, Pascal; Castiaux, Annick; Krug, Bruno

2014-10-01

Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured interviews. A process map identified 17 activities, to which the detailed cost data are related. One-way sensitivity analyses on the patient throughput, the cost of the equipment or operative times were performed. The total cost for supraglottic open (135-203 min), TLM (110-210 min) and TORS (35-130 min) approaches were 3,349 euro (3,193-3,499 euro), 3,461 euro (3,207-3,664 euro) and 5,650 euro (4,297-5,974 euro), respectively. For total laryngectomy, the overall cost were 3,581 euro (3,215-3,846 euro) for open and 6,767 euro (6,418-7,389 euro) for TORS. TORS cost is mostly influenced by equipment (54%) where the other procedures are predominantly determined by personnel cost (about 45%). Even when we doubled the yearly case-load, used the shortest operative times or a calculation without robot equipment costs we did not reach cost equivalence. TORS is more expensive than standard approaches and mainly influenced by purchase and maintenance costs and the use of proprietary instruments. Further trials on long-term outcomes and costs following TORS are needed to evaluate its cost-effectiveness.

Analysis of therapeutic methods for treating vocal process granulomas.

PubMed

Ma, Lijing; Xiao, Yang; Ye, Jingying; Yang, Qingwen; Wang, Jun

2015-03-01

The combination of laryngeal microsurgery and local injections of botulinum toxin type A (BTA) can increase the cure rate of patients with vocal process granulomas (VPGs). To analyze the therapeutic effects of conservative treatments, microsurgical resection with suturing and microsurgery in combination with local injections of BTA for the treatment of VPGs. A retrospective analysis of 168 cases of VPG was performed. All of the patients initially received a conservative treatment. Some of the patients who did not respond to the conservative treatments were treated using microsurgical resection and microsuturing using an 8-0 absorbable filament. Other patients additionally received a four-point injection of BTA into the thyroarytenoid muscle and the arytenoid muscle on the operated side. The lesions of 41.3% (71/168) of the patients who were given the conservative treatments (including acid suppression, vocal rest, and voice therapy) disappeared, and the lesions of 10.7% (18/168) of the patients were reduced. The conservative treatments were unsuccessful for 47% (79/168) of the patients. The cure rate was 78.4% (29/37) for the patients who were treated by microscope resection using a CO2 laser and microsuturing of the surrounding mucosa. Of the eight patients who experienced a recurrence, five of them had lesions that disappeared after 3 months of conservative treatment, whereas the other three patients recovered after a second operation. The cure rate of the 42 patients who were treated using microsurgery combined with local injections of BTA was 95.2% (40/42), with only 2 cases of recurrence at 2 months post-treatment.

Laryngeal amyloidosis: diagnosis, pathophysiology and management.

PubMed

Phillips, N M; Matthews, E; Altmann, C; Agnew, J; Burns, H

2017-07-01

Laryngeal amyloidosis represents approximately 1 per cent of all benign laryngeal lesions, and can cause variable symptoms depending on anatomical location and size. Treatment ranges from observation through to endoscopic microsurgery, laser excision and laryngectomy. To highlight the diversity of presentations, increase awareness of paediatric amyloidosis and update the reader on current management. Five cases are illustrated. Four adult patients were female, and the one child, the second youngest in the literature, was male. Amyloid deposits were identified in all laryngeal areas, including the supraglottis, glottis and subglottis. Treatment consisted of balloon dilatation, endoscopic excision, laser cruciate incision, and resection with carbon dioxide laser, a microdebrider and coblation wands. Laryngeal amyloidosis remains a rare and clinically challenging condition. Diagnosis should be considered for unusual appearing submucosal laryngeal lesions. Treatment of this disease needs to be evaluated on a case-by-case basis and managed within an appropriate multidisciplinary team.

Laser microsurgery of higher plant cell walls permits patch-clamp access

NASA Technical Reports Server (NTRS)

Henriksen, G. H.; Taylor, A. R.; Brownlee, C.; Assmann, S. M.; Evans, M. L. (Principal Investigator)

1996-01-01

Plasma membranes of guard cells in epidermal peels of Vicia faba and Commelina communis can be made accessible to a patch-clamp pipet by removing a small portion (1-3 micrometers in diameter) of the guard cell wall using a microbeam of ultraviolet light generated by a nitrogen laser. Using this laser microsurgical technique, we have measured channel activity across plasma membranes of V. faba guard cells in both cell-attached and isolated patch configurations. Measurements made in the inside-out patch configuration revealed two distinct K(+)-selective channels. Major advantages of the laser microsurgical technique include the avoidance of enzymatic protoplast isolation, the ability to study cell types that have been difficult to isolate as protoplasts or for which enzymatic isolation protocols result in protoplasts not amenable to patch-clamp studies, the maintenance of positional information in single-channel measurements, reduced disruption of cell-wall-mediated signaling pathways, and the ability to investigate intercellular signaling through studies of cells remaining situated within tissue.

High power diode lasers for solid-state laser pumps

NASA Technical Reports Server (NTRS)

Linden, Kurt J.; Mcdonnell, Patrick N.

1994-01-01

The development and commercial application of high power diode laser arrays for use as solid-state laser pumps is described. Such solid-state laser pumps are significantly more efficient and reliable than conventional flash-lamps. This paper describes the design and fabrication of diode lasers emitting in the 780 - 900 nm spectral region, and discusses their performance and reliability. Typical measured performance parameters include electrical-to-optical power conversion efficiencies of 50 percent, narrow-band spectral emission of 2 to 3 nm FWHM, pulsed output power levels of 50 watts/bar with reliability values of over 2 billion shots to date (tests to be terminated after 10 billion shots), and reliable operation to pulse lengths of 1 ms. Pulse lengths up to 5 ms have been demonstrated at derated power levels, and CW performance at various power levels has been evaluated in a 'bar-in-groove' laser package. These high-power 1-cm stacked-bar arrays are now being manufactured for OEM use. Individual diode laser bars, ready for package-mounting by OEM customers, are being sold as commodity items. Commercial and medical applications of these laser arrays include solid-state laser pumping for metal-working, cutting, industrial measurement and control, ranging, wind-shear/atmospheric turbulence detection, X-ray generation, materials surface cleaning, microsurgery, ophthalmology, dermatology, and dental procedures.

Towards a Global Understanding and Standardisation of Education and Training in Microsurgery

PubMed Central

Leung, Clement Chi Ming; Tos, Pierluigi; Ionac, Mihai; Froschauer, Stefan; Myers, Simon R

2013-01-01

With an increasing emphasis on microsurgery skill acquisition through simulated training, the need has been identified for standardised training programmes in microsurgery. We have reviewed microsurgery training courses available across the six continents of the World. Data was collected of relevant published output from PubMed, MEDLINE (Ovid), and EMBASE (Ovid) searches, and from information available on the Internet of up to six established microsurgery course from each of the six continents of the World. Fellowships and courses that concentrate on flap harvesting rather than microsurgical techniques were excluded. We identified 27 centres offering 39 courses. Total course length ranged from 20 hours to 1,950 hours. Student-to-teacher ratios ranged from 2:1 to 8:1. Only two-thirds of courses offered in-vivo animal models. Instructions in microvascular end-to-end and end-to-side anastomoses were common, but peripheral nerve repair or free groin flap transfer were not consistently offered. Methods of assessment ranged from no formal assessment, where an instructor monitored and gave instant feedback, through immediate assessment of patency and critique on quality of repair, to delayed re-assessment of patency after a 12 to 24 hours period. Globally, training in microsurgery is heterogeneous, with variations primarily due to resource and regulation of animal experimentation. Despite some merit to diversity in curricula, there should be a global minimum standard for microsurgery training. PMID:23898423

Methods for Generation and Detection of Nonstationary Vapor Nanobubbles Around Plasmonic Nanoparticles.

PubMed

Lukianova-Hleb, Ekaterina Y; Lapotko, Dmitri O

2017-01-01

Laser pulse-induced vapor nanobubbles are nonstationary nanoevents that offer a broad range of applications, especially in the biomedical field. Plasmonic (usually gold) nanoparticles have the highest energy efficacy of the generation of vapor nanobubbles and such nanobubbles were historically named as plasmonic nanobubbles. Below we review methods (protocols) for generating and detecting plasmonic nanobubbles in liquids. The biomedical applications of plasmonic nanobubbles include in vivo and in vitro detection and imaging, gene transfer, micro-surgery, drug delivery, and other diagnostic, therapeutic, and theranostic applications.

Dexterity-Enhanced Telerobotic Microsurgery

NASA Technical Reports Server (NTRS)

Charles, Steve; Das, Hari; Ohm, Timothy; Boswell, Curtis; Rodriguez, Guillermo; Steele, Robert; Istrate, Dan

1997-01-01

The work reported in this paper is the result, of a collaboration between researchers at the Jet Propulsion Laboratory and Steve Charles, MD, a vitreo-retinal surgeon. The Robot Assisted MicroSurgery (RAMS) telerobotic workstation developed at JPL is a prototype of a system that will be completely under the manual control of a surgeon. The system has a slave robot that will hold surgical instruments. The slave robot motions replicate in six degrees of freedom those of tile. surgeon's hand measured using a master input device with a surgical instrument, shaped handle. The surgeon commands motions for the instrument by moving the handle in the desired trajectories. The trajectories are measured, filtered, and scaled down then used to drive the slave robot.

[Perioperative coagulation management in microsurgery: report of the consensus workshops in the course of the 31st and 32nd Annual Meeting of the German-language Working Group for microsurgery of the peripheral nerves and vessels (DAM) November 2009 in Erlangen and November 2010 in Basel].

PubMed

Schmitz, M; Riss, R; Kneser, U; Jokuszies, A; Harder, Y; Beier, J P; Schäfer, D J; Vogt, P M; Fansa, H; Andree, C; Pierer, G; Horch, R E

2011-12-01

Microsurgery is a very relevant component of reconstructive surgery. In this context anticoagulation plays an increasing role. At the moment there are no unanimously accepted prospective studies or generally accepted regimes available that could serve as evidence-based guidelines for the prevention of thrombosis in microsurgery. With regard to this problem the aim of a series of workshops during the annual meetings of the German-speaking group for microsurgery in 2009 and 2010 was to establish a first possible consensus. This article reflects the main aspects of the ongoing development of a generally acceptable guideline for anticoagulation in microsurgery as interim report of these consensus workshops. Basically there are 3 main agents in thromboprophylaxis available: antiplatelet drugs, dextran and heparin. In the course of the workshops no general use of aspirin or dextran for anticoagulation in microsurgery was recommended. The use of heparin as anticoagulation agent is advisable for different indications. Low molecular heparins (LMH) have certain advantages in comparison to unfractionated heparins (UFH) and are therefore preferred by most participants. Indications for UFH are still complex microsurgical revisions, renal failure and some specific constellations in patients undergoing reconstruction of the lower extremity, where the continuous administration of heparin is recommended. At the moment of clamp release a single-shot of UFH is still given by many microsurgeons, despite a lack of scientific evidence. Future prospective clinical trials and the establishment of a generally accepted evidence-based guideline regarding anticoagulation treatment in microsurgery are deemed necessary. © Georg Thieme Verlag KG Stuttgart · New York.

The Rat Model in Microsurgery Education: Classical Exercises and New Horizons

PubMed Central

Shurey, Sandra; Akelina, Yelena; Legagneux, Josette; Malzone, Gerardo; Jiga, Lucian

2014-01-01

Microsurgery is a precise surgical skill that requires an extensive training period and the supervision of expert instructors. The classical training schemes in microsurgery have started with multiday experimental courses on the rat model. These courses have offered a low threat supervised high fidelity laboratory setting in which students can steadily and rapidly progress. This simulated environment allows students to make and recognise mistakes in microsurgery techniques and thus shifts any related risks of the early training period from the operating room to the lab. To achieve a high level of skill acquisition before beginning clinical practice, students are trained on a comprehensive set of exercises the rat model can uniquely provide, with progressive complexity as competency improves. This paper presents the utility of the classical rat model in three of the earliest microsurgery training centres and the new prospects that this versatile and expansive training model offers. PMID:24883268

Diode Laser for Laryngeal Surgery: a Systematic Review.

PubMed

Arroyo, Helena Hotz; Neri, Larissa; Fussuma, Carina Yuri; Imamura, Rui

2016-04-01

Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.

Diode Laser for Laryngeal Surgery: a Systematic Review

PubMed Central

Arroyo, Helena Hotz; Neri, Larissa; Fussuma, Carina Yuri; Imamura, Rui

2016-01-01

Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. Conclusion: The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects. PMID:27096024

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2014-10-01

Shahani B. Peripheral-nerve allotransplantation in rats immunosuppressed with transient or long-term FK-506. Journal of reconstructive microsurgery ...multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions . Microsurgery . 2012 Jan;32(1):1-14. PubMed PMID: 22121093...PTB method can provide fixation strengths 6 approaching that of conventional microsurgery and that the PTB repair is unlikely to be disturbed in

Twelve tips for postgraduate or undergraduate medics building a basic microsurgery simulation training course.

PubMed

Mason, Katrina A; Theodorakopoulou, Evgenia; Pafitanis, Georgios; Ghanem, Ali M; Myers, Simon R

2016-09-01

Microsurgery is used in a variety of surgical specialties, including Plastic Surgery, Maxillofacial Surgery, Ophthalmic Surgery, Otolaryngology and Neurosurgery. It is considered one of the most technically challenging fields of surgery. Microsurgical skills demand fine, precise and controlled movements, and microsurgical skill acquisition has a steep initial learning curve. Microsurgical simulation provides a safe environment for skill acquisition before operating clinically. The traditional starting point for anyone wanting to pursue microsurgery is a basic simulation training course. We present twelve tips for postgraduate and undergraduate medics on how to set up and run a basic ex-vivo microsurgery simulation training course suitable for their peers.

Stepwise training for reconstructive microsurgery: the journey to becoming a confident microsurgeon in singapore.

PubMed

Ramachandran, Savitha; Ong, Yee-Siang; Chin, Andrew Yh; Song, In-Chin; Ogden, Bryan; Tan, Bien-Keem

2014-05-01

Microsurgery training in Singapore began in 1980 with the opening of the Experimental Surgical Unit. Since then, the unit has continued to grow and have held microsurgical training courses biannually. The road to becoming a full-fledged reconstructive surgeon requires the mastering of both microvascular as well as flap raising techniques and requires time, patience and good training facilities. In Singapore, over the past 2 decades, we have had the opportunity to develop good training facilities and to refine our surgical education programmes in reconstructive microsurgery. In this article, we share our experience with training in reconstructive microsurgery.

Stepwise Training for Reconstructive Microsurgery: The Journey to Becoming a Confident Microsurgeon in Singapore

PubMed Central

Ong, Yee-Siang; Chin, Andrew YH; Song, In-Chin; Ogden, Bryan; Tan, Bien-Keem

2014-01-01

Microsurgery training in Singapore began in 1980 with the opening of the Experimental Surgical Unit. Since then, the unit has continued to grow and have held microsurgical training courses biannually. The road to becoming a full-fledged reconstructive surgeon requires the mastering of both microvascular as well as flap raising techniques and requires time, patience and good training facilities. In Singapore, over the past 2 decades, we have had the opportunity to develop good training facilities and to refine our surgical education programmes in reconstructive microsurgery. In this article, we share our experience with training in reconstructive microsurgery. PMID:24883269

Dermal Coverage of Traumatic War Wounds

DTIC Science & Technology

2015-11-01

Meeting in Washington, DC in December 2014 and at the ASRM (American Society for Reconstructive Microsurgery ) Annual Meeting in the Bahamas in January...Society for Reconstructive Microsurgery ) Annual Meeting in the Bahamas in January 2015.  The first compassionate care case was presented by Dr. Fleming...for Reconstructive Microsurgery ) Annual Meeting in the Bahamas in January 2015. Moreover, the first compassionate care case was presented by Dr. Fleming

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2014-10-01

nerve allotransplantation in rats immunosuppressed with transient or long-term FK-506. Journal of reconstructive microsurgery . 1996 Oct;12(7):451-9...outcomes in sensory, mixed, and motor nerve reconstructions . Microsurgery . 2012 Jan;32(1):1-14. PubMed PMID: 22121093. Epub 2011/11/29. eng. 12...method can provide fixation strengths 5 approaching that of conventional microsurgery and that the PTB repair is unlikely to be disturbed in vivo

Evaluating the effects of a 532-nm fiber-based KTP laser on transoral laser surgery supplies.

PubMed

Coughlan, Carolyn A; Verma, Sunil P

2013-11-01

The KTP laser has become commonplace in transoral head and neck surgery. The interactions of this laser with commonly used supplies in transoral surgery have not been formally examined. This study evaluates the effects of the KTP laser on surgical supplies. Experimental study. The study was conducted in an empty operating room at a university-affiliated medical center. An Aura XP 532-nm KTP laser with a 600-nm fiber was used in pulsed and continuous modes. The beam was focused at the shaft and balloon of 3 "laser-safe" endotracheal tubes (ETTs), a polyvinyl chloride (PVC) ETT, and a Codman surgical patty. Time to penetrate was recorded. Results The KTP laser beam was unable to penetrate any of the laser-resistant ETTs. It did react with the black number markings on the PVC ETT by producing sparks but was unable to penetrate the shaft of the ETT. The KTP laser was nonreactive with all ETT cuffs except in 1 of 3 trials with the outer balloon cuff of a Rusch Lasertubus ETT when the laser was used in a continuous mode. The KTP laser caused the production of a flame upon contact with the blue radiopaque strip of the surgical patty, even when the patty was wet. This study demonstrates that a number of safe ETT options may be used during transoral laser microsurgery with a KTP laser. In addition, Codman surgical patties are shown to be a significant fire risk in KTP laser surgery.

Translational microsurgery. A new platform for transplantation research.

PubMed

Kobayashi, Eiji; Haga, Junko

2016-03-01

Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.

Microsurgery: the top 50 classic papers in plastic surgery: a citation analysis.

PubMed

Joyce, Cormac Weekes; Carroll, Sean Michael

2014-03-01

The number of citations that a published article has received reflects the importance of the paper in the particular area of practice. In microsurgery, thus far, which journal articles are cited most frequently is unknown. The purpose of this study was to identify and analyze the characteristics of the top 50 papers in the field of microsurgery in the plastic surgery literature. The 50 most cited papers published in high impact plastic surgery and microsurgery journals were identified. The articles were ranked in the order of the number of citations received. These 50 classic papers were analyzed for article type, journal distribution, and geographic and institutional origin. Six international journals contributed to the top 50 papers in microsurgery. The most cited paper reported on the early use of the vascularized bone graft and was cited 116 times. The top 50 papers originated from just 10 countries with the United States producing the most. The Preston and Northcote Community Hospital, Melbourne published 5 papers and this was the most productive institution in the top 50. These papers represent many important milestones in the relatively short history of microsurgery. Furthermore, our citation analysis provides useful information to budding authors as to what makes a paper attain a "classic" status.

Evaluation of the content and accessibility of microsurgery fellowship program websites.

PubMed

Silvestre, Jason; Vargas, Christina R; Ho, Olivia; Lee, Bernard T

2015-10-01

Microsurgery fellowship applicants utilize Internet-based resources such as the San Francisco Match (SF Match) to manage their applications. In deciding where to apply, applicants rely on advice from mentors and online resources including microsurgery fellowship websites (MFWs). The purpose of this study was to evaluate the content and accessibility of MFWs. While microsurgery is practiced by many surgical specialties, this study focused on MFWs for programs available in the 2014 Microsurgery Fellowship Match. Program lists from the American Society for Reconstructive Microsurgery (ASRM) and the San Francisco Match (SF Match) were analyzed for the accessibility of MFW links. MFWs were evaluated for education and recruitment content, and MFW comprehensiveness was compared on the basis of program characteristics using chi square tests. Of the 25 fellowships available, only 18 had websites (72%). SF Match and ASRM listed similar programs (96% overlap) and provided website links (89%, 76%), but only a minority connected directly to the MFW (38%, 23%). A minority of programs were responsive via email inquiry (36%). MFWs maintained minimal education and recruitment content. MFW comprehensiveness was not associated with program characteristics. MFWs are often not readily accessible and contain limited information for fellowship applicants. Given the relative low-cost of website development, MFWs may be improved to facilitate fellow recruitment. © 2015 Wiley Periodicals, Inc.

A microcosting study of microsurgery, LINAC radiosurgery, and gamma knife radiosurgery in meningioma patients

PubMed Central

van Putten, Erik; Nijdam, Wideke M.; Hanssens, Patrick; Beute, Guus N.; Nowak, Peter J.; Dirven, Clemens M.; Hakkaart-van Roijen, Leona

2010-01-01

The aim of the present study is to determine and compare initial treatment costs of microsurgery, linear accelerator (LINAC) radiosurgery, and gamma knife radiosurgery in meningioma patients. Additionally, the follow-up costs in the first year after initial treatment were assessed. Cost analyses were performed at two neurosurgical departments in The Netherlands from the healthcare providers’ perspective. A total of 59 patients were included, of whom 18 underwent microsurgery, 15 underwent LINAC radiosurgery, and 26 underwent gamma knife radiosurgery. A standardized microcosting methodology was employed to ensure that the identified cost differences would reflect only actual cost differences. Initial treatment costs, using equipment costs per fraction, were €12,288 for microsurgery, €1,547 for LINAC radiosurgery, and €2,412 for gamma knife radiosurgery. Higher initial treatment costs for microsurgery were predominantly due to inpatient stay (€5,321) and indirect costs (€4,350). LINAC and gamma knife radiosurgery were equally expensive when equipment was valued per treatment (€2,198 and €2,412, respectively). Follow-up costs were slightly, but not significantly, higher for microsurgery compared with LINAC and gamma knife radiosurgery. Even though initial treatment costs were over five times higher for microsurgery compared with both radiosurgical treatments, our study gives indications that the relative cost difference may decrease when follow-up costs occurring during the first year after initial treatment are incorporated. This reinforces the need to consider follow-up costs after initial treatment when examining the relative costs of alternative treatments. PMID:20526795

Highest Impact Articles in Microsurgery: A Citation Analysis.

PubMed

Kim, Kuylhee; Ibrahim, Ahmed M S; Koolen, Pieter G L; Markarian, Mark K; Lee, Bernard T; Lin, Samuel J

2015-09-01

Microsurgery has developed significantly since the inception of the first surgical microscope. There have been few attempts to describe "classic" microsurgery articles. In this study citation analysis was done to identify the most highly cited clinical and basic science articles published in five peer-reviewed plastic surgery journals. Thomson/Reuters web of knowledge was used to identify the most highly cited microsurgery articles from five journals: Plastic and Reconstructive Surgery, Annals of Plastic Surgery, Journal of Plastic, Reconstructive & Aesthetic Surgery, Journal of Reconstructive Microsurgery, and Microsurgery. Articles were identified and sorted based on the number of citations and citations per year. The 50 most cited clinical and basic science articles were identified. For clinical articles, number of total citations ranged from 120 to 691 (mean, 212.38) and citations per year ranged from 30.92 to 3.05 (mean, 9.33). The most common defect site was the head and neck (n = 15, 30%), and flaps were perforator and muscle/musculocutaneous flaps (n = 10 each, 20%, respectively). For basic science articles, number of citations ranged from 71 to 332 (mean, 130.82) and citations per year ranged from 2.20 to 11.07 (mean, 5.27). There were 27 animal, 21 cadaveric, and 2 combined studies. The most highly cited microsurgery articles are a direct reflection of the educational and clinical trends. Awareness of the most frequently cited articles may serve as a basis for core knowledge in the education of plastic surgery trainees. III. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Controllable generation of reactive oxygen species by femtosecond-laser irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yan, Wei; He, Hao, E-mail: haohe@tju.edu.cn; Wang, Yintao

Femtosecond lasers have been advancing Biophotonics research in the past two decades with multiphoton microscopy, microsurgery, and photodynamic therapy. Nevertheless, laser irradiation is identified to bring photodamage to cells via reactive oxygen species (ROS) generation with unclear mechanism. Meanwhile, currently in biological researches, there is no effective method to provide controllable ROS production precisely, which originally is leaked from mitochondria during respiration and plays a key role in a lot of important cellular processes and cellular signaling pathways. In this study, we show the process of how the tightly focused femtosecond-laser induces ROS generation solely in mitochondria at the verymore » beginning and then release to cytosol if the stimulus is intense enough. At certain weak power levels, the laser pulses induce merely moderate Ca{sup 2+} release but this is necessary for the laser to generate ROS in mitochondria. Cellular original ROS are also involved with a small contribution. When the power is above a threshold, ROS are then released to cytosol, indicating photodamage overwhelming cellular repair ability. The mechanisms in those two cases are quite different. Those results clarify parts of the mechanism in laser-induced ROS generation. Hence, it is possible to further this optical scheme to provide controllable ROS generation for ROS-related biological researches including mitochondrial diseases and aging.« less

Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms.

PubMed

Marcus, Hani J; Seneci, Carlo A; Payne, Christopher J; Nandi, Dipankar; Darzi, Ara; Yang, Guang-Zhong

2014-03-01

Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance. To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery. The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was performed. Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field. New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

[Microsurgery in children].

PubMed

Duteille, F; Yeo, S; Perrot, P

2016-10-01

While we celebrated the fortieth anniversary of the first free flap in children, new techniques emerged in reconstructive surgery (NPT, artificial dermis…) and reduced microsurgery procedures. However, microsurgery in children as in adults still have clinical applications in reconstructive surgery. Free flaps remain essential in clinical situations where they are the only ones to provide capacity for growth and stability scarring, two elements essential to the future quality of life of the children. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Microsurgery Training for the Twenty-First Century

PubMed Central

Myers, Simon Richard; Froschauer, Stefan; Akelina, Yelena; Tos, Pierluigi; Kim, Jeong Tae

2013-01-01

Current educational interventions and training courses in microsurgery are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess current training tools in microsurgery education and devise alternative methods that would enhance training. Simulation is an increasingly important tool for educators because, whilst facilitating improved technical proficiency, it provides a way to reduce risks to both trainees and patients. The International Microsurgery Simulation Society has been founded in 2012 in order to consolidate the global effort in promoting excellence in microsurgical training. The society's aim to achieve standarisation of microsurgical training worldwide could be realised through the development of evidence based educational interventions and sharing best practices. PMID:23898422

Periodontal microsurgery: A case report

PubMed Central

Kapadia, Janak Anil; Bhedasgoankar, Surekha Y.; Bhandari, Saurabh Dilip

2013-01-01

The purpose of this article is to limelight the benefit of periodontal microsurgery in the surgical disciplines. It reviews the benefits and potential applications of magnification and microsurgery in the specialty of periodontics and a case report on microsurgical approach for free gingival graft surgery in the treatment of gingival recession. The increased demand for mucogingival esthetics has required the optimization of periodontal procedures. Microsurgery is a minimally invasive technique that is performed with the surgical microscope and adapted instruments and suture materials. Although this hardware and knowledge of various operations are necessary to achieve patient esthetic expectations, clinicians must be willing to undergo an extended period of systematic training to become familiar with novel operating procedures and instruments. This article describes the application of the surgical microscope to provide enhanced perioplastic treatment. PMID:24554892

DNA Damage in Bone Marrow Cells Induced by Femtosecond and Nanosecond Ultraviolet Laser Pulses.

PubMed

Morkunas, Vaidotas; Gabryte, Egle; Vengris, Mikas; Danielius, Romualdas; Danieliene, Egle; Ruksenas, Osvaldas

2015-12-01

The purpose of this study was to investigate the possible genotoxic impact of new generation 205 nm femtosecond solid-state laser irradiation on the DNA of murine bone marrow cells in vitro, and to compare the DNA damage caused by both femtosecond and nanosecond UV laser pulses. Recent experiments of corneal stromal ablation in vitro and in vivo applying femtosecond UV pulses showed results comparable with or superior to those obtained using nanosecond UV lasers. However, the possible genotoxic effect of ultrashort laser pulses was not investigated. Mouse bone marrow cells were exposed to different doses of 205 nm femtosecond, 213 and 266 nm nanosecond lasers, and 254 nm UV lamp irradiation. The comet assay was used for the evaluation of DNA damage. All types of irradiation demonstrated intensity-dependent genotoxic impact. The DNA damage induced depended mainly upon wavelength rather than on other parameters such as pulse duration, repetition rate, or beam delivery to a target. Both 205 nm femtosecond and clinically applied 213 nm nanosecond lasers' pulses induced a comparable amount of DNA breakage in cells exposed to the same irradiation dose. To further evaluate the suitability of femtosecond UV laser sources for microsurgery, a separate investigation of the genotoxic and mutagenic effects on corneal cells in vitro and, particularly, in vivo is needed.

Functional Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma.

PubMed

Fink, Daniel S; Sibley, Haley; Kunduk, Melda; Schexnaildre, Mell; Sutton, Collin; Kakade-Pawar, Anagha; McWhorter, Andrew J

2016-10-01

Transoral laser microsurgery (TLM) has been increasingly used in lieu of total laryngectomy to treat malignancy after definitive radiation. There are few data in the literature regarding functional outcomes. We retrospectively reviewed voice and swallowing outcomes in patients who underwent TLM for recurrent laryngeal carcinoma. Case series with chart review. Tertiary care center. Forty-two patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013: 28 patients with glottic recurrence and 14 with supraglottic recurrence. Swallowing outcomes were evaluated by gastrostomy tube dependence, the MD Anderson Dysphagia Inventory, and the Functional Oral Intake Scale. Voice outcomes were evaluated by the Voice Handicap Index and observer-rated perceptual analysis. No significant difference was noted between mean pre- and postoperative MD Anderson Dysphagia Inventory scores: 78.25 and 74.9, respectively (P = .118, t = 1.6955). Mean Functional Oral Intake Scale scores after TLM for supraglottic and glottic recurrences were 6.4 and 6.6, respectively. Of 42 patients, 17 (40.5%) required a gastrostomy tube either during radiation or in conjunction with the salvage procedure. Of 17 patients, 15 resumed sufficient oral diet for tube removal. Patients' mean Voice Handicap Index score did increase from 34.3 to 51.5 (P = .047), and their mean perceptual score did decrease from 60.0 to 45.3 (P = .005). However, at 1-year follow-up, there was no significant difference in perceptual score: 61.1 to 57.1 (P = .722). TLM is a successful surgical option for recurrent laryngeal cancer with acceptable functional outcomes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Microsurgery within reconstructive surgery of extremities.

PubMed

Pheradze, I; Pheradze, T; Tsilosani, G; Goginashvili, Z; Mosiava, T

2006-05-01

Reconstructive surgery of extremities is an object of a special attention of surgeons. Vessel and nerve damages, deficiency of soft tissue, bone, associated with infection results in a complete loss of extremity function, it also raises a question of amputation. The goal of the study was to improve the role of microsurgery in reconstructive surgery of limbs. We operated on 294 patients with various diseases and damages of extremities: pathology of nerves, vessels, tissue loss. An original method of treatment of large simultaneous functional defects of limbs has been used. Good functional and aesthetic results were obtained. Results of reconstructive operations on extremities might be improved by using of microsurgery methods. Microsurgery is deemed as a method of choice for extremities' reconstructive surgery as far as outcomes achieved through application of microsurgical technique significantly surpass the outcomes obtained through the use of routine surgical methods.

Light-activated microbubbles around gold nanorods for photoacoustic microsurgery

NASA Astrophysics Data System (ADS)

Cavigli, Lucia; Centi, Sonia; Lai, Sarah; Borri, Claudia; Micheletti, Filippo; Tortoli, Paolo; Panettieri, Ilaria; Streit, Ingolf; Rossi, Francesca; Ratto, Fulvio; Pini, Roberto

2018-02-01

The increasing interest around imaging and microsurgery techniques based on the photoacoustic effect has boosted active research into the development of exogenous contrast agents that may enhance the potential of this innovative approach. In this context, plasmonic particles as gold nanorods are achieving resounding interest, owing to their efficiency of photothermal conversion, intense optical absorbance in the near infrared region, inertness in the body and convenience for conjugation with ligands of molecular targets. On the other hand, the photoinstability of plasmonic particles remains a remarkable obstacle. In particular, gold nanorods easily reshape into nanospheres and so lose their optical absorbance in the near infrared region, under exposure to few-ns-long laser pulses. This issue is attracting much attention and stimulating ad-hoc solutions, such as the addition of rigid shells and the optimization of multiple parameters. In this contribution, we focus on the influence of the shape of gold nanorods on their photothermal behavior and photostability. We describe the photothermal process in the gold nanorods by modeling their optical absorption and consequent temperature dynamics as a function of their aspect ratio (length / diameter). Our results suggest that increasing the aspect ratio does probably not limit the photostability of gold nanorods, while shifting the plasmonic peak towards wavelengths around 1100 nm, which hold more technological interest.

A Telerobot to Extend the Skill of Microsurgeons

NASA Technical Reports Server (NTRS)

Das, H.; Ohm, T.; Boswell, C.; Rodriguez, G.; Steele, R.; Charles, S.

1998-01-01

The engineering details of the Robot Assisted MicroSurgery (RAMS) telerobotic system designed to assist microsurgeons improve the precision and dexterity with which they can position surgical instruments is described in this paper.

Enabling high-precision nonlinear three-dimensional photoprocessing of premeditated designs on a conventional multiphoton imaging system

NASA Astrophysics Data System (ADS)

Garsha, Karl E.

2004-06-01

There is an increasing amount of interest in functionalized microstructural, microphotonic and microelectromechanical systems (MEMS) for use in biological applications. By scanning a tightly focused ultra-short pulsed laser beam inside a wide variety of commercially available polymer systems, the flexibility of the multiphoton microscope can be extended to include routine manufacturing of micro-devices with feature sizes well below the diffraction limit. Compared with lithography, two-photon polymerization has the unique ability to additively realize designs with high resolution in three dimensions; this permits the construction of cross-linked components and structures with hollow cavities. In light of the increasing availability of multiphoton imaging systems at research facilities, femtosecond laser manufacturing becomes particularly attractive in that the modality provides a readily accessible, rapid and high-accuracy 3-D processing capability to biological investigators interested in culture scaffolds and biomimetic tissue engineering, bio-MEMS, biomicrophotonics and microfluidics applications. This manuscript overviews recent efforts towards to enabling user accessible 3-D micro-manufacturing capabilities on a conventional proprietary-based imaging system. Software which permits the off-line design of microstructures and leverages the extensibility of proprietary LCSM image acquisition software to realize designs is introduced. The requirements for multiphoton photo-disruption (ablation) are in some ways analogous to those for multiphoton polymerization. Hence, "beam-steering" also facilitates precision photo-disruption of biological tissues with 3-D resolution, and applications involving tissue microdissection and intracellular microsurgery or three-dimensionally resolved fluorescence recovery after photobleaching (FRAP) studies can benefit from this work as well.

Impact of reconstructive microsurgery in patients with advanced oral cavity cancers.

PubMed

Hanasono, Matthew M; Friel, Michael T; Klem, Christopher; Hsu, Patrick W; Robb, Geoffrey L; Weber, Randal S; Roberts, Dianna B; Chang, David W

2009-10-01

Our goal was to determine the impact of reconstructive microsurgery on the treatment of advanced oral cavity cancers. We reviewed 484 patients undergoing resection of T3-4 oral cavity squamous cell cancers from 1980 to 2004. To examine how reconstructive microsurgery affects outcomes, we compared 135 patients treated prior to the introduction of free tissue transfer and 349 patients treated after the introduction of free tissue transfer. Cancers treated after the introduction of free flaps included a significantly higher proportion of T4 compared to T3 lesions and significantly more advanced N classification lesions. Although cancers were more advanced, survival and recurrence rates were maintained and the rate of positive pathologic margins decreased significantly. In addition, fistula and tracheostomy dependence rates decreased and rates of intelligible speech increased. Reconstructive microsurgery contributes to improved oncologic outcomes in addition to better function and lower morbidity in oral cavity cancer treatment. (c) 2009 Wiley Periodicals, Inc.

Advances in open microsurgery for cerebral aneurysms.

PubMed

Davies, Jason M; Lawton, Michael T

2014-02-01

Endovascular techniques introduced strong extrinsic forces that provoked reactive changes in aneurysm surgery. Microsurgery has become less invasive, more appealing to patients, lower risk, and efficacious for complex aneurysms, particularly those unfavorable for or failing endovascular therapy. To review specific advances in open microsurgery for aneurysms. A university-based, single-surgeon practice was examined for the use of minimally invasive craniotomies, surgical management of recurrence after coiling, the use of intracranial-intracranial bypass techniques, and cerebrovascular volume-outcome relationships. The mini-pterional, lateral supraorbital, and orbital-pterional craniotomies are minimally invasive alternatives to standard craniotomies. Mini-pterional and lateral supraorbital craniotomies were used in one-fourth of unruptured patients, increasing from 22% to 28%, whereas 15% of patients underwent orbital-pterional craniotomies and trended upward from 11% to 20%. Seventy-four patients were treated for coil recurrences (2.3% of all aneurysms) with direct clip occlusion (77%), clip occlusion after coil extraction (7%), or parent artery occlusion with bypass (16%). Intracranial-intracranial bypass (in situ bypass, reimplantation, reanastomosis, and intracranial grafts) transformed the management of giant aneurysms and made the surgical treatment of posterior inferior cerebellar artery aneurysms competitive with endovascular therapy. Centralization maximized the volume-outcome relationships observed with clipping. Aneurysm microsurgery has embraced minimalism, tailoring the exposure to the patient's anatomy with the smallest possible craniotomy that provides adequate exposure. The development of intracranial-intracranial bypasses is an important advancement that makes microsurgery a competitive option for complex and recurrent aneurysms. Trends toward centralizing aneurysm surgery in tertiary centers optimize results achievable with open microsurgery.

Current state and future development of intracranial neuroendoscopic surgery.

PubMed

Cinalli, Giuseppe; Cappabianca, Paolo; de Falco, Raffaele; Spennato, Pietro; Cianciulli, Emilio; Cavallo, Luigi Maria; Esposito, Felice; Ruggiero, Claudio; Maggi, Giuseppe; de Divitiis, Enrico

2005-05-01

Since the introduction of the modern, smaller endoscopes in the 1960s, neuroendoscopy has become an expanding field of neurosurgery. Neuroendoscopy reflects the tendency of modern neurosurgery to aim towards minimalism; that is, access and visualization through the narrowest practical corridor and maximum effective action at the target point with minimal disruption of normal tissue. Transventricular neuroendoscopy allows the treatment of several pathologies inside the ventricular system, such as obstructive hydrocephalus and intra-/paraventricular tumors or cysts, often avoiding the implantation of extracranial shunts or more invasive craniotomic approaches. Endoscopic endonasal transphenoidal surgery allows the treatment of pathologies of the sellar and parasellar region, with the advantage of a wider vision of the surgical field, less traumatism of the nasal structures, greater facility in the treatment of possible recurrences and reduced complications. However, an endoscope may be used to assist microsurgery in virtually any kind of neurosurgical procedures (endoscope-assisted microsurgery), particularly in aneurysm and tumor surgery. Basic principles of optical imaging and the physics of optic fibers are discussed, focusing on the neuroendoscope. The three main chapters of neuroendoscopy (transventricular, endonasal transphenoidal and endoscope-assisted microsurgery) are reviewed, concerning operative instruments, surgical procedures, main indications and results.

Basic Microvascular Anastomosis Simulation Hub Microsurgery Course: An Innovative Competency-Based Approach to Microsurgical Training for Early Year's Plastic Surgery Trainees.

PubMed

Ali, Stephen

2018-04-01

Early year's plastic surgery trainees are faced with a large choice of microsurgery courses to select from. In the context of dwindling study budgets and busy on-call rotas, the pressure to select a high yield course that delivers value for money is of paramount importance.The Basic Microvascular Anastomosis Simulation Hub Microsurgery Course is a GBP £600 (US $790) 5-day 40-hour course based at Barts and The London School of Medicine and Dentistry increasing in popularity among junior trainees to fit this brief.

Microsurgery “without borders”: new limits for reconstruction of post-burn sequelae in the humanitarian setting

PubMed Central

Tocco-Tussardi, I.; Presman, B.; Cherubino, M.; Garusi, C.; Bassetto, F.

2016-01-01

Summary Post-burn contractures account for up to 50% of the workload of a plastic surgery team volunteering in developing nations. Best possible outcome most likely requires extensive surgery. However, extensive approaches such as microsurgery are generally discouraged in these settings. We report two successful cases of severe hand contractures reconstructed with free flaps on a surgical mission in Kenya. Microsurgery can be safely performed in the humanitarian setting by an integration of: personal skills; technical means; education of local personnel; follow-up services; and an effective network for communication. PMID:27857655

Pediatric Microsurgery: A Global Overview.

PubMed

Izadpanah, Ali; Moran, Steven L

2017-04-01

As microsurgical expertise has improved, allowing for the safe transfer of smaller and more refined flaps, free tissue transfer has continued to gain popularity for the management of pediatric soft tissue and bony defects. For the past 2 decades pediatric microsurgery has been shown to be technically feasible and reliable. The major advantage of free tissue transfer in children is the ability to reconstruct defects in a single stage, avoiding the historic treatments of skin grafting, tissue expansion, and pedicled flaps. This article reviews the present state-of-the-art in pediatric microsurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Is There Bias against Simulation in Microsurgery Training?

PubMed

Theman, Todd A; Labow, Brian I

2016-09-01

Background While other surgical specialties have embraced virtual reality simulation for training and recertification, microsurgery has lagged. This study aims to assess the opinions of microsurgeons on the role of simulation in microsurgery assessment and training. Methods We surveyed faculty members of the American Society of Reconstructive Microsurgery to ascertain opinions on their use of simulation in training and opinions about the utility of simulation for skills acquisition, teaching, and skills assessment. The 21-question survey was disseminated online to 675 members. Results Eighty-nine members completed the survey for a 13.2% response rate. Few microsurgeons have experience with high-fidelity simulation, and opinions on its utility are internally inconsistent. Although 84% of respondents could not identify a reason why simulation would not be useful, only 24% believed simulation is a useful measure of clinical performance. Nearly three-fourths of respondents were skeptical that simulation would improve their skills. Ninety-four percent had no experience with simulator-based assessment. Conclusion Simulation has been shown to improve skills acquisition in microsurgery, but our survey suggests that unfamiliarity may foster bias against the technology. Failure to incorporate simulation may adversely affect training and may put surgeons at a disadvantage should these technologies be adopted for recertification by regulatory agencies. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis

PubMed Central

Wang, Jun; Xia, Shu-Jie; Liu, Zhi-Hong; Tao, Le; Ge, Ji-Fu; Xu, Chen-Min; Qiu, Jian-Xin

2015-01-01

Conventional meta-analyses have shown inconsistent results for the efficacy of various treatments of varicoceles. Therefore, we performed a multiple-treatment meta-analysis to assess the effectiveness and safety of 10 methods of varicocelectomy and embolization/sclerotherapy. We systematically reviewed 35 randomized controlled trials and observational studies, from 1966 to August 5, 2013, which compared any of the following treatments for varococeles: laparoscopic, retroperitoneal, open inguinal and subinguinal varicocelectomy, microsurgical subinguinal and inguinal varicocelectomy, percutaneous venous embolization, Tauber antegrade sclerotherapy, retrograde sclerotherapy and expectant therapy (no treatment). Inguinal and subinguinal microsurgery, open inguinal, laparoscopic varicocelectomy showed a significant advantage over expectant therapy in terms of pregnancy rates (odds ratio (OR): 3.48, 2.68, 2.92 and 2.90, respectively). Compared with retroperitoneal open surgery, inguinal microsurgery showed an improvement of sperm density (mean difference (MD): 10.60, 95% confidence interval (CI): 1.92–19.60) and sperm motility (MD: 9.09, 95% CI: 4.88–13.30). Subinguinal and inguinal microsurgery outperformed retroperitoneal open surgery in terms of recurrence (OR: 0.05, 0.06 respectively). Tauber antegrade sclerotherapy and subinguinal microsurgery were associated with the lowest risk of hydrocele formation. The odds of overall complication, compared with retroperitoneal open varicocelectomy, were lowest for inguinal microsurgery (OR = 0.07, 95% CI: 0.02–0.19), followed by subinguinal microsurgery (OR = 0.09, 95% CI: 0.02–0.19). Inguinal and subinguinal micro-varicocelectomy had the highest pregnancy rates, significant increases in sperm parameters, with low odds of complication. These results warrant additional properly conducted randomized controlled clinical studies with larger sample sizes. PMID:25248652

Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.

PubMed

Myrseth, Erling; Møller, Per; Pedersen, Paal-Henning; Vassbotn, Flemming S; Wentzel-Larsen, Tore; Lund-Johansen, Morten

2005-05-01

The aim of the present study was to evaluate the overall treatment efficacy (tumor control, facial nerve function, complications) and quality of life for patients treated primarily for unilateral vestibular schwannomas of 30 mm or less, either by microsurgery or by gamma knife (GK) radiosurgery. The results for the two treatment groups are compared with each other, with main emphasis on the long-term quality of life. This is a retrospective study of 189 consecutive patients, 86 treated by microsurgery and 103 by gamma knife. The mean observation time was 5.9 years. All patients had a magnetic resonance imaging scan and clinical evaluation performed toward the end of the study. To evaluate the quality of life, we used two standardized questionnaires, the Glasgow Benefit Inventory and Short-Form 36. The questionnaires were sent to the 168 living patients. The reply rate was 83.3%. A total of 79.8% of the patients in the microsurgery group and 94.8% of the GK patients had a good facial nerve function (House-Brackmann Grade 1-2). Hearing was usually lost after microsurgery, whereas the GK patients had preserved hearing, which often became reduced over the years after the treatment. The treatment efficacy, defined as no need for additional treatment, was similar for the two treatment modalities. Quality of life was reduced compared with normative data, being most reduced in the microsurgery group. Some of the quality of life questions showed an association with facial nerve function and sex. Posttreatment facial nerve function, hearing, complication rates, and quality of life were all significantly in favor of GK radiosurgery.

[Plastic reconstructive microsurgery in the elderly patient - Consensus statement of the German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels].

PubMed

Ludolph, Ingo; Lehnhardt, Marcus; Arkudas, Andreas; Kneser, Ulrich; Pierer, Gerhard; Harder, Yves; Horch, Raymund E

2018-04-01

During the last two decades, understanding and experience of microsurgical reconstruction have increased. This is linked to improved instruments and technical devices, as well as to the increased number of available donor sites for microvascular flap transfer. If the indication is appropriate, it is now possible to perform personalised, safe and successful microsurgical reconstructions, almost independently of the patients' age. Despite these constant developments, there is little specific literature on microsurgery related to the specific problems of the elderly patient. During two consensus workshops organised by the DAM (German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels), the latest findings and experience with microsurgical reconstruction in the elderly patient were presented by a group of experts and current recommendations were formulated. On the basis of these consensus workshops and the current literature, this article discusses important issues in this area. Georg Thieme Verlag KG Stuttgart · New York.

Reconstructive Microsurgery: The Future Is Today.

PubMed

Amin, Kavit; Mohan, Anita T

2017-01-01

This reconstructive microsurgery course will run yearly and was borne and popularized from its infant meeting the year before, primarily focused on perforator flaps. It is a 2-day course updating residents/registrars to attending physicians/consultants about the most topical advancements in microvascular reconstructive surgery. The course is held at the New York University Langone Hospital in the United States.The timetable is primarily lecture based with the advantage of live-surgical procedures by world-renowned faculty. The timetable includes, but not limited to, facial/hand vascularized composite allotransplantation, upper/lower limb, breast, head and neck, transgender, and lymphedema surgery. Lectures were highly informative and there was ample time for case discussion with the appreciation that managing complex situations often requires input from other colleagues. The faculty focused on the lessons they have learned and potential pitfalls to avoid. The faculty was comprised of leading experts in reconstructive microsurgery from Europe, Korea, and throughout the United States.The primary emphasis of the course was to appreciate the global recognition in advances in microsurgery.

Mastering Lymphatic Microsurgery: A New Training Model in Living Tissue.

PubMed

Campisi, Corrado Cesare; Jiga, Lucian P; Ryan, Melissa; di Summa, Pietro G; Campisi, Corradino; Ionac, Mihai

2017-09-01

Advanced microsurgical techniques have emerged as a promising approach for the treatment of lymphedema, but achieving international standards is limited by a scarcity of adequate training models. The purpose of this report is to describe our in vivo porcine training model for microsurgery. Five female common-breed pigs (Sus scrofa domesticus) weighing 20 to 28 kg were placed under general anesthesia, and blue patent violet dye was injected to highlight lymphatic structures and prepare the pigs for anatomical exploration and microsurgery. The number and type of patent anastomoses achieved and lymph node flaps created and any anatomical differences between porcine and human vessels were noted, in light of evaluating the use of pigs as a training model for microsurgery in living tissue. Multiple lymphatic-venous anastomoses were created at the site of a single incision made at the subinguinal region, running medial and parallel to the saphenous vessels. Ten multiple lymphatic-venous anastomoses were created in total, and all were demonstrated to be patent. Four lymph node flaps were prepared for lymph node transfer. The superficial lymphatic collector system in the caudal limb of the pig was identified and described with particular reference to the superficial, medial (dominant), and lateral branches along the saphenous vein and its accessory. The authors present a safe and adaptable in vivo experimental microsurgical porcine model that provides the opportunity to practice several advanced lymphatic microsurgical techniques in the same animal. The ideal lymph node transfer training model can be developed from this anatomical detail, giving the opportunity to use it for artery-to-artery anastomoses, vein-to-vein anastomoses, and lymphatic-to-lymphatic anastomoses.

[A little story of microsurgery].

PubMed

Qassemyar, Q

2014-10-01

It is difficult to write about the history of microsurgery because many things have already been said. Exhaustive lists of names, dates and "first clinical" are available but some details may be more relevant to appreciate the human adventure that represents microsurgery. Its finality is a precise, methodical and rigorous technical procedure but its origin is audacity, imagination and force of conviction. What seems a priori a paradox is the singularity of a speciality whose applications have forever changed the face of reconstructive surgery. So, some details are reported and are basis of reflection about this great surgical advance. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The reconstructive microsurgery ladder in orthopaedics.

PubMed

Tintle, Scott M; Levin, L Scott

2013-03-01

Since the advent of the operating microscope by Julius Jacobson in 1960, reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the reconstructive ladder for wound closure. The concept of the reconstructive ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical reconstructive ladder. The microsurgical reconstruction ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article. Copyright © 2013. Published by Elsevier Ltd.

Microsurgical free flaps: Controversies in maxillofacial reconstruction

PubMed Central

George, Rinku K.; Krishnamurthy, Arvind

2013-01-01

Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps. PMID:23662264

Pneumoretroperitoneum and Sepsis After Transanal Endoscopic Resection of a Rectal Lateral Spreading Tumor

PubMed Central

Coura, Marcelo de Melo Andrade; de Almeida, Romulo Medeiros; Moreira, Natascha Mourão; de Sousa, João Batista; de Oliveira, Paulo Gonçalves

2017-01-01

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis. PMID:28761873

Robust gap repair in the contractile ring ensures timely completion of cytokinesis

PubMed Central

Maiato, Helder; Pinto, Inês Mendes; Rubinstein, Boris

2016-01-01

Cytokinesis in animal cells requires the constriction of an actomyosin contractile ring, whose architecture and mechanism remain poorly understood. We use laser microsurgery to explore the biophysical properties of constricting rings in Caenorhabditis elegans embryos. Laser cutting causes rings to snap open. However, instead of disintegrating, ring topology recovers and constriction proceeds. In response to severing, a finite gap forms and is repaired by recruitment of new material in an actin polymerization–dependent manner. An open ring is able to constrict, and rings repair from successive cuts. After gap repair, an increase in constriction velocity allows cytokinesis to complete at the same time as controls. Our analysis demonstrates that tension in the ring increases while net cortical tension at the site of ingression decreases throughout constriction and suggests that cytokinesis is accomplished by contractile modules that assemble and contract autonomously, enabling local repair of the actomyosin network. Consequently, cytokinesis is a highly robust process impervious to discontinuities in contractile ring structure. PMID:27974482

Composition and Dynamics of the Nucleolinus, a Link between the Nucleolus and Cell Division Apparatus in Surf Clam (Spisula) Oocytes*

PubMed Central

Alliegro, Mark C.; Hartson, Steven; Alliegro, Mary Anne

2012-01-01

The nucleolinus is a little-known cellular structure, discovered over 150 years ago (Agassiz, L. (1857) Contributions to the Natural History of the United States of America, First Monograph, Part IIL, Little, Brown and Co., Boston) and thought by some investigators in the late 19th to mid-20th century to function in the formation of the centrosomes or spindle. A role for the nucleolinus in formation of the cell division apparatus has recently been confirmed in oocytes of the surf clam, Spisula solidissima (Alliegro, M. A., Henry, J. J., and Alliegro, M. C. (2010) Proc. Natl. Acad. Sci. U.S.A. 107, 13718–13723). However, we know so little about the composition and dynamics of this compartment, it is difficult to construct mechanistic hypotheses or even to be sure that prior reports were describing analogous structures in the cells of mammals, amphibians, plants, and other organisms where it was observed. Surf clam oocytes are an attractive model to approach this problem because the nucleolinus is easily visible by light microscopy, making it accessible by laser microsurgery as well as isolation by common cell fractionation techniques. In this report, we analyze the macromolecular composition of isolated Spisula nucleolini and examine the relationship of this structure to the nucleolus and cell division apparatus. Analysis of nucleolinar RNA and protein revealed a set of molecules that overlaps with but is nevertheless distinct from the nucleolus. The proteins identified were primarily ones involved in nucleic acid metabolism and cell cycle regulation. Monoclonal antibodies generated against isolated nucleolini revealed centrosomal forerunners in the oocyte cytoplasm. Finally, induction of damage to the nucleolinus by laser microsurgery altered the trafficking of α- and γ-tubulin after fertilization. These observations strongly support a role for the nucleolinus in cell division and represent our first clues regarding mechanism. PMID:22219192

Composition and dynamics of the nucleolinus, a link between the nucleolus and cell division apparatus in surf clam (Spisula) oocytes.

PubMed

Alliegro, Mark C; Hartson, Steven; Alliegro, Mary Anne

2012-02-24

The nucleolinus is a little-known cellular structure, discovered over 150 years ago (Agassiz, L. (1857) Contributions to the Natural History of the United States of America, First Monograph, Part IIL, Little, Brown and Co., Boston) and thought by some investigators in the late 19th to mid-20th century to function in the formation of the centrosomes or spindle. A role for the nucleolinus in formation of the cell division apparatus has recently been confirmed in oocytes of the surf clam, Spisula solidissima (Alliegro, M. A., Henry, J. J., and Alliegro, M. C. (2010) Proc. Natl. Acad. Sci. U.S.A. 107, 13718-13723). However, we know so little about the composition and dynamics of this compartment, it is difficult to construct mechanistic hypotheses or even to be sure that prior reports were describing analogous structures in the cells of mammals, amphibians, plants, and other organisms where it was observed. Surf clam oocytes are an attractive model to approach this problem because the nucleolinus is easily visible by light microscopy, making it accessible by laser microsurgery as well as isolation by common cell fractionation techniques. In this report, we analyze the macromolecular composition of isolated Spisula nucleolini and examine the relationship of this structure to the nucleolus and cell division apparatus. Analysis of nucleolinar RNA and protein revealed a set of molecules that overlaps with but is nevertheless distinct from the nucleolus. The proteins identified were primarily ones involved in nucleic acid metabolism and cell cycle regulation. Monoclonal antibodies generated against isolated nucleolini revealed centrosomal forerunners in the oocyte cytoplasm. Finally, induction of damage to the nucleolinus by laser microsurgery altered the trafficking of α- and γ-tubulin after fertilization. These observations strongly support a role for the nucleolinus in cell division and represent our first clues regarding mechanism.

Robotic assisted andrological surgery

PubMed Central

Parekattil, Sijo J; Gudeloglu, Ahmet

2013-01-01

The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE). PMID:23241637

Microsurgery for lymphedema: clinical research and long-term results.

PubMed

Campisi, Corradino; Bellini, Carlo; Campisi, Corrado; Accogli, Susanna; Bonioli, Eugenio; Boccardo, Francesco

2010-05-01

To report the wide clinical experience and the research studies in the microsurgical treatment of peripheral lymphedema. More than 1800 patients with peripheral lymphedema have been treated with microsurgical techniques. Derivative lymphatic microvascular procedures recognize today its most exemplary application in multiple lymphatic-venous anastomoses (LVA). In case of associated venous disease reconstructive lymphatic microsurgery techniques have been developed. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Subjective improvement was noted in 87% of patients. Objectively, volume changes showed a significant improvement in 83%, with an average reduction of 67% of the excess volume. Of those patients followed-up, 85% have been able to discontinue the use of conservative measures, with an average follow-up of more than 10 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. Microsurgical LVA have a place in the treatment of peripheral lymphedema, and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. 2010 Wiley-Liss, Inc. Microsurgery, 2010.

Periapical Microsurgery: The Effects of Locally Injected Dexamethasone on Pain, Swelling, Bruising, and Wound Healing.

PubMed

Kan, Elena; Coelho, Marcelo Santos; Reside, Jonathan; Card, Steven J; Tawil, Peter Z

2016-11-01

The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the postoperative healing of endodontic periapical microsurgery after local administration of dexamethasone. Sixty patients were divided into 2 groups. The dexamethasone group received a single local submucosal injection of 4 mg dexamethasone, and the placebo group received a submucosal injection of saline solution at the conclusion of standardized periapical microsurgery. Acetaminophen and hydrocodone/acetaminophen were prescribed for pain relief. A Likert-like 6-point scale was used for self-evaluation of pain, bruising, swelling, and wound healing at 24, 48, 72, 96 hours and at 1 week. The number of tablets taken was registered. Data were analyzed using the chi-square and Fisher exact tests at a significance level of P < .05. No improvements in pain, bruising, and wound healing were registered at any time interval. No difference was found in the number of tablets taken for pain relief. Subjects who received the dexamethasone injection reported less swelling 24 hours after periapical microsurgery (P < .05) but showed no significant benefit for the longer follow-up periods. This study shows that a 4-mg dose of dexamethasone administered through a local submucosal injection after periapical microsurgery has minimal impact on pain, bruising, and apparent wound healing at any time over a 7-day interval, and the impact on swelling seems limited. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Hands-on Simulation versus Traditional Video-learning in Teaching Microsurgery Technique

PubMed Central

SAKAMOTO, Yusuke; OKAMOTO, Sho; SHIMIZU, Kenzo; ARAKI, Yoshio; HIRAKAWA, Akihiro; WAKABAYASHI, Toshihiko

2017-01-01

Bench model hands-on learning may be more effective than traditional didactic practice in some surgical fields. However, this has not been reported for microsurgery. Our study objective was to demonstrate the efficacy of bench model hands-on learning in acquiring microsuturing skills. The secondary objective was to evaluate the aptitude for microsurgery based on personality assessment. Eighty-six medical students comprising 62 men and 24 women were randomly assigned to either 20 min of hands-on learning with a bench model simulator or 20 min of video-learning using an instructional video. They then practiced microsuturing for 40 min. Each student then made three knots, and the time to complete the task was recorded. The final products were scored by two independent graders in a blind fashion. All participants then took a personality test, and their microsuture test scores and the time to complete the task were compared. The time to complete the task was significantly shorter in the simulator group than in the video-learning group. The final product scores tended to be higher with simulator-learning than with video-learning, but the difference was not significant. Students with high “extraversion” scores on the personality inventory took a shorter time to complete the suturing test. Simulator-learning was more effective for microsurgery training than video instruction, especially in understanding the procedure. There was a weak association between personality traits and microsurgery skill. PMID:28381653

An evaluation of accessibility and content of microsurgery fellowship websites.

PubMed

Hu, Jiayi; Zhen, Meng; Olteanu, Cristina; Avram, Ronen

2016-01-01

Websites for residency and fellowship programs serve as effective educational and recruitment tools. To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development. A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive 'Google' search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant). A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed 'eligibility criteria' (87%) and 'general information' (87%). 'Evaluation criteria' were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on 'extremity' versus 'breast' (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process. Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.

Microsurgical principles and postoperative adhesions: lessons from the past.

PubMed

Gomel, Victor; Koninckx, Philippe R

2016-10-01

"Microsurgery" is a set of principles developed to improve fertility surgery outcomes. These principles were developed progressively based on common sense and available evidence, under control of clinical feedback obtained with the use of second-look laparoscopy. Fertility outcome was the end point; significant improvement in fertility rates validated the concept clinically. Postoperative adhesion formation being a major cause of failure in fertility surgery, the concept of microsurgery predominantly addresses prevention of postoperative adhesions. In this concept, magnification with a microscope or laparoscope plays a minor role as technical facilitator. Not surprisingly, the principles to prevent adhesion formation are strikingly similar to our actual understanding: gentle tissue handling, avoiding desiccation, irrigation at room temperature, shielding abdominal contents from ambient air, meticulous hemostasis and lavage, avoiding foreign body contamination and infection, administration of dexamethasone postoperatively, and even the concept of keeping denuded areas separated by temporary adnexal or ovarian suspension. The actual concepts of peritoneal conditioning during surgery and use of dexamethasone and a barrier at the end of surgery thus confirm without exception the tenets of microsurgery. Although recent research helped to clarify the pathophysiology of adhesion formation, refined its prevention and the relative importance of each factor, the clinical end point of improvement of fertility rates remains demonstrated for only the microsurgical tenets as a whole. In conclusion, the principles of microsurgery remain fully valid as the cornerstones of reproductive microsurgery, whether performed by means of open access or laparoscopy. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Added Qualifications in Microsurgery: Consideration for Subspecialty Certification in Microvascular Surgery in Europe.

PubMed

Heidekrueger, Paul I; Tanna, Neil; Weichman, Katie E; Szpalski, Caroline; Tos, Pierluigi; Ninkovic, Milomir; Broer, P Niclas

2016-07-01

Background While implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a "Certificate of Added Qualifications (CAQ) in microsurgery." Methods An anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n = 205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted. Results The response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship.A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed. Discussion This is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves. Conclusion This study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An evaluation of accessibility and content of microsurgery fellowship websites

PubMed Central

Hu, Jiayi; Zhen, Meng; Olteanu, Cristina; Avram, Ronen

2016-01-01

BACKGROUND Websites for residency and fellowship programs serve as effective educational and recruitment tools. OBJECTIVE To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development. METHODS A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive ‘Google’ search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant). RESULTS A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed ‘eligibility criteria’ (87%) and ‘general information’ (87%). ‘Evaluation criteria’ were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on ‘extremity’ versus ‘breast’ (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process. CONCLUSION Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process. PMID:28439508

Status of Microsurgical Simulation Training in Plastic Surgery: A Survey of United States Program Directors.

PubMed

Al-Bustani, Saif; Halvorson, Eric G

2016-06-01

Various simulation models for microsurgery have been developed to overcome the limitations of Halstedian training on real patients. We wanted to assess the status of microsurgery simulation in plastic surgery residency programs in the United States. Data were analyzed from responses to a survey sent to all plastic surgery program directors in the United States, asking for type of simulation, quality of facilities, utilization by trainees, evaluation of trainee sessions, and perception of the relevance of simulation. The survey response rate was 50%. Of all programs, 69% provide microsurgical simulation and 75% of these have a laboratory with microscope and 52% provide live animal models. Half share facilities with other departments. The quality of facilities is rated as good or great in 89%. Trainee utilization is once every 3 to 6 months in 82% of programs. Only in 11% is utilization monthly. Formal evaluation of simulation sessions is provided by 41% of programs. All program directors agree simulation is relevant to competence in microsurgery, 60% agree simulation should be mandatory, and 43% require trainees to complete a formal microsurgery course prior to live surgery. There seems to be consensus that microsurgical simulation improves competence, and the majority of program directors agree it should be mandatory. Developing and implementing standardized simulation modules and assessment tools for trainees across the nation as part of a comprehensive competency-based training program for microsurgery is an important patient safety initiative that should be considered. Organizing with other departments to share facilities may improve their quality and hence utilization.

Treatment of localized gingival recession using the free rotated papilla autograft combined with coronally advanced flap by conventional (macrosurgery) and surgery under magnification (microsurgical) technique: A comparative clinical study

PubMed Central

Pandey, Suraj; Mehta, D. S.

2013-01-01

Background: The aim of the present study was to evaluate and compare the conventional (macro-surgical) and microsurgical approach in performing the free rotated papilla autograft combined with coronally advanced flap surgery in treatment of localized gingival recession. Materials and Methods: A total of 20 sites from 10 systemically healthy patients were selected for the study. The selected sites were randomly divided into experimental site A and experimental site B by using the spilt mouth design. Conventional (macro-surgical) approach for site A and micro-surgery for site B was applied in performing the free rotated papilla autograft combined with coronally advanced flap. Recession depth (RD), recession width (RW) clinical attachment level (CAL.) and width of keratinized tissue (WKT.) were recorded at baseline, 3 months and 6 months post-operatively. Results: Both (macro- and microsurgery) groups showed significant clinical improvement in all the parameters (RD, RW, CAL and WKT). However, on comparing both the groups, these parameters did not reach statistical significance. Conclusion: Both the surgical procedures were equally effective in treatment of localized gingival recession by the free rotated papilla autograft technique combined with coronally advanced flap. However, surgery under magnification (microsurgery) may be clinically better than conventional surgery in terms of less post-operative pain and discomfort experienced by patients at the microsurgical site. PMID:24554888

Basic Microsurgery Training Using the Laboratory Rat (Rattus norvegicus)

DTIC Science & Technology

2018-03-01

all information . Use additional pages if necessary.) PROTOCOL #: FDG20170016A DATE: 1 March 2018 PROTOCOL TITLE: “Basic Microsurgery Training...2018__ RYAN M. DIEPENBROCK, Lt Col, USAF, DC (Date) 3 FDG20170016A Attachments: Attachment 1: Defense Technical Information Center (DTIC) Abstract...Submission Attachment 1 Defense Technical Information Center (DTIC) Abstract Submission Objectives: The purpose of this course is to

Tongue paraesthesia and dysgeusia post suspension laryngoscopy.

PubMed

Mohamad, Hazama; Mohamad, Irfan

2012-08-28

Suspension laryngoscopy is a common laryngeal procedure in Endolaryngeal microsurgery (ELMS). Oral mucosa and dental injuries are the known complications of the procedure. Nerve injury however is an infrequent encounter. We report a rare complication of lingual nerve injury which manifested as tongue numbness and altered taste following Endolaryngeal microsurgery procedure. The condition improved completely after few months of conservative management.

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2013-10-01

can provide fixation strengths approaching that of conventional microsurgery and that the PTB repair is unlikely to be disturbed in vivo. The...of nerve wrap biomaterial during long periods of recovery associated with large nerve deficit reconstruction and long nerve grafts. As with the...PTB/xHAM wrap compared to standard (suture) of care microsurgery . Demonstrated improved nerve regeneration in a muscle mass retention model

Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview

PubMed Central

Sharma, Ritu; Hegde, Vivek; Siddharth, M; Hegde, Rashmi; Manchanda, Gunsha; Agarwal, Pratul

2014-01-01

Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies. PMID:25506135

Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview.

PubMed

Sharma, Ritu; Hegde, Vivek; Siddharth, M; Hegde, Rashmi; Manchanda, Gunsha; Agarwal, Pratul

2014-11-01

Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.

Design and creation of an experimental program of advanced training in reconstructive microsurgery.

PubMed

Lorenzo, Andrés R; Alvarez, Angel; Garcia-Barreiro, Juan; Centeno, Alberto; Lopez, Eduardo; Martelo, Francisco

2006-01-01

In this study, we design an experimental protocol for the purpose of enhancing performance in training in microsurgery. It is based on five free tissue transfer exercises in rat (epigastric cutaneous flap, saphenous fasciocutaneous flap, epigastric neurovascular flap, saphenous muscular flap, and hindlimb replantation), which simulate the principal clinical procedures of reconstructive microsurgery. The first part of the study consists of an anatomical review of the flaps of 5 rats and in the second part we have carried out the free transfer of flaps on 25 rats divided into 5 groups. To differentiate between them, we have created a mathematical function, referred to as difficulty in a microsurgical exercise, which has enabled us to establish a scale of progression for training, ranging form the easiest to the most difficult. As a conclusion, we believe that this protocol is a useful instrument as it allows for a more precise assessment of microsurgical capacity due to enhanced accuracy in the reproduction of global procedures and the fact that the quantification of progress in training is based on clinical monitoring after 7 days. (c) 2006 Wiley-Liss, Inc. Microsurgery, 2006.

Teaching core competencies of reconstructive microsurgery with the use of standardized patients.

PubMed

Son, Ji; Zeidler, Kamakshi R; Echo, Anthony; Otake, Leo; Ahdoot, Michael; Lee, Gordon K

2013-04-01

The Accreditation Council of Graduate Medical Education has defined 6 core competencies that residents must master before completing their training. Objective structured clinical examinations (OSCEs) using standardized patients are effective educational tools to assess and teach core competencies. We developed an OSCE specific for microsurgical head and neck reconstruction. Fifteen plastic surgery residents participated in the OSCE simulating a typical new patient consultation, which involved a patient with oral cancer. Residents were scored in all 6 core competencies by the standardized patients and faculty experts. Analysis of participant performance showed that although residents performed well overall, many lacked proficiency in systems-based practice. Junior residents were also more likely to omit critical elements of the physical examination compared to senior residents. We have modified our educational curriculum to specifically address these deficiencies. Our study demonstrates that the OSCE is an effective assessment tool for teaching and assessing all core competencies in microsurgery.

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2013-10-01

approaching that of conventional microsurgery and that the PTB repair is unlikely to be disturbed in vivo. The results in Figure 5 were obtained with...with large nerve deficit reconstruction and long nerve grafts. As with the human amnion nerve wraps, it was important for us to confirm that, in...xHAM wrap compared to standard (suture) of care microsurgery . Demonstrated improved nerve regeneration in a muscle mass retention model

Large Extremity Peripheral Nerve Repair

DTIC Science & Technology

2013-10-01

show that the PTB method can provide fixation strengths approaching that of conventional microsurgery and that the PTB repair is unlikely to be...biomaterial during long periods of recovery associated with large nerve deficit reconstruction and long nerve grafts. As with the human amnion nerve...functional recovery model (SFI, sciatic function index) using PTB/xHAM wrap compared to standard (suture) of care microsurgery . Demonstrated improved nerve

The Quality of Systematic Reviews in Head and Neck Microsurgery: A Perspective from Plastic Surgery and Otolaryngology.

PubMed

Sun, Beatrice J; Tijerina, Jonathan; Nazerali, Rahim S; Lee, Gordon K

2018-05-01

In recent years, there has been a push to publish higher level of evidence studies in medicine, particularly in plastic surgery. Well-conducted systematic reviews are considered the strongest level of evidence in medicine, recently becoming the key process indicators for quality delivery. A varying quality of systematic reviews, however, has led to concerns of their validity in clinical decision-making. We perform a quality analysis of systematic reviews published in head and neck microsurgery by the surgical specialties of plastic surgery and otolaryngology. An evaluation of systematic reviews published on microsurgery in 13 high-impact surgical journals was conducted by searching PubMed and Scopus. Two authors independently performed searches, screened for eligibility, and extracted data from included articles. Discrepancies were resolved by discussion and consensus. Assessment of Multiple Systematic Reviews (AMSTAR) criteria were used to assess methodological quality. The initial database search retrieved 166 articles. After removing duplicates, screening titles and abstracts, 26 articles remained for full text review. Seven did not focus on head and neck microsurgery and were further excluded, leaving 19 systematic reviews for final analysis. Of those, 10 systematic reviews were published by otolaryngology, and 9 were published by plastic surgery. Median AMSTAR score was 8 for otolaryngology, 7 for plastic surgery, and 8 overall, reflecting "fair to good" quality. The number of systematic reviews on head and neck microsurgery markedly increased over time. Of note, both the AMSTAR score and the number of systematic reviews published by plastic surgery have steadily increased from 2014 to 2016, whereas those published by otolaryngology have remained relatively stable since 2010. Our review shows a trend toward publishing more systematic reviews. The increasing quantity and quality of systematic reviews published by plastic surgeons indicates recognition in the need for higher levels of evidence in plastic surgery, as well as growing interest and advances in microsurgery. Given these trends, familiarity with quality assessment guidelines, such as AMSTAR, will remain important in providing a basis for building relevant value-based quality measures.

Safety of Microsurgery Under Loupes Versus Microscope: A Head-to-Head Comparison of 2 Surgeons With Similar Experiences.

PubMed

Ehanire, Tosan; Singhal, Dhruv; Mast, Bruce; Leyngold, Mark

2018-01-24

Microsurgery is performed using either the operating microscope or loupe magnification. Use of the operating microscope is considered the "criterion standard"; however, loupes are emerging as a safe and reliable technique to perform microsurgery. The purpose of this study was to analyze the safety of microsurgery under loupe magnification compared with the microscope. Previous studies discussing the safety of loupe magnification during microsurgery have been published; however, this is the first study to compare free flap outcomes from 2 surgeons at the same institution, each using their respective technique. The outcomes were compared by retrospective chart review of 116 patients, and 148 microvascular free tissue transfers were performed between January 1, 2013, and July 15, 2016, by 2 surgeons (D.S.) and (M.L.). Patients' demographics, free flap failure rate, and other surgical complications were analyzed. Statistical significance was determined by unpaired t test, and χ analysis was used to determine statistical significance in proportions between groups. Thirty-eight percent of flaps were performed under ×3.5 loupe magnification and 62% under the operating microscope. Most free flaps used were deep inferior epigastric perforator or muscle sparing transverse rectus abdominis flaps (52%) for breast reconstruction, remainder of free flaps included ALT, radial forearm, and latissimus dorsi for a variety of reconstructive applications. There was no significant difference between the loupes and microscope groups in intraoperative anastomotic revision rate (27% vs 17%), postoperative arterial or venous thrombosis (4.4% vs 2.6%, 5.4% vs 2.2%), flap loss (3.6% vs 2.2%), or median length of stay (6 days vs 6.5 days). The loupe magnification group had statistically significant shorter setup time (20 minutes, P < 0.01). Consistent with previously reported studies, we found no statistical difference in free flap outcomes and safety under loupe magnification compared with the operating microscope. This is the first study to demonstrate these findings with 2 microsurgeons both in their first 3 years in practice, with similar training and experience, operating at the same institution and given the same resources, each using either microscopes or loupes for microsurgery.

Single bolus parecoxib attenuates sore throat after laryngeal microsurgery: a randomized double-blind control study.

PubMed

Huang, Hui-Fang; Chang, Pi-Ying; Chen, Yu-Chun; Tseng, Kuang-Yi; Hsu, Hung-Te; Cheng, Kuang-I; Lu, I-Cheng

2014-11-01

Laryngeal microsurgery is performed to assess disorders of the larynx. Parecoxib is the only parenterally administered selective cyclooxygenase (COX)-2 inhibitor widely used in acute pain control. The purpose of this study is to assess the analgesic effects of parecoxib compared with morphine for postoperative sore throat in patients undergoing laryngeal microsurgery. Fifty patients were randomly allocated to receive either parecoxib 0.5 mg/kg or morphine 50 μg/kg prior to anesthesia induction. General anesthesia was maintained with sevoflurane 2-4%. Postoperative sore throat and other outcomes were measured at a postanesthesia care unit (PACU) 4 hours and 24 hours postoperatively. The severity of postoperative sore throat was assessed by sore throat score as follows: none (0) = no pharyngeal or laryngeal discomfort; mild (1) = no pain at rest, but swallowing induced mild pain or discomfort; moderate (2) = constant pain without swallowing exacerbation; and severe (3) = constant pain with swallowing or respiratory exacerbation. The incidences of postoperative side effects (nausea, vomiting, itching, dizziness, and somnolence) were also recorded. Demographic data from the parecoxib (n = 25) and morphine (n = 25) groups did not differ significantly. The parecoxib group depicted similar sore throat scores as the morphine group at three measured postoperative time points. Patients requiring postoperative analgesics were comparable between the parecoxib group and morphine group (2/25, 8% vs. 3/25, 12%, p = 0.64). Overall postoperative adverse events were fewer in the parecoxib group than the morphine group (3/25, 12% vs. 9/25, 36%, p = 0.047). Both parecoxib and morphine are effective to attenuate postoperative sore throat after laryngeal microsurgery. Parecoxib may be an effective and well-tolerated injectable analgesic to manage postoperative sore throat after laryngeal microsurgery. Copyright © 2014. Published by Elsevier Taiwan.

Breast Microsurgery in Plastic Surgery Literature: A 21-Year Analysis of Publication Trends

PubMed Central

Daly, Lauren Tracy; Mowlds, Donald; Brodsky, Merrick A.; Abrouk, Michael; Gandy, Jessica R.; Wirth, Garrett A.

2018-01-01

Introduction Microsurgical reconstruction of the breast represents an area of continual evolution, as new autologous flaps are introduced and principles are refined. This progression can be demonstrated by bibliometric analysis of the scientific literature. Methods The top 10 plastic surgery journals were determined by impact factor (IF). Each issue of every journal from 1993 to 2013 was accessed directly, and all articles discussing microsurgery on the female breast were classified by authors’ geographic location, study design, and level of evidence (LOE, I–V). The productivity index and productivity share of each geographic region was calculated based on number of articles published and IF. Results A total of 706 breast microsurgery articles were analyzed. There was a significant increase in microsurgical breast research (p < 0.01), with an average 33.6 ± 31.1 articles per year and a mean increase of 4.4 articles per year. Most research was of lower LOE, with level I constituting 0.14% and level II constituting 5.21% of all articles. United States contributed the most research with 336.4 articles, followed by Western Europe with 242.2. However, Western Europe experienced the greatest increase in productivity share, with + 0.50 ± 0.29 growth, while United States demonstrated the greatest decrease in productivity share with − 1.23 ± 0.31 growth. Among autologous flaps, transverse rectus abdominis muscle research had the greatest yearly publication volume until 2002, when overtaken by deep inferior epigastric perforator flap research. Conclusion Over the 21-year study period, the United States not only contributed the greatest volume of research on female breast microsurgery but also demonstrated the greatest decline in research productivity. Efforts should be made to increase the LOE in breast microsurgery research. PMID:26645157

Treatment outcome and prognostic factor of CO2 laser cordectomy for early glottic cancer

NASA Astrophysics Data System (ADS)

Chung, Phil-Sang; Lee, Sang Joon

2012-02-01

Objectives: Laser cordectomy is very popular nowadays and become one of the treatments of choice for early glottis carcinoma. Transoral laser microsurgery has many advantages comparing conventional open surgery or radiation therapy. In this study, we examined the oncologic results of laser cordectomy for early glottic cancer and analyzed the prognostic impact on the survival of the several tumor-related and treatment-related factors. Methods: Patients who were diagnosed as early glottic squamous cell carcinoma, treated by laser cordectomy with curative intent were analyzed. Patients with preivous radiation therapy were included. From June 1988 to March 2005, 202 patients from five hospitals were analyzed (174 T1, 28 T2). Results: Five-year overall survival and disease-free survival were 98.4% and 84.9%. Twenty two patients developed local recurrence. Total laryngectomy was done in 6 patients and laryngeal preservation rate was 97%. Recurrence was higher in the patients with anterior commissure involvement (9/39) than without anterior commissure involvement (13/163). Recurrence was higher in T1b (4/15) than T1a (13/159). Previous radiation was also highly related to the recurrence (7/20 vs 15/182). Twenty patients with local recurrence after radiation therapy were treated by salvage laser cordectomy. Of them, 7 patients developed local recurrence and 5 year disease-free survival was 57%. Complication was rare with one case of hemorrhage. Tracheotomy was not necessary in all patients. Conclusions: Laser cordectomy for early glottic carcinoma showed high survival, laryngeal preservation rate and low complication rate. The prognostic factors were anterior commissure involvement, both vocal fold involvement and previous radiotherapy.

Virtual environment for training in microsurgery

NASA Astrophysics Data System (ADS)

Montgomery, Kevin N.; Stephanides, Michael; Brown, Joel; Latombe, Jean-Claude; Schendel, Stephen A.

1999-05-01

Microsurgery is a well-established medical field, and involves repair of approximately 1mm vessels and nerves under an operating microscope in order to reattach severed fingers or transfer tissue for reconstruction. Initial skill sin microvascular surgery are usually developed in the animal lab and subsequently in the operating room. Development of these skills typically requires about 6 months of animal based training before additional learning takes place in the operating room.

Evaluation of a new eLearning platform for distance teaching of microsurgery.

PubMed

Messaoudi, T; Bodin, F; Hidalgo Diaz, J J; Ichihara, S; Fikry, T; Lacreuse, I; Liverneaux, P; Facca, S

2015-06-01

Online learning (or eLearning) is in constant evolution in medicine. An analytical survey of the websites of eight academic societies and medical schools was carried out. These sites were evaluated against parameters that define the quality of an eLearning website, as well as the shareable content object reference model (SCORM) technical standards. All studied platforms were maintained by a webmaster and regularly updated. Only two platforms had teleconference opportunities, five had courses in PDF format, and four allowed online testing. Based on SCORM standards, only four platforms allowed direct access without a password. The content of all platforms was adaptable, interoperable and reusable. But their sustainability was difficult to assess. In parallel, we developed the first eLearning platform to be used as part of a university diploma in microsurgery in France. The platform was evaluated by students enrolled this diploma program. A satisfaction survey and platform evaluation showed that students were generally satisfied and had used the platform for microsurgery education, especially the seven students living abroad. ELearning for microsurgery allows the content to be continuously updated, makes for fewer classroom visits, provides easy remote access, and especially better training time management and cost savings in terms of travel and accommodations. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

A case of desmoid tumor co-existing with recurrent squamous cell carcinoma in the larynx.

PubMed

Shinohara, Shogo; Suehiro, Atsushi; Kikuchi, Masahiro; Harada, Hiroyuki; Kishimoto, Ippei; Imai, Yukihiro

2017-06-01

Extra-abdominal desmoid tumor, also known as aggressive fibromatosis, has aggressive behavior with local infiltration and tendency for recurrence. Though head and neck is reported to be one of the most common sites, a desmoid tumor in the larynx is extremely rare. A 67-year-old male visited our hospital with prolonged hoarseness and received laryngo-microsurgery with the diagnosis of laryngeal polyp. After the operation, he eventually developed a laryngeal squamous cell carcinoma with papilloma, confirmed by second laryngo-microsurgery and received radiation therapy. After the third laryngo-microsurgery to remove residual papilloma, white irregular mass appeared on the right vocal cord and grew rapidly beneath the glottis, causing dyspnea. After 2 additional laryngo-microsurgeries, he was diagnosed having the dermoid tumor co-existing with recurrent squamous cell carcinoma. He underwent near-total laryngectomy and is currently alive without disease, speaking using a vocal shunt. Only five cases of the desmoid tumors arising in the adult larynx have been reported in the English literature. In this case, repeated surgery and radiation were suspected as the causes. Also, the present report is the first to describe desmoid tumor co-existing with recurrent squamous cell carcinoma in the larynx. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Courses in microsurgical techniques in France and abroad].

PubMed

Alzakri, A; Al-Rajeh, M; Liverneaux, P A; Facca, S

2014-06-01

The objective of this work was to determine the state of current training programs for microsurgery in France and abroad. Our survey of microsurgery training programs determined the registration volume, program contents, and number of students in France, and looked at registration volume and teaching time for programs abroad. Data were obtained from the Internet, university administration, those responsible for university diploma programs, and students. There were 18 university diploma programs in microsurgery in France. The average list price was €1,129 for an average of 19 hours of theoretical training and 100 hours of practice. Evaluation methods varied, but all required at least vascular anastomosis in rats. In 2011-2012, 148 students were enrolled and 126 graduated (85% passing rate). Abroad, 16 basic courses were listed in the USA, Europe and Asia. Nine advanced courses were offered. The average price was $1,346 for 36 hours of practice in the basic courses and $1,955 for over 50 hours of training in advanced courses. None of these courses gave out a diploma. Our results show that in France, university diploma programs in microsurgery are heterogeneous and the French College should consider updating them. Globally, a study is underway by the International Microsurgical Simulation Society. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Optical manipulation of microparticles and biological structures

NASA Astrophysics Data System (ADS)

Gahagan, Kevin Thomas

1998-06-01

We report experimental and theoretical investigations of the trapping of microparticles and biological objects using radiation pressure. Part I of this thesis presents a technique for trapping both low and high index microparticles using a single, stationary focused laser beam containing an optical vortex. Advantages of this vortex trap include the ease of implementation, a lower exposure level for high-index particles compared to a standard Gaussian beam trap, and the ability to isolate individual low-index particles in concentrated dispersions. The vortex trap is modeled using ray-tracing methods and a more precise electromagnetic model, which is accurate for particles less than 10 μm in diameter. We have measured the stable equilibrium position for two low-index particle systems (e.g., hollow glass spheres (HGS) in water, and water droplets in acetophenone (W/A)). The strength of the trap was measured for the HGS system along the longitudinal and transverse directions. We also demonstrate simultaneous trapping of a low and high index particle with a vortex beam. The stability of this dual-particle trap is found to depend on the relative particle size, the divergence angle of the beam, and the depth of the particles within the trapping chamber. Part II presents results from an interdisciplinary and collaborative investigation of an all-optical genetic engineering technique whereby Agrobacterium rhizogenes were inserted through a laser-ablated hole in the cell wall of the plant, Gingko biloba. We describe a protocol which includes the control of osmotic conditions, culturing procedures, viability assays and laser microsurgery. We succeeded in placing up to twelve viable bacteria into a single plant cell using this technique. The bacteria are believed to be slightly heated by the Gaussian beam trap. A numerical model is presented predicting a temperature rise of just a few degrees. Whereas G. biloba and A. rhitogenes were chosen for this study because of Ginkgo's pharmaceutical importance, only slight modification of the protocol is needed for other plant species.

1.9-μm diode-laser-assisted anastomoses (LAMA) in reconstructive microsurgery: results of the preliminary clinical study

NASA Astrophysics Data System (ADS)

Mordon, Serge R.; Schoofs, Michel; Martinot, Veronique L.; Capon, Alexandre; Buys, Bruno; Patenotre, Philippe; Pellerin, P. N.

2001-05-01

The authors report an original 1.9-micrometers diode laser assisted microvascular anastomosis (LAMA) in human. This technique has been applied in 20 patients during reconstructive surgery for digital replantations (nequals6), for digital revascularizations (nequals4) and for free flap transfers (nequals10). LAMA were always performed on vessel (16 arteries and 6 veins) which did not impede the chance of success of the surgical procedure in case of thrombosis. LAMA was performed with a 1.9-micrometers diode laser after placement of 2 equidistant stitches at 180 degrees. The diode spot was obtained by means of a 300-micrometers optic fiber transmitted to the vessel wall via a pencil size hand piece. The following parameters were used: spot size equals 500 micrometers , power equals 70 to 220 mW, pulse duration equals 0.7 to 3 seconds. Ten to 15 spots were applied on each face. The mechanism involved is a thermal effect on the collagen of the adventitia and media leading to a phenomenon which the authors have termed 'heliofusion'. Immediate assessment consisted in evaluating the permeability by patency test (O'Brien) and water tightness. Secondary assessment consisted in evaluating the clinical success, confirmed by Doppler at one month.

In Vivo Near Infrared Virtual Intraoperative Surgical Photoacoustic Optical Coherence Tomography

PubMed Central

Lee, Donghyun; Lee, Changho; Kim, Sehui; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

2016-01-01

Since its first implementation in otolaryngological surgery nearly a century ago, the surgical microscope has improved the accuracy and the safety of microsurgeries. However, the microscope shows only a magnified surface view of the surgical region. To overcome this limitation, either optical coherence tomography (OCT) or photoacoustic microscopy (PAM) has been independently combined with conventional surgical microscope. Herein, we present a near-infrared virtual intraoperative photoacoustic optical coherence tomography (NIR-VISPAOCT) system that combines both PAM and OCT with a conventional surgical microscope. Using optical scattering and absorption, the NIR-VISPAOCT system simultaneously provides surgeons with real-time comprehensive biological information such as tumor margins, tissue structure, and a magnified view of the region of interest. Moreover, by utilizing a miniaturized beam projector, it can back-project 2D cross-sectional PAM and OCT images onto the microscopic view plane. In this way, both microscopic and cross-sectional PAM and OCT images are concurrently displayed on the ocular lens of the microscope. To verify the usability of the NIR-VISPAOCT system, we demonstrate simulated surgeries, including in vivo image-guided melanoma resection surgery and in vivo needle injection of carbon particles into a mouse thigh. The proposed NIR-VISPAOCT system has potential applications in neurosurgery, ophthalmological surgery, and other microsurgeries. PMID:27731390

Use of piezoelectric bone scalpel in hand and reconstructive microsurgery.

PubMed

Arnez, Z; Papa, G; Renzi, N; Ramella, V; Panizzo, N; Toffanetti, F

2009-01-01

Performing osteotomies with piezoelectric bone scalpel is also possible with bones of larger diameter/thickness. At the same time, adjacent soft tissues are not in danger from cutting or thermal damage, reducing the risk of damaging neurovascular structures - which is of primary importance in hand and reconstructive microsurgery. These features contribute to the safety and easy execution of the procedure. The resulting bony cut is precise and permits immediate and safe bone fixation. Osteotomy of bones of >1 cm thickness takes 20-30% longer than when using a conventional oscillating saw, though the increased safety of the procedure more than compensates for this. Three cases are presented, illustrating of the use of Genera Ultrasonic for cutting bones of major thickness (metacarpal, fibula and rib) without any complication. Because of its selectivity for bony tissue, precision and ability to protect soft tissues we also advocate the use of the Genera piezoelectric bone scalpel in hand and reconstructive microsurgery.

Measurement of tremor transmission during microsurgery.

PubMed

Verrelli, David I; Qian, Yi; Wood, James; Wilson, Michael K

2016-12-01

Tremor is a major impediment to performing fine motor tasks, as in microsurgery. However, conventional measurements do not involve tasks representative of microsurgery. We developed a low-cost surgical simulator incorporating a force transducer capable of detecting and quantifying the effects of tremor upon high-fidelity silicone replicas of cardiac vessels and substrate muscle. Experienced and trainee surgeons performed simulated anastomoses on this rig. We characterized procedures in terms of tremor intensity, based on Lomb-Scargle periodograms. Distinctive force oscillations occurred at 8-12 Hz, characteristic of enhanced physiological tremor, yielding peaks in power spectral density. These early results suggest a significantly lower transmission of tremor to the operative field by the experienced surgeon in comparison to the trainees. This new device quantifies the action of tremor upon a manipulandum during a complex task, which may be used for assessment and providing feedback to trainee surgeons. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Virtual finger boosts three-dimensional imaging and microsurgery as well as terabyte volume image visualization and analysis.

PubMed

Peng, Hanchuan; Tang, Jianyong; Xiao, Hang; Bria, Alessandro; Zhou, Jianlong; Butler, Victoria; Zhou, Zhi; Gonzalez-Bellido, Paloma T; Oh, Seung W; Chen, Jichao; Mitra, Ananya; Tsien, Richard W; Zeng, Hongkui; Ascoli, Giorgio A; Iannello, Giulio; Hawrylycz, Michael; Myers, Eugene; Long, Fuhui

2014-07-11

Three-dimensional (3D) bioimaging, visualization and data analysis are in strong need of powerful 3D exploration techniques. We develop virtual finger (VF) to generate 3D curves, points and regions-of-interest in the 3D space of a volumetric image with a single finger operation, such as a computer mouse stroke, or click or zoom from the 2D-projection plane of an image as visualized with a computer. VF provides efficient methods for acquisition, visualization and analysis of 3D images for roundworm, fruitfly, dragonfly, mouse, rat and human. Specifically, VF enables instant 3D optical zoom-in imaging, 3D free-form optical microsurgery, and 3D visualization and annotation of terabytes of whole-brain image volumes. VF also leads to orders of magnitude better efficiency of automated 3D reconstruction of neurons and similar biostructures over our previous systems. We use VF to generate from images of 1,107 Drosophila GAL4 lines a projectome of a Drosophila brain.

Middle-ear microsurgery simulation to improve new robotic procedures.

PubMed

Kazmitcheff, Guillaume; Nguyen, Yann; Miroir, Mathieu; Péan, Fabien; Ferrary, Evelyne; Cotin, Stéphane; Sterkers, Olivier; Duriez, Christian

2014-01-01

Otological microsurgery is delicate and requires high dexterity in bad ergonomic conditions. To assist surgeons in these indications, a teleoperated system, called RobOtol, is developed. This robot enhances gesture accuracy and handiness and allows exploration of new procedures for middle ear surgery. To plan new procedures that exploit the capacities given by the robot, a surgical simulator is developed. The simulation reproduces with high fidelity the behavior of the anatomical structures and can also be used as a training tool for an easier control of the robot for surgeons. In the paper, we introduce the middle ear surgical simulation and then we perform virtually two challenging procedures with the robot. We show how interactive simulation can assist in analyzing the benefits of robotics in the case of complex manipulations or ergonomics studies and allow the development of innovative surgical procedures. New robot-based microsurgical procedures are investigated. The improvement offered by RobOtol is also evaluated and discussed.

Middle-Ear Microsurgery Simulation to Improve New Robotic Procedures

PubMed Central

Kazmitcheff, Guillaume; Nguyen, Yann; Miroir, Mathieu; Péan, Fabien; Ferrary, Evelyne; Cotin, Stéphane; Sterkers, Olivier; Duriez, Christian

2014-01-01

Otological microsurgery is delicate and requires high dexterity in bad ergonomic conditions. To assist surgeons in these indications, a teleoperated system, called RobOtol, is developed. This robot enhances gesture accuracy and handiness and allows exploration of new procedures for middle ear surgery. To plan new procedures that exploit the capacities given by the robot, a surgical simulator is developed. The simulation reproduces with high fidelity the behavior of the anatomical structures and can also be used as a training tool for an easier control of the robot for surgeons. In the paper, we introduce the middle ear surgical simulation and then we perform virtually two challenging procedures with the robot. We show how interactive simulation can assist in analyzing the benefits of robotics in the case of complex manipulations or ergonomics studies and allow the development of innovative surgical procedures. New robot-based microsurgical procedures are investigated. The improvement offered by RobOtol is also evaluated and discussed. PMID:25157373

Actomyosin purse strings: renewable resources that make morphogenesis robust and resilient

PubMed Central

Rodriguez-Diaz, Alice; Toyama, Yusuke; Abravanel, Daniel L.; Wiemann, John M.; Wells, Adrienne R.; Tulu, U. Serdar; Edwards, Glenn S.; Kiehart, Daniel P.

2008-01-01

Dorsal closure in Drosophila is a model system for cell sheet morphogenesis and wound healing. During closure two sheets of lateral epidermis move dorsally to close over the amnioserosa and form a continuous epidermis. Forces from the amnioserosa and actomyosin-rich, supracellular purse strings at the leading edges of these lateral epidermal sheets drive closure. Purse strings generate the largest force for closure and occur during development and wound healing throughout phylogeny. We use laser microsurgery to remove some or all of the purse strings from developing embryos. Free edges produced by surgery undergo characteristic responses as follows. Intact cells in the free edges, which previously had no purse string, recoil away from the incision and rapidly assemble new, secondary purse strings. Next, recoil slows, then pauses at a turning point. Following a brief delay, closure resumes and is powered to completion by the secondary purse strings. We confirm that the assembly of the secondary purse strings requires RhoA. We show that α-actinin alternates with nonmuscle myosin II along purse strings and requires nonmuscle myosin II for its localization. Together our data demonstrate that purse strings are renewable resources that contribute to the robust and resilient nature of closure. PMID:19404432

From Autotransplantation to Allotransplantation: A Perspective on the Future of Reconstructive Microsurgery.

PubMed

Levin, L Scott

2018-04-28

It has been half a century since Susumu Tamai reported on the first thumb replantation. The evolution of reconstructive microsurgery has continually added new applications of the operating microscope for reconstructive surgery and has had profound impact on countless patients. From the time of Harold Gillies until today, the reconstructive ladder has evolved to a reconstructive elevator with the "penthouse" floor being represented by vascularized composite allotransplantation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Microsurgery Fellowship at Chang Gung Memorial Hospital: Blossom of Caterpillars

PubMed Central

2015-01-01

Summary: Against a background of globalization and medical migration, issues have been raised regarding training outside the clinician’s own context. Fellowship was not commonly used as a career step, or a means of migration, but as a process of professional and personal development. Taking Chang Gung Memorial Hospital Microsurgery Fellowship as the case study, I would like to highlight an example of a long-running successful training program in a special field such as plastic surgery. PMID:25973354

Safe Tissue Manipulation in Retinal Microsurgery via Motorized Instruments with Force Sensing.

PubMed

Gonenc, Berk; Gehlbach, Peter; Taylor, Russell H; Iordachita, Iulian

2017-01-01

Retinal microsurgery involves careful manipulation of delicate tissues by applying very small amount of forces most of which lie below the tactile sensory threshold of the surgeons. Membrane peeling is a common task in this domain, where application of excessive peeling forces can easily lead to serious complications, hence needs to be avoided. To quantify tool-tissue interaction forces during retinal microsurgery, various force-sensing tools were developed based on fiber Bragg grating sensors, yet the most beneficial way of using the acquired force information is currently unknown. In this study, using a motorized force-sensing micro-forceps tool, we develop an assistive method that enhances safety during membrane peeling by automatically opening the forceps and releasing the tissue based on the detected peeling forces. Through peeling experiments using bandages, we demonstrate that our method can effectively maintain the peeling force at a safe level even in case of non-homogeneous adhesion properties of the membrane.

Transoral laser surgery for laryngeal carcinoma: has Steiner achieved a genuine paradigm shift in oncological surgery?

PubMed

Harris, A T; Tanyi, A; Hart, R D; Trites, J; Rigby, M H; Lancaster, J; Nicolaides, A; Taylor, S M

2018-01-01

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO 2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predominantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase 'paradigm shift' in his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and colleagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the management of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples' dogma makes his contribution truly a genuine paradigm shift.

A Systematic Review of Topical Vasodilators for the Treatment of Intraoperative Vasospasm in Reconstructive Microsurgery.

PubMed

Vargas, Christina R; Iorio, Matthew L; Lee, Bernard T

2015-08-01

Intraoperative vasospasm during reconstructive microsurgery is common, often unpredictable, and potentially devastating with regard to flap survival. Current methods of pharmacologic management vary, and may be shifting as a result of changes in the availability of individual medications. This review aims to provide a concise examination of the published literature regarding use, efficacy, and adverse effects of the agents described for local management of vascular spasm during microsurgery. A systematic review of the literature was performed to identify articles relevant to pharmacologic treatment of intraoperative vasospasm in vivo. An additional review of the literature was performed with regard to each agent identified in order to provide clinical background information. Systematic review identified 20 articles, in which 14 vasodilator agents were evaluated. Drugs were classified into five pharmacologic categories: phosphodiesterase inhibitors (papaverine, pentoxifylline, and amrinone), local anesthetics (lidocaine), calcium channel blockers (nicardipine, verapamil, nifedipine, and magnesium sulfate), direct vasodilators (sodium nitroprusside, prostaglandin E1, nitroglycerin, and hydralazine), and alpha antagonists (phentolamine and chlorpromazine). Despite a variety of methods, these studies indicate some degree of experimental evidence of efficacy for each of these agents. Available literature regarding use of topical vasodilating agents for intraoperative management of vasospasm during microsurgery is limited and largely based on animal models, which may not reliably generalize to the reconstructive patient population. Well-controlled translational study in clinically applicable and reproducible models is needed to guide evidence-based clinical management of this important phenomenon.

Stress wave focusing transducers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Visuri, S.R., LLNL

Conversion of laser radiation to mechanical energy is the fundamental process behind many medical laser procedures, particularly those involving tissue destruction and removal. Stress waves can be generated with laser radiation in several ways: creation of a plasma and subsequent launch of a shock wave, thermoelastic expansion of the target tissue, vapor bubble collapse, and ablation recoil. Thermoelastic generation of stress waves generally requires short laser pulse durations and high energy density. Thermoelastic stress waves can be formed when the laser pulse duration is shorter than the acoustic transit time of the material: {tau}{sub c} = d/c{sub s} where dmore » = absorption depth or spot diameter, whichever is smaller, and c{sub s} = sound speed in the material. The stress wave due to thermoelastic expansion travels at the sound speed (approximately 1500 m/s in tissue) and leaves the site of irradiation well before subsequent thermal events can be initiated. These stress waves, often evolving into shock waves, can be used to disrupt tissue. Shock waves are used in ophthalmology to perform intraocular microsurgery and photodisruptive procedures as well as in lithotripsy to fragment stones. We have explored a variety of transducers that can efficiently convert optical to mechanical energy. One such class of transducers allows a shock wave to be focused within a material such that the stress magnitude can be greatly increased compared to conventional geometries. Some transducer tips could be made to operate regardless of the absorption properties of the ambient media. The size and nature of the devices enable easy delivery, potentially minimally-invasive procedures, and precise tissue- targeting while limiting thermal loading. The transducer tips may have applications in lithotripsy, ophthalmology, drug delivery, and cardiology.« less

Recent conclusions regarding the reconstructive microsurgery of peripheral nerves

PubMed Central

Doina, Dumitrescu-Ionescu

2008-01-01

The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3.000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: • A huge amount of work involved in carrying out microsurgical reconstructions of over 7,500 peripheral nerves in over 3,000 patients, 1,800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. • Experimental microsurgery on rabbit ears • The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally • The Moberg test • Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months) • Taking pictures and recording pre, intra and postoperative stages • The patients’ professional, social and familial reintegration • The patients’ state of mind; level of cooperation • Comparing results with those of classic and palliative repairs • Comparing the data resulting from this experience with the information provided by the specialist literature of the world • Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3.000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: • A huge amount of work involved in carrying out microsurgical reconstructions of over 7,500 peripheral nerves in over 3,000 patients, 1,800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. • Experimental microsurgery on rabbit ears • The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally • The Moberg test • Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months) • Taking pictures and recording pre, intra and postoperative stages • The patients’ professional, social and familial reintegration • The patients’ state of mind; level of cooperation • Comparing results with those of classic and palliative repairs • Comparing the data resulting from this experience with the information provided by the specialist literature of the world • Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept PMID:20108464

Vascular lesions of the vocal fold.

PubMed

Gökcan, Kürşat Mustafa; Dursun, Gürsel

2009-04-01

The aim of the study was to present symptoms, laryngological findings, clinical course, management modalities, and consequences of vascular lesions of vocal fold. This study examined 162 patients, the majority professional voice users, with vascular lesions regarding their presenting symptoms, laryngological findings, clinical courses and treatment results. The most common complaint was sudden hoarseness with hemorrhagic polyp. Microlaryngoscopic surgery was performed in 108 cases and the main indication of surgery was the presence of vocal fold mass or development of vocal polyp during clinical course. Cold microsurgery was utilized for removal of vocal fold masses and feeding vessels cauterized using low power, pulsed CO(2) laser. Acoustic analysis of patients revealed a significant improvement of jitter, shimmer and harmonics/noise ratio values after treatment. Depending on our clinical findings, we propose treatment algorithm where voice rest and behavioral therapy is the integral part and indications of surgery are individualized for each patient.

Acquisition of basic microsurgery skills using home-based simulation training: A randomised control study.

PubMed

Malik, Mohsan M; Hachach-Haram, Nadine; Tahir, Muaaz; Al-Musabi, Musab; Masud, Dhalia; Mohanna, Pari-Naz

2017-04-01

Acquisition of fine motor skills required in microsurgery can be challenging in the current training system. Therefore, there is an increased demand for novel training and assessment methods to optimise learning outside the clinical setting. Here, we present a randomised control trial of three microsurgical training models, namely laboratory tabletop training microscope (Laboratory Microscope, LM), low-cost jewellers microscope (Home Microscope, HM) and iPad trainer (Home Tablet, HT). Thirty-nine participants were allocated to four groups, control n = 9, LM n = 10, HM n = 10 and HT n = 10. The participants performed a chicken femoral artery anastomosis at baseline and at the completion of training. The performance was assessed as follows: structured assessment of microsurgery skills (SAMS) score, time taken to complete anastomosis and time for suture placement. No statistically significant difference was noted between the groups at baseline. There was a statistically significant improvement in all training arms between the baseline and post-training for SAMS score, time taken to complete the anastomosis and time per suture placement. In addition, a reduction was observed in the leak rate. No statistical difference was observed among the training arms. Our study demonstrated that at the early stages of microsurgical skill acquisition, home training using either the jewellers microscope or iPad produces comparable results to laboratory-based training using a tabletop microscope. Therefore, home microsurgical training is a viable, easily accessible cost-effective modality that allows trainees to practice and take ownership of their technical skill development in this area. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

The Stanford Microsurgery and Resident Training (SMaRT) Scale: validation of an on-line global rating scale for technical assessment.

PubMed

Satterwhite, Thomas; Son, Ji; Carey, Joseph; Echo, Anthony; Spurling, Terry; Paro, John; Gurtner, Geoffrey; Chang, James; Lee, Gordon K

2014-05-01

We previously reported results of our on-line microsurgery training program, showing that residents who had access to our website significantly improved their cognitive and technical skills. In this study, we report an objective means for expert evaluators to reliably rate trainees' technical skills under the microscope, with the use of our novel global rating scale. "Microsurgery Essentials" (http://smartmicrosurgery.com) is our on-line training curriculum. Residents were randomly divided into 2 groups: 1 group reviewed this online resource and the other did not. Pre- and post-tests consisted of videotaped microsurgical sessions in which the trainee performed "microsurgery" on 3 different models: latex glove, penrose drain, and the dorsal vessel of a chicken foot. The SMaRT (Stanford Microsurgery and Resident Training) scale, consisting of 9 categories graded on a 5-point Likert scale, was used to assess the trainees. Results were analyzed with ANOVA and Student t test, with P less than 0.05 indicating statistical significance. Seventeen residents participated in the study. The SMaRT scale adequately differentiated the performance of more experienced senior residents (PGY-4 to PGY-6, total average score=3.43) from less experienced junior residents (PGY-1 to PGY-3, total average score=2.10, P<0.0001). Residents who viewed themselves as being confident received a higher score on the SMaRT scale (average score 3.5), compared to residents who were not as confident (average score 2.1) (P<0.001). There were no significant differences in scoring among all 3 evaluators (P>0.05). Additionally, junior residents who had access to our website showed a significant increase in their graded technical performance by 0.7 points when compared to residents who did not have access to the website who showed an improvement of only 0.2 points (P=0.01). Our SMaRT scale is valid and reliable in assessing the microsurgical skills of residents and other trainees. Current trainees are more likely to use self-directed on-line education because of its easy accessibility and interactive format. Our global rating scale can help ensure residents are achieving appropriate technical milestones.

Recent conclusions regarding the reconstructive microsurgery of peripheral nerves.

PubMed

Dumitrescu-Ionescu, Doina

2008-01-01

The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: A huge amount of work involved in carrying out microsurgical reconstructions of over 7500 peripheral nerves in over 3000 patients, 1800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. Experimental microsurgery on rabbit ears The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally. The Moberg test. Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months). Taking pictures and recording pre, intra and postoperative stages. The patients' professional, social and familial reintegration. The patients' state of mind; level of cooperation. Comparing results with those of classic and palliative repairs. Comparing the data resulting from this experience with the information provided by the specialist literature of the world. Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept.

Academic productivity of faculty associated with microsurgery fellowships.

PubMed

Ruan, Qing Zhao; Ricci, Joseph A; Silvestre, Jason; Ho, Olivia A; Lee, Bernard T

2017-09-01

The Hirsch index (h-index) is widely recognized as a reliable measure of academic productivity. While previous studies have applied the h-index to surgical disciplines, none have analyzed microsurgery faculty. This manuscript aims to examine the h-index of microsurgery fellowship faculty to categorize its applicability to microsurgeons as a determinant of academic output. Faculty demographics and institution characteristics were obtained from the American Society of Reconstructive Microsurgery (ASRM) and official program websites. Faculty h-indices were calculated using the Scopus database (Elsevier, USA). Data was assessed using bivariate analysis and multiple linear regression models to determine the relationship between independent variables and total publications, career h-index and 5-year h-index (h5-index) of each faculty. A total of 139 faculties from 22 programs met inclusion criteria. The median faculty age was 44 (IQR 13) and 84.9% of faculty were male. Faculty size, number of years of fellowship existence, number of fellows, FACS memberships, number of free flaps annually, and academic appointment title were significantly associated with the total publications, h-index, and h5-index. Multivariable analysis based on the significant independent variables demonstrated that geographical region and faculty ranks were significantly associated with the h5-index. Variables associated with seniority (age, years of practice after fellowship, and academic appointment) were positively correlated with the h-index. Given the increased use of bibliometrics in academic medicine, these results show that h-index is a viable tool that can be used to assess research productivity among academic microsurgeons. © 2016 Wiley Periodicals, Inc.

Modern adjuncts and technologies in microsurgery: an historical and evidence-based review.

PubMed

Pratt, George F; Rozen, Warren M; Chubb, Daniel; Whitaker, Iain S; Grinsell, Damien; Ashton, Mark W; Acosta, Rafael

2010-11-01

While modern reconstructive surgery was revolutionized with the introduction of microsurgical techniques, microsurgery itself has seen the introduction of a range of technological aids and modern techniques aiming to improve dissection times, anastomotic times, and overall outcomes. These include improved preoperative planning, anastomotic aides, and earlier detection of complications with higher salvage rates. Despite the potential for substantial impact, many of these techniques have been evaluated in a limited fashion, and the evidence for each has not been universally explored. The purpose of this review was to establish and quantify the evidence for each technique. A search of relevant medical databases was performed to identify literature providing evidence for each technology. Levels of evidence were thus accumulated and applied to each technique. There is a relative paucity of evidence for many of the more recent technologies described in the field of microsurgery, with no randomized controlled trials, and most studies in the field comprising case series only. Current evidence-based suggestions include the use of computed tomographic angiography (CTA) for the preoperative planning of perforator flaps, the intraoperative use of a mechanical anastomotic coupling aide (particularly the Unilink® coupler), and postoperative flap monitoring with strict protocols using clinical bedside monitoring and/or the implantable Doppler probe. Despite the breadth of technologies introduced into the field of microsurgery, there is substantial variation in the degree of evidence presented for each, suggesting the role for much future research, particularly from emerging technologies such as robotics and modern simulators. Copyright © 2010 Wiley-Liss, Inc.

Development of a shape memory alloy actuator for transanal endoscopic microsurgery.

PubMed

Wang, Zhigang; Hewit, Jim; Abel, Eric; Slade, Alan; Steele, Bob

2005-01-01

This paper describes problems in traditional transanal endoscopic microsurgery (TEM), and proposes a mechatronics approach in new design. As one of several actuation mechanisms to expose rectal cavity, a compression coil spring made of shape memory alloy (SMA) has been studied. A custom SMA spring actuator was designed to displace 12 mm with 45 N driving force. This actuator was embedded with our new TEM tubular structure and can be used to expose a rectal site up to 60 mm wide and 80 mm long. This exposure is considered to be sufficient for treating many tumors.

Feeding status and serotonin rapidly and reversibly modulate a Caenorhabditis elegans chemosensory circuit

PubMed Central

Chao, Michael Y.; Komatsu, Hidetoshi; Fukuto, Hana S.; Dionne, Heather M.; Hart, Anne C.

2004-01-01

Serotonin (5-HT) modulates synaptic efficacy in the nervous system of vertebrates and invertebrates. In the nematode Caenorhabditis elegans, many behaviors are regulated by 5-HT levels, which are in turn regulated by the presence or absence of food. Here, we show that both food and 5-HT signaling modulate chemosensory avoidance response of octanol in C. elegans, and that this modulation is both rapid and reversible. Sensitivity to octanol is decreased when animals are off food or when 5-HT levels are decreased; conversely, sensitivity is increased when animals are on food or have increased 5-HT signaling. Laser microsurgery and behavioral experiments reveal that sensory input from different subsets of octanol-sensing neurons is selectively used, depending on stimulus strength, feeding status, and 5-HT levels. 5-HT directly targets at least one pair of sensory neurons, and 5-HT signaling requires the Gα protein GPA-11. Glutamatergic signaling is required for response to octanol, and the GLR-1 glutamate receptor plays an important role in behavioral response off food but not on food. Our results demonstrate that 5-HT modulation of neuronal activity via G protein signaling underlies behavioral plasticity by rapidly altering the functional circuitry of a chemosensory circuit. PMID:15492222

Persistent extraradicular infection in root-filled asymptomatic human tooth: scanning electron microscopic analysis and microbial investigation after apical microsurgery.

PubMed

Signoretti, Fernanda G C; Endo, Marcos S; Gomes, Brenda P F A; Montagner, Francisco; Tosello, Fernanda B; Jacinto, Rogério C

2011-12-01

Procedural accidents have a negative effect on healing and might contribute to the persistence of infections in inaccessible apical areas, requiring surgical intervention. This report describes a case of persistent apical periodontitis of a lower left first molar associated with the sinus tract and a periapical lesion that required nonsurgical endodontic retreatment and apical surgery for resolution. The tooth had received endodontic treatment 3 years ago and had to be retreated using the crown-down technique with chemical auxiliary substance (2% chlorhexidine gel), foramen patency, and enlargement and was filled in a single appointment. The occlusal access cavity was immediately restored with composite resin. After 1 month, it could be observed that the sinus tract persisted and, radiographically, the lesion remained unaltered. Therefore, endodontic microsurgery was indicated. Apical microsurgery was performed under magnification with the use of a dental operating microscope including apicectomy, root end with ultrasound, and sealing with mineral trioxide aggregate. A microbiological sample was collected from the apical lesion. The resected distal root apex was observed by scanning electron microscopy. The following species were detected: Actinomyces naeslundii and Actinomyces meyeri, Propionibacterium propionicum, Clostridium botullinum, Parvimonas micra, and Bacteroides ureolyticus; scanning electron microscopic analysis revealed bacterial biofilm surrounding the apical foramen and external radicular surface. Gutta-percha overfilling at the apex because of a zip caused during initial endodontic treatment could be observed. A 6-month follow-up showed apparent radiographic periapical healing, which progressed after 24 months. Gram-positive anaerobic bacteria and extraradicular biofilm seem to participate in the maintenance of persistent periapical pathology, and endodontic retreatment followed by periapical microsurgery proved to be a successful alternative in the resolution of persistent extraradicular infections. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Vestibular schwannoma management: Part II. Failed radiosurgery and the role of delayed microsurgery.

PubMed

Pollock, Bruce E; Lunsford, L Dade; Kondziolka, Douglas; Sekula, Raymond; Subach, Brian R; Foote, Robert L; Flickinger, John C

2013-12-01

The indications, operative findings, and outcomes of vestibular schwannoma microsurgery are controversial when it is performed after stereotactic radiosurgery. To address these issues, the authors reviewed the experience at two academic medical centers. During a 10-year interval, 452 patients with unilateral vestibular schwannomas underwent gamma knife radiosurgery. Thirteen patients (2.9%) underwent delayed microsurgery at a median of 27 months (range 7–72 months) after they had undergone radiosurgery. Six of the 13 patients had undergone one or more microsurgical procedures before they underwent radiosurgery. The indications for surgery were tumor enlargement with stable symptoms in five patients, tumor enlargement with new or increased symptoms in five patients, and increased symptoms without evidence of tumor growth in three patients. Gross-total resection was achieved in seven patients and near-gross-total resection in four patients. The surgery was described as more difficult than that typically performed for schwannoma in eight patients, no different in four patients, and easier in one patient. At the last follow-up evaluation, three patients had normal or near-normal facial function, three patients had moderate facial dysfunction, and seven had facial palsies. Three patients were incapable of caring for themselves, and one patient died of progression of a malignant triton tumor. Failed radiosurgery in cases of vestibular schwannoma was rare. No clear relationship was demonstrated between the use of radiosurgery and the subsequent ease or difficulty of delayed microsurgery. Because some patients have temporary enlargement of their tumor after radiosurgery, the need for surgical resection after radiosurgery should be reviewed with the neurosurgeon who performed the radiosurgery and should be delayed until sustained tumor growth is confirmed. A subtotal tumor resection should be considered for patients who require surgical resection of their tumor after vestibular schwannoma radiosurgery.

Comparison of the effect of endodontic-periodontal combined lesion on the outcome of endodontic microsurgery with that of isolated endodontic lesion: survival analysis using propensity score analysis.

PubMed

Song, Minju; Kang, Minji; Kang, Dae Ryong; Jung, Hoi In; Kim, Euiseong

2018-05-01

The purpose of this retrospective clinical study was to evaluate the effect of lesion types related to endodontic microsurgery on the clinical outcome. Patients who underwent endodontic microsurgery between March 2001 and March 2014 with a postoperative follow-up period of at least 1 year were included in the study. Survival analyses were conducted to compare the clinical outcomes between isolated endodontic lesion group (endo group) and endodontic-periodontal combined lesion group (endo-perio group) and to evaluate other clinical variables. To reduce the effect of selection bias in this study, the estimated propensity scores were used to match the cases of the endo group with those of the endo-perio group. Among the 414 eligible cases, the 83 cases in the endo-perio group were matched to 166 out of the 331 cases in the endo group based on propensity score matching (PSM). The cumulated success rates of the endo and endo-perio groups were 87.3 and 72.3%, respectively. The median success period of the endo-perio group was 12 years (95% CI: 5.507, 18.498). Lesion type was found to be significant according to both Log-rank test (P = 0.002) and Cox proportional hazard regression analysis (P = 0.001). Among the other clinical variables, sex (female or male), age, and tooth type (anterior, premolar, or molar) were determined to be significant in Cox regression analysis (P < 0.05). Endodontic-periodontal combined lesions had a negative effect on the clinical outcome based on an analysis that utilized PSM, a useful statistical matching method for observational studies. Lesion type is a significant predictor of the outcome of endodontic microsurgery.

Frankfurt microsurgery course: the first 175 trainees.

PubMed

Perez-Abadia, G; Janko, M; Pindur, L; Sauerbier, M; Barker, J H; Joshua, I; Marzi, I; Frank, J

2017-06-01

Microsurgery courses, taught external to surgical training programs, are essential for acquiring the high level of technical skill required for clinical proficiency. The Frankfurt microsurgery course is a 5-day, intensive course that teaches arterial and venous anastomosis using end-to-end, end-to-side, one-way-up, continuous-suture, and vessel graft techniques. During the course, the instructor records the level of skill (in-course data) achieved by each trainee by assessing anastomosis completion and patency. Demographic information is also collected. Post-course trainees are invited to complete an online survey (post-course data) to get their opinions of the courses' effectiveness. The in-course "skill achievement" and post-course "course effectiveness" data are presented below. In-course data: 94.8 and 59.9% of participants completed patent end-to-end arterial and venous anastomoses, respectively, while 85.4% performed a patent end-to-side anastomosis. 96.1 and 57.1% of participants who attempted arterial and venous anastomoses using the one-way-up technique were successful, as were 90.9% of those attempting continuous-suture technique. Patent venous grafts were performed by 54.7% of participants. All respondents indicated significant improvement of their microsurgical skills after taking the course. 66.7% of respondents considered the full-time presence of the instructor to be the most valuable aspect of the course. All respondents would highly recommend the course to colleagues. The microcourse significantly increased trainees' clinical microsurgery skills, confidence, and the number of clinical cases they perform. Of all the anastomosis techniques taught, venous anastomosis and grafting were the most difficult to learn. The presence of a full-time experienced instructor was most important.

Assessment of three-dimensional high-definition visualization technology to perform microvascular anastomosis.

PubMed

Wong, Alex K; Davis, Gabrielle B; Nguyen, T JoAnna; Hui, Kenneth J W S; Hwang, Brian H; Chan, Linda S; Zhou, Zhao; Schooler, Wesley G; Chandrasekhar, Bala S; Urata, Mark M

2014-07-01

Traditional visualization techniques in microsurgery require strict positioning in order to maintain the field of visualization. However, static posturing over time may lead to musculoskeletal strain and injury. Three-dimensional high-definition (3DHD) visualization technology may be a useful adjunct to limiting static posturing and improving ergonomics in microsurgery. In this study, we aimed to investigate the benefits of using the 3DHD technology over traditional techniques. A total of 14 volunteers consisting of novice and experienced microsurgeons performed femoral anastomoses on male Sprague-Dawley retired breeder rats using traditional techniques as well as the 3DHD technology and compared the two techniques. Participants subsequently completed a questionnaire regarding their preference in terms of operational parameters, ergonomics, overall quality, and educational benefits. Efficiency was also evaluated by mean times to complete the anastomosis with each technique. A total of 27 anastomoses were performed, 14 of 14 using the traditional microscope and 13 of 14 using the 3DHD technology. Preference toward the traditional modality was noted with respect to the parameters of precision, field adjustments, zoom and focus, depth perception, and overall quality. The 3DHD technique was preferred for improved stamina and less back and eye strain. Participants believed that the 3DHD technique was the better method for learning microsurgery. Longer mean time of anastomosis completion was noted in participants utilizing the 3DHD technique. The 3DHD technology may prove to be valuable in improving proper ergonomics in microsurgery. In addition, it may be useful in medical education when applied to the learning of new microsurgical skills. More studies are warranted to determine its efficacy and safety in a clinical setting. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Multimodal ophthalmic imaging using spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography

NASA Astrophysics Data System (ADS)

El-Haddad, Mohamed T.; Malone, Joseph D.; Li, Jianwei D.; Bozic, Ivan; Arquitola, Amber M.; Joos, Karen M.; Patel, Shriji N.; Tao, Yuankai K.

2017-08-01

Ophthalmic surgery involves manipulation of delicate, layered tissue structures on milli- to micrometer scales. Traditional surgical microscopes provide an inherently two-dimensional view of the surgical field with limited depth perception which precludes accurate depth-resolved visualization of these tissue layers, and limits the development of novel surgical techniques. We demonstrate multimodal swept-source spectrally encoded scanning laser ophthalmoscopy and optical coherence tomography (SS-SESLO-OCT) to address current limitations of image-guided ophthalmic microsurgery. SS-SESLO-OCT provides inherently co-registered en face and cross-sectional field-of-views (FOVs) at a line rate of 400 kHz and >2 GPix/s throughput. We show in vivo imaging of the anterior segment and retinal fundus of a healthy volunteer, and preliminary results of multi-volumetric mosaicking for ultrawide-field retinal imaging with 90° FOV. Additionally, a scan-head was rapid-prototyped with a modular architecture which enabled integration of SS-SESLO-OCT with traditional surgical microscope and slit-lamp imaging optics. Ex vivo surgical maneuvers were simulated in cadaveric porcine eyes. The system throughput enabled volumetric acquisition at 10 volumes-per-second (vps) and allowed visualization of surgical dynamics in corneal sweeps, compressions, and dissections, and retinal sweeps, compressions, and elevations. SESLO en face images enabled simple real-time co-registration with the surgical microscope FOV, and OCT cross-sections provided depth-resolved visualization of instrument-tissue interactions. Finally, we demonstrate novel augmented-reality integration with the surgical view using segmentation overlays to aid surgical guidance. SS-SESLO-OCT may benefit clinical diagnostics by enabling aiming, registration, and mosaicking; and intraoperative imaging by allowing for real-time surgical feedback, instrument tracking, and overlays of computationally extracted biomarkers of disease.

Comparison of effects on voice of diode laser and cold knife microlaryngology techniques for vocal fold polyps.

PubMed

Karasu, Mehmet Fatih; Gundogdu, Ramazan; Cagli, Sedat; Aydin, Mesut; Arli, Turan; Aydemir, Samet; Yuce, Imdat

2014-05-01

To compare the effects on voice of endolaryngeal microsurgery (EMS) with cold instruments and a new method, "diode laser," for vocal fold polyps. Fifty-one patients with vocal fold polyps suffering from dysphonia who were treated in the Erciyes University Department of Otolaryngology were included in the study. Voice analysis was performed in a soundproof room, holding the microphone 15 cm away from the patients' mouth and by recording a sustained [a] vowel for at least 10 seconds. Fundamental frequency (F0), Jitter, Shimmer, and noise-to-harmonic ratio (NHR) parameters were evaluated in terms of vocal analysis. All patients were asked for to fill in a questionnaire, after being informed about the voice handicap index (VHI). EMS was performed with a diode laser and cold knife on 26 and 25 patients, respectively. Patient follow-up was performed 8 weeks after surgery. Changes in F0, Jitter, Shimmer, and NHR values were measured and recorded. VHI was also completed and reassessed. There was a significant difference in each technique's VHI score between the preoperative and postoperative questionnaire (P < 0.001). Postoperatively, there was no significant difference in VHI scores between two groups (P > 0.05). There was a significant difference in voice analysis values measured preoperatively and at the postoperative controls for both groups (P < 0.05). Postoperatively, there was no significant difference in voice analysis values between two groups (P > 0.05). In the treatment of vocal polyps, EMS with both diode laser and traditional cold knife is effective. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Pac-man motility of kinetochores unleashed by laser microsurgery

PubMed Central

LaFountain, James R.; Cohan, Christopher S.; Oldenbourg, Rudolf

2012-01-01

We report on experiments directly in living cells that reveal the regulation of kinetochore function by tension. X and Y sex chromosomes in crane fly (Nephrotoma suturalis) spermatocytes exhibit an atypical segregation mechanism in which each univalent maintains K-fibers to both poles. During anaphase, each maintains a leading fiber (which shortens) to one pole and a trailing fiber (which elongates) to the other. We used this intriguing behavior to study the motile states that X-Y kinetochores are able to support during anaphase. We used a laser microbeam to either sever a univalent along the plane of sister chromatid cohesion or knock out one of a univalent's two kinetochores to release one or both from the resistive influence of its sister's K-fiber. Released kinetochores with attached chromosome arms moved poleward at rates at least two times faster than normal. Furthermore, fluorescent speckle microscopy revealed that detached kinetochores converted their functional state from reverse pac-man to pac-man motility as a consequence of their release from mechanical tension. We conclude that kinetochores can exhibit pac-man motility, even though their normal behavior is dominated by traction fiber mechanics. Unleashing of kinetochore motility through loss of resistive force is further evidence for the emerging model that kinetochores are subject to tension-sensitive regulation. PMID:22740625

A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult's recurrent craniopharyngioma.

PubMed

Preece, David; Allan, Alfred; Becerra, Rodrigo

2016-01-01

To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning. JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy. JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy. Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD's IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained. These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.

The outcome of apical microsurgery using MTA as the root-end filling material: 2- to 6-year follow-up study.

PubMed

Çalışkan, M K; Tekin, U; Kaval, M E; Solmaz, M C

2016-03-01

To evaluate the influence of various predictors on the healing outcome 2-6 years after apical microsurgery (AMS) using MTA as the root-end filling material. A total of 90 anterior teeth with asymptomatic persistent periradicular periodontitis of strictly endodontic origin that failed after either nonsurgical or surgical treatment were included. Surgery was completed under local anaesthesia using a standardized clinical protocol. Clinical and radiographic measures as well as the follow-up period were used to determine the healing outcome. For statistical analysis of the predictors, the outcome was dichotomized into healed cases and nonhealed cases. Odds ratios were calculated, and Pearson chi-square or Fisher's exact tests were used to analyse the data. Clinical and radiographic assessment of AMS revealed that 80% were healed, 14.4% were nonhealed, whilst 5.6% were judged to be uncertain. None of the various predictors investigated had a significant influence on the outcome of AMS. The results of this clinical study demonstrated that 80% of cases that received apical microsurgery healed when using MTA as the root-end filling material. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Evidence and evidence gaps of laryngeal cancer surgery

PubMed Central

Wiegand, Susanne

2016-01-01

Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal. PMID:28025603

Design, Kinematic Optimization, and Evaluation of a Teleoperated System for Middle Ear Microsurgery

PubMed Central

Miroir, Mathieu; Nguyen, Yann; Szewczyk, Jérôme; Sterkers, Olivier; Bozorg Grayeli, Alexis

2012-01-01

Middle ear surgery involves the smallest and the most fragile bones of the human body. Since microsurgical gestures and a submillimetric precision are required in these procedures, the outcome can be potentially improved by robotic assistance. Today, there is no commercially available device in this field. Here, we describe a method to design a teleoperated assistance robotic system dedicated to the middle ear surgery. Determination of design specifications, the kinematic structure, and its optimization are detailed. The robot-surgeon interface and the command modes are provided. Finally, the system is evaluated by realistic tasks in experimental dedicated settings and in human temporal bone specimens. PMID:22927789

[Image guided and robotic treatment--the advance of cybernetics in clinical medicine].

PubMed

Fosse, E; Elle, O J; Samset, E; Johansen, M; Røtnes, J S; Tønnessen, T I; Edwin, B

2000-01-10

The introduction of advanced technology in hospitals has changed the treatment practice towards more image guided and minimal invasive procedures. Modern computer and communication technology opens up for robot aided and pre-programmed intervention. Several robotic systems are in clinical use today both in microsurgery and in major cardiac and orthopedic operations. As this trend develops, professions which are new in this context such as physicists, mathematicians and cybernetic engineers will be increasingly important in the treatment of patients.

Controlled propulsion of artificial magnetic nanostructured propellers.

PubMed

Ghosh, Ambarish; Fischer, Peer

2009-06-01

For biomedical applications, such as targeted drug delivery and microsurgery, it is essential to develop a system of swimmers that can be propelled wirelessly in fluidic environments with good control. Here, we report the construction and operation of chiral colloidal propellers that can be navigated in water with micrometer-level precision using homogeneous magnetic fields. The propellers are made via nanostructured surfaces and can be produced in large numbers. The nanopropellers can carry chemicals, push loads, and act as local probes in rheological measurements.

Does apical root resection in endodontic microsurgery jeopardize the prosthodontic prognosis?

PubMed Central

Cho, Sin-Yeon

2013-01-01

Apical surgery cuts off the apical root and the crown-to-root ratio becomes unfavorable. Crown-to-root ratio has been applied to periodontally compromised teeth. Apical root resection is a different matter from periodontal bone loss. The purpose of this paper is to review the validity of crown-to-root ratio in the apically resected teeth. Most roots have conical shape and the root surface area of coronal part is wider than apical part of the same length. Therefore loss of alveolar bone support from apical resection is much less than its linear length.The maximum stress from mastication concentrates on the cervical area and the minimum stress was found on the apical 1/3 area. Therefore apical root resection is not so harmful as periodontal bone loss. Osteotomy for apical resection reduces longitudinal width of the buccal bone and increases the risk of endo-perio communication which leads to failure. Endodontic microsurgery is able to realize 0 degree or shallow bevel and precise length of root resection, and minimize the longitudinal width of osteotomy. The crown-to-root ratio is not valid in evaluating the prosthodontic prognosis of the apically resected teeth. Accurate execution of endodontic microsurgery to preserve the buccal bone is essential to avoid endo-perio communication. PMID:23741707

The fusion of craniofacial reconstruction and microsurgery: a functional and aesthetic approach.

PubMed

Broyles, Justin M; Abt, Nicholas B; Shridharani, Sachin M; Bojovic, Branko; Rodriguez, Eduardo D; Dorafshar, Amir H

2014-10-01

Reconstruction of large, composite defects in the craniofacial region has evolved significantly over the past half century. During this time, there have been significant advances in craniofacial and microsurgical surgery. These contributions have often been in parallel; however, over the past 10 years, these two disciplines have begun to overlap more frequently, and the techniques of one have been used to advance the other. In the current review, the authors aim to describe the available options for free tissue reconstruction in craniofacial surgery. A review of microsurgical reconstructive options of aesthetic units within the craniofacial region was undertaken with attention directed toward surgeon flap preference. Anatomical areas analyzed included scalp, calvaria, forehead, frontal sinus, nose, maxilla and midface, periorbita, mandible, lip, and tongue. Although certain flaps such as the ulnar forearm flap and lateral circumflex femoral artery-based flaps were used in multiple reconstructive sites, each anatomical location possesses a unique array of flaps to maximize outcomes. Craniofacial surgery, like plastic surgery, has made tremendous advancements in the past 40 years. With innovations in technology, flap design, and training, microsurgery has become safer, faster, and more commonplace than at any time in history. Reconstructive microsurgery allows the surgeon to be creative in this approach, and free tissue transfer has become a mainstay of modern craniofacial reconstruction.

Porcine experimental model for perforator flap raising in reconstructive microsurgery.

PubMed

González-García, José A; Chiesa-Estomba, Carlos M; Álvarez, Leire; Altuna, Xabier; García-Iza, Leire; Thomas, Izaskun; Sistiaga, Jon A; Larruscain, Ekhiñe

2018-07-01

Perforator free flap-based reconstruction of the head and neck is a challenging surgical procedure and needs a steep learning curve. A reproducible mammal large animal model with similarities to human anatomy is relevant for perforator flap raising and microanastomosis. The aim of this study was to assess the feasibility of a swine model for perforator-based free flaps in reconstructive microsurgery. Eleven procedures were performed under general anesthesia in a porcine model, elevating a skin flap vascularized by perforating musculocutaneous branches of the superior epigastric artery to evaluate the relevance of this model for head and neck reconstructive microsurgery. The anterior abdominal skin perforator-based free flap in a swine model irrigated by the superior epigastric artery was elevated in eleven procedures. In six of these procedures, we could perform an arterial and venous microanastomosis to the great vessels located in the base of the neck. The porcine experimental model of superior epigastric artery perforator-based free flap reconstruction offers relevant similarities to the human deep inferior epigastric artery perforator flap. We could demonstrate this model as acceptable for perforator free flap training due to the necessity of perforator and pedicle dissection and transfer to a distant area. Copyright © 2018 Elsevier Inc. All rights reserved.

Is there still a role for reconstructive microsurgery in tubal infertility?

PubMed

Schippert, Cordula; Garcia-Rocha, Guillermo-José

2011-06-01

To review the current role of tubal reconstructive surgery in the era of assisted reproductive techniques (ARTs). After tubal reconstructive surgery, couples may have unlimited attempts to conceive naturally. Operative risks are low; the risk for ectopic pregnancy after surgery is 4-10%. ART is associated with a number of potential complications: severe ovarian hyperstimulation syndrome (0.25-2%), multiple pregnancies (up to 25%), a higher rate of major malformations and stillbirths, and ectopic pregnancy (1-13%). Birth rates following ART differ between 19 and 35%, depending on different laws governing the fertilization of a limited number of oocytes and the number of embryos transferred. Resterilization is a main indication for microsurgery with resulting pregnancy rates up to 84%. Salpingostomy and dense adhesiolysis have the lowest success rates (term pregnancy rates: 3-65%). Proximal tubal obstructions can be successfully treated by tubocornual anastomosis. Hydrosalpinges should be removed prior to in-vitro fertilization if they cannot be reconstructed. ART is recommended for patients older than 37-38 years, for women with severe tubal pathology, after repeated ectopic pregnancies, and in case of male infertility. Tubal reconstructive surgery still plays a role in infertility treatment. ART has not replaced microsurgery routinely as first-line treatment for tubal infertility.

Reconstructive microsurgery in pediatric population-a series of 25 patients.

PubMed

Yildirim, Serkan; Calikapan, Gaye Taylan; Akoz, Tayfun

2008-01-01

Pediatric microsurgery procedures possess various difficulties when compared with adults. However, both free tissue transfers and replantation of the amputated parts show remarkable success rates in children. The concerns of survival of the flaps and the amputated parts have shifted to the function of these in the adulthood. Several key points and hints allow successfull rates for both survival and function. We present a series of microsurgical procedures both free tissue transfers (12 patients) and digital replantations (13 patients). Free tissue transfers included toe-to-hand transfers in 5, latissimus dorsi flaps in 4, fibular flaps in 4, and anterolateral thigh flaps in 2 patients. Thirteen patients involved 17 digital replantations. The survival rate was less in the replantation group (58.75%) than in the free tissue transfer group (93%). Both the functional and the cosmetic results were promising. The follow-up period was between 1 and 6 years (mean 37 months) for the free tissue transfer group and 1-5 years (mean 20 months) for the replantation group. The major technical difficulties include the age group of 0-2 years. Aside from these the high capacity of regeneration and the improved learning capacity increase the feasibility of the microsurgical procedures proceeded among children. Copyright 2008 Wiley-Liss, Inc. Microsurgery, 2008.

Transsphenoidal microsurgery in the treatment of acromegaly and gigantism.

PubMed

Arafah, B U; Brodkey, J S; Kaufman, B; Velasco, M; Manni, A; Pearson, O H

1980-03-01

Twenty-five patients with acromegaly and 3 patients with gigantism underwent transsphenoidal microsurgery in an attempt to remove the tumor and preserve normal pituitary function whenever possible. An adenoma was identified and removed in 27 of 28 patients. Evaluation 3--6 months postoperatively revealed a GH level less than 5 ng/ml in 29 patients, 5--10 ng/ml in 4 patients and 11--29 ng/ml in 4 other patients. Dynamics of GH secretion were normal in 11 patients who had normal pituitary function and are considered cured. Two patients with low or undetectable GH levels are also considered cured at the expense of being hypopituitary. Three of 7 patients with normal basal GH levels but abnormal dynamics of GH secretion relapsed within 1 yr. Eleven of the 13 patients considered cured did not have extrasellar extension, while 14 of the 15 patients not cured had extrasellar extension. Five patients who were not cured with surgery received radiation therapy. Three patients were treated with an ergot derivative, Lergotrile mesylate, after surgery and radiation therapy failed to normalize GH levels. Transsphenoidal microsurgery is an optimal form of therapy for patients with acromegaly or gigantism, especially those with no extrasellar extension. Dynamics of GH secretion are very useful in evaluating the completeness of adenoma removal.

Dexterity enhancement in microsurgery using telemicro-robotics

NASA Technical Reports Server (NTRS)

Charles, Steve

1994-01-01

The presentation will focus on finding the spectrum of dexterity performance while performing microsurgery in various specialties. It will be noted that individuals vary markedly in their performance in the position, velocity, stability, and force domains. There are surgeons who have a tremor who otherwise move very slowly and carefully while there are other surgeons who apply excessive force, but never have a tremor or move excessively fast. There are yet other surgeons who move excessively fast, yet they do not have a tremor. Dexterity enhancement includes position down scaling, tremor filtering, fatigue elimination, and other second-order issues such as confining the work space, velocities, accelerations, or forces. It will be described that the hand's position performance is degraded when it is asked to actuate the tools and that remote actuation alone increases the positioning capabilities. It will be noted that rotary and telescopic functions are far more difficult than writing or engraving-like motions. The safety issues concerning velocities and forces will be discussed and the need for impedance control pointed out. Simplistically, the devices should be made with variable compliance so that they can function rigidly as a robot would or compliantly as a human would, depending on the setting of this parameter. Tool interfaces will be discussed with an emphasis on the overall performance of the position, end effector, and tool as a unit. Space constraints, force, and velocity requirements will be discussed in this section as well. Referencing the coordinate system to pre- or inter-operative imaging systems will be discussed as well as an emphasis on the system architecture.

21 CFR 882.4525 - Microsurgical instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4525 Microsurgical instrument. (a) Identification. A microsurgical instrument is a nonpowered surgical instrument used in neurological microsurgery...

21 CFR 882.4525 - Microsurgical instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4525 Microsurgical instrument. (a) Identification. A microsurgical instrument is a nonpowered surgical instrument used in neurological microsurgery...

Military Medical Care: Questions and Answers

DTIC Science & Technology

2009-05-14

framework including GWOT, counterterrorism, counterinsurgency, and military support for stabilization and reconstruction efforts. With respect to the... microsurgery (rodents); and combat trauma training (goats and swine

Investigation of Reperfusion Injury and Ischemic Preconditioning in Microsurgry

PubMed Central

Wang, Wei Zhong

2008-01-01

Ischemia/reperfusion (I/R) is inevitable in many vascular and musculoskeletal traumas, diseases, free tissue transfers, and during time-consuming reconstructive surgeries in the extremities. Salvage of a prolonged ischemic extremity or flap still remains a challenge for the microvascular surgeon. One of the common complications after microsurgery is I/R-induced tissue death or I/R injury. Twenty years after the discovery, ischemic preconditioning (IPC) has emerged as a powerful method for attenuating I/R injury in a variety of organs or tissues. However, its therapeutic expectations still need to be fulfilled. In this article, the author reviews some important experimental evidences of I/R injury as well as preconditioning-induced protection in the fields relevant to microsurgery. PMID:18946882

[RESEARCH PROGRESS OF PERIPHERAL NERVE SURGERY ASSISTED BY Da Vinci ROBOTIC SYSTEM].

PubMed

Shen, Jie; Song, Diyu; Wang, Xiaoyu; Wang, Changjiang; Zhang, Shuming

2016-02-01

To summarize the research progress of peripheral nerve surgery assisted by Da Vinci robotic system. The recent domestic and international articles about peripheral nerve surgery assisted by Da Vinci robotic system were reviewed and summarized. Compared with conventional microsurgery, peripheral nerve surgery assisted by Da Vinci robotic system has distinctive advantages, such as elimination of physiological tremors and three-dimensional high-resolution vision. It is possible to perform robot assisted limb nerve surgery using either the traditional brachial plexus approach or the mini-invasive approach. The development of Da Vinci robotic system has revealed new perspectives in peripheral nerve surgery. But it has still been at the initial stage, more basic and clinical researches are still needed.

The OCT penlight: in-situ image guidance for microsurgery

NASA Astrophysics Data System (ADS)

Galeotti, John; Sajjad, Areej; Wang, Bo; Kagemann, Larry; Shukla, Gaurav; Siegel, Mel; Wu, Bing; Klatzky, Roberta; Wollstein, Gadi; Schuman, Joel S.; Stetten, George

2010-02-01

We have developed a new image-based guidance system for microsurgery using optical coherence tomography (OCT), which presents a virtual image in its correct location inside the scanned tissue. Applications include surgery of the cornea, skin, and other surfaces below which shallow targets may advantageously be displayed for the naked eye or low-power magnification by a surgical microscope or loupes (magnifying eyewear). OCT provides real-time highresolution (3 micron) images at video rates within a two or more millimeter axial range in soft tissue, and is therefore suitable for guidance to various shallow targets such as Schlemm's canal in the eye (for treating Glaucoma) or skin tumors. A series of prototypes of the "OCT penlight" have produced virtual images with sufficient resolution and intensity to be useful under magnification, while the geometrical arrangement between the OCT scanner and display optics (including a half-silvered mirror) permits sufficient surgical access. The two prototypes constructed thus far have used, respectively, a miniature organic light emitting diode (OLED) display and a reflective liquid crystal on silicon (LCoS) display. The OLED has the advantage of relative simplicity, satisfactory resolution (15 micron), and color capability, whereas the LCoS can produce an image with much higher intensity and superior resolution (12 micron), although it is monochromatic and more complicated optically. Intensity is a crucial limiting factor, since light flux is greatly diminished with increasing magnification, thus favoring the LCoS as the more practical system.

Robot-assisted vitreoretinal surgery: current perspectives

PubMed Central

Roizenblatt, Marina; Edwards, Thomas L; Gehlbach, Peter L

2018-01-01

Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation. The inherent attributes of robotic approaches therefore, provide logical, strategic and promising solutions to the numerous challenges associated with retinal microsurgery. Robotic retinal surgery is a rapidly emerging technology that has witnessed an exponential growth in capabilities and applications over the last decade. There is now a worldwide movement toward evaluating robotic systems in an expanding number of clinical applications. Coincident with this expanding application is growth in the number of laboratories committed to “robotic medicine”. Recent technological advances in conventional retina surgery have also led to tremendous progress in the surgeon’s capabilities, enhanced outcomes, a reduction of patient discomfort, limited hospitalization and improved safety. The emergence of robotic technology into this rapidly advancing domain is expected to further enhance important aspects of the retinal surgery experience for the patients, surgeons and society. PMID:29527537

Robot-assisted vitreoretinal surgery: current perspectives.

PubMed

Roizenblatt, Marina; Edwards, Thomas L; Gehlbach, Peter L

2018-01-01

Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation. The inherent attributes of robotic approaches therefore, provide logical, strategic and promising solutions to the numerous challenges associated with retinal microsurgery. Robotic retinal surgery is a rapidly emerging technology that has witnessed an exponential growth in capabilities and applications over the last decade. There is now a worldwide movement toward evaluating robotic systems in an expanding number of clinical applications. Coincident with this expanding application is growth in the number of laboratories committed to "robotic medicine". Recent technological advances in conventional retina surgery have also led to tremendous progress in the surgeon's capabilities, enhanced outcomes, a reduction of patient discomfort, limited hospitalization and improved safety. The emergence of robotic technology into this rapidly advancing domain is expected to further enhance important aspects of the retinal surgery experience for the patients, surgeons and society.

The evolution of neuroArm.

PubMed

Sutherland, Garnette R; Wolfsberger, Stefan; Lama, Sanju; Zarei-nia, Kourosh

2013-01-01

Intraoperative imaging disrupts the rhythm of surgery despite providing an excellent opportunity for surgical monitoring and assessment. To allow surgery within real-time images, neuroArm, a teleoperated surgical robotic system, was conceptualized. The objective was to design and manufacture a magnetic resonance-compatible robot with a human-machine interface that could reproduce some of the sight, sound, and touch of surgery at a remote workstation. University of Calgary researchers worked with MacDonald, Dettwiler and Associates engineers to produce a requirements document, preliminary design review, and critical design review, followed by the manufacture, preclinical testing, and clinical integration of neuroArm. During the preliminary design review, the scope of the neuroArm project changed to performing microsurgery outside the magnet and stereotaxy inside the bore. neuroArm was successfully manufactured and installed in an intraoperative magnetic resonance imaging operating room. neuroArm was clinically integrated into 35 cases in a graded fashion. As a result of this experience, neuroArm II is in development, and advances in technology will allow microsurgery within the bore of the magnet. neuroArm represents a successful interdisciplinary collaboration. It has positive implications for the future of robotic technology in neurosurgery in that the precision and accuracy of robots will continue to augment human capability.

High performance bilateral telerobot control.

PubMed

Kline-Schoder, Robert; Finger, William; Hogan, Neville

2002-01-01

Telerobotic systems are used when the environment that requires manipulation is not easily accessible to humans, as in space, remote, hazardous, or microscopic applications or to extend the capabilities of an operator by scaling motions and forces. The Creare control algorithm and software is an enabling technology that makes possible guaranteed stability and high performance for force-feedback telerobots. We have developed the necessary theory, structure, and software design required to implement high performance telerobot systems with time delay. This includes controllers for the master and slave manipulators, the manipulator servo levels, the communication link, and impedance shaping modules. We verified the performance using both bench top hardware as well as a commercial microsurgery system.

Radiographic and histological evaluation of persistent periapical lesions associated with endodontic failures after apical microsurgery.

PubMed

Çalışkan, M K; Kaval, M E; Tekin, U; Ünal, T

2016-11-01

To determine the histology of persistent periapical lesions associated with nonsurgical endodontic treatment failures and to compare radiographically the sizes of periapical lesions and the presence or absence of the radiopaque lamina with the histological findings. Ninety-three anterior teeth designated for apical microsurgery were included in the study. After taking standard radiographs of all cases using the parallel technique, the films were scanned and evaluated for the size of periapical radiolucent lesions and the presence or absence of radiopaque lamina by two calibrated observers. Biopsy specimens were obtained during apical microsurgery and examined under light microscopy by oral pathologists. Histological analysis established diagnoses of granuloma, cyst, abscess and scar tissue. Interobserver agreement was evaluated by the kappa test, and the relationship between histological diagnosis and lesion size was analysed by the Pearson's chi-square test. The 93 specimens consisted of 72% periradicular granulomas; 21.5% radicular cysts, including two keratocysts; 4.3% abscesses; and 2.2% scar tissue. Cystic prevalence increased as the size of the periapical lesion increased; however, there was no correlation between the presence of a radiopaque lamina and histological diagnosis of cyst. Neither radiographic size nor presence of an associated radiopaque line alone was sufficient to determine the type of lesion. Histological examination is required in order to reach to a definitive diagnosis. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Classification of the terminal arterial vascularization of the appendix with a view to its use in reconstructive microsurgery.

PubMed

Ouattara, Djibril; Kipré, Yvan Zunon; Broalet, Esperance; Séri, Fréjuis Gotta; Angaté, Hervé Yangni; Bi N'Guessan, Gabriel Gnanazan; Kassanyou, Salami

2007-12-01

The aim of this study was to examine the arterial vascularization of the appendix, in order to propose a classification of the different vascular types of the appendix for the realization of free transfer in reconstructive microsurgery. We achieved the removal as a monobloc of the cecum, of a part of the ileum, and the upper colon, then conducted the intra-arterial injection of a mixture composed of minium, and went on to the dissection of 25 specimens of appendix from West Africa. We analyzed the appendicular territory vascularized by the different discovered arteries. The average length of the appendix was 10.5 cm, ranging from 6.5 to 13.5 cm. The vascularization of the appendix was guaranteed by three arteries: the main appendicular artery, the ceco-appendicular artery and by one or several appendicular accessory arteries. We found five types of vascularization of the appendix according to the number and type of artery needed to guarantee the vascularization of the whole of the appendix including its base. It is evident from this study that a detailed analysis of the vascularization of the appendix is necessary before its removal for a reconstructive microsurgery, because in three cases out of four, the transplant must include at least two vessels in order to guarantee the whole of its vascularization.

Skin lesion biopsy

MedlinePlus

... biopsy - skin; Skin cancer - biopsy; Melanoma - biopsy; Squamous cell cancer - biopsy; Basal cell cancer - biopsy; Mohs microsurgery ... dermatitis Infection from bacteria or fungus Melanoma Basal cell skin cancer Squamous cell skin cancer

1.9-um diode-laser-assisted anastomoses in reconstructive microsurgery: preliminary results in 12 patients

NASA Astrophysics Data System (ADS)

Mordon, Serge R.; Schoffs, Michel; Martinot, Veronique L.; Buys, Bruno; Patenotre, Philippe; Lesage, Jean C.; Dhelin, Guy

1998-01-01

The authors reported an original 1.9 micrometer diode laser assisted microvascular anastomosis (LAMA) in human. This technique has been applied in 12 patients during reconstructive surgery for digital replantations (n equals 2), for digital revascularizations (n equals 3) and for free flap transfers (n equals 7). Fourteen end-to-end anastomoses (10 arteries, 4 veins) were performed. LAMA were always performed on vessel which did not impede the chance of success of the surgical procedure in case of thrombosis. LAMA was performed with a 1.9 micrometer diode laser after placement of 2 equidistant stitches. The didoes spot was obtained by means of an optic fiber transmitted to the vessel wall via a pencil size hand piece. The used parameters were as followed: spot size equals 400 micrometer, power equals 70 to 220 mW, time equals 0.7 to 2 seconds, mean fluence equals 115 J/cm2. The mechanism involved is a thermal effect on the collagen of the adventitia and media leading to a phenomena which the authors have termed 'heliofusion.' This preliminary trial has permitted to define the modalities of its use in human. The technique is simple, rapid and easily learned. The equipment is not cumbersome, sterilizable and very ergonomic. LAMA does not replace sutures but is complementary, thanks to a reduction in the number of stitches used and to an access to surgical areas which are not easily accessible. This study must be completed by a larger scale study to confirm this technique and its reliability. Others uses could performed on different tissues such as biliary and urinary track, specially under laparoscopic conditions.

Light activated microbubbles for imaging and microsurgery

NASA Astrophysics Data System (ADS)

Cavigli, Lucia; Micheletti, Filippo; Tortoli, Paolo; Centi, Sonia; Lai, Sarah; Borri, Claudia; Rossi, Francesca; Ratto, Fulvio; Pini, Roberto

2017-03-01

Imaging and microsurgery procedures based on the photoacoustic effect have recently attracted much attention for cancer treatment. Light absorption in the nanosecond regime triggers thermoelastic processes that induce ultrasound emission and even cavitation. The ultrasound waves may be detected to reconstruct images, while cavitation may be exploited to kill malignant cells. The potential of gold nanorods as contrast agents for photoacoustic imaging has been extensively investigated, but still little is known about their use to trigger cavitation. Here, we investigated the influence of environment thermal properties on the ability of gold nanorods to trigger cavitation by probing the photoacoustic emission as a function of the excitation fluence. We are confident that these results will provide useful directions to the development of new strategies for therapies based on the photoacoustic effect.

Advances and Innovations in Microsurgery.

PubMed

Park, Julie E; Chang, David W

2016-11-01

After reading this article, the participant should be able to: 1. summarize the evolution of perforator, chimeric, and free style flaps; 2. define and give examples of supermicrosurgery as well as understand its application in treatment of lymphedema; and 3. appreciate the development and advancements of composite tissue allotransplantation. Although microsurgery may seem like a highly specialized niche within plastic surgery, it is more than just a discipline that focuses on small anastomoses. It is a tool and a way of thinking that allows us to embody the true tenets of plastic surgery, as quoted by Tagliocozzi. What began as a challenge of returning amputated tissue to the body and achieving wound closure has evolved into a refinement of technique and change in philosophy that empowers the plastic surgeon to work creatively to "restore, rebuild, and make whole."

[Replantation of amputated penis in Chinese men: a meta-analysis].

PubMed

Li, Gui-Zhong; Man, Li-Bo; He, Feng; Huang, Guang-Lin

2013-08-01

To evaluate the methods for the replantation of the amputated penis in Chinese men. We performed a meta-analysis on the domestic literature relating replantation of the amputated penis, particularly its successful methods published from 1964 to January 2012. We identified 109 reports on 111 cases of replantation of the amputated penis that met the inclusion criteria, including 103 adults and 8 children. The mean age, warm ischemia time and total ischemia time were 29 +/- 11 years (range 2 - 56 years), 5.2 +/- 5.7 hours (range 0 - 38 hours) and 6.3 +/- 5.7 hours (range 1 - 38 hours). Fifty-three of the cases were treated by microsurgery and 44 by non-microsurgery. Complications occurred in 81 (73%) of the cases, including ED in 14 cases, urethral stricture in 16, urinary fistula in 8, skin necrosis in 58 and skin sensory abnormality in 31. The incidences of ED, urethral stricture and urinary fistula exhibited significant differences between the microsurgery and non-microsurgery groups of the partial amputation patients (P < 0.05). The incidence of ED was correlated negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.05), anastomosis of dorsal veins (r = -0.2, P = 0.02) and anastomosis of arteries (r = -0.2, P = 0.03), but positively with skin sensory abnormality (r = 0.4, P < 0.01), that of urethral stricture negatively with the anastomosis of dorsal nerves (r = -0.2, P = 0.02) and arteries (r = -0.2, P = 0.016), but positively with the anastomosis of corpus cavernosum (r = 0.3, P = 0.01), that of skin necrosis negatively with the total number of anastomosed blood vessels (r = -0.2, P = 0.04), and that of complications negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.01), dorsal veins (r = -0.2, P = 0.04), arteries (r = -0.2, P = 0.023) and micro-anastomosis (r = -0.3, P < 0.05). Early micro-anastomosis of the most possible penile dorsal veins, arteries and dorsal nerves is essential for the survival of the replanted penis and reduction of complications, and therefore can be regarded as a "standard" method for penile replantation in China.

Breast Reconstruction with Flap Surgery

MedlinePlus

... vessels requires expertise in surgery through a microscope (microsurgery). An advantage to this type of breast reconstruction ... of your disease Require additional surgery to correct reconstructive problems What breast reconstruction won't do: Make ...

Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery.

PubMed

Choi, Eun-Su; Jeong, Woo-Jin; Ahn, Soon-Hyun; Oh, Ah-Young; Jeon, Young-Tae; Do, Sang-Hwan

2017-02-01

We evaluated the effect of magnesium sulfate-an enhancer of neuromuscular blockade-on onset and duration of low dose of rocuronium, and on operating conditions during laryngeal microsurgery. Randomized, prospective, double-blinded study. Eighty-four patients scheduled for elective laryngeal microsurgery. Patients were randomly allocated to receive different doses of rocuronium: 0.6 mg/kg (group C, n=28), 0.45 mg/kg (group LR, n=28), or 0.45 mg/kg plus magnesium sulfate 30 mg/kg (group LM, n=28). We measured the onset time and duration of action of rocuronium, and evaluated the surgeon's satisfaction with the operating conditions. Group LR showed significantly delayed onset time (group C: 87±22 seconds, group LR: 127±47 seconds, and group LM: 89±32 seconds; P=.001) and maximal suppression than did other groups (group C: 102±30 seconds, group LR: 155±66 seconds, and group LM: 105±36 seconds; P=.002). Duration of action of rocuronium was significantly longer in group C than in other groups (group C: 39±7 minutes, group LR: 28±8 minutes, group LRM: 31±8 minutes; P<.001). Laryngoscope placement score (P=.002), surgeon's satisfaction (P=.005), and sore throat (P=.035) were significantly worse in group LR. Magnesium sulfate 30 mg/kg accelerated the onset and improved operating conditions of low-dose rocuronium without prolongation of action. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality improvement of microsurgery through telecommunication--the postoperative care after microvascular transfer of intestine.

PubMed

Chen, Hung-Chi; Kuo, Hsin-Chih; Chung, Kuo-Piao; Chen, Shih-Heng; Tang, Yueh-Bih; Su, Syi

2012-02-01

The purpose of this report is to describe the use of telecommunication to improve the quality of postoperative care following microsurgery, especially following microvascular transfer of intestinal transfer for which shortening of ischemia time is of utmost importance to achieve high success rate. From 2003 to 2009 microvascular transfer of intestinal flaps had been performed in 112 patients. After surgery the patients were put in intensive care unit and the flaps were checked every 1 hour. The image for circulatory status of the flaps was sent directly to the attending surgeon for judgment. The information was sent through intranet and the surgeon can get access to the intranet through internet if necessary. Among the 112 cases, there were 9 cases of reexploration. The average duration between the time of problem detection and the time of starting reexploration was 54 min in 7 cases, and other 2 cases were delayed to enter the operating room which had been occupied by other cases of major trauma. Only two flaps were lost completely, two patients developed narrowing at the junction of cervical esophagus and thoracic esophagus. The rate of salvage for intestinal flap is apparently higher than those reported in the literature. In the postoperative management of microsurgery in ICU, telecommunication can help to reduce the ischemia time after vascular compromise in the transfer of free intestinal flap. Telecommunication is really an easy and effective tool in improving the outcome of reconstructive surgery. Copyright © 2012 Wiley Periodicals, Inc.

Anticoagulative strategies in reconstructive surgery – clinical significance and applicability

PubMed Central

Jokuszies, Andreas; Herold, Christian; Niederbichler, Andreas D.; Vogt, Peter M.

2012-01-01

Advanced strategies in reconstructive microsurgery and especially free tissue transfer with advanced microvascular techniques have been routinely applied and continously refined for more than three decades in day-to-day clinical work. Bearing in mind the success rates of more than 95%, the value of these techniques in patient care and comfort (one-step reconstruction of even the most complex tissue defects) cannot be underestimated. However, anticoagulative protocols and practices are far from general acceptance and – most importantly – lack the benchmark of evidence basis while the reconstructive and microsurgical methods are mostly standardized. Therefore, the aim of our work was to review the actual literature and synoptically lay out the mechanisms of action of the plethora of anticoagulative substances. The pharmacologic prevention and the surgical intervention of thrombembolic events represent an established and essential part of microsurgery. The high success rates of microvascular free tissue transfer as of today are due to treatment of patients in reconstructive centers where proper patient selection, excellent microsurgical technique, tissue transfer to adequate recipient vessels, and early anastomotic revision in case of thrombosis is provided. Whether the choice of antithrombotic agents is a factor of success remains still unclear. Undoubtedly however the lack of microsurgical experience and bad technique can never be compensated by any regimen of antithrombotic therapy. All the more, the development of consistent standards and algorithms in reconstructive microsurgery is absolutely essential to optimize clinical outcomes and increase multicentric and international comparability of postoperative results and complications. PMID:22294976

Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography

PubMed Central

Carrasco-Zevallos, O. M.; Keller, B.; Viehland, C.; Shen, L.; Waterman, G.; Todorich, B.; Shieh, C.; Hahn, P.; Farsiu, S.; Kuo, A. N.; Toth, C. A.; Izatt, J. A.

2016-01-01

Minimally-invasive microsurgery has resulted in improved outcomes for patients. However, operating through a microscope limits depth perception and fixes the visual perspective, which result in a steep learning curve to achieve microsurgical proficiency. We introduce a surgical imaging system employing four-dimensional (live volumetric imaging through time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic heads-up display provides real-time interactive volumetric feedback to the surgeon. We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging was performed in 48 human eye surgeries and was demonstrated to successfully visualize the pathology of interest in concordance with preoperative diagnosis in 93% of retinal surgeries and the surgical site of interest in 100% of anterior segment surgeries. In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced lesions that were invisible through the operating microscope during standard surgical maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions and prevent post-operative complications. Our novel surgical visualization platform achieves surgeon-interactive 4D visualization of live surgery which could expand the surgeon’s capabilities. PMID:27538478

Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography

NASA Astrophysics Data System (ADS)

Carrasco-Zevallos, O. M.; Keller, B.; Viehland, C.; Shen, L.; Waterman, G.; Todorich, B.; Shieh, C.; Hahn, P.; Farsiu, S.; Kuo, A. N.; Toth, C. A.; Izatt, J. A.

2016-08-01

Minimally-invasive microsurgery has resulted in improved outcomes for patients. However, operating through a microscope limits depth perception and fixes the visual perspective, which result in a steep learning curve to achieve microsurgical proficiency. We introduce a surgical imaging system employing four-dimensional (live volumetric imaging through time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic heads-up display provides real-time interactive volumetric feedback to the surgeon. We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging was performed in 48 human eye surgeries and was demonstrated to successfully visualize the pathology of interest in concordance with preoperative diagnosis in 93% of retinal surgeries and the surgical site of interest in 100% of anterior segment surgeries. In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced lesions that were invisible through the operating microscope during standard surgical maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions and prevent post-operative complications. Our novel surgical visualization platform achieves surgeon-interactive 4D visualization of live surgery which could expand the surgeon’s capabilities.

Design of an ultrasonic micro-array for near field sensing during retinal microsurgery.

PubMed

Clarke, Clyde; Etienne-Cummings, Ralph

2006-01-01

A method for obtaining the optimal and specific sensor parameters for a tool-tip mountable ultrasonic transducer micro-array is presented. The ultrasonic transducer array sensor parameters, such as frequency of operation, element size, inter-element spacing, number of elements and transducer geometry are obtained using a quadratic programming method to obtain a maximum directivity while being constrained to a total array size of 4 mm2 and the required resolution for retinal imaging. The technique is used to design a uniformly spaced NxN transducer array that is capable of resolving structures in the retina that are as small as 2 microm from a distance of 100 microm. The resultant 37x37 array of 16 microm transducers with 26 microm spacing will be realized as a Capacitive Micromachined Ultrasonic Transducer (CMUT) array and used for imaging and robotic guidance during retinal microsurgery.

Innovations in diabetic foot reconstruction using supermicrosurgery.

PubMed

Suh, Hyun Suk; Oh, Tae Suk; Hong, Joon Pio

2016-01-01

The treatment of diabetic foot ulceration is complex with multiple factors involved, and it may often lead to limb amputation. Hence, a multidisciplinary approach is warranted to cover the spectrum of treatment for diabetic foot, but in complex wounds, surgical treatment is inevitable. Surgery may involve the decision to preserve the limb by reconstruction or to amputate it. Reconstruction involves preserving the limb with secure coverage. Local flaps usually are able to provide sufficient coverage for small or moderate sized wound, but for larger wounds, soft tissue coverage involves flaps that are distantly located from the wound. Reconstruction of distant flap usually involves microsurgery, and now, further innovative methods such as supermicrosurgery have further given complex wounds a better chance to be reconstructed and limbs salvaged. This article reviews the microsurgery involved in reconstruction and introduces the new method of supermicrosurgery. Copyright © 2016 John Wiley & Sons, Ltd.

The use of dextran post free tissue transfer.

PubMed

Ridha, H; Jallali, N; Butler, P E

2006-01-01

Dextran has been used in microsurgery to reduce the risk of free tissue transfer loss. A number of regimens which vary considerably in dosage and timing have been published in the literature. Using a postal questionnaire, a survey was conducted to delineate the current practise of UK plastic surgeons. Data were received from 161 plastic surgeons in 51 units (response rate of 61%). Forty-five percent of microsurgeons routinely use dextran post-operatively whilst 29% use alternative thromboprophylaxis. The indications, post-operative regimes and duration of administration of dextran vary significantly amongst surgeons and units. The reported success rates of free tissue transfer and digital replants were 97 and 85.1%, respectively, and was not significantly affected by the use of dextran. We conclude that there is considerable variation amongst UK plastic surgeons regarding thromboprophylaxis post microsurgery. Our data suggest that the use of dextrans does not affect free tissue transfer success rates.

Measuring surgeons' treatment preferences and satisfaction with nerve reconstruction techniques for children with unique brachial plexus birth palsies.

PubMed

Shah, Amee K; Zurakowski, David; Jessel, Rebecca H; Kuo, Anne; Waters, Peter M

2006-09-15

This study surveyed microsurgeons on treatments chosen for infants with brachial plexus birth palsies who have had failure of antigravity biceps and/or triceps function due to nerve surgery or natural history. Questionnaires were sent to surgeons participating in a prospective multicenter brachial plexus birth palsy study. With a response rate of 82 percent, the sample comprised 22 surgeons with extensive experience in treating brachial plexus birth palsy. The survey gathered collective information on two unique clinical groups: (1) infants with no antigravity biceps function but intact antigravity deltoid and radial nerve function and (2) infants with no antigravity radial nerve function (wrist and digital extension, triceps) but intact antigravity biceps and deltoid function. Analysis of data and age-based trends was performed using the Fisher's exact test. With failure of biceps recovery, surgeons preferred microsurgery for children 6 to 18 months old and tendon transfers for children older than 18 months. Both procedures were preferred over observation alone (p < 0.001). With regard to microsurgery techniques, with increasing age, surgeons used nerve transfers more than resected neuroma and grafting. With tendon transfers, regional transfers were performed more than 90 percent of the time at all ages. For patients with no antigravity radial nerve function, most cases at all ages were managed by observation rather than microsurgery or tendon transfers (p < 0.001). The authors' data indicate a general consensus in treatment choices for the two cases of microsurgical failure in infants with brachial plexus birth palsies as well as in satisfaction among experienced surgeons in using these treatments.

A systematic review of evidence for education and training interventions in microsurgery.

PubMed

Ghanem, Ali M; Hachach-Haram, Nadine; Leung, Clement Chi Ming; Myers, Simon Richard

2013-07-01

Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.

The risk of ectopic pregnancy following tubal reconstructive microsurgery and assisted reproductive technology procedures.

PubMed

Schippert, Cordula; Soergel, Philipp; Staboulidou, Ismini; Bassler, Christina; Gagalick, Susanne; Hillemanns, Peter; Buehler, Klaus; Garcia-Rocha, Guillermo-José

2012-03-01

The incidence of ectopic pregnancy (EP) in the general population is 2%, whereas the EP rate following assisted reproductive technologies (ART) is between 2.1 and 11%. EP is also an adverse effect of tubal surgery with incidences up to 40% depending on the type, location, and severity of tubal disease and the surgical procedure. This paper looks at the incidence of EP following tubal reconstructive microsurgery, analyzes risk factors for EP following own 1,295 ART cycles and looks on the incidence of EP in 128,314 pregnancies following ART according to the presence or absence of tubal infertility using data from the German IVF Registry (DIR). In our clinic, the EP rate following resterilization was 6.7%. In the presence of acquired tubal disease, the EP rate following adhesiolysis, salpingostomy, salpingoneostomy, fimbrioplasty, and anastomosis was 7.9%. The EP rate following ART in our clinic was 5.6%. Previous abdominal surgeries, microsurgical procedures, hydro-/sactosalpinges, salpingitis, salpingitis isthmica nodosa, and periadnexal adhesions showed a significant positive correlation with EP as outcome. Data of DIR demonstrate a significantly increased incidence of EP in the presence of tubal pathology. The highest EP rate related to all clinical pregnancies was 4.5% (95% CI 3.0-6.0) in smoking women <30 years with tubal pathology following IVF. In the presence of tubal infertility, the incidence of EP following ART and tubal microsurgery are approximately comparable with each other and higher than in women without tubal infertility. The success of infertility surgery depends on a careful selection of appropriate patients.

Heads-up 3D Microscopy: An Ergonomic and Educational Approach to Microsurgery

PubMed Central

Mendez, Bernardino M.; Chiodo, Michael V.; Vandevender, Darl

2016-01-01

Summary: Traditional microsurgery can lead surgeons to use postures that cause musculoskeletal fatigue, leaving them more prone to work-related injuries. A new technology from TrueVision transmits the microscopic image onto a 3-dimensional (3D) monitor, allowing surgeons to operate while sitting/standing in a heads-up position. The purpose of this study was to evaluate the feasibility of performing heads-up 3D microscopy as a more ergonomic alternative to traditional microsurgery. A feasibility study was conducted comparing heads-up 3D microscopy and traditional microscopy by performing femoral artery anastomoses on 8 Sprague-Dawley rats. Operative times and patency rates for each technology were compared. The 8 microsurgeons completed a questionnaire comparing image quality, comfort, technical feasibility, and educational value of the 2 technologies. Rat femoral artery anastomoses were successfully carried out by all 8 microsurgeons with each technology. There was no significant difference in anastomosis time between heads-up 3D and traditional microscopy (average times, 34.5 and 33.8 minutes, respectively; P = 0.66). Heads-up 3D microscopy was rated superior in neck and back comfort by 75% of participants. Image resolution, field of view, and technical feasibility were found to be superior or equivalent in 75% of participants, whereas 63% evaluated depth perception to be superior or equivalent. Heads-up 3D microscopy is a new technology that improves comfort for the microsurgeon without compromising image quality or technical feasibility. Its use has become prevalent in the field of ophthalmology and may also have utility in plastic and reconstructive surgery. PMID:27579241

Optical Magnification Should Be Mandatory for Microsurgery: Scientific Basis and Clinical Data Contributing to Quality Assurance

PubMed Central

Schoeffl, Harald; Lazzeri, Davide; Schnelzer, Richard; Froschauer, Stefan M.

2013-01-01

Background Microsurgical techniques are considered standard procedures in reconstructive surgery. Although microsurgery by itself is defined as surgery aided by optical magnification, there are no guidelines for determining in which clinical situations a microscope or loupe should be used. Therefore, we conducted standardized experiments to objectively assess the impact of optical magnification in microsurgery. Methods Sixteen participants of microsurgical training courses had to complete 2 sets of experiments. Each set had to be performed with an unaided eye, surgical loupes, and a regular operating microscope. The first set of experiments included coaptation of a chicken femoral nerve, and the second set consisted of anastomosing porcine coronary arteries. Evaluation of the sutured nerves and vessels were performed by 2 experienced microsurgeons using an operating microscope. Results The 16 participants of the study completed all of the experiments. The nerve coaptation and vascular anastomoses exercises showed a direct relationship of error frequency and lower optical magnification, meaning that the highest number of microsurgical errors occurred with the unaided eye. For nerve coaptation, there was a strong relationship (P<0.05) between the number of mistakes and magnification, and this relationship was very strong (P<0.01) for vascular anastomoses. Conclusions We were able to prove that microsurgical success is directly related to optical magnification. The human eye's ability to discriminate potentially important anatomical structures is limited, which might be detrimental for clinical results. Although not legally mandatory, surgeries such as reparative surgery after hand trauma should be conducted with magnifying devices for achieving optimal patient outcomes. PMID:23532716

Advanced telepresence surgery system development.

PubMed

Jensen, J F; Hill, J W

1996-01-01

SRI International is currently developing a prototype remote telepresence surgery system, for the Advanced Research Projects Agency (ARPA), that will bring life-saving surgical care to wounded soldiers in the zone of combat. Remote surgery also has potentially important applications in civilian medicine. In addition, telepresence will find wide medical use in local surgery, in endoscopic, laparoscopic, and microsurgery applications. Key elements of the telepresence technology now being developed for ARPA, including the telepresence surgeon's workstation (TSW) and associated servo control systems, will have direct application to these areas of minimally invasive surgery. The TSW technology will also find use in surgical training, where it will provide an immersive visual and haptic interface for interaction with computer-based anatomical models. In this paper, we discuss our ongoing development of the MEDFAST telesurgery system, focusing on the TSW man-machine interface and its associated servo control electronics.

Distal Nerve Transfer: Perspective of Reconstructive Microsurgery.

PubMed

Doi, Kazuteru

2018-04-01

Recent articles have strongly emphasized the superiority of distal nerve transfers despite indefinite assessment. I would like to introduce the problems associated with functional evaluation following nerve transfers. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Establishment and Evaluation of a Microsurgery Course for Medical Students].

PubMed

Beier, J P; Horch, R E; Boos, A M; Taeger, C D; Breuer, G; Arkudas, A

2015-12-01

Very few microsurgical courses have been offered for medical students in Germany to date. To raise early interest in this technique, which is essential for plastic and reconstructive surgery, and to guide eligible medical students to choose plastic surgery as their specialist field, the Department of Plastic and Hand Surgery, supported by the Faculty of Medicine of the Friedrich-Alexander-University of Erlangen-Nuremberg, implemented a microsurgical course for students in 2011. This study describes the implementation of that course and evaluates its impact on the subsequent choice of the participants' specialist fields. Since the summer of 2011, the microsurgery course for medical students has taken place regularly 3 times per term. It is free of charge for participants and is guided by senior physicians of the Department of Plastic and Hand Surgery together with student tutors from the Faculty of Medicine. The arterial end-to-end anastomosis in the fresh chicken leg is used as a training model. Based on a questionnaire survey the participants were evaluated and statistically analysed regarding their course satisfaction, self-assessment of their own eligibility before and after the course, the anticipated future choice of their medical specialist field and how their choice was influenced by this course. After the successful implementation of the microsurgical course in 2011, a significant number of students were interested in microsurgery. According to the questionnaire, the level of enthusiasm was high among all participants. The self-assessment of microsurgical skills improved significantly after the course compared with the pre-course assessment. In 82% of the participants, the course had a strong positive influence on the future choice of their specialist field. The regular implementation of a microsurgical course for students in the form described here is practicable and possible without undue personnel and cost of materials. The ongoing interest among students in such an offer is enormous and the satisfaction of the participants is very high. This might be a way to recruit future plastic surgeons by raising early enthusiasm for microsurgery. These future plastic surgeons, in turn, would be given the chance to experience a very fascinating aspect of plastic surgery, which might help them to decide on their specialisation within that field at a later point in their career. © Georg Thieme Verlag KG Stuttgart · New York.

Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery.

PubMed

Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell

2011-06-01

This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information.

Prototyping a Hybrid Cooperative and Tele-robotic Surgical System for Retinal Microsurgery

PubMed Central

Balicki, Marcin; Xia, Tian; Jung, Min Yang; Deguet, Anton; Vagvolgyi, Balazs; Kazanzides, Peter; Taylor, Russell

2013-01-01

This paper presents the design of a tele-robotic microsurgical platform designed for development of cooperative and tele-operative control schemes, sensor based smart instruments, user interfaces and new surgical techniques with eye surgery as the driving application. The system is built using the distributed component-based cisst libraries and the Surgical Assistant Workstation framework. It includes a cooperatively controlled EyeRobot2, a da Vinci Master manipulator, and a remote stereo visualization system. We use constrained optimization based virtual fixture control to provide Virtual Remote-Center-of-Motion (vRCM) and haptic feedback. Such system can be used in a hybrid setup, combining local cooperative control with remote tele-operation, where an experienced surgeon can provide hand-over-hand tutoring to a novice user. In another scheme, the system can provide haptic feedback based on virtual fixtures constructed from real-time force and proximity sensor information. PMID:24398557

Wall-to-lumen ratio of intracranial arteries measured by indocyanine green angiography

PubMed Central

Nakagawa, Daichi; Shojima, Masaaki; Yoshino, Masanori; Kin, Taichi; Imai, Hideaki; Nomura, Seiji; Saito, Toki; Nakatomi, Hirofumi; Oyama, Hiroshi; Saito, Nobuhito

2016-01-01

Background: The wall-to-lumen ratio (WLR) is an important parameter in vascular medicine because it indicates the character of vascular wall as well as the degree of stenosis. Despite the advances in medical imaging technologies, it is still difficult to measure the thin-walled normal intracranial arteries, and the reports on the WLR of normal intracranial artery are limited. It might be possible to calculate the WLR using the indocyanine green (ICG) angiography, which is used to observe intracranial vessels during microsurgery. Purpose: To evaluate the WLR of normal intracranial arteries using ICG angiography. Materials and Methods: From the three cases in which ICG angiography was recorded with a ruler during microsurgery, 20 measurement points were chosen for the analysis. The ICG was injected intravenously with a dose of 0.2 mg/kg, and the vessels were inspected at high magnification using an operating microscope equipped with near-infrared illumination system. The vessel outer diameter and the luminal diameter were measured using the images before and after the ICG arrival based on the pixel ratio method using a ruler as reference, respectively. The WLR was calculated as 0.5 × (vessel outer diameter − vessel luminal diameter). Results: The WLR (mean ± standard deviation) of normal intracranial arteries was 0.086 ± 0.022. The WLR tended to be high in small arteries. Conclusion: The WLR of normal intracranial arteries calculated using ICG angiography was consistent with the WLR reported in the previous reports based on human autopsy. PMID:27695538

Topical Vasodilators in Microsurgery: What Is the Evidence?

PubMed

Rinkinen, Jacob; Halvorson, Eric G

2017-01-01

Background  Topical vasodilators are frequently used during free tissue transfer to prevent and treat vasospasm and microvascular thrombosis. A variety of agents have been studied and are available, yet most microsurgeons select an agent based on anecdotal evidence or personal training. Our aim was to review the literature on topical vasodilators so microsurgeons can make more informed decisions about which agent to use. Methods  A systemic review of the literature was performed on PubMed, EMBASE, and Google Scholar using keywords "topical vasodilator," "antispasmodic," "vasospasm," "free flaps," and "microsurgery." Studies were included if they provided a comparative quantitative assessment of topical vasodilators and were written in English. In vitro, in vivo , and clinical studies were included. Results  A total of 15 studies were identified and included in our analysis. The three most common classes of topical vasodilator include local anesthetics, phosphodiesterase inhibitors, and calcium channel blockers (CCBs). Of the most commonly used topical vasodilators, CCBs (nifedipine and verapamil) were most effective followed by papaverine and lidocaine. Conclusion  The most effective topical vasodilators appear to be CCBs including nifedipine, nicardipine, and verapamil. Evidence suggests that these agents are more effective than papaverine and lidocaine solutions that are commonly used. Future research should directly compare individual CCBs to assess the most effective agent. Studies to date have focused on vessels other than those used by microsurgeons, and therefore further studies specific to these vessels are warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Design and experimental characterization of flexure activated by SMA wires for microassembly operations

NASA Astrophysics Data System (ADS)

Flores, Abiud; Ahuett, Horacio; Song, Gangbing

2006-03-01

Compliant mechanisms have a wide range of application in microassembly, micromanipulation and microsurgery. This article presents a low cost Flexure-Stage actuated by two SMA-wires that produces displacement in one direction in a range from 0 to 10 μm. The Flexure-Stage acts as a mechanical transform by reducing and changing the direction of the SMA actuator output displacement. The Flexure-Stage system has its application in microassembly operation and was built at cost of US$ 35 cost. The design methodology of a flexure-stage from concept design through FEA modeling and finally to construction and characterization is presented in this paper.

The robotic ENT microsurgery system: A novel robotic platform for microvascular surgery.

PubMed

Feng, Allen L; Razavi, Christopher R; Lakshminarayanan, Pranav; Ashai, Zaid; Olds, Kevin; Balicki, Marcin; Gooi, Zhen; Day, Andrew T; Taylor, Russell H; Richmon, Jeremy D

2017-11-01

Assess the feasibility of a novel robotic platform for use in microvascular surgery. Prospective feasibility study. Robotics laboratory. The Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS) (Galen Robotics, Inc., Sunnyvale, CA) is a robotic arm that stabilizes a surgeon's instrument, allowing precise, tremor-free movement. Six microvascular naïve medical students and one microvascular expert performed microvascular anastomosis of a chicken ischiatic artery, with and without the REMS. Trials were blindly graded by seven microvascular surgeons using a microvascular tremor scale (MTS) based on instrument tip movement as a function of vessel width. Time to completion (TTC) was measured, and an exit survey assessed participants' experience. The interrater reliability of the MTS was calculated. For microvascular-naïve participants, the mean MTS score for REMS-assisted trials was 0.72 (95% confidence interval [CI] 0.64-1.07) and 2.40 (95% CI 2.12-2.69) for freehand (P < 0.001). The mean TTC was 1,265 seconds for REMS-assisted trials and 1,320 seconds for freehand (P > 0.05). For the microvascular expert, the mean REMS-assisted MTS score was 0.71 (95% CI 0.15-1.27) and 0.86 (95% CI 0.35-1.37) for freehand (P > 0.05). TTC was 353 seconds for the REMS-assisted trial and 299 seconds for freehand. All participants thought the REMS was more accurate and improved instrument handling and stability. The intraclass correlation coefficient for MTS ratings was 0.914 (95% CI 0.823-0.968) for consistency and 0.901 (95% CI 0.795-0.963) for absolute value. The REMS is a feasible adjunct for microvascular surgery and a potential teaching tool capable of reducing tremor in novice users. Furthermore, the MTS is a feasible grading system for assessing microvascular tremor. NA. Laryngoscope, 127:2495-2500, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Kinetochore motors drive congression of peripheral polar chromosomes by overcoming random arm-ejection forces.

PubMed

Barisic, Marin; Aguiar, Paulo; Geley, Stephan; Maiato, Helder

2014-12-01

Accurate chromosome segregation during cell division in metazoans relies on proper chromosome congression at the equator. Chromosome congression is achieved after bi-orientation to both spindle poles shortly after nuclear envelope breakdown, or by the coordinated action of motor proteins that slide misaligned chromosomes along pre-existing spindle microtubules. These proteins include the minus-end-directed kinetochore motor dynein, and the plus-end-directed motors CENP-E at kinetochores and chromokinesins on chromosome arms. However, how these opposite and spatially distinct activities are coordinated to drive chromosome congression remains unknown. Here we used RNAi, chemical inhibition, kinetochore tracking and laser microsurgery to uncover the functional hierarchy between kinetochore and arm-associated motors, exclusively required for congression of peripheral polar chromosomes in human cells. We show that dynein poleward force counteracts chromokinesins to prevent stabilization of immature/incorrect end-on kinetochore-microtubule attachments and random ejection of polar chromosomes. At the poles, CENP-E becomes dominant over dynein and chromokinesins to bias chromosome ejection towards the equator. Thus, dynein and CENP-E at kinetochores drive congression of peripheral polar chromosomes by preventing arm-ejection forces mediated by chromokinesins from working in the wrong direction.

Modeling the Morphogenesis of Epidermal Tissues on the Surface of a 3D Last

NASA Astrophysics Data System (ADS)

McCleery, W. Tyler; Crews, Sarah M.; Mashburn, David N.; Veldhuis, Jim; Brodland, G. Wayne; Hutson, M. Shane

2014-03-01

Embryogenesis in the fruit fly Drosophila melanogaster is coordinated by the interaction of cells in adjacent tissues. For some events of embryogenesis, e.g., dorsal closure, two-dimensional models have been sufficient to elucidate the relevant cell and tissue mechanics. Here, we describe a new three-dimensional cell-level finite element model for investigating germ band retraction - a morphogenetic event where one epidermal tissue, the germ band, initially wraps around the posterior end of the ellipsoidal embryo. This tissue then retracts with a mechanical assist from contraction of cells in a second epidermal tissue, the amnioserosa. To speed simulation run times and focus on the relevant tissues, we only model epidermal tissue interactions. Epidermal cells are defined as polygons constrained to lie on the surface of the ellipsoidal last, but have adjustable parameters such as edge tensions and cell pressures. Tissue movements are simulated by balancing these dynamic cell-level forces with viscous resistance and allowing cells to exchange neighbors. Our choice of modeling parameters is informed by in vivo measurements of cell-level forces using laser microsurgery. We use this model to investigate the multicellular stress fields in normal and aberrant development.

Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation?

PubMed

Martins, Regina Helena Garcia; Tavares, Elaine Lara Mendes; Pessin, Adriana Bueno Benito

2017-05-01

Reinke's edema is a benign lesion of the vocal folds that affects chronic smokers, especially women. The voice becomes hoarse and virilized, and the treatment is microsurgery. However, even after surgery and smoking cessation, many patients remain with a deep and hoarse voice. The aim of the present study was to compare pre- and postoperative acoustic and perceptual-auditory vocal analyses of women with Reinke's edema and of women in the control group, who were non-smokers. A total of 20 women with videolaryngoscopy diagnosis of Reinke's edema who underwent laryngeal microsurgery were evaluated pre- and postoperatively (6 months) by videolaryngoscopy, acoustic voice, and perceptual-auditory analyses (General degree of dysphonia, Roughness, Breathiness, Asthenia, Strain, and Instability [GRBASI] scale), and the maximum phonation times were calculated. The pre- and postoperative parameters of the women with Reinke's edema were compared with those of the control group of women with no laryngeal lesions, smoking habit, or vocal symptoms. Acoustic vocal perceptual-auditory analyses and the maximum phonation time of women with Reinke's edema improved significantly in the postoperative evaluations; nevertheless, 6 months after surgery, their voices became worse than the voices of the women from the control group. Abnormalities caused by smoking in Reinke's edema in women are not fully reversible with surgery and smoking cessation. One explanation would be the presence of possible structural alterations in fibroblasts caused by the toxicity of cigarette components, resulting in the uncontrolled production of fibrous matrix in the lamina propria, and preventing complete vocal recovery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Challenges in global microsurgery: A six year review of outcomes at an East African hospital.

PubMed

Citron, Isabelle; Galiwango, George; Hodges, Andrew

2016-02-01

Free tissue transfer is an invaluable resource for reconstruction of complex defects. There is very little evidence as to the feasibility and outcomes of microsurgery performed in East Africa. This study will analyse outcomes of 114 consecutive free flaps, performed over 6 years at a single plastic surgery unit in Uganda. It aims to demonstrate that despite its challenges, successful microsurgical practice can be set up in East Africa. The notes of 100 consecutive patients who underwent 114 free flaps between 01/06/2009 and 01/07/2015 at CoRSU Hospital, Uganda were analysed. One hundred and fourteen free flaps were performed on 100 patients. The types of free flaps used included free fibula (n = 41), ALT (n = 30), gracillis (n = 8), radial forearm (n = 7), latissimus dorsi (n = 9) and rectus (n = 7) amongst others (n = 12). The most common indications for surgery were head and neck cancer (n = 50), trauma (n = 19), osteomyelitis (n = 18), burns (n = 13), head and neck infection (n = 6). Over the six year period there was an overall 76% survival of the flaps. However in the last two years of the series there was a flap survival rate of over 93% (n = 50). There were 40 non-microsurgical complications including wound infection (n = 10) and graft loss (n = 8). This is one of the first studies to report on the outcomes of free flaps performed at an East African centre. There is a steep but surmountable learning curve to improve microsurgery delivery in East Africa. This study identifies challenges in patient demographics, surgical experience and resources that have been overcome to improve outcomes. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Patient Motivation and Long-Term Satisfaction with Treatment Choice in Vestibular Schwannoma.

PubMed

Carlson, Matthew L; Tveiten, Øystein Vesterli; Lund-Johansen, Morten; Tombers, Nicole M; Lohse, Christine M; Link, Michael J

2018-06-01

To ascertain primary motivation and long-term satisfaction with treatment selection in patients with vestibular schwannoma. A multicenter, cross-sectional survey was performed. Patients with small- to medium-sized sporadic vestibular schwannoma who underwent stereotactic radiosurgery (SRS; n = 247), microsurgery (n = 144), or observation (n = 148) between 1998 and 2008 were surveyed regarding their motivation behind treatment selection and hindsight satisfaction with their choice of management. "Physician recommendation" was the most commonly stated reason for modality selection in all 3 groups. The second and third most common reasons for selecting SRS included "less invasive option than surgery" in 80 patients (32%) and "less recovery time than surgery" in 16 patients (6%). The second and third most common reasons for selecting observation included "to avoid side-effects of treatment" in 25 patients (17%) and "symptoms not severe enough to warrant intervention" in 22 patients (15%). The second and third most common reasons for selecting microsurgery included "do not want tumor in head" in 35 patients (24%) and "most definitive treatment" in 15 patients (10%). Overall, 232 patients (96%) treated with SRS, 141 observed patients (97%), and 121 patients (85%) who underwent microsurgical treatment were satisfied with their original decision (P < 0.001). Motivation behind treatment selection varies between individuals. Those who select observation and SRS commonly reference less invasiveness and lower risk, whereas those who select microsurgery are commonly motivated by having their tumor physically removed and the more definitive nature of treatment. Posttreatment satisfaction is highest in patients who undergo SRS and observation, although all 3 groups report high levels of satisfaction. Copyright © 2018 Elsevier Inc. All rights reserved.

Modern radiosurgical and endovascular classification schemes for brain arteriovenous malformations.

PubMed

Tayebi Meybodi, Ali; Lawton, Michael T

2018-05-04

Stereotactic radiosurgery (SRS) and endovascular techniques are commonly used for treating brain arteriovenous malformations (bAVMs). They are usually used as ancillary techniques to microsurgery but may also be used as solitary treatment options. Careful patient selection requires a clear estimate of the treatment efficacy and complication rates for the individual patient. As such, classification schemes are an essential part of patient selection paradigm for each treatment modality. While the Spetzler-Martin grading system and its subsequent modifications are commonly used for microsurgical outcome prediction for bAVMs, the same system(s) may not be easily applicable to SRS and endovascular therapy. Several radiosurgical- and endovascular-based grading scales have been proposed for bAVMs. However, a comprehensive review of these systems including a discussion on their relative advantages and disadvantages is missing. This paper is dedicated to modern classification schemes designed for SRS and endovascular techniques.

The natural history and management of brachial plexus birth palsy.

PubMed

Buterbaugh, Kristin L; Shah, Apurva S

2016-12-01

Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3-6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.

Versatile microrobotics using simple modular subunits

NASA Astrophysics Data System (ADS)

Cheang, U. Kei; Meshkati, Farshad; Kim, Hoyeon; Lee, Kyoungwoo; Fu, Henry Chien; Kim, Min Jun

2016-07-01

The realization of reconfigurable modular microrobots could aid drug delivery and microsurgery by allowing a single system to navigate diverse environments and perform multiple tasks. So far, microrobotic systems are limited by insufficient versatility; for instance, helical shapes commonly used for magnetic swimmers cannot effectively assemble and disassemble into different size and shapes. Here by using microswimmers with simple geometries constructed of spherical particles, we show how magnetohydrodynamics can be used to assemble and disassemble modular microrobots with different physical characteristics. We develop a mechanistic physical model that we use to improve assembly strategies. Furthermore, we experimentally demonstrate the feasibility of dynamically changing the physical properties of microswimmers through assembly and disassembly in a controlled fluidic environment. Finally, we show that different configurations have different swimming properties by examining swimming speed dependence on configuration size.

Versatile microrobotics using simple modular subunits

PubMed Central

Cheang, U Kei; Meshkati, Farshad; Kim, Hoyeon; Lee, Kyoungwoo; Fu, Henry Chien; Kim, Min Jun

2016-01-01

The realization of reconfigurable modular microrobots could aid drug delivery and microsurgery by allowing a single system to navigate diverse environments and perform multiple tasks. So far, microrobotic systems are limited by insufficient versatility; for instance, helical shapes commonly used for magnetic swimmers cannot effectively assemble and disassemble into different size and shapes. Here by using microswimmers with simple geometries constructed of spherical particles, we show how magnetohydrodynamics can be used to assemble and disassemble modular microrobots with different physical characteristics. We develop a mechanistic physical model that we use to improve assembly strategies. Furthermore, we experimentally demonstrate the feasibility of dynamically changing the physical properties of microswimmers through assembly and disassembly in a controlled fluidic environment. Finally, we show that different configurations have different swimming properties by examining swimming speed dependence on configuration size. PMID:27464852

JPRS Report. China: Qiushi (Seeking Truth) No. 19, 1 October 1989

DTIC Science & Technology

1989-12-14

terms of technology such as acupuncture anesthesia, microsurgery , treatment of extensive burns; early diag- nosis and treatment of liver cancer... reconstruction , Tiananmen Square has become the center of the whole city. The Tiananmen tower and building, which overlook the square, have a magnificient

Comparison of tunable lasers based on diode pumped Tm-doped crystals

NASA Astrophysics Data System (ADS)

Šulc, Jan; Jelínková, Helena; Koranda, Petr; Černý, Pavel; Jabczyński, Jan K.; Żendzian, Waldemar; Kwiatkowski, Jacek; Urata, Yoshiharu; Higuchi, Mikio

2008-12-01

We report on continuously tunable operation of a diode pumped lasers based on Tm-doped materials, emitting in the 1.8 - 2.μ1 m spectral band. In our study we compare results obtained with three various single crystals doped by Tm3+ ions: Yttrium Aluminum perovskite YAP (YAlO3), Gadolinium orthovanadate GdVO4, and Yttrium Lithium Fluoride YLF (YLiF4). Following samples were available: the 3mm long a-cut crystal rod of Tm:YAP with 4% at. Tm/Y (diameter 3 mm); the 8mm long b-cut crystal rod of Tm:YLF with 3.5% at. Tm/Y (diameter 3 mm); the 2.7mm long a-cut crystal block of Tm:GdVO4 with 2% at. Tm/Gd (crystal face 5×3 mm). For active medium pumping, the laser diode radiation was used. Because the tested samples differs significantly in absorption spectra, two fibre-coupled (core diameter 400 µm) temperature-tuned laser diodes were used: first operating at wavelength 793nm was used for Tm:YAP and Tm:YLF; the second operating at wavelength 802nm was used for Tm:GdVO4. In both cases, the continuous power up to 20W was available for pumping. The diode radiation was focused into the active crystal by two achromatic doublet lenses with the focal length f = 75 mm. The measured radius of pumping beam focus inside the crystal was 260 µm. The longitudinally diode pumped crystals were tested in linear, 80mm long, hemispherical laser cavity. The curved (radius 150mm) output coupler reflectivity was ~ 97 % in range from 1.8 up to 2.1 μm. The pumping flat mirror had maximal reflectivity in this range and it had high transmission around 0.8 μm. A 1.5mm thick birefringent plate made from quartz (Lyot filter) inserted under a Brewster's angle was used as a tuning element. This plate was placed inside the resonator between the crystal and the output coupler. Using Tm:YAP crystal, the maximal output power of 2.8W in this set-up was obtained. The laser could be tuned from 1865nm up to 2036nm with a maximum at 1985 nm. Laser based on Tm:YLF crystal was tunable from 1835nm up to 2010nm with a maximum at 1928 nm (3.0W was reached). Using the Tm:GdVO4 tunable operation with greater that 1W output at 1920nm and 130nm tuning range (1842-1972 nm) was demonstrated. The overall reached tuning range of over 200nm covers many important atmospheric absorption lines and contains also the local absorption peak of liquid water, making them attractive for applications such as high resolution spectroscopy, atmospheric remote sensing, laser radar, and laser microsurgery.

Mechanical Loading for Peripheral Nerve Stabilization and Regeneration

DTIC Science & Technology

2012-10-01

Dahlin, L., Johansson, F., Lindwall, C., and Kanje, M. Chapter 28: Future perspective in peripheral nerve reconstruction . Int Rev Neurobiol 87, 507...Genden, E.M., MacKinnon, S.E., Doolabh, V.B., and Hunter, D.A. Regeneration through long nerve grafts in the swine model. Microsurgery 18, 379, 1998. 12

Pituitary adenomas: historical perspective, surgical management and future directions

PubMed Central

Theodros, Debebe; Patel, Mira; Ruzevick, Jacob; Lim, Michael; Bettegowda, Chetan

2016-01-01

Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity. PMID:26497533

[The 80-th anniversary of the use of an operating microscope in otorhinolaryngology. Part II. Technical principle and operation of surgical microscope].

PubMed

Mroczkowski, Edward; Wielgosz, Romuald

2004-01-01

The first step to microsurgery is getting to know about technical principle and operation of the surgical microscopes. Special attention is paid to those modules and items of microscopes, which surgeon use most frequently, such as objectives, binocular tubes, eyepieces.

Generalized interactions using virtual tools within the spring framework: probing, piercing, cauterizing and ablating

NASA Technical Reports Server (NTRS)

Montgomery, Kevin; Bruyns, Cynthia D.

2002-01-01

We present schemes for real-time generalized interactions such as probing, piercing, cauterizing and ablating virtual tissues. These methods have been implemented in a robust, real-time (haptic rate) surgical simulation environment allowing us to model procedures including animal dissection, microsurgery, hysteroscopy, and cleft lip repair.

CRF-Based Model for Instrument Detection and Pose Estimation in Retinal Microsurgery.

PubMed

Alsheakhali, Mohamed; Eslami, Abouzar; Roodaki, Hessam; Navab, Nassir

2016-01-01

Detection of instrument tip in retinal microsurgery videos is extremely challenging due to rapid motion, illumination changes, the cluttered background, and the deformable shape of the instrument. For the same reason, frequent failures in tracking add the overhead of reinitialization of the tracking. In this work, a new method is proposed to localize not only the instrument center point but also its tips and orientation without the need of manual reinitialization. Our approach models the instrument as a Conditional Random Field (CRF) where each part of the instrument is detected separately. The relations between these parts are modeled to capture the translation, rotation, and the scale changes of the instrument. The tracking is done via separate detection of instrument parts and evaluation of confidence via the modeled dependence functions. In case of low confidence feedback an automatic recovery process is performed. The algorithm is evaluated on in vivo ophthalmic surgery datasets and its performance is comparable to the state-of-the-art methods with the advantage that no manual reinitialization is needed.

Fabricating biomedical origami: a state-of-the-art review

PubMed Central

Johnson, Meredith; Chen, Yue; Hovet, Sierra; Xu, Sheng; Wood, Bradford; Ren, Hongliang; Tokuda, Junichi; Tse, Zion Tsz Ho

2018-01-01

Purpose Origami-based biomedical device design is an emerging technology due to its ability to be deployed from a minimal foldable pattern to a larger volume. This paper aims to review state-of-the-art origami structures applied in the medical device field. Methods Publications and reports of origami structure related to medical device design from the past 10 years are reviewed and categorized according to engineering specifications, including the application field, fabrication material, size/volume, deployment method, manufacturability, and advantages. Results This paper presents an overview of the biomedical applications of devices based on origami structures, including disposable sterilization covers, cardiac catheterization, stent grafts, encapsulation and microsurgery, gastrointestinal microsurgery, laparoscopic surgical grippers, microgrippers, microfluidic devices, and drug delivery. Challenges in terms of materials and fabrication, assembly, modeling and computation design, and clinical adoptability are discussed at the end of this paper to provide guidance for future origami-based design in the medical device field. Conclusion Concepts from origami can be used to design and develop novel medical devices. Origami-based medical device design is currently progressing, with researchers improving design methods, materials, fabrication techniques, and folding efficiency. PMID:28260164

Fabricating biomedical origami: a state-of-the-art review.

PubMed

Johnson, Meredith; Chen, Yue; Hovet, Sierra; Xu, Sheng; Wood, Bradford; Ren, Hongliang; Tokuda, Junichi; Tse, Zion Tsz Ho

2017-11-01

Origami-based biomedical device design is an emerging technology due to its ability to be deployed from a minimal foldable pattern to a larger volume. This paper aims to review state-of-the-art origami structures applied in the medical device field. Publications and reports of origami structure related to medical device design from the past 10 years are reviewed and categorized according to engineering specifications, including the application field, fabrication material, size/volume, deployment method, manufacturability, and advantages. This paper presents an overview of the biomedical applications of devices based on origami structures, including disposable sterilization covers, cardiac catheterization, stent grafts, encapsulation and microsurgery, gastrointestinal microsurgery, laparoscopic surgical grippers, microgrippers, microfluidic devices, and drug delivery. Challenges in terms of materials and fabrication, assembly, modeling and computation design, and clinical adoptability are discussed at the end of this paper to provide guidance for future origami-based design in the medical device field. Concepts from origami can be used to design and develop novel medical devices. Origami-based medical device design is currently progressing, with researchers improving design methods, materials, fabrication techniques, and folding efficiency.

[Extended middle fossa approach in treatment of vestibular schwannoma--technique of surgery and postoperative complications].

PubMed

Jamróz, Barbara; Niemczyk, Kazimierz; Morawski, Krzysztof; Bartoszewicz, Robert

2010-06-01

The main tumor of cerebellopontine angle are vestibular schwannoma (80-90%). According to National Institute of Health Consensus Development Conference the best treatment method is microsurgery. There are three principal surgical approaches: translabyrinthin, retrosigmoid and middle fossa. Only the latter two approaches provide the possibility of hearing preservation. Technique of surgery and postoperative morbidity after MFA. 39 patients (40 tumor) suffered from tumor of cerebellopontine angle, operated by using middle fossa approach in years 1998-2007. We evaluate hearing preservation and function of facial nerve and others postoperative morbidity. 22.5% of patients has hearing impairment and 32.5% has facial weakness. By individual cases we observed: CSF leak, meningitis, corneal ulceration, ischialgia, wound bleeding and venue thrombosis. 1/3 of patients suffered from headache and disequilibrium and 1/6 suffered from tinnitus. According to NIH middle fossa approach is one of three possible approaches in microsurgery of cerebellopontine angle tumors. There is possible total tumor removal with hearing preservation. Monitoring of facial and cochlear nerve during operation is recommended.

[Transanal endocopic microsurgery (TEM) in advanced rectal cancer disease treatment].

PubMed

Paci, Marcello; Scoglio, Daniele; Ursi, Pietro; Barchetti, Luciana; Fabiani, Bernardina; Ascoli, Giada; Lezoche, Giovanni

2010-01-01

After Heald's revolution in 1982, who introduced the total mesorectal excision, for improve the results in terms of recurrance and survival rate, there is a need to explore new therapeutic options in treatment of sub-peritoneal rectal cancer. In particular, local excision represent more often a valid technique for non advanced rectal cancer treatment in comparison with the more invasive procedure, especially in elderly and/or in poor health patients. The introduction of TEM by Buess (transanal endoscopy microsurgery), has extended the local treatment also to classes of patients who would normally have been candidates for TME. The author gives literature's details and his experience in the use of TEM for early rectal cancer sub-peritoneal. The aim of the study is to analyze short and long term results in terms of local recurrence and survival rate comparing TEM technique with the other transanal surgery in rectal cancer treatment. Preoperative Chemio-Radio therapy and rigorous Imaging Staging are the first steps to planning surgery. It's time, for local rectal cancer, has come to make the devolution a few decades ago has been accomplished in the treatment of breast cancer

Five-year longitudinal assessment of the prognosis of apical microsurgery.

PubMed

von Arx, Thomas; Jensen, Simon S; Hänni, Stefan; Friedman, Shimon

2012-05-01

Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported. Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression. At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤ 3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P < .02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P < .004). This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used. Copyright © 2012 American Association of Endodontists. All rights reserved.

Epidemiology of injuries treated at a hand and microsurgery hospital.

PubMed

Davas Aksan, Aslı; Durusoy, Raika; Ada, Sait; Kayalar, Murat; Aksu, Feride; Bal, Emin

2010-01-01

The aim of this study was to evaluate the epidemiology of injuries treated at a hand and microsurgery hospital between 1992 and 2005. This is a descriptive retrospective study based on medical records of a hand and microsurgery hospital in İzmir for the years 1992-2005. A total of 8,946 injuries involving 8,817 patients were included. Data on diagnosis were recorded according to ICD-10. Intent, activity when injured, mechanism of injury, object/substance producing injury, and place of injury were recoded according to International Classification of External Causes of Injury (ICECI). The most common types of injury were amputations (32.3%), fractures (23.7%), and open wounds (19.9%) of the wrist and hand. Most injuries were sustained by males; 28.4% of injuries occurred during summer. According to activity, 76.3% were injured during paid work, 10.4% during transportation, 9.1% during unpaid work, and 3.8% during leisure time sports and exercise. Injuries most commonly occurred while operating a machine. The risk of hand injury was elevated in those younger than 35 years of age, males, persons outside İzmir province, and in Social Security Instution (SSI) insured workers (p<0.001). The riskiest activity for hand injuries was paid work. Compared to baseline, the risk of hand injuries was 29 times [95% confidence interval (CI) 16.36-50.40] as high in industrial or construction areas, and 50 times (95% CI 17.29-143.96) as high in commercial places Hand injuries are important because of their consequences, such as permanent disability and their high treatment costs. This study points out many important risk factors, and has contributed the development of hypotheses about injury types, under-notification of occupational injuries, and child labour. The inclusion of medical records from such specialized hospitals into national databases will aid in the prevention of these injuries, and induce developments in diagnosis and treatment.

Epidemiology of traumatic upper limb amputations.

PubMed

Pomares, G; Coudane, H; Dap, F; Dautel, G

2018-04-01

While published data on functional outcomes after upper limb amputations are plentiful, epidemiology data are relatively rare. This led us to performing an epidemiology study of traumatic upper limb amputations at our facility. This retrospective study spanned a 10-year period of cases seen at the SOS Main (Hand emergency center) of the Nancy University Hospital in France. Patients who suffered traumatic amputation of the upper limb were identified and divided into two groups: replantation and surgical amputation. All anatomical amputation levels were retained. Non-traumatic amputations were excluded. Epidemiology data (sex, age, dominant side, injured side) was collected along with the specific anatomical level of the injury, the injury mechanism and whether it was work-related. We also looked at the success rate of microsurgery and whether multi-finger amputations were partial or complete. In parallel, the annual incidence of amputations seen at the SOS Main over this period was calculated. Over the 10-year period, 1715 traumatic upper-limb amputations were identified, which was 3% of all cases seen at the SOS Main. Most of the cases involved middle-aged men. Revascularization was attempted in one-third of cases and microsurgery was successful in 70% of cases. The surgical amputation group consisted of 1132 patients with a mean age of 59 years, while the replantation group consisted of 583 patients with a mean age of 48 years. The primary mechanism of injury was a table saw. This injury, which must be addressed urgently, is not very common in everyday practice. This is contrary to lower limb amputations, which are more common and occur in the context of micro- and macroangiopathy in older patients. The success rate of microsurgery in this cohort must be placed in the context of age, amputation level and mechanism. The functional outcomes are not always as good as the vascular outcomes. This data is invaluable as it fills a gap in our knowledge about amputations. IV. Copyright © 2018. Published by Elsevier Masson SAS.

Training Medical Novices in Spinal Microsurgery: Does the Modality Matter? A Pilot Study Comparing Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool

PubMed Central

Tubbs, R. Shane; Page, Jeni; Chapman, Alexandra; Burgess, Brittni; Laws, Tyler; Warren, Haylie; Oskouian, Rod J

2016-01-01

The operative microscope has been a staple instrument in the neurosurgical operating room over the last 50 years. With advances in optoelectronics, options such as robotically controlled high magnification have become available. Such robotically controlled optoelectronic systems may offer new opportunities in surgical technique and teaching. However, traditionally trained surgeons may find it hard to accept newer technologies due to an inherent bias emerging from their previous background. We, therefore, studied how a medically naïve population in a pilot study would meet set microsurgical goals in a cadaver experiment using either a conventional operative microscope or BrightMatter™ Servo system, ​a robotically controlled optoelectronic system (Synaptive Medical, Toronto, Ontario, Canada). We found that the relative ease in teaching medical novices with a robotically controlled optoelectronic system was more valuable when compared to using a modern-day surgical microscope. PMID:26973804

Robotic phrenic nerve harvest: a feasibility study in a pig model.

PubMed

Porto de Melo, P; Miyamoto, H; Serradori, T; Ruggiero Mantovani, G; Selber, J; Facca, S; Xu, W-D; Santelmo, N; Liverneaux, P

2014-10-01

The aim of this study was to report on the feasibility of robotic phrenic nerve harvest in a pig model. A surgical robot (Da Vinci S™ system, Intuitive Surgical(®), Sunnyvale, CA) was installed with three ports on the pig's left chest. The phrenic nerve was transected distally where it enters the diaphragm. The phrenic nerve harvest was successfully performed in 45 minutes without major complications. The advantages of robotic microsurgery for phrenic nerve harvest are the motion scaling up to 5 times, elimination of physiological tremor, and free movement of joint-equipped robotic arms. Robot-assisted neurolysis may be clinically useful for harvesting the phrenic nerve for brachial plexus reconstruction. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Atmospheric pressure plasma analysis by modulated molecular beam mass spectrometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aranda Gonzalvo, Y.; Whitmore, T.D.; Rees, J.A.

Fractional number density measurements for a rf plasma 'needle' operating at atmospheric pressure have been obtained using a molecular beam mass spectrometer (MBMS) system designed for diagnostics of atmospheric plasmas. The MBMS system comprises three differentially pumped stages and a mass/energy analyzer and includes an automated beam-to-background measurement facility in the form of a software-controlled chopper mechanism. The automation of the beam modulation allows the neutral components in the plasma to be rapidly and accurately measured using the mass spectrometer by threshold ionization techniques. Data are reported for plasma generated by a needle plasma source operated using a helium/air mixture.more » In particular, data for the conversion of atmospheric oxygen and nitrogen into nitric oxide are discussed with reference to its significance for medical applications such as disinfecting wounds and dental cavities and for microsurgery.« less

Patient motion tracking in the presence of measurement errors.

PubMed

Haidegger, Tamás; Benyó, Zoltán; Kazanzides, Peter

2009-01-01

The primary aim of computer-integrated surgical systems is to provide physicians with superior surgical tools for better patient outcome. Robotic technology is capable of both minimally invasive surgery and microsurgery, offering remarkable advantages for the surgeon and the patient. Current systems allow for sub-millimeter intraoperative spatial positioning, however certain limitations still remain. Measurement noise and unintended changes in the operating room environment can result in major errors. Positioning errors are a significant danger to patients in procedures involving robots and other automated devices. We have developed a new robotic system at the Johns Hopkins University to support cranial drilling in neurosurgery procedures. The robot provides advanced visualization and safety features. The generic algorithm described in this paper allows for automated compensation of patient motion through optical tracking and Kalman filtering. When applied to the neurosurgery setup, preliminary results show that it is possible to identify patient motion within 700 ms, and apply the appropriate compensation with an average of 1.24 mm positioning error after 2 s of setup time.

[Basic research in traumatology and its contribution to routine operation].

PubMed

Hausner, T; Redl, H

2017-02-01

Basic research in traumatology supports the clinical outcome of patients in trauma care and tries to find science-based solutions for clinical problems. Furthermore, institutions for basic research in traumatology usually offer training in different skills, such as how to write a scientific paper, or practice in microsurgery or intubation. Two examples of clinically significant research topics are presented.

Transanal endoscopic microsurgery: a New Zealand experience.

PubMed

Bloomfield, Ian; Van Dalen, Roelof; Lolohea, Simione; Wu, Linus

2018-06-01

Transanal endoscopic microsurgery (TEMS) is a proven alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. It has proven benefits with lower morbidity and mortality compared with total mesorectal excision, and a lower local recurrence rate when compared to endoscopic mucosal techniques. A retrospective data collection of TEMS procedures performed through Waikato District Health Board, New Zealand, from 2010 to 2015 was conducted. Supportive follow-up data were sourced from patient records and from local centres around New Zealand. A total of 137 procedures were performed over the study period, with five being repeat procedures. Procedures were mostly performed for benign lesions (66.4%) with an overall complication rate of 15.3%, only five of which were Clavien-Dindo grade III (3.6%). Our local recurrence rate after resection of benign lesions was 5.1%. Our data set demonstrates the TEMS procedure to be safe compared to radical resection (total mesorectal excision) for sessile rectal lesions. Close endoscopic follow-up is recommended, especially for close or incomplete margins. Good therapeutic results can be obtained for appropriately selected early malignant lesions. TEMS provides better oncological results than endoscopic mucosal resection or transanal excision. © 2017 Royal Australasian College of Surgeons.

The Hungry Fly: Hydrodynamics of feeding in the common house fly

NASA Astrophysics Data System (ADS)

Prakash, Manu; Steele, Miles

2010-11-01

A large number of insect species feed primarily on a fluid diet. To do so, they must overcome the numerous challenges that arise in the design of high-efficiency, miniature pumps. Although the morphology of insect feeding structures has been described for decades, their dynamics remain largely unknown even in the most well studied species (e.g. fruit fly). Here, we use invivo imaging and microsurgery to elucidate the design principles of feeding structures of the common house fly. Using high-resolution X-ray microscopy, we record invivo flow of sucrose solutions through the body over many hours during fly feeding. Borrowing from microsurgery techniques common in neurophysiology, we are able to perturb the pump to a stall position and thus evaluate function under load conditions. Furthermore, fluid viscosity-dependent feedback is observed for optimal pump performance. As the gut of the fly starts to fill up, feedback from the stretch receptors in the cuticle dictates the effective flow rate. Finally, via comparative analysis between the house fly, blow fly, fruit fly and bumble bees, we highlight the common design principles and the role of interfacial phenomena in feeding.

Hypo-fractionated stereotactic radiotherapy of five fractions with linear accelerator for vestibular schwannomas: A systematic review and meta-analysis.

PubMed

Nguyen, Thien; Duong, Courtney; Sheppard, John P; Lee, Seung Jin; Kishan, Amar U; Lee, Percy; Tenn, Stephen; Chin, Robert; Kaprealian, Tania B; Yang, Isaac

2018-03-01

Vestibular schwannomas (VS) are benign tumors stemming from the eighth cranial nerve. Treatment options for VS include conservative management, microsurgery, stereotactic radiosurgery, and fractionated radiotherapy. Though microsurgery has been the standard of care for larger lesions, hypo-fractionated stereotactic radiotherapy (hypo-FSRT) is an emerging modality. However, its clinical efficacy and safety have yet to be established. We conducted a systematic review and meta-analysis of manuscripts indexed in PubMed, Scopus, Web of Science, Embase, and Cochrane databases reporting outcomes of VS cases treated with hypo-FSRT. Five studies representing a total of 228 patients were identified. Across studies, the pooled rates of tumor control, hearing, facial nerve, and trigeminal nerve preservation were 95%, 37%, 97%, and 98%. No instances of malignant induction were observed at median follow-up of 34.8 months. Complications included trigeminal neuropathy (n = 3), maxillary paresthesia (n = 1), neuralgia (n = 1), vestibular dysfunction (n = 1), radionecrosis (n = 1), and hydrocephalus (n = 1). Hypo-FSRT may be another useful approach to manage VS, but studies with extended follow-up times are required to establish long-term safety. Copyright © 2018. Published by Elsevier B.V.

[Multicentric study of thrombosis prevention in upper-extremity microsurgery. Survey at the Fesum centers].

PubMed

Dumont, L-A; Rongières, M; Tchénio, P; Gangloff, D; Garrido-Stowhas, I

2010-04-01

Thrombosis is still the first cause of microsurgery failure. Lots of publications have been made but no consensus exists. We first analysed the results of our study in 53 French expert surgeons, then we compared them with the last published datas, most of all, with the similar surveys. If a big majority (81 %) of the surgeons use a preventing method, we observed majors variations between them and also compared to the anglosaxons surgeons habits. This survey permits to make the point on today's practice and to show that some of them are based on low proof level and something even done without any medical references. After datas analysis, we observed that none of the medical treatments proved efficiency on preventing vascular thrombosis. The low molecular weight heparins (LMWH) could be used on postops without increase bleeding but not to lower specially the microvascular thrombosis rate. Aspirin did not improve the positive rates and its adjonction to LMWH increased the bleeding. Until scientific studies prove efficacy of a treatment, the surgeon has to make a personal choice: keeping habits or following evidence-based medicine. Copyright 2010 Elsevier Masson SAS. All rights reserved.

Magnetically actuated propulsion at low Reynolds numbers: towards nanoscale control.

PubMed

Fischer, Peer; Ghosh, Ambarish

2011-02-01

Significant progress has been made in the fabrication of micron and sub-micron structures whose motion can be controlled in liquids under ambient conditions. The aim of many of these engineering endeavors is to be able to build and propel an artificial micro-structure that rivals the versatility of biological swimmers of similar size, e.g. motile bacterial cells. Applications for such artificial "micro-bots" are envisioned to range from microrheology to targeted drug delivery and microsurgery, and require full motion-control under ambient conditions. In this Mini-Review we discuss the construction, actuation, and operation of several devices that have recently been reported, especially systems that can be controlled by and propelled with homogenous magnetic fields. We describe the fabrication and associated experimental challenges and discuss potential applications.

Magnetically actuated propulsion at low Reynolds numbers: towards nanoscale control

NASA Astrophysics Data System (ADS)

Fischer, Peer; Ghosh, Ambarish

2011-02-01

Significant progress has been made in the fabrication of micron and sub-micron structures whose motion can be controlled in liquids under ambient conditions. The aim of many of these engineering endeavors is to be able to build and propel an artificial micro-structure that rivals the versatility of biological swimmers of similar size, e.g. motile bacterial cells. Applications for such artificial ``micro-bots'' are envisioned to range from microrheology to targeted drug delivery and microsurgery, and require full motion-control under ambient conditions. In this Mini-Review we discuss the construction, actuation, and operation of several devices that have recently been reported, especially systems that can be controlled by and propelled with homogenous magnetic fields. We describe the fabrication and associated experimental challenges and discuss potential applications.

Essentials of Endodontic Microsurgery

DTIC Science & Technology

2010-04-01

protocol is divided into regional and local injections and are as follows: 1. The administration of a long-acting anesthetic agent such as bupivicaine (Mar...mandibular anterior teeth receive bilateral mental nerve blocks. All of these can be supplemented, as need be, with corresponding palatal or lingual...infiltrations of the same anesthetic . In studies examining the effectiveness of lidocaine versus bupivicaine, it was shown that lidocaine was faster in

Patient Centered Outcomes Assessment of Retreatment and Endodontic Microsurgery Using CBCT Volumetric Analysis

DTIC Science & Technology

2018-11-09

Retreatment and EMS were completed using a dental operating microscope (Zeiss OPMJ PROergo) and contemporary materials and techniques. Retreatrnent...paralleling technique and external cone positioning device (XCP) using size 2 digital sensors (Kodak RVG 6100). A dental x-ray machine (Planmeca...EMS and retreatment were calculated. Examiners used MiPACS dental enterprise viewer (LEAD Technologies Inc, Charlotte, NC) to interpret randomized

Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap

PubMed Central

Upadhyaya, Divya N.; Khanna, Vaibhav; Kohli, Romesh; Tulsi, Satendar P. S.; Garg, Sandeep

2012-01-01

Managing the complex tendo Achilles defect involves reconstructing the Achilles tendon as well as providing soft tissue cover to the heel area. The advent of microsurgery has revolutionised the reconstruction of this difficult defect providing a number of options to the reconstructive surgeon. We present a case of complex tendo Achilles defect reconstructed by the latissimus dorsi free flap. PMID:23450740

Cerebral arteriovenous malformations and seizures: differential impact on the time to seizure-free state according to the treatment modalities.

PubMed

Hyun, Seung-Jae; Kong, Doo-Sik; Lee, Jung-Il; Kim, Jong-Soo; Hong, Seung-Chyul

2012-06-01

To determine the prognostic factors for the incidence and the outcome of seizure in patients with cerebral arteriovenous malformation (AVM) and to identify the time to seizure-free state according to the treatment modalities. Between 1995 and 2008, the multidisciplinary team at our institution treated 399 patients with cerebral AVMs. Treatment consisted of surgical resection, radiosurgery, and embolization, either alone or in combination. The median follow-up period was 6.0 years (range, 3.0-16.2 years). Eighty-six patients (21.5 %) experienced seizures before treatment. We investigated the variables associated with seizure incidence and seizure outcome and analyzed the outcomes of seizure among each treatment modality. After treatment, 60 (70 %) patients were seizure-free. Compared with 313 patients who did not experience seizures, we found that younger age (≤ 35 years), size ≥ 3 cm, and location of temporal lobe were associated with seizures (p < 0.05). Short seizure history, accompanying intracerebral hemorrhage, generalized tonic-clonic type seizure, deep-seated or infratentorial AVM, complete obliteration of AVM, and a favorable neurological outcome at 12 months were closely associated with Engel Class I outcomes (p < 0.05). Seizure-free outcomes after microsurgery, radiosurgery, or embolization were 78 %, 66 %, and 50 %, respectively. The overall annual bleeding rate was 1.0 % and 2.2 % in microsurgery-treated and radiosurgery-treated AVMs, respectively. In the surgery group, the median time to seizure-free status was 1.1 months (95 % CI, 0.7-1.2 months), whereas the radiosurgery group and embolization-alone group showed 20.5 months (95 % CI, 18.3-23.8 months), and 8.1 months (95 % CI, 6.0-13.5 months), respectively. A multidisciplinary team approach for cerebral AVMs achieved satisfactory seizure control results. Microsurgery led to the highest percentage of seizure-free outcomes and had the lowest annual bleeding rate, whereas radiosurgery had a higher bleeding rate. Median time to seizure-free status in surgically treated patients was shorter than in patients who underwent radiosurgical or endovascular treatment.

A multiple phase transitioning peptide hydrogel for use in vascular a | NCI Technology Transfer Center | TTC

Cancer.gov

Researchers at the National Cancer Institute (NCI), in collaboration with surgical specialists from Johns Hopkins University, have developed hydrogel compositions and methods to suture blood vessels with the hydrogels during microsurgery. These hydrogels are particularly beneficial for surgeons in whole tissue transplant procedures. The NCI researchers seek licensing and/or co-development research collaborations for further development of this technology.

High-Energy Trauma and Damage Control in the Lower Limb

DTIC Science & Technology

2010-01-01

Reconstruction : From Microsurgery Reconstruction to Transplantation; Guest Editors, Chih-Hung Lin, M.D., and Fu-Chan Wei, M.D. Semin Plast Surg...continue intraoperatively.12–14 The goal is to achieve hemostasis, restore normal physiology, and potentially complete a vascular reconstruction upon...injuries and the need for vascular reconstruction at the time of admission is crucial to the success of grafting and maximizes the chances of limb

[Surgical excision and botulinum toxin A injection for vocal process granuloma].

PubMed

Ma, Lijing; Xiao, Yang; Ye, Jingying; Yang, Qingwen; Wang, Jun

2015-01-01

To study the efficacy of treatment with microsurgery in combination with local injection of type A botulinum toxin for vocal process granuloma. 28 patients with vocal process granuloma received endotracheal intubation under general anesthesia. The lesion was removed with micro-scissor and CO2 laster under a self-retaining laryngoscope and microscope. The incision and mucous membrane surrounding the wound was closed with 8-0 absorbable suture. 4-point injection of botulinum toxin type A 8-15 u was then performed along the thyroarytenoid muscle and arytenoid muscle of the same side. Postoperative medication was administered based on disease causes. All patients experienced vocal cord dyskinesia of the injected side 2-3 days after surgery. At 1 month after the surgery, wound healing was good in all the 28 patients, and the vocal cord movement was limited at the injected side. At 3 months, movement of the bilateral vocal cords was normal, and the vocal cord process mucosa was smooth. Patients were followed up for more than a year, and only one patient had recurrence in 2 months after surgery. The cure rate was 96. 4%. Combination of laryngeal microsurgery and type A botulinum toxin local injection can shorten the treatment course of vocal process granuloma.

Intralesional Steroid Injection as An Alternative Treatment for 57 Patients of Vocal Fold Mucus Retention Cysts.

PubMed

Wu, Po-Hsuan; Cheng, Po-Wen; Lin, Feng-Chuan; Wang, Chi-Te

2018-05-16

This study intends to validate the effectiveness of vocal fold steroid injection (VFSI) for mucus retention cysts (MRCs) by comparing the treatment outcome with a control group and investigate the risk factors for recurrence. This study recruited 57 patients with vocal fold MRCs treated with in-office VFSI between January 2014 and December 2016. Another 24 patients with MRCs receiving only conservative treatment during the same study period were included as the control group. Treatment outcomes comparison of the 22 age- and sex- matched patients between the VFSI and control groups demonstrated significantly better improvements among the patients receiving VFSI in maximal phonation, perceptual voice quality, and 10-item voice handicap index. Among the 48 patients exhibited significant lesion resolution after VFSI for MRCs, follow up of a median interval of 18 months showed 16 patients with recurring lesions, ranging from 3 to 43 months. Patients with active alcohol consumption were associated with a higher risk for recurrence. When microsurgery for MRCs is not feasible, VFSI might offer temporary symptom relief. Nevertheless, patients should be informed that the duration of VFSI varies, recurrence is common, and microsurgery remain the gold standard. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Comparison of reversal with neostigmine of low-dose rocuronium vs. reversal with sugammadex of high-dose rocuronium for a short procedure.

PubMed

Choi, E S; Oh, A Y; Koo, B W; Hwang, J W; Han, J W; Seo, K S; Ahn, S H; Jeong, W J

2017-10-01

Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty-four patients undergoing elective laryngeal micro-surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg -1 with neostigmine (50 μg.kg -1 with glycopyrrolate 10 μg.kg -1 ) reversal (moderate block group) vs. rocuronium 0.90 mg.kg -1 with sugammadex (4 mg.kg -1 ) reversal (deep block group). The primary outcome was the intubating conditions during laryngoscopy secondary outcomes included recovery of neuromuscular block; conditions for tracheal intubation; satisfaction score as determined by the surgeon; onset of neuromuscular block; and postoperative sore throat. The onset of neuromuscular block was more rapid, and intubation conditions and ease of intra-operative laryngoscopy were more favourable, and the satisfaction score was lower in the moderate block group compared with the deep block group. No difference was found in the incidence of postoperative sore throat. In laryngeal micro-surgery, the use of rocuronium 0.9 mg.kg -1 with sugammadex for reversal was associated with better surgical conditions and a shorter recovery time than rocuronium 0.45 mg.kg -1 with neostigmine. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal.

PubMed

Scheich, Matthias; Ginzkey, Christian; Ehrmann Müller, Desiree; Shehata Dieler, Wafaa; Hagen, Rudolf

2017-08-01

To analyze postoperative complications after microsurgery for acoustic neuroma (AN) via the middle fossa approach (MFA). In total, 203 consecutive patients of a tertiary skull base referral center at a university hospital were included in this retrospective chart and database analysis. All patients had undergone primary microsurgery at the Otorhinolaryngology department via MFA between December 2005 and October 2014. Postoperative complications were documented during the inpatient stay and outpatient follow-up. Overall, 41 complications were registered in 35 patients. The most common was cerebrospinal fluid (CSF) leakage in 13% of the patients. Bleeding complications were documented in seven patients: two cerebellar bleedings, one subdural and one epidural hematoma, two hematomas of the skin, and one bleeding through the closed wound. Two patients experienced meningitis and one patient had a transient ischemic attack. Furthermore, three cases of deep vein thrombosis occurred, which led to a lethal pulmonary embolism in one case. One patient sustained temporary palsy of the vocal fold and another reported antibiotic-associated diarrhea. Acoustic neuroma surgery via the MFA can be conducted with low morbidity and mortality. The most common complication is CSF leakage, which can be treated in most cases in a stepwise conservative manner. Severe adverse events that may require revision surgery are very scarce (1%).

Iatrogenic surgical microscope skin burns: A systematic review of the literature and case report.

PubMed

Lopez, Joseph; Soni, Ashwin; Calva, Daniel; Susarla, Srinivas M; Jallo, George I; Redett, Richard

2016-06-01

Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Retrospective health-care associated infection surveillance in oral and maxillofacial reconstructive microsurgery.

PubMed

Patyi, Márta; Sejben, István; Cserni, Gábor; Sántha, Beáta; Gaál, Zoltán; Pongrácz, Júlia; Oberna, Ferenc

2014-12-01

In polymorbid or anaemic patients who receive preoperative radiotherapy or undergo long duration surgery involving potentially infectious sites, perioperative antibiotic prophylaxis (PAP) that is effective against normal oral bacterial flora is mandatory and plays an important role in preventing postoperative infection. In a four-year retrospective analysis, the incidence, outcome, and the efficacy of PAP were evaluated in patients treated at the Department of Oral and Maxillofacial Surgery and Otorhinolaryngology at Kecskemét Hospital. The results were compared with data from the literature to determine if the use of PAP was adequate at the Department.During the study period (between 01/09/2007 and 31/01/2011) 108 patients were evaluated. The mean duration of prophylactic antibiotic treatment was 8.3 ± 5.2 days, with cefotaxime+metronidazole being the most commonly used combination. Surgical site infection occurred in 8 patients (7.5%) in the clean-contaminated category.Our results showed that the perioperative antibiotic prophylaxis administered at our Department was efficient and effective against the oral bacterial flora of patients. Its use is recommended in head and neck microsurgery. To avoid development of antibiotic resistance and to reduce costs, it seems that the duration of antibiotic regimen for primary surgery can be reduced from 8.3 ± 5.2 days to 3 days.

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

PubMed Central

Hong, WenMing; Cheng, HongWei; Wang, XiaoJie; Feng, ChunGuo

2017-01-01

Objective To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma. Methods Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function. Results Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78). Conclusion Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms. PMID:28264236

An Affordable Microsurgical Training System for a Beginning Neurosurgeon: How to Realize the Self-Training Laboratory.

PubMed

Chung, Sang-Bong; Ryu, Jiwook; Chung, Yeongu; Lee, Sung Ho; Choi, Seok Keun

2017-09-01

To provide detailed information about how to realize a self-training laboratory with cost-effective microsurgical instruments, especially pertinent for the novice trainee. Our training model is designed to allow the practice of the microsurgery skills in an efficient and cost-effective manner. A used stereoscopic microscope is prepared for microsurgical training. A sufficient working distance for microsurgical practice is obtained by attaching an auxiliary objective lens. The minimum instrument list includes 2 jeweler's forceps, iris scissors, and alligator clips. The iris scissors and alligator clip provide good alternatives to micro-scissors and microvascular clamp. The short time needed to set up the microscope and suture the gauze with micro-forceps makes the training model suitable for daily practice. It takes about 15 minutes to suture 10 neighboring fibers of the gauze with 10-0 nylon; thus, training can be completed more quickly. We have developed an inexpensive and efficient micro-anastomosis training system using a stereoscopic microscope and minimal micro-instruments. Especially useful for novice trainees, this system provides high accessibility for microsurgical training. Copyright © 2017 Elsevier Inc. All rights reserved.

Radiosurgery for cerebral arteriovenous malformations in hereditary hemorrhagic telangiectasia.

PubMed

Maarouf, M; Runge, M; Kocher, M; Zähringer, M; Treuer, H; Sturm, V

2004-07-27

The authors evaluated the efficacy of radiosurgery (RS) for cerebral arteriovenous malformations in hereditary hemorrhagic telangiectasia (HHT AVMs). Two patients with seven HHT AVMs were treated by linear accelerator-RS. Complete obliteration was achieved 18 to 24 months post-treatment without side effects. Because HHT AVMs are small and multiple, RS is superior to microsurgery because it is noninvasive and all AVMs can be treated in one session regardless of their location.

Professor, member of the Academy of (Medical) Sciences, Igor Dmitrievich Kirpatovsky and his scientific heritage

NASA Astrophysics Data System (ADS)

Kaitova, Z.; Smirnova, E.; Protasov, A.

2015-11-01

Academician Igor Dmitrievich Kirpatovsky created a scientific school at the Department of Operative Surgery at the Russian People's Friendship University. Unique studies have been conducted in various areas of medicine and science: vascular and abdominal surgery; microsurgery; traumatology and orthopedics; clinical anatomy and relief anatomy; nervous and endocrine transplantation; andrology transplantation; experiments in the area of renal transplantation, small intestine and limb transplantation; transplantation immunology.

A Band of Surgeons, a Long Healing Line: Development of Craniofacial Surgery in Response to Armed Conflict

DTIC Science & Technology

2010-07-01

Unauthorized reproduction of this article is prohibited. During the same remarkable era, Ralph Buncke added microsurgery to the reconstructive ... reconstruction , war, history, military, surgery (J Craniofac Surg 2010;21: 991 997) The will to conquer is the first condition of victory. Marshal Ferdinand...Homer practicing in Kashi, India. Sushruta’s regional flaps for nasal reconstruction (circa 600 BCE) are the first recorded plastic techniques

Development of Laser Propulsion and Tracking System for Laser-Driven Micro-Airplane

NASA Astrophysics Data System (ADS)

Ishikawa, Hiroyasu; Kajiwara, Itsuro; Hoshino, Kentaro; Yabe, Takashi; Uchida, Shigeaki; Shimane, Yoshichika

2004-03-01

The purposes of this paper are to improve the control performance of the developed laser tracking system and to develop an integrated laser propulsion/tracking system for realizing a continuous flight and control of the micro-airplane. The laser propulsion is significantly effective to achieve the miniaturization and lightening of the micro-airplane. The laser-driven micro-airplane has been studied with a paper-craft airplane and YAG laser, resulting in a successful glide of the airplane. In the next stage of the laser-driven micro-airplane development, the laser tracking is expected as key technologies to achieve continuous propulsion. Furthermore, the laser propulsion system should be combined with the laser tracking system to supply continuous propulsion. Experiments are carried out to evaluate the performance of the developed laser tracking system and integrated laser propulsion/tracking system.

IOL Tetraflex, KH 3500--presbyopia treatment.

PubMed

Ferko, J; Ferkova, A

2009-01-01

Presbyopia is a loss of accommodative capacity of the eye determined by age. The possible solutions for its treatment are spectacle correction (mono-, bi- or multifocal), multifocal contact lenses, conductive keratoplasty, excimer laser surgery and surgical solution - CLE. Four-year experience with using LOL Tetraflex KH 3500 by Lenstec. Between 2005 and 2009, 71 eyes of 35 patients with the average age of 52 were operated at the private ophthalmological clinic 3F Microsurgery of the Eye in Kosice. The patients were selected by strict indication criteria recommended by the producer. We have evaluated the ability of the implanted lens to substitute for the presbyopic correction. The subjective criterion of patient's evaluation was the expression of content in common life situations on the scale of 1 to 10. The objective evaluation was constituted by the measurement of the accommodation width, the presence of PCO, its solution by means of YAG capsulotomy and the subsequent influence on the pseudo accommodative capacity of the lense. 92% of operated patients expressed their complete satisfaction with the surgery results. By objective accommodometer measurement, we have identified the average accommodation width of +1,5 dioptres on the operated eyes. The presence of PCO was discovered in 42,2% cases. All cases were treated by YAG Capsulotomy. By further observation we have tried to determine the influence of YAG Capsulotomy on the accommodation width and pseudo accommodative capacity of the eye. The selection and use of TETRAFLEX lens is an appropriate alternative to presbyopia treatment with suitable patients.

Surgery in the HPV era: the role of robotics and microsurgical techniques.

PubMed

Ridge, John A

2014-01-01

Retrospective studies suggested that head and neck cancers associated with human papilloma virus (HPV) are more frequently cured than those caused by substance use. The Eastern Cooperative Oncology Group (ECOG) subsequently confirmed the observation in a prospective trial. Most HPV-initiated cancers arise in the oropharynx. Survival differences between patients with cancers caused by HPV and those caused by alcohol and tobacco use persist despite modern treatment. The impression that treatment intensification has resulted in improved survivorship may well be attributable to an increasing proportion of patients with cancers caused by HPV infection. Unsatisfactory results for cancers attributable to substance use and encouraging improvements in tumor control for patients with HPV-initiated cancers have led to dissatisfaction with the current nonsurgical management paradigm. Ongoing advances in surgical techniques permit transoral resection of oropharyngeal cancers, thus limiting exposure-related morbidity and permitting ready recovery in terms of speech and swallowing. Transoral laser microsurgery (TLM) is increasingly employed and transoral robotic surgery (TORS) has dramatically popularized surgical treatment of oropharyngeal cancers. Resection affords the opportunity to increase local control at the primary site and surgical management of neck allows risk-based stratification of postoperative radiation therapy. Case series from several institutions show encouraging results. Transoral surgical resection is safe, can be undertaken with acceptable morbidity, and provides comparable locoregional control to that achieved with chemoradiation. Prospective trials for patients with HPV-initiated cancers, as well as those referable to substance use, are underway.

[Hand transplantation and implantation of nerve chips. New developments within hand surgery].

PubMed

Dahlin, L; Fridén, J; Hagberg, L; Lundborg, G

1999-10-06

Injuries and diseases of the hand naturally have an enormous impact on hand function and on quality of life, both occupational and social. The majority of hand-injury patients are under 30 years of age. Hand surgery, an established specialty in Sweden since 1969, is of great importance in terms of clinical developments, education and research. In the coming decade, scientific and clinical advances are to be expected in several fields such as nerve injuries including brachial plexus lesion, microsurgery, flexor tendon injuries and tendon transfer. Bioimplant research and new advances at the biotechnological interface will yield new options in nerve reconstruction, microchip implants in the nervous system, and the restoration of muscle-tendon function following injury. Artificial limbs with advanced motor and sensory functions will be important future aids in the rehabilitation of amputees. Transplantation of human hands is another promising reconstructive procedure which may open up new perspectives in the coming millennium.

[Hand transplantation and implantation of nerve chips. New developments within hand surgery].

PubMed

Dahlin, L; Fridén, J; Hagberg, L; Lundborg, G

2000-03-20

Injuries and diseases of the hand naturally have an enormous impact on hand function and on quality of life, both occupational and social. The majority of hand-injury patients are under 30 years of age. Hand surgery, an established specialty in Sweden since 1969, is of great importance in terms of clinical developments, education and research. In the coming decade, scientific and clinical advances are to be expected in several fields such as nerve injuries including brachial plexus lesion, microsurgery, flexor tendon injuries and tendon transfer. Bioimplant research and new advances at the biotechnological interface will yield new options in nerve reconstruction, microchip implants in the nervous system, and the restoration of muscle-tendon function following injury. Artificial limbs with advanced motor and sensory functions will be important future aids in the rehabilitation of amputees. Transplantation of human hands is another promising reconstructive procedure which may open iup new perspectives in the coming millennium.

30 Years of Neurosurgical Robots: Review and Trends for Manipulators and Associated Navigational Systems.

PubMed

Smith, James Andrew; Jivraj, Jamil; Wong, Ronnie; Yang, Victor

2016-04-01

This review provides an examination of contemporary neurosurgical robots and the developments that led to them. Improvements in localization, microsurgery and minimally invasive surgery have made robotic neurosurgery viable, as seen by the success of platforms such as the CyberKnife and neuromate. Neurosurgical robots can now perform specific surgical tasks such as skull-base drilling and craniotomies, as well as pedicle screw and cochlear electrode insertions. Growth trends in neurosurgical robotics are likely to continue but may be tempered by concerns over recent surgical robot recalls, commercially-driven surgeon training, and studies that show operational costs for surgical robotic procedures are often higher than traditional surgical methods. We point out that addressing performance issues related to navigation-related registration is an active area of research and will aid in improving overall robot neurosurgery performance and associated costs.

Functional evaluation of anterolateral thigh flap donor sites: isokinetic torque comparisons for knee function.

PubMed

Tsuji, Naoko; Suga, Hirotaka; Uda, Koichi; Sugawara, Yasushi

2008-01-01

The anterolateral thigh flap is thought to have minor donor site morbidity, but muscle dissection is unavoidable when skin perforator vessels run through the vastus lateralis muscle. The purpose of this study was to investigate the functional problems associated with the anterolateral thigh flap donor site. We evaluated 12 patients who underwent free anterolateral thigh flap transfer between March 2003 and November 2005. A questionnaire and dynamic functional evaluation of the knee joint using the Biodex System were performed preoperatively and 6 months postoperatively. No patients reported any disturbance in their daily life. No significant differences were found between donor and normal thighs on isokinetic power tests of the quadriceps muscle. The function of the donor site after harvesting the anterolateral thigh flap was maintained. Damage to or functional disturbance of the donor site is minimal even if muscle is injured when harvesting the flap. (c) 2008 Wiley-Liss, Inc. Microsurgery, 2008

Laser and solar-photovoltaic space power systems comparison. II.

NASA Technical Reports Server (NTRS)

De Young, R. J.; Stripling, J.; Enderson, T. M.; Humes, D. H.; Davis, W. T.

1984-01-01

A comparison of total system cost is made between solar photovoltaic and laser/receiver systems. The laser systems assume either a solar-pumped CO2 blackbody transfer laser with MHD receiver or a solar pumped liquid neodymium laser with a photovoltaic receiver. Total system costs are less for the laser systems below 300 km where drag is significant. System costs are highly dependent on altitude.

Solar-pumped laser for free space power transmission

NASA Technical Reports Server (NTRS)

Lee, Ja H.

1989-01-01

Laser power transmission; laser systems; space-borne and available lasers; 2-D and 1 MW laser diode array systems; technical issues; iodine solar pumped laser system; and laser power transmission applications are presented. This presentation is represented by viewgraphs only.

Basic Microsurgery Training Using the Laboratory Rat (Rattus norvegicus)

DTIC Science & Technology

2017-03-23

CHANGES: Have there been any personnel/staffing changes (PI/CI/ AI /TC/lnstructor) since the last IACUC approval of protocol, or annual review? _X_ Yes No If...Include Name, Protocol function - PI/CI/ AI /TC/lnstructor, IACUC approval -Yes/No) Maj Ryan Diepenbrock (PI) IACUC Approval Yes 18Jun 15 DELETIONS...Include Name, Protocol function - PI/CI/ AI /TC/lnstructor, Effective date of deletion) Lt Col Jean Luc Niel (PI) June 2015 Col Bradley Turner (Al)July

Organ-preserving and reconstructive microsurgery of the fallopian tubes in tubal infertility: still an alternative to in vitro fertilization (IVF).

PubMed

Schippert, Cordula; Hille, Ursula; Bassler, Christina; Soergel, Philipp; Hollwitz, Bettina; Garcia-Rocha, Guillermo José

2010-07-01

Tubal infertility mostly results from infections. Conception only is possible through complex treatments (in vitro fertilization or surgery). Success cannot be guaranteed, even after repeated treatments. Unfortunately, many couples are not informed about the prospect for success of tubal reconstruction. Problems of in vitro fertilization are low pregnancy and birth rates of 28.4% and <20% respectively (Germany) and the high number of multiple pregnancies (21%). In this retrospective study 462 women with acquired tubal infertility and further 127 women after previous sterilization underwent microsurgical treatment (microsurgical adhesiolysis, anastomosis, fimbrioplasty, salpingostomy, and refertilization due to former sterilization). The main outcome measures are the pregnancy and birth rates following the microsurgical procedure. Pregnancy and birth rates of 43.4% and 29.2%, respectively, were higher than the outcomes post-single in vitro fertilization (abortion: 6.4%, extrauterine pregnancy: 7.9%). When reversal of sterilization was performed, pregnancy and birth rates were higher at 73% and 50.6%, respectively (abortion: 15.7%, extrauterine pregnancy: 6.7%). The advantages of reconstructive microsurgery over in vitro fertilization include the ideally permanent restoration of woman's ability to conceive naturally (repeated pregnancies are possible without further therapy), a high postoperative birth rate overall, and avoidance of multiple births. It is advisable to inform the patient about the objective possibility of reconstructive tubal surgery. Thieme Medical Publishers.

The S&T Lecture: An Introduction to the 9th Congress of WSRM.

PubMed

Hallock, Geoffrey G

2018-05-03

Just what is the S&T lecture? In the beginning it appeared to be a dubious distinction, another task thrust upon me but different in that I had absolutely no idea what was wanted or would be appropriate. At the least, it seemed reasonable to recite a simple introductory story for what would be an extraordinary conclave. First, an appreciation was due to our dedicated leaders of World Society of Reconstructive Microsurgery (WSRM), who this year (2017) have put together the most extravagant meeting ever, intended to include not just the glamorous but the entire scope of rudimentary reconstructive microsurgery. We know we must acquire all this knowledge to succeed today and tomorrow, but also need not to overlook the struggles and sacrifices our predecessors had to overcome. Too often the past is forgotten, only to then inefficiently be repeated. Today then, this will be a short story, a story of our past that must never be cast aside. The WSRM here today is a great international forum where we can then mingle with all of our colleagues to help dictate the present, but also define the future role of all specialities here where the ultimate goal is to help those most in need. This S&T lecture will just be a history story, subject to your interpretation. Enjoy! Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Task five report: Laser communications for data acquisition networks. [characteristics of lasers and laser systems for optical communication applications

NASA Technical Reports Server (NTRS)

1973-01-01

Laser communication technology and laser communication performance are reviewed. The subjects discussed are: (1) characteristics of laser communication systems, (2) laser technology problems, (3) means of overcoming laser technology problems, and (4) potential schedule for including laser communications into data acquisition networks. Various types of laser communication systems are described and their capabilities are defined.

Localization and Tracking of Implantable Biomedical Sensors

PubMed Central

Umay, Ilknur; Fidan, Barış; Barshan, Billur

2017-01-01

Implantable sensor systems are effective tools for biomedical diagnosis, visualization and treatment of various health conditions, attracting the interest of researchers, as well as healthcare practitioners. These systems efficiently and conveniently provide essential data of the body part being diagnosed, such as gastrointestinal (temperature, pH, pressure) parameter values, blood glucose and pressure levels and electrocardiogram data. Such data are first transmitted from the implantable sensor units to an external receiver node or network and then to a central monitoring and control (computer) unit for analysis, diagnosis and/or treatment. Implantable sensor units are typically in the form of mobile microrobotic capsules or implanted stationary (body-fixed) units. In particular, capsule-based systems have attracted significant research interest recently, with a variety of applications, including endoscopy, microsurgery, drug delivery and biopsy. In such implantable sensor systems, one of the most challenging problems is the accurate localization and tracking of the microrobotic sensor unit (e.g., robotic capsule) inside the human body. This article presents a literature review of the existing localization and tracking techniques for robotic implantable sensor systems with their merits and limitations and possible solutions of the proposed localization methods. The article also provides a brief discussion on the connection and cooperation of such techniques with wearable biomedical sensor systems. PMID:28335384

ALMDS laser system

NASA Astrophysics Data System (ADS)

Kushina, Mark E.; Heberle, Geoff; Hope, Michael; Hall, David; Bethel, Michael; Calmes, Lonnie K.

2003-06-01

The ALMDS (Airborne Laser Mine Detection System) has been developed utilizing a solid-state laser operating at 532nm for naval mine detection. The laser system is integrated into a pod that mounts externally on a helicopter. This laser, along with other receiver systems, enables detailed underwater bathymetry. CEO designs and manufactures the laser portion of this system. Arete Associates integrates the laser system into the complete LIDAR package that utilizes sophisticated streak tube detection technology. Northrop Grumman is responsible for final pod integration. The laser sub-system is comprised of two separate parts: the LTU (Laser Transmitter Unit) and the LEU (Laser Electronics Unit). The LTU and LEU are undergoing MIL-STD-810 testing for vibration, shock, temperature storage and operation extremes, as well as MIL-STD-704E electrical power testing and MIL-STD-461E EMI testing. The Nd:YAG MOPA laser operates at 350 Hz pulse repetition frequency at 45 Watts average 532nm power and is controlled at the system level from within the helicopter. Power monitor circuits allow real time laser health monitoring, which enables input parameter adjustments for consistent laser behavior.

Spectral and Radiometric Calibration Using Tunable Lasers

NASA Technical Reports Server (NTRS)

McCorkel, Joel (Inventor)

2017-01-01

A tunable laser system includes a tunable laser, an adjustable laser cavity for producing one or more modes of laser light emitted from the tunable laser, a first optical parametric oscillator positioned in a light path of the adjustable laser cavity, and a controller operable to simultaneously control parameters of at least the tunable laser, the first optical parametric oscillator, and the adjustable laser cavity to produce a range of wavelengths emitted from the tunable laser system. A method of operating a tunable laser system includes using a controller to simultaneously control parameters of a tunable laser, an adjustable laser cavity for producing one or more modes of laser light emitted from the tunable laser, and a first optical parametric oscillator positioned in a light path of the adjustable laser cavity, to produce a range of wavelengths emitted from the tunable laser system.

The choice: Welding with CO2 or Nd:YAG lasers

NASA Astrophysics Data System (ADS)

Leong, Keng H.

The recent commercial availability of multi-kilowatt Nd:YAG lasers has opened new avenues for rapid laser processing as well as intensified the competition (cost effectiveness) between CO2 and Nd:YAG laser systems. Vendors offering Nd:YAG laser systems may claim lower operating costs (than CO2) and fiberoptic beam delivery flexibility while CO2 systems vendors may emphasize lower capital cost and well established processing requirements and experience. The capital and operating costs of a laser system are impacted by demand and supply economics and technological advances. Frequently the total cost of a workcell using a laser for processing has to be considered rather than the laser system alone. Consequently it is not very practical to approach the selection of a laser system based on its capital cost and estimated operating cost only. This presentation describes a more pragmatic approach to aid the user in the selection of the optimal multi-kilowatt laser system for a particular processing requirement with emphasis on welding. CO2 laser systems are well established on the factory floor. Consequently, emphasis is given to the comparative application of Nd:YAG lasers, process requirements and performance. Requirements for the laser welding of different metals are examined in the context of hardware (laser system and beam delivery) selection and examples of welding speeds that can be achieved using CO2 and Nd:YAG lasers are examined.

Comparison of electrically driven lasers for space power transmission

NASA Technical Reports Server (NTRS)

Deyoung, R. J.; Lee, J. H.; Williams, M. D.; Schuster, G.; Conway, E. J.

1988-01-01

High-power lasers in space could provide power for a variety of future missions such as spacecraft electric power requirements and laser propulsion. This study investigates four electrically pumped laser systems, all scaled to 1-MW laser output, that could provide power to spacecraft. The four laser systems are krypton fluoride, copper vapor, laser diode array, and carbon dioxide. Each system was powered by a large solar photovoltaic array which, in turn, provided power for the appropriate laser power conditioning subsystem. Each system was block-diagrammed, and the power and efficiency were found for each subsystem block component. The copper vapor system had the lowest system efficiency (6 percent). The CO2 laser was found to be the most readily scalable but has the disadvantage of long laser wavelength.

Method and system for modulation of gain suppression in high average power laser systems

DOEpatents

Bayramian, Andrew James [Manteca, CA

2012-07-31

A high average power laser system with modulated gain suppression includes an input aperture associated with a first laser beam extraction path and an output aperture associated with the first laser beam extraction path. The system also includes a pinhole creation laser having an optical output directed along a pinhole creation path and an absorbing material positioned along both the first laser beam extraction path and the pinhole creation path. The system further includes a mechanism operable to translate the absorbing material in a direction crossing the first laser beam extraction laser path and a controller operable to modulate the second laser beam.

High throughput solar cell ablation system

DOEpatents

Harley, Gabriel; Pass, Thomas; Cousins, Peter John; Viatella, John

2014-10-14

A solar cell is formed using a solar cell ablation system. The ablation system includes a single laser source and several laser scanners. The laser scanners include a master laser scanner, with the rest of the laser scanners being slaved to the master laser scanner. A laser beam from the laser source is split into several laser beams, with the laser beams being scanned onto corresponding wafers using the laser scanners in accordance with one or more patterns. The laser beams may be scanned on the wafers using the same or different power levels of the laser source.

High throughput solar cell ablation system

DOEpatents

Harley, Gabriel; Pass, Thomas; Cousins, Peter John; Viatella, John

2012-09-11

A solar cell is formed using a solar cell ablation system. The ablation system includes a single laser source and several laser scanners. The laser scanners include a master laser scanner, with the rest of the laser scanners being slaved to the master laser scanner. A laser beam from the laser source is split into several laser beams, with the laser beams being scanned onto corresponding wafers using the laser scanners in accordance with one or more patterns. The laser beams may be scanned on the wafers using the same or different power levels of the laser source.

Repetitive output laser system and method using target reflectivity

DOEpatents

Johnson, Roy R.

1978-01-01

An improved laser system and method for implosion of a thermonuclear fuel pellet in which that portion of a laser pulse reflected by the target pellet is utilized in the laser system to initiate a succeeding target implosion, and in which the energy stored in the laser system to amplify the initial laser pulse, but not completely absorbed thereby, is used to amplify succeeding laser pulses initiated by target reflection.

The study of laser beam riding guided system based on 980nm diode laser

NASA Astrophysics Data System (ADS)

Qu, Zhou; Xu, Haifeng; Sui, Xin; Yang, Kun

2015-10-01

With the development of science and technology, precision-strike weapons has been considered to be important for winning victory in military field. Laser guidance is a major method to execute precision-strike in modern warfare. At present, the problems of primary stage of Laser guidance has been solved with endeavors of countries. Several technical aspects of laser-beam riding guided system have been mature, such as atmosphere penetration of laser beam, clutter inhibition on ground, laser irradiator, encoding and decoding of laser beam. Further, laser beam quality, equal output power and atmospheric transmission properties are qualified for warfare situation. Riding guidance instrument is a crucial element of Laser-beam riding guided system, and is also a vital element of airborne, vehicle-mounted and individual weapon. The optical system mainly consist of sighting module and laser-beam guided module. Photoelectric detector is the most important sensing device of seeker, and also the key to acquire the coordinate information of target space. Currently, in consideration of the 1.06 u m of wavelength applied in all the semi-active laser guided weapons systems, lithium drifting silicon photodiode which is sensitive to 1.06 u m of wavelength is used in photoelectric detector. Compared to Solid and gas laser, diode laser has many merits such as small volume, simple construction, light weight, long life, low lost and easy modulation. This article introduced the composition and operating principle of Laser-beam riding guided system based on 980 nm diode laser, and made a analysis of key technology; for instance, laser irradiator, modulating disk of component, laser zooming system. Through the use of laser diode, Laser-beam riding guided system is likely to have smaller shape and very light.

Plastic and reconstructive robotic microsurgery--a review of current practices.

PubMed

Saleh, D B; Syed, M; Kulendren, D; Ramakrishnan, V; Liverneaux, P A

2015-08-01

We sought to review the current state of robotics in this specialty. A Pubmed and Medline search was performed using key search terms for a comprehensive review of the whole cross-section of plastic and reconstructive practice. Overall, 28 publications specific to robotic plastic and reconstructive procedures were suitable for appraisal. The current evidence suggests robotics is comparable to standard methods despite its infancy. The possible applications are wide and could translate into superior patient outcomes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Exploring New Frontiers of Microsurgery: From Anatomy to Clinical Methods.

PubMed

Wang, Zeng Tao; Zheng, You Mao; Zhu, Lei; Hao, Li Wen; Zhang, Ya Bin; Chen, Chao; Xia, Li Feng; Liu, Lin Feng

2017-04-01

This article presents the authors' understanding and experience concerning anatomic studies and clinical methods in microsurgical hand reconstruction. The 4 parts of this article include anatomic study of the hand for developing new flaps; application of miniflaps from the hand, including clinical experience with 8 unique flaps in the hand; anatomic and clinical considerations concerning several flaps from other parts of the human body; And our experience with vascularized free toe joint transfer. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of a telerobotic system to assist surgeons in microsurgery

NASA Technical Reports Server (NTRS)

Das, H.; Zak, H.; Johnson, J.; Crouch, J.; Frambach, D.

1999-01-01

A tool was developed that assists surgeons in manipulating surgical instruments more precisely than is possible manually. The tool is a telemanipulator that scales down the surgeon's hand motion and filters tremor in the motion. The signals measured from the surgeon's hand are transformed and used to drive a six-degrees-of-freedom robot to position the surgical instrument mounted on its tip. A pilot study comparing the performance of the telemanipulator system against manual instrument positioning was conducted at the University of Southern California School of Medicine. The results show that a telerobotic tool can improve the performance of a microsurgeon by increasing the precision with which he can position surgical instruments, but this is achieved at the cost of increased time in performing the task. We believe that this technology will extend the capabilities of microsurgeons and allow more surgeons to perform highly skilled procedures currently performed only by the best surgeons. It will also enable performance of new surgical procedures that are beyond the capabilities of even the most skilled surgeons. Copyright 1999 Wiley-Liss, Inc.

Heterodyne laser diagnostic system

DOEpatents

Globig, Michael A.; Johnson, Michael A.; Wyeth, Richard W.

1990-01-01

The heterodyne laser diagnostic system includes, in one embodiment, an average power pulsed laser optical spectrum analyzer for determining the average power of the pulsed laser. In another embodiment, the system includes a pulsed laser instantaneous optical frequency measurement for determining the instantaneous optical frequency of the pulsed laser.

Research on the laser angle deception jamming technology of laser countermeasure

NASA Astrophysics Data System (ADS)

Ma, Shi-wei; Chen, Wen-jian; Gao, Wei; Duan, Yuan-yuan

2015-10-01

In recent years , laser guided weapons behave very well at destroying the military goals in the local wars, the single-shot probability, effective range and hitting precision getting better. And the semi-active laser guided weapons are the most widely used laser guided weapons. In order to improve the viability and protect important military goals, it's necessary to study the technology to against the semi-active guided weapons. This paper studies the working principle, the advantages and disadvantages of the semi-active guided weapons at first, and analyze the possibility of laser angle deception jamming system working. Then it analyzes the working principle and process of laser angle deception jamming technology. Finally it designs a half-real simulation system of laser angle deception jamming, which consists of semi-active laser guided weapons simulation system and laser angle deception jamming system. The simulation system demonstrates the working process of the laser angle deception jamming system. This paper provides fundamental base for the research on the countermeasure technology of semi-active laser guided weapons.

Laser beam riding guided system principle and design research

NASA Astrophysics Data System (ADS)

Qu, Zhou; Jin, Yi; Xu, Zhou; Xing, Hao

2016-01-01

With the development of science and technology, precision-strike weapons has been considered to be important for winning victory in military field. Laser guidance is a major method to execute precision-strike in modern warfare. At present, the problems of primary stage of Laser guidance has been solved with endeavors of countries. Several technical aspects of laser-beam riding guided system have been mature, such as atmosphere penetration of laser beam, clutter inhibition on ground, laser irradiator, encoding and decoding of laser beam. Further, laser beam quality, equal output power and atmospheric transmission properties are qualified for warfare situation. Riding guidance instrument is a crucial element of Laser-beam riding guided system, and is also a vital element of airborne, vehicle-mounted and individual weapon. The optical system mainly consist of sighting module and laser-beam guided module. Photoelectric detector is the most important sensing device of seeker, and also the key to acquire the coordinate information of target space. Currently, in consideration of the 1.06 u m of wavelength applied in all the semi-active laser guided weapons systems, lithium drifting silicon photodiode which is sensitive to 1.06 u m of wavelength is used in photoelectric detector. Compared to Solid and gas laser, diode laser has many merits such as small volume, simple construction, light weight, long life, low lost and easy modulation. This article introduced the composition and operating principle of Laser-beam riding guided system based on 980 nm diode laser, and made a analysis of key technology; for instance, laser irradiator, modulating disk of component, laser zooming system. Through the use of laser diode, Laser-beam riding guided system is likely to have smaller shape and very light.

Target isolation system, high power laser and laser peening method and system using same

DOEpatents

Dane, C. Brent; Hackel, Lloyd A.; Harris, Fritz

2007-11-06

A system for applying a laser beam to work pieces, includes a laser system producing a high power output beam. Target delivery optics are arranged to deliver the output beam to a target work piece. A relay telescope having a telescope focal point is placed in the beam path between the laser system and the target delivery optics. The relay telescope relays an image between an image location near the output of the laser system and an image location near the target delivery optics. A baffle is placed at the telescope focal point between the target delivery optics and the laser system to block reflections from the target in the target delivery optics from returning to the laser system and causing damage.

Laser-Ultrasonic Testing and its Applications to Nuclear Reactor Internals

NASA Astrophysics Data System (ADS)

Ochiai, M.; Miura, T.; Yamamoto, S.

2008-02-01

A new nondestructive testing technique for surface-breaking microcracks in nuclear reactor components based on laser-ultrasonics is developed. Surface acoustic wave generated by Q-switched Nd:YAG laser and detected by frequency-stabilized long pulse laser coupled with confocal Fabry-Perot interferometer is used to detect and size the cracks. A frequency-domain signal processing is developed to realize accurate sizing capability. The laser-ultrasonic testing allows the detection of surface-breaking microcrack having a depth of less than 0.1 mm, and the measurement of their depth with an accuracy of 0.2 mm when the depth exceeds 0.5 mm including stress corrosion cracking. The laser-ultrasonic testing system combined with laser peening system, which is another laser-based maintenance technology to improve surface stress, for inner surface of small diameter tube is developed. The generation laser in the laser-ultrasonic testing system can be identical to the laser source of the laser peening. As an example operation of the system, the system firstly works as the laser-ultrasonic testing mode and tests the inner surface of the tube. If no cracks are detected, the system then changes its work mode to the laser peening and improves surface stress to prevent crack initiation. The first nuclear industrial application of the laser-ultrasonic testing system combined with the laser peening was completed in Japanese nuclear power plant in December 2004.

Motion-compensated hand-held common-path Fourier-domain optical coherence tomography probe for image-guided intervention

NASA Astrophysics Data System (ADS)

Huang, Yong; Song, Cheol; Liu, Xuan; Kang, Jin U.

2013-03-01

A motion-compensated hand-held common-path Fourier-domain optical coherence tomography imaging probe has been developed for image guided intervention during microsurgery. A hand-held prototype instrument was designed and fabricated by integrating an imaging fiber probe inside a stainless steel needle which is attached to the ceramic shaft of a piezoelectric motor housed in an aluminum handle. The fiber probe obtains A-scan images. The distance information was extracted from the A-scans to track the sample surface distance and a fixed distance was maintained by a feedback motor control which effectively compensated hand tremor and target movements in the axial direction. Graphical user interface, real-time data processing, and visualization based on a CPU-GPU hybrid programming architecture were developed and used in the implantation of this system. To validate the system, free-hand optical coherence tomography images using various samples were obtained. The system can be easily integrated into microsurgical tools and robotics for a wide range of clinical applications. Such tools could offer physicians the freedom to easily image sites of interest with reduced risk and higher image quality.

Solid-state coherent laser radar wind shear measuring systems

NASA Technical Reports Server (NTRS)

Huffaker, R. Milton

1992-01-01

Coherent Technologies, Inc. (CTI) was established in 1984 to engage in the development of coherent laser radar systems and subsystems with applications in atmospheric remote sensing, and in target tracking, ranging and imaging. CTI focuses its capabilities in three major areas: (1) theoretical performance and design of coherent laser radar system; (2) development of coherent laser radar systems for government agencies such as DoD and NASA; and (3) development of coherent laser radar systems for commercial markets. The topics addressed are: (1) 1.06 micron solid-state coherent laser radar system; (2) wind measurement using 1.06 micron system; and flashlamp-pumped 2.09 micron solid-state coherent laser radar system.

21 CFR 884.6200 - Assisted reproduction laser system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction laser system. 884.6200... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

21 CFR 884.6200 - Assisted reproduction laser system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction laser system. 884.6200... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

21 CFR 884.6200 - Assisted reproduction laser system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction laser system. 884.6200... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

21 CFR 884.6200 - Assisted reproduction laser system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction laser system. 884.6200... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

21 CFR 884.6200 - Assisted reproduction laser system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction laser system. 884.6200... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

Laser system using ultra-short laser pulses

DOEpatents

Dantus, Marcos [Okemos, MI; Lozovoy, Vadim V [Okemos, MI; Comstock, Matthew [Milford, MI

2009-10-27

A laser system using ultrashort laser pulses is provided. In another aspect of the present invention, the system includes a laser, pulse shaper and detection device. A further aspect of the present invention employs a femtosecond laser and binary pulse shaping (BPS). Still another aspect of the present invention uses a laser beam pulse, a pulse shaper and a SHG crystal.

Airborne laser sensors and integrated systems

NASA Astrophysics Data System (ADS)

Sabatini, Roberto; Richardson, Mark A.; Gardi, Alessandro; Ramasamy, Subramanian

2015-11-01

The underlying principles and technologies enabling the design and operation of airborne laser sensors are introduced and a detailed review of state-of-the-art avionic systems for civil and military applications is presented. Airborne lasers including Light Detection and Ranging (LIDAR), Laser Range Finders (LRF), and Laser Weapon Systems (LWS) are extensively used today and new promising technologies are being explored. Most laser systems are active devices that operate in a manner very similar to microwave radars but at much higher frequencies (e.g., LIDAR and LRF). Other devices (e.g., laser target designators and beam-riders) are used to precisely direct Laser Guided Weapons (LGW) against ground targets. The integration of both functions is often encountered in modern military avionics navigation-attack systems. The beneficial effects of airborne lasers including the use of smaller components and remarkable angular resolution have resulted in a host of manned and unmanned aircraft applications. On the other hand, laser sensors performance are much more sensitive to the vagaries of the atmosphere and are thus generally restricted to shorter ranges than microwave systems. Hence it is of paramount importance to analyse the performance of laser sensors and systems in various weather and environmental conditions. Additionally, it is important to define airborne laser safety criteria, since several systems currently in service operate in the near infrared with considerable risk for the naked human eye. Therefore, appropriate methods for predicting and evaluating the performance of infrared laser sensors/systems are presented, taking into account laser safety issues. For aircraft experimental activities with laser systems, it is essential to define test requirements taking into account the specific conditions for operational employment of the systems in the intended scenarios and to verify the performance in realistic environments at the test ranges. To support the development of such requirements, useful guidelines are provided for test and evaluation of airborne laser systems including laboratory, ground and flight test activities.

The simulation study on optical target laser active detection performance

NASA Astrophysics Data System (ADS)

Li, Ying-chun; Hou, Zhao-fei; Fan, Youchen

2014-12-01

According to the working principle of laser active detection system, the paper establishes the optical target laser active detection simulation system, carry out the simulation study on the detection process and detection performance of the system. For instance, the performance model such as the laser emitting, the laser propagation in the atmosphere, the reflection of optical target, the receiver detection system, the signal processing and recognition. We focus on the analysis and modeling the relationship between the laser emitting angle and defocus amount and "cat eye" effect echo laser in the reflection of optical target. Further, in the paper some performance index such as operating range, SNR and the probability of the system have been simulated. The parameters including laser emitting parameters, the reflection of the optical target and the laser propagation in the atmosphere which make a great influence on the performance of the optical target laser active detection system. Finally, using the object-oriented software design methods, the laser active detection system with the opening type, complete function and operating platform, realizes the process simulation that the detection system detect and recognize the optical target, complete the performance simulation of each subsystem, and generate the data report and the graph. It can make the laser active detection system performance models more intuitive because of the visible simulation process. The simulation data obtained from the system provide a reference to adjust the structure of the system parameters. And it provides theoretical and technical support for the top level design of the optical target laser active detection system and performance index optimization.

Injection mode-locking Ti-sapphire laser system

DOEpatents

Hovater, James Curtis; Poelker, Bernard Matthew

2002-01-01

According to the present invention there is provided an injection modelocking Ti-sapphire laser system that produces a unidirectional laser oscillation through the application of a ring cavity laser that incorporates no intracavity devices to achieve unidirectional oscillation. An argon-ion or doubled Nd:YVO.sub.4 laser preferably serves as the pump laser and a gain-switched diode laser serves as the seed laser. A method for operating such a laser system to produce a unidirectional oscillating is also described.

Potential use of lasers for penetrating keratoplasty.

PubMed

Thompson, K P; Barraquer, E; Parel, J M; Loertscher, H; Pflugfelder, S; Roussel, T; Holland, S; Hanna, K

1989-07-01

Experimental corneal trephination has been achieved with the 193 nm argon fluoride excimer and 2.9 microns hydrogen fluoride and Er:YAG laser systems. Compared with metal blades and other lasers, the 193 nm excimer laser creates the best quality corneal excision, but has a relatively slow etch rate through the stroma, and its use requires toxic gas. The mid-infrared laser systems trephine the cornea in less than 10 seconds, but cause a 10 microns to 15 microns zone of adjacent stromal damage and create wounds that are approximately 2.5 times larger than wounds made by metal scalpels. The wavelength and laser pulse duration influence the cutting characteristics of the laser. Optical delivery systems using an axicon lens, a rotating slit, and a computer controlled scanning optical system have been developed for penetrating keratoplasty. Selection of the optimal laser system for penetrating keratoplasty must await further experimental studies. Refinements of the laser cavity and delivery system are necessary before clinical studies can begin. A carefully controlled randomized clinical trial comparing laser trephination with conventional mechanical trephines will be necessary to determine the safety and efficacy of a laser trephination system.

Long distance high power optical laser fiber break detection and continuity monitoring systems and methods

DOEpatents

Rinzler, Charles C.; Gray, William C.; Faircloth, Brian O.; Zediker, Mark S.

2016-02-23

A monitoring and detection system for use on high power laser systems, long distance high power laser systems and tools for performing high power laser operations. In particular, the monitoring and detection systems provide break detection and continuity protection for performing high power laser operations on, and in, remote and difficult to access locations.

Heterodyne laser spectroscopy system

DOEpatents

Wyeth, Richard W.; Paisner, Jeffrey A.; Story, Thomas

1990-01-01

A heterodyne laser spectroscopy system utilizes laser heterodyne techniques for purposes of laser isotope separation spectroscopy, vapor diagnostics, processing of precise laser frequency offsets from a reference frequency, and provides spectral analysis of a laser beam.

Clinical applications of commercially available video recording and monitoring systems: inexpensive, high-quality video recording and monitoring systems for endoscopy and microsurgery.

PubMed

Tsunoda, Koichi; Tsunoda, Atsunobu; Ishimoto, ShinnIchi; Kimura, Satoko

2006-01-01

The exclusive charge-coupled device (CCD) camera system for the endoscope and electronic fiberscopes are in widespread use. However, both are usually stationary in an office or examination room, and a wheeled cart is needed for mobility. The total costs of the CCD camera system and electronic fiberscopy system are at least US Dollars 10,000 and US Dollars 30,000, respectively. Recently, the performance of audio and visual instruments has improved dramatically, with a concomitant reduction in their cost. Commercially available CCD video cameras with small monitors have become common. They provide excellent image quality and are much smaller and less expensive than previous models. The authors have developed adaptors for the popular mini-digital video (mini-DV) camera. The camera also provides video and acoustic output signals; therefore, the endoscopic images can be viewed on a large monitor simultaneously. The new system (a mini-DV video camera and an adaptor) costs only US Dollars 1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casualty setting, or on house calls for the purpose of patient education. In the future, the authors plan to introduce the clinical application of a high-vision camera and an infrared camera as medical instruments for clinical and research situations.

Comparison of different laser systems in the treatment of hypertrophic and atrophic scars and keloids

NASA Astrophysics Data System (ADS)

Scharschmidt, D.; Algermissen, Bernd; Willms-Jones, J.-C.; Philipp, Carsten M.; Berlien, Hans-Peter

1997-12-01

Different laser systems and techniques are used for the treatment of hypertrophic scars, keloids and acne scars. Significant criteria in selecting a suitable laser system are the scar's vascularization, age and diameter. Flashlamp- pumped dye-lasers, CO2-lasers with scanner, Argon and Nd:YAG-lasers are used. Telangiectatic scars respond well to argon lasers, erythematous scars and keloids to dye-laser treatment. Using interstitial Nd:YAG-laser vaporization, scars with a cross-section over 1 cm can generally be reduced. For the treatment of atrophic and acne scars good cosmetic results are achieved with a CO2-laser/scanner system, which allows a precise ablation of the upper dermis with low risk of side-effects.

Heterodyne laser spectroscopy system

DOEpatents

Wyeth, Richard W.; Paisner, Jeffrey A.; Story, Thomas

1989-01-01

A heterodyne laser spectroscopy system utilizes laser heterodyne techniques for purposes of laser isotope separation spectroscopy, vapor diagnostics, processing of precise laser frequency offsets from a reference frequency and the like, and provides spectral analysis of a laser beam.

The Geoscience Laser Altimeter System Laser Transmitter

NASA Technical Reports Server (NTRS)

Afzal, R. S.; Dallas, J. L.; Yu, A. W.; Mamakos, W. A.; Lukemire, A.; Schroeder, B.; Malak, A.

2000-01-01

The Geoscience Laser Altimeter System (GLAS), scheduled to launch in 2001, is a laser altimeter and lidar for tile Earth Observing System's (EOS) ICESat mission. The laser transmitter requirements, design and qualification test results for this space- based remote sensing instrument are presented.

Study of the Histopathologic Characteristics and Surface Morphologies of Glottic Carcinomas With Anterior Vocal Commissure Involvement.

PubMed

Wu, Jianhui; Zhao, Jing; Wang, Zhangfeng; Li, Zenghong; Luo, Jie; Liao, Bing; Yang, Zhiyun; Liu, Qihong; Wang, Bin; Wen, Weiping; Lei, Wenbin

2015-07-01

This article explores the features and the role of the anterior vocal commissure (AVC) structure and the surface morphologies of glottic carcinomas with AVC involvement to provide a reference for the selection of transoral carbon dioxide (CO2) laser surgery. A total of 31 cases of glottic carcinomas with AVC involvement from May 2012 to January 2014 were included. All patients underwent electronic laryngoscopic examinations and computed tomography scans to determine the surface morphology. After surgery, the tumor specimens were resected integrally, and axial serial sections parallel to the plane of vocal cords were taken to explore the features and possible invasion paths of the glottic carcinomas with AVC involvement. The rates of involvement of the supraglottis and subglottis were 71.4% and 14.8%, respectively, via the AVC. The involvement of the superficial layer of the unilateral or bilateral vocal cords without involvement of the vocal muscle in the AVC region (IVM) or the cartilage was present in 15 cases (48.4%). The involvement of the superficial layer of the unilateral and bilateral vocal cords occurred in 16 cases (51.6%) with the IVM in 13 cases and the involvement of the intermediate lamina of the thyroid cartilage (ITC) in 8 cases. The involvement of the ITC was associated with the involvement of the vocal muscle of the AVC region (P < 0.05). Among the pushing carcinomas, 15 of 21 (71.4%) presented with well-defined tumor mass, and 8 of 10 (80.0%) infiltrating carcinomas presented with multiple tumor nests that were often surrounded by fibrosis (P < 0.05). The AVC is an important path of invasion of subglottic in glottic carcinomas but less so for suparglottic. The Broyles' ligaments acted as a barrier against the spread of the tumors to the thyroid cartilage, but this role was obviously weaken by the involvement of the vocal muscle of the AVC region. The infiltrating carcinomas presented with multiple tumor nests in fibrous tissue. When CO2 laser microsurgery is considered as a treatment option, these facts should be kept in mind.

A study of directional instability during mitotic chromosome movement

NASA Astrophysics Data System (ADS)

Joglekar, Ajit P.

Mitotic chromosome movements are responsible for the correct segregation of duplicated chromosomes into the daughter cells. Errors in this process are known to play a role in some of the serious diseases such as cancer, and the little understood process of aging. A thorough comprehension of the physical basis of this process is therefore necessary. An intriguing aspect of chromosome movements during mitosis is "directional instability": runs with approximately constant speed punctuated by abrupt reversal in direction of motion. I have constructed a mechanistic model that views chromosome movement as a result of interplay between poleward and antipoleward or polar ejection forces (PEF) on a chromosome; and microtubule (MT) depolymerization-coupled movement of the chromosome. Computer simulations based on this model using a single set of parameters accurately and quantitatively predict: the force, character, speed, and duration of chromosome movements, oscillations of chromosomes associated with only one spindle pole, the larger force during anaphase, the effect of MT-depolymerizing drugs on chromosome movements, and the decreased turnover of kinetochore-MTs during anaphase. The model also predicts how chromosome behavior should respond to perturbations of the PEF. These predictions could be unequivocally tested if it were possible to destroy structures smaller than the light resolution limit with minimal collateral damage. To address these requirements, I developed a methodology for ultrahigh resolution microsurgery with tightly-focused, ultrafast lasers pulses. This entailed an in-depth study of optical breakdown in dielectrics. Characterization of the single pulse damage in test dielectric materials ranging from silicon and glass to cell walls and membranes has shown that in the target regions where the laser intensity exceeds critical intensity, optical breakdown proceeds by tunneling ionization followed by a runaway avalanche ionization that ends with the ionization of all the valence electrons. Highly reproducible features on the nanometer size-scale indicate that the valence electron density is the central factor determining the critical intensity, implying that high precision can be maintained in a wide range of solids. Along with the new understanding optical breakdown, this technique will find potential applications in diverse fields ranging from MEMS fabrication to nano-fluidics, as well as cellular nanosurgery.

Study of the Histopathologic Characteristics and Surface Morphologies of Glottic Carcinomas With Anterior Vocal Commissure Involvement

PubMed Central

Wu, Jianhui; Zhao, Jing; Wang, Zhangfeng; Li, Zenghong; Luo, Jie; Liao, Bing; Yang, Zhiyun; Liu, Qihong; Wang, Bin; Wen, Weiping; Lei, Wenbin

2015-01-01

Abstract This article explores the features and the role of the anterior vocal commissure (AVC) structure and the surface morphologies of glottic carcinomas with AVC involvement to provide a reference for the selection of transoral carbon dioxide (CO2) laser surgery. A total of 31 cases of glottic carcinomas with AVC involvement from May 2012 to January 2014 were included. All patients underwent electronic laryngoscopic examinations and computed tomography scans to determine the surface morphology. After surgery, the tumor specimens were resected integrally, and axial serial sections parallel to the plane of vocal cords were taken to explore the features and possible invasion paths of the glottic carcinomas with AVC involvement. The rates of involvement of the supraglottis and subglottis were 71.4% and 14.8%, respectively, via the AVC. The involvement of the superficial layer of the unilateral or bilateral vocal cords without involvement of the vocal muscle in the AVC region (IVM) or the cartilage was present in 15 cases (48.4%). The involvement of the superficial layer of the unilateral and bilateral vocal cords occurred in 16 cases (51.6%) with the IVM in 13 cases and the involvement of the intermediate lamina of the thyroid cartilage (ITC) in 8 cases. The involvement of the ITC was associated with the involvement of the vocal muscle of the AVC region (P < 0.05). Among the pushing carcinomas, 15 of 21 (71.4%) presented with well-defined tumor mass, and 8 of 10 (80.0%) infiltrating carcinomas presented with multiple tumor nests that were often surrounded by fibrosis (P < 0.05). The AVC is an important path of invasion of subglottic in glottic carcinomas but less so for suparglottic. The Broyles’ ligaments acted as a barrier against the spread of the tumors to the thyroid cartilage, but this role was obviously weaken by the involvement of the vocal muscle of the AVC region. The infiltrating carcinomas presented with multiple tumor nests in fibrous tissue. When CO2 laser microsurgery is considered as a treatment option, these facts should be kept in mind. PMID:26200618

Improved microsurgical creation of venous pouch arterial bifurcation aneurysms in rabbits.

PubMed

Sherif, C; Marbacher, S; Erhardt, S; Fandino, J

2011-01-01

The choice of the experimental aneurysm model is essential for valid embolization-device evaluations. So far, the use of the rabbit venous pouch arterial bifurcation aneurysm model has been limited by demanding microsurgery, low aneurysm patency rates, and high mortality. This study aimed to facilitate microsurgery and to reduce mortality by optimized peri-/postoperative management. Aneurysms were created in 16 New Zealand white rabbits under general intravenous anesthesia. Using modified microsurgical techniques, we sutured a jugular vein pouch into a bifurcation created between both CCAs. Aggressive anticoagulation (intraoperative intravenous: 1000-IU heparin, 10-mg acetylsalicylic acid/kg; postoperative subcutaneous: 14 days, 250-IU/kg /day heparin) and prolonged postoperative anesthesia (fentanyl patches: 12.5 μg/h for 72 hours) were applied. Angiographic characteristics of created experimental aneurysms were assessed. The reduced number of interrupted sutures and aggressive anticoagulation caused no intra-/postoperative bleeding, resulting in 0% mortality. Four weeks postoperation, angiography showed patency in 14 of 16 aneurysms (87.5%) and Ohshima type B bifurcation geometry. Mean values of parent-artery diameters (2.3 mm), aneurysm lengths (7.9 mm), and neck widths (4.1 mm) resulted in a mean 1.9 aspect ratio. Compared with historical controls, the use of modified microsurgical techniques, aggressive anticoagulation, and anesthesia resulted in higher aneurysm patency rates and lower mortality rates in the venous pouch arterial bifurcation aneurysm model. Gross morphologic features of these aneurysms were similar to those of most human intracranial aneurysms.

The history of varicocele: from antiquity to the modern ERA.

PubMed

Marte, Antonio

2018-01-01

Men have most likely been affected by varicocele since the assumption of the upright position. In De Medicina, written during the first century AD, Celsus credits the Greeks with the first description of a varicocele, and he recorded his own acute observation: "The veins are swollen and twisted over the testicle, which becomes smaller". Celsus himself is credited with the distinction between varicocele (dilation of surface veins) and "cirsocele" (dilation of deep veins). There has been a long history of treatment attempts and failures, some of which are remarkably strange, that have sometimes culminated in tragedy, as in the case of French professor Jacques-Mathieu Delpech (1772- 1832). Although some questions regarding the etiopathology and treatment of varicocele remain unanswered, a succession of more or less conservative attempts involving all medical cultures has been performed throughout history. The report by W.S. Tulloch in 1952 brought varicocele into the era of modern evidence-based medicine, and varicocele surgery finally progressed beyond the aim of merely relieving scrotal pain and swelling. From 1970 to 2000, varicocelectomies gained worldwide attention for the treatment of male infertility. Several innovative procedures to correct varicoceles began to appear in the world's literature as interventional radiology, microsurgery, laparoscopy, and robotics, while comprehensive review articles were also published on the subject of varicocelectomies. Microsurgery is nowadays used worldwide and it can be considered to be the gold standard for correcting infertility linked to varicocele. Copyright® by the International Brazilian Journal of Urology.

Sodium Fluorescein-Guided Resection under the YELLOW 560 nm Surgical Microscope Filter in Malignant Gliomas: Our First 38 Cases Experience.

PubMed

Zhang, Ningning; Tian, Hailong; Huang, Dezhang; Meng, Xianbing; Guo, Wenqiang; Wang, Chaochao; Yin, Xin; Zhang, Hongying; Jiang, Bin; He, Zheng; Wang, Zhigang

2017-01-01

Sodium fluorescein (FL) had been safely used in fluorescence-guided microsurgery for imaging various brain tumors. Under the YELLOW 560 nm surgical microscope filter, low-dose FL as a fluorescent dye helps in visualization. Our study investigated the safety and efficacy of this innovative technique in malignant glioma (MG) patients. 38 patients suffering from MGs confirmed by pathology underwent FL-guided resection under YELLOW 560 nm surgical microscope filter. We retrospectively analyzed the clinical characters, microsurgery procedure, extent of resection, pathology of MGs, progression-free survival (PFS), and overall survival (OS). Thirty-eight patients had MGs (10 WHO grade III, 28 WHO grade IV). With YELLOW 560 nm surgical microscope filter combined with neuronavigation, sodium fluorescein-guided gross total resection (GTR) was achieved in 35 (92.1%) patients and subtotal resection in 3 (7.69%). The sensitivity and specificity of FL were 94.4% and 88.6% regardless of radiographic localization. Intraoperatively, 10 biopsies (10/28 FL[+]) showed "low" or "high" fluorescence in non-contrast-enhancement region and are also confirmed by pathology. Our data showed 6-month PFS of 92.3% and median survival of 11 months. FL-guided resection of MGs under the YELLOW 560 nm surgical microscope filter combined with neuronavigation was safe and effective, especially in non-contrast-MRI regions. It is feasible for improving the extent of resection in MGs especially during emergency cases.

Animal models in plastic and reconstructive surgery simulation-a review.

PubMed

Loh, Charles Yuen Yung; Wang, Aline Yen Ling; Tiong, Vincent Tze Yang; Athanassopoulos, Thanassi; Loh, Meiling; Lim, Philip; Kao, Huang-Kai

2018-01-01

The use of live and cadaveric animal models in surgical training is well established as a means of teaching and improving surgical skill in a controlled setting. We aim to review, evaluate, and summarize the models published in the literature that are applicable to Plastic Surgery training. A PubMed search for keywords relating to animal models in Plastic Surgery and the associated procedures was conducted. Animal models that had cross over between specialties such as microsurgery with Neurosurgery and pinnaplasty with ear, nose, and throat surgery were included as they were deemed to be relevant to our training curriculum. A level of evidence and recommendation assessment was then given to each surgical model. Our review found animal models applicable to plastic surgery training in four major categories namely-microsurgery training, flap raising, facial surgery, and hand surgery. Twenty-four separate articles described various methods of practicing microsurgical techniques on different types of animals. Fourteen different articles each described various methods of conducting flap-based procedures which consisted of either local or perforator flap dissection. Eight articles described different models for practicing hand surgery techniques. Finally, eight articles described animal models that were used for head and neck procedures. A comprehensive summary of animal models related to plastic surgery training has been compiled. Cadaveric animal models provide a readily available introduction to many procedures and ought to be used instead of live models when feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

Computed Tomography Angiography in Microsurgery: Indications, Clinical Utility, and Pitfalls

PubMed Central

Lee, Gordon K.; Fox, Paige M.; Riboh, Jonathan; Hsu, Charles; Saber, Sepideh; Rubin, Geoffrey D.; Chang, James

2013-01-01

Objective: Computed tomographic angiography (CTA) can be used to obtain 3-dimensional vascular images and soft-tissue definition. The goal of this study was to evaluate the reliability, usefulness, and pitfalls of CTA in preoperative planning of microvascular reconstructive surgery. Methods: A retrospective review of patients who obtained preoperative CTA in preparation for planned microvascular reconstruction was performed over a 5-year period (2001–2005). The influence of CTA on the original operative plan was assessed for each patient, and CTA results were correlated to the operative findings. Results: Computed tomographic angiography was performed on 94 patients in preparation for microvascular reconstruction. In 48 patients (51%), vascular abnormalities were noted on CTA. Intraoperative findings correlated with CTA results in 97% of cases. In 42 patients (45%), abnormal CTA findings influenced the original operative plan, such as the choice of vessels, side of harvest, or nature of the reconstruction (local flap instead of free tissue transfer). Technical difficulties in performing CTA were encountered in 5 patients (5%) in whom interference from external fixation devices was the main cause. Conclusions: This large study of CTA obtained for preoperative planning of reconstructive microsurgery at both donor and recipient sites study demonstrates that CTA is safe and highly accurate. Computed tomographic angiography can alter the surgeon's reconstructive plan when abnormalities are noted preoperatively and consequently improve results by decreasing vascular complication rates. The use of CTA should be considered for cases of microsurgical reconstruction where the vascular anatomy may be questionable. PMID:24023972

Efficacy of sellar opening in the pituitary adenoma resection of transsphenoidal surgery influences the degree of tumor resection.

PubMed

Wang, Shousen; Qin, Yong; Xiao, Deyong; Wei, Liangfeng

2017-07-24

Endonasal transsphenoidal microsurgery is often adopted in the resection of pituitary adenoma, and has showed satisfactory treatment and minor injuries. It is important to accurately localize sellar floor and properly incise the bone and dura matter. Fifty-one patients with pituitary adenoma undergoing endonasal transsphenoidal microsurgery were included in the present study. To identify the scope of sellar floor opening, CT scan of the paranasal sinus and MRI scan of the pituitary gland were performed for each subject. Intraoperatively, internal carotid artery injury, leakage of cerebrospinal fluid, and tumor texture were recorded, and postoperative complications and residual tumors were identified. The relative size of sellar floor opening significantly differed among the pituitary micro-, macro- and giant adenoma groups, and between the total and partial tumor resection groups. The ratio of sellar floor opening area to maximal tumor area was significantly different between the total and partial resection groups. Logistic regression analysis revealed that the ratio of sellar floor opening area to the largest tumor area, tumor texture, tumor invasion and age were independent prognostic factors. The vertical distance between the top point of sellar floor opening and planum sphenoidale significantly differed between the patients with and without leakage of cerebrospinal fluid. These results together indicated that relatively insufficient sellar floor opening is a cause of leading to residual tumor, and the higher position of the opening and closer to the planum sphenoidale are likely to induce the occurrence of leakage of cerebrospinal fluid.

The Geoscience Laser Altimeter System (GLAS) Laser Transmitter

NASA Technical Reports Server (NTRS)

Afzal, Robert S.; Yu, Anthony W.; Dallas, Joseph L.; Melak, Anthony; Lukemir, Alan; Ramos-Izqueirdo, L.; Mamakos, William

2007-01-01

The Geoscience Laser Altimeter System (GLAS), launched in January 2003, is a laser altimeter and lidar for the Earth Observing System's (EOS) ICESat mission. GLAS accommodates three, sequentially operated, diode-pumped, solid-state, Nd:YAG laser transmitters. The laser transmitter requirements, design and qualification test results for this space-based remote sensing instrument is summarized and presented

Laser ablation system, and method of decontaminating surfaces

DOEpatents

Ferguson, Russell L.; Edelson, Martin C.; Pang, Ho-ming

1998-07-14

A laser ablation system comprising a laser head providing a laser output; a flexible fiber optic cable optically coupled to the laser output and transmitting laser light; an output optics assembly including a nozzle through which laser light passes; an exhaust tube in communication with the nozzle; and a blower generating a vacuum on the exhaust tube. A method of decontaminating a surface comprising the following steps: providing an acousto-optic, Q-switched Nd:YAG laser light ablation system having a fiber optically coupled output optics assembly; and operating the laser light ablation system to produce an irradiance greater than 1.times.10.sup.7 W/cm.sup.2, and a pulse width between 80 and 170 ns.

Comparison of three different laser systems for application in dentistry

NASA Astrophysics Data System (ADS)

Mindermann, Anja; Niemz, M. H.; Eisenmann, L.; Loesel, Frieder H.; Bille, Josef F.

1993-12-01

Three different laser systems have been investigated according to their possible application in dentistry: a free running and a Q-switched microsecond Ho:YAG laser, a free running microsecond Er:YAG laser and picosecond Nd:YLF laser system consisting of an actively mode locked oscillator and a regenerative amplifier. The experiments focused on the question if lasers can support or maybe replace ordinary drilling machines. For this purpose several cavities were generated with the lasers mentioned above. Their depth and quality were judged by light and electron microscopy. The results of the experiments showed that the picosecond Nd:YLF laser system has advantages compared to other lasers regarding their application in dentistry.

Laser Safety and Hazardous Analysis for the ARES (Big Sky) Laser System

DOE Office of Scientific and Technical Information (OSTI.GOV)

AUGUSTONI, ARNOLD L.

A laser safety and hazard analysis was performed for the ARES laser system based on the 2000 version of the American National Standards Institute's (ANSI) Standard Z136.1,for Safe Use of Lasers and the 2000 version of the ANSI Standard Z136.6, for Safe Use of Lasers Outdoors. The ARES laser system is a Van/Truck based mobile platform, which is used to perform laser interaction experiments and tests at various national test sites.

Laser power conversion system analysis, volume 2

NASA Technical Reports Server (NTRS)

Jones, W. S.; Morgan, L. L.; Forsyth, J. B.; Skratt, J. P.

1979-01-01

The orbit-to-ground laser power conversion system analysis investigated the feasibility and cost effectiveness of converting solar energy into laser energy in space, and transmitting the laser energy to earth for conversion to electrical energy. The analysis included space laser systems with electrical outputs on the ground ranging from 100 to 10,000 MW. The space laser power system was shown to be feasible and a viable alternate to the microwave solar power satellite. The narrow laser beam provides many options and alternatives not attainable with a microwave beam.

Applications of lasers and electro-optics

NASA Astrophysics Data System (ADS)

Tan, B. C.; Low, K. S.; Chen, Y. H.; Ahmad, Harith; Tou, T. Y.

Supported by the IRPA Programme on Laser Technology and Applications, many types of lasers have been designed, constructed and applied in various areas of science, medicine and industries. Amongst these lasers constructed were high power carbon dioxide lasers, rare gas halide excimer lasers, solid state Neodymium-YAG lasers, nitrogen lasers, flashlamp pumped dye lasers and nitrogen and excimer laser pumped dye lasers. These lasers and the associated electro-optics system, some with computer controlled, are designed and developed for the following areas of applications: (1) industrial applications of high power carbon dioxide lasers for making of i.c. components and other materials processing purposes -- prototype operational systems have been developed; (2) Medical applications of lasers for cancer treatment using the technique of photodynamic therapy -- a new and more effective treatment protocol has been proposed; (3) agricultural applications of lasers in palm oil and palm fruit-fluorescence diagnostic studies -- fruit ripeness signature has been developed and palm oil oxidation level were investigated; (4) development of atmospheric pollution monitoring systems using laser lidar techniques -- laboratory scale systems were developed; and (5) other applications of lasers including laser holographic and interferometric methods for the non destructive testing of materials.

Technology Development of a Fiber Optic-Coupled Laser Ignition System for Multi-Combustor Rocket Engines

NASA Technical Reports Server (NTRS)

Trinh, Huu P.; Early, Jim; Osborne, Robin; Thomas, Matthew E.; Bossard, John A.

2002-01-01

This paper addresses the progress of technology development of a laser ignition system at NASA Marshall Space Flight Center (MSFC). The first two years of the project focus on comprehensive assessments and evaluations of a novel dual-pulse laser concept, flight- qualified laser system, and the technology required to integrate the laser ignition system to a rocket chamber. With collaborations of the Department of Energy/Los Alamos National Laboratory (LANL) and CFD Research Corporation (CFDRC), MSFC has conducted 26 hot fire ignition tests with lab-scale laser systems. These tests demonstrate the concept feasibility of dual-pulse laser ignition to initiate gaseous oxygen (GOX)/liquid kerosene (RP-1) combustion in a rocket chamber. Presently, a fiber optic- coupled miniaturized laser ignition prototype is being implemented at the rocket chamber test rig for future testing. Future work is guided by a technology road map that outlines the work required for maturing a laser ignition system. This road map defines activities for the next six years, with the goal of developing a flight-ready laser ignition system.

The pulsed dye laser versus the Q-switched Nd:YAG laser in laser-induced shock-wave lithotripsy.

PubMed

Thomas, S; Pensel, J; Engelhardt, R; Meyer, W; Hofstetter, A G

1988-01-01

To date, there are two fairly well-established alternatives for laser-induced shock-wave lithotripsy in clinical practice. The Q-switched Nd:YAG laser is distinguished by the high-stone selectivity of its coupler systems. The necessity of a coupler system and its fairly small conversion rate of light energy into mechanical energy present serious drawbacks. Furthermore, the minimal outer diameter of the transmission system is 1.8 mm. The pulsed-dye laser can be used with a highly flexible and uncomplicated 200-micron fiber. However, the laser system itself is more complicated than the Q-switched Nd:YAG laser and requires a great deal of maintenance. Biological evaluation of damage caused by direct irradiation shows that both laser systems produce minor damage of different degrees. YAG laser lithotripsy with the optomechanical coupler was assessed in 31 patients with ureteral calculi. The instability and limited effectiveness of the fiber application system necessitated auxiliary lithotripsy methods in 14 cases. Dye-laser lithotripsy is currently being tested in clinical application. Further development, such as systems for blind application or electronic feedback mechanisms to limit adverse tissue effects, have yet to be optimized. Nevertheless, laser-induced shock-wave lithotripsy has the potential to become a standard procedure in the endourologic management of stone disease.

Investigation of possibilities for solar-powered high-energy lasers in space

NASA Technical Reports Server (NTRS)

1982-01-01

Solar pumped lasers were investigated. The literature was reviewed for possible solar laser candidates from optical pumping experiments. A baseline CO electric discharge laser system was shown to be technically feasible. The most promising direct solar pumped laser was identified to be CF3I. Using the 'STAG' solar laser concept and CF3I, it was found that such a system could be weight competitive with the baseline CO laser system.

High throughput laser processing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harley, Gabriel; Pass, Thomas; Cousins, Peter John

A solar cell is formed using a solar cell ablation system. The ablation system includes a single laser source and several laser scanners. The laser scanners include a master laser scanner, with the rest of the laser scanners being slaved to the master laser scanner. A laser beam from the laser source is split into several laser beams, with the laser beams being scanned onto corresponding wafers using the laser scanners in accordance with one or more patterns. The laser beams may be scanned on the wafers using the same or different power levels of the laser source.

Development of a US Gravitational Wave Laser System for LISA

NASA Technical Reports Server (NTRS)

Camp, Jordan B.; Numata, Kenji

2015-01-01

A highly stable and robust laser system is a key component of the space-based LISA mission architecture.In this talk I will describe our plans to demonstrate a TRL 5 LISA laser system at Goddard Space Flight Center by 2016.The laser system includes a low-noise oscillator followed by a power amplifier. The oscillator is a low-mass, compact 10mW External Cavity Laser, consisting of a semiconductor laser coupled to an optical cavity, built by the laser vendorRedfern Integrated Optics. The amplifier is a diode-pumped Yb fiber with 2W output, built at Goddard. I will show noiseand reliability data for the full laser system, and describe our plans to reach TRL 5 by 2016.

Optical air data systems and methods

NASA Technical Reports Server (NTRS)

Caldwell, Loren M. (Inventor); Tang, Shoou-yu (Inventor); O'Brien, Martin (Inventor)

2010-01-01

Systems and methods for sensing air outside a moving aircraft are presented. In one embodiment, a system includes a laser for generating laser energy. The system also includes one or more transceivers for projecting the laser energy as laser radiation to the air. Subsequently, each transceiver receives laser energy as it is backscattered from the air. A computer processes signals from the transceivers to distinguish molecular scattered laser radiation from aerosol scattered laser radiation and determines one or more air parameters based on the scattered laser radiation. Such air parameters may include air speed, air pressure, air temperature and aircraft orientation angle, such as yaw, angle of attack and sideslip.

Optical air data systems and methods

NASA Technical Reports Server (NTRS)

Caldwell, Loren M. (Inventor); O'Brien, Martin J. (Inventor); Weimer, Carl S. (Inventor); Nelson, Loren D. (Inventor)

2008-01-01

Systems and methods for sensing air outside a moving aircraft are presented. In one embodiment, a system includes a laser for generating laser energy. The system also includes one or more transceivers for projecting the laser energy as laser radiation to the air. Subsequently, each transceiver receives laser energy as it is backscattered from the air. A computer processes signals from the transceivers to distinguish molecular scattered laser radiation from aerosol scattered laser radiation and determines one or more air parameters based on the scattered laser radiation. Such air parameters may include air speed, air pressure, air temperature and aircraft orientation angle, such as yaw, angle of attack and sideslip.

Optical air data systems and methods

NASA Technical Reports Server (NTRS)

Caldwell, Loren M. (Inventor); O'Brien, Martin J. (Inventor); Weimer, Carl S. (Inventor); Nelson, Loren D. (Inventor)

2005-01-01

Systems and methods for sensing air outside a moving aircraft are presented. In one embodiment, a system includes a laser for generating laser energy. The system also includes one or more transceivers for projecting the laser energy as laser radiation to the air. Subsequently, each transceiver receives laser energy as it is backscattered from the air. A computer processes signals from the transceivers to distinguish molecular scattered laser radiation from aerosol scattered laser radiation and determines one or more air parameters based on the scattered laser radiation. Such air parameters may include air speed, air pressure, air temperature and aircraft orientation angle, such as yaw, angle of attack and sideslip.

Tracking Control and System Development for Laser-Driven Micro-Vehicles

NASA Astrophysics Data System (ADS)

Kajiwara, Itsuro; Hoshino, Kentaro; Hara, Shinji; Shiokata, Daisuke; Yabe, Takashi

The purpose of this paper is to design a control system for an integrated laser propulsion/tracking system to achieve continuous motion and control of laser-driven micro-vehicles. Laser propulsion is significant in achieving miniature and light micro-vehicles. A laser-driven micro-airplane has been studied using a paper airplane and YAG laser, resulting in successful gliding of the airplane. High-performance laser tracking control is required to achieve continuous flight. This paper presents a control design strategy based on the generalized Kalman-Yakubovic-Popov lemma to achieve this requirement. Experiments have been carried out to evaluate the performance of the integrated laser propulsion/tracking system.

Laser-SPS systems analysis and environmental impact assessment

NASA Technical Reports Server (NTRS)

Beverly, R. E., III

1980-01-01

The systems feasibility and environmental impact of replacing the microwave transmitters on the Satellite Power System with laser transmitters are examined. The lasers suggested are two molecular-gas electric-discharge lasers (EDL's), namely the CO and CO2 lasers. Calculations are made on system efficiency, atmospheric transmission efficiency, and laser beam spreading. It is found that the present satellite concept using lasers is far too inefficient and massive to be economically viable. However, the safety issues associated with laser power transmission appear tractable, and no effects could be identified which present a real danger of serious injury to the environment, although certain phenomena deserve closer scrutiny.

Laser spark distribution and ignition system

DOEpatents

Woodruff, Steven [Morgantown, WV; McIntyre, Dustin L [Morgantown, WV

2008-09-02

A laser spark distribution and ignition system that reduces the high power optical requirements for use in a laser ignition and distribution system allowing for the use of optical fibers for delivering the low peak energy pumping pulses to a laser amplifier or laser oscillator. An optical distributor distributes and delivers optical pumping energy from an optical pumping source to multiple combustion chambers incorporating laser oscillators or laser amplifiers for inducing a laser spark within a combustion chamber. The optical distributor preferably includes a single rotating mirror or lens which deflects the optical pumping energy from the axis of rotation and into a plurality of distinct optical fibers each connected to a respective laser media or amplifier coupled to an associated combustion chamber. The laser spark generators preferably produce a high peak power laser spark, from a single low power pulse. The laser spark distribution and ignition system has application in natural gas fueled reciprocating engines, turbine combustors, explosives and laser induced breakdown spectroscopy diagnostic sensors.

Video-microscopy for use in microsurgical aspects of complex hepatobiliary and pancreatic surgery: a preliminary report

PubMed Central

Nissen, Nicholas N; Menon, Vijay; Williams, James; Berci, George

2011-01-01

Background The use of loupe magnification during complex hepatobiliary and pancreatic (HBP) surgery has become routine. Unfortunately, loupe magnification has several disadvantages including limited magnification, a fixed field and non-variable magnification parameters. The aim of this report is to describe a simple system of video-microscopy for use in open surgery as an alternative to loupe magnification. Methods In video-microscopy, the operative field is displayed on a TV monitor using a high-definition (HD) camera with a special optic mounted on an adjustable mechanical arm. The set-up and application of this system are described and illustrated using examples drawn from pancreaticoduodenectomy, bile duct repair and liver transplantation. Results This system is easy to use and can provide variable magnification of ×4–12 at a camera distance of 25–35 cm from the operative field and a depth of field of 15 mm. This system allows the surgeon and assistant to work from a HD TV screen during critical phases of microsurgery. Conclusions The system described here provides better magnification than loupe lenses and thus may be beneficial during complex HPB procedures. Other benefits of this system include the fact that its use decreases neck strain and postural fatigue in the surgeon and it can be used as a tool for documentation and teaching. PMID:21929677

Excimer laser system Profile-500

NASA Astrophysics Data System (ADS)

Atejev, V. V.; Bukreyev, V. S.; Vartapetov, Serge K.; Semenov, A. D.; Sugrobov, V. A.; Turin, V. S.; Fedorov, Sergei N.

1999-07-01

The description of ophthalmological excimer laser system 'PROFILE-500' for photorefractive and physiotherapeutic keratectomy is presented. Excimer Laser Systems 'PROFILE- 500' are optical system that use ArF excimer lasers to perform photorefractive keratectomy or LASIK; surgical procedures used to correct myopia, hyperopia and astigmatism.

Updated laser safety & hazard analysis for the ARES laser system based on the 2007 ANSI Z136.1 standard.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Augustoni, Arnold L.

A laser safety and hazard analysis was performed for the temperature stabilized Big Sky Laser Technology (BSLT) laser central to the ARES system based on the 2007 version of the American National Standards Institutes (ANSI) Standard Z136.1, for Safe Use of Lasers and the 2005 version of the ANSI Standard Z136.6, for Safe Use of Lasers Outdoors. The ARES laser system is a Van/Truck based mobile platform, which is used to perform laser interaction experiments and tests at various national test sites.

Laser energy conversion

NASA Technical Reports Server (NTRS)

Jalufka, N. W.

1989-01-01

The conversion of laser energy to other, more useful, forms is an important element of any space power transmission system employing lasers. In general the user, at the receiving sight, will require the energy in a form other than laser radiation. In particular, conversion to rocket power and electricity are considered to be two major areas where one must consider various conversion techniques. Three systems (photovoltaic cells, MHD generators, and gas turbines) have been identified as the laser-to-electricity conversion systems that appear to meet most of the criteria for a space-based system. The laser thruster also shows considerable promise as a space propulsion system. At this time one cannot predict which of the three laser-to-electric converters will be best suited to particular mission needs. All three systems have some particular advantages, as well as disadvantages. It would be prudent to continue research on all three systems, as well as the laser rocket thruster. Research on novel energy conversion systems, such as the optical rectenna and the reverse free-electron laser, should continue due to their potential for high payoff.

Green high-power tunable external-cavity GaN diode laser at 515  nm.

PubMed

Chi, Mingjun; Jensen, Ole Bjarlin; Petersen, Paul Michael

2016-09-15

A 480 mW green tunable diode laser system is demonstrated for the first time to our knowledge. The laser system is based on a GaN broad-area diode laser and Littrow external-cavity feedback. The green laser system is operated in two modes by switching the polarization direction of the laser beam incident on the grating. When the laser beam is p-polarized, an output power of 50 mW with a tunable range of 9.2 nm is achieved. When the laser beam is s-polarized, an output power of 480 mW with a tunable range of 2.1 nm is obtained. This constitutes the highest output power from a tunable green diode laser system.

Laser beam monitoring system

DOEpatents

Weil, Bradley S.; Wetherington, Jr., Grady R.

1985-01-01

Laser beam monitoring systems include laser-transparent plates set at an angle to the laser beam passing therethrough and light sensor for detecting light reflected from an object on which the laser beam impinges.

Laser beam monitoring system

DOEpatents

Weil, B.S.; Wetherington, G.R. Jr.

Laser beam monitoring systems include laser-transparent plates set at an angle to the laser beam passing therethrough and light sensor for detecting light reflected from an object on which the laser beam impinges.

Satellite Power Systems (SPS) laser studies. Volume 1: Laser environmental impact study

NASA Technical Reports Server (NTRS)

Beverly, R. E., III

1980-01-01

The environmental impact of space to Earth power transmission using space borne laser subsystems is emphasized. A laser system is defined, estimates of relevant efficiencies for laser power generation and atmospheric transmission are developed, and a comparison is made to a microwave system. Ancillary issues, such as laser beam spreading, safety and security, mass and volume estimates and technology growth are considered.

The ARGOS laser system: green light for ground layer adaptive optics at the LBT

NASA Astrophysics Data System (ADS)

Raab, Walfried; Rabien, Sebastian; Gässler, Wolfgang; Esposito, Simone; Barl, Lothar; Borelli, Jose; Daysenroth, Matthias; Gemperlein, Hans; Kulas, Martin; Ziegleder, Julian

2014-07-01

We report on the development of the laser system of ARGOS, the multiple laser guide star adaptive optics system for the Large Binocular Telescope (LBT). The system uses a total of six high powered, pulsed Nd:YAG lasers frequency-doubled to a wavelength of 532 nm to generate a set of three guide stars above each of the LBT telescopes. The position of each of the LGS constellations on sky as well as the relative position of the individual laser guide stars within this constellation is controlled by a set of steerable mirrors and a fast tip-tilt mirror within the laser system. The entire opto-mechanical system is housed in two hermetically sealed and thermally controlled enclosures on the SX and DX side of the LBT telescope. The laser beams are propagated through two refractive launch telescopes which focus the beams at an altitude of 12 km, creating a constellation of laser guide stars around a 4 arcminute diameter circle by means of Rayleigh scattering. In addition to the GLAO Rayleigh beacon system, ARGOS has also been designed for a possible future upgrade with a hybrid sodium laser - Rayleigh beacon combination, enabling diffraction limited operation. The ARGOS laser system was successfully installed at the LBT in April 2013. Extensive functional tests have been carried out and have verified the operation of the systems according to specifications. The alignment of the laser system with respect to the launch telescope was carried out during two more runs in June and October 2013, followed by the first propagation of laser light on sky in November 2013.

Control system for high power laser drilling workover and completion unit

DOEpatents

Zediker, Mark S; Makki, Siamak; Faircloth, Brian O; DeWitt, Ronald A; Allen, Erik C; Underwood, Lance D

2015-05-12

A control and monitoring system controls and monitors a high power laser system for performing high power laser operations. The control and monitoring system is configured to perform high power laser operation on, and in, remote and difficult to access locations.

Optical diagnostics integrated with laser spark delivery system

DOEpatents

Yalin, Azer [Fort Collins, CO; Willson, Bryan [Fort Collins, CO; Defoort, Morgan [Fort Collins, CO; Joshi, Sachin [Fort Collins, CO; Reynolds, Adam [Fort Collins, CO

2008-09-02

A spark delivery system for generating a spark using a laser beam is provided, and includes a laser light source and a laser delivery assembly. The laser delivery assembly includes a hollow fiber and a launch assembly comprising launch focusing optics to input the laser beam in the hollow fiber. The laser delivery assembly further includes exit focusing optics that demagnify an exit beam of laser light from the hollow fiber, thereby increasing the intensity of the laser beam and creating a spark. Other embodiments use a fiber laser to generate a spark. Embodiments of the present invention may be used to create a spark in an engine. Yet other embodiments include collecting light from the spark or a flame resulting from the spark and conveying the light for diagnostics. Methods of using the spark delivery systems and diagnostic systems are provided.

Fiber laser coupled optical spark delivery system

DOEpatents

Yalin, Azer [Fort Collins, CO; Willson, Bryan [Fort Collins, CO; Defoort, Morgan [Fort Collins, CO; Joshi, Sachin [Fort Collins, CO; Reynolds, Adam [Fort Collins, CO

2008-03-04

A spark delivery system for generating a spark using a laser beam is provided, and includes a laser light source and a laser delivery assembly. The laser delivery assembly includes a hollow fiber and a launch assembly comprising launch focusing optics to input the laser beam in the hollow fiber. The laser delivery assembly further includes exit focusing optics that demagnify an exit beam of laser light from the hollow fiber, thereby increasing the intensity of the laser beam and creating a spark. Other embodiments use a fiber laser to generate a spark. Embodiments of the present invention may be used to create a spark in an engine. Yet other embodiments include collecting light from the spark or a flame resulting from the spark and conveying the light for diagnostics. Methods of using the spark delivery systems and diagnostic systems are provided.

New 223-nm excimer laser surgical system for photorefractive keratectomy

NASA Astrophysics Data System (ADS)

Bagaev, Sergei N.; Razhev, Alexander M.; Zhupikov, Andrey A.

1999-02-01

The using of KrCl (223 nm) excimer laser in ophthalmic devices for Photorefractive Keratectomy (PRK) and phototherapeutic Keratectomy (PTK) is offered. The structure and functions of a new surgical UV ophthalmic laser systems Medilex using ArF (193 nm) or KrCl (223 nm) excimer laser for corneal surgery are presented. The systems Medilex with the new optical delivery system is used for photoablative reprofiling of the cornea to correct refraction errors (myopia, hyperopia and astigmatism) and to treat a corneal pathologies. The use of the 223 nanometer laser is proposed to have advantages over the 193 nanometer laser. The results of application of the ophthalmic excimer laser systems Medilex for treatment of myopia are presented.

SU-E-T-99: Design and Development of Isocenter Parameter System for CT Simulation Laser Based On DICOM RT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Luo, G

2014-06-01

Purpose: In order to receive DICOM files from treatment planning system and generate patient isocenter positioning parameter file for CT laser system automatically, this paper presents a method for communication with treatment planning system and calculation of isocenter parameter for each radiation field. Methods: Coordinate transformation and laser positioning file formats were analyzed, isocenter parameter was calculated via data from DICOM CT Data and DICOM RTPLAN file. An in-house software-DicomGenie was developed based on the object-oriented program platform-Qt with DCMTK SDK (Germany OFFIS company DICOM SDK) . DicomGenie was tested for accuracy using Philips CT simulation plan system (Tumor LOC,more » Philips) and A2J CT positioning laser system (Thorigny Sur Marne, France). Results: DicomGenie successfully established DICOM communication between treatment planning system, DICOM files were received by DicomGenie and patient laser isocenter information was generated accurately. Patient laser parameter data files can be used for for CT laser system directly. Conclusion: In-house software DicomGenie received and extracted DICOM data, isocenter laser positioning data files were created by DicomGenie and can be use for A2J laser positioning system.« less

A 1J LD pumped Nd:YAG pulsed laser system

NASA Astrophysics Data System (ADS)

Yi, Xue-bin; Wang, Bin; Yang, Feng; Li, Jing; Liu, Ya-Ping; Li, Hui-Jun; Wang, Yu; Chen, Ren

2017-11-01

A 1J LD pumped Nd;YAG pulsed laser was designed. The laser uses an oscillation and two-staged amplification structure, and applies diode bar integrated array as side-pump. The TEC temperature control device combing liquid cooling system is organized to control the temperature of the laser system. This study also analyzed the theoretical threshold of working material, the effect of thermal lens and the basic principle of laser amplification. The results showed that the laser system can achieve 1J, 25Hz pulse laser output, and the laser pulse can be output at two width: 6-7ns and 10ns, respectively, and the original beam angle is 1.2mrad. The laser system is characterized by small size, light weight, as well as good stability, which make it being applied in varied fields such as photovoltaic radar platform and etc

The laser and optical system for the RIBF-PALIS experiment

NASA Astrophysics Data System (ADS)

Sonoda, T.; Iimura, H.; Reponen, M.; Wada, M.; Katayama, I.; Sonnenschein, V.; Takamatsu, T.; Tomita, H.; Kojima, T. M.

2018-01-01

This paper describes the laser and optical system for the Parasitic radioactive isotope (RI) beam production by Laser Ion-Source (PALIS) in the RIKEN fragment separator facility. This system requires an optical path length of 70 m for transporting the laser beam from the laser light source to the place for resonance ionization. To accomplish this, we designed and implemented a simple optical system consisting of several mirrors equipped with compact stepping motor actuators, lenses, beam spot screens and network cameras. The system enables multi-step laser resonance ionization in the gas cell and gas jet via overlap with a diameter of a few millimeters, between the laser photons and atomic beam. Despite such a long transport distance, we achieved a transport efficiency for the UV laser beam of about 50%. We also confirmed that the position stability of the laser beam stays within a permissible range for dedicated resonance ionization experiments.

Laser safety and hazard analysis for the temperature stabilized BSLT ARES laser system.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Augustoni, Arnold L.

A laser safety and hazard analysis was performed for the temperature stabilized Big Sky Laser Technology (BSLT) laser central to the ARES system based on the 2000 version of the American National Standards Institute's (ANSI) Standard Z136.1, for Safe Use of Lasers and the 2000 version of the ANSI Standard Z136.6, for Safe Use of Lasers Outdoors. As a result of temperature stabilization of the BSLT laser the operating parameters of the laser had changed requiring a hazard analysis based on the new operating conditions. The ARES laser system is a Van/Truck based mobile platform, which is used to performmore » laser interaction experiments and tests at various national test sites.« less

Development of a low-cost multiple diode PIV laser for high-speed flow visualization

NASA Astrophysics Data System (ADS)

Bhakta, Raj; Hargather, Michael

2017-11-01

Particle imaging velocimetry (PIV) is an optical visualization technique that typically incorporates a single high-powered laser to illuminate seeded particles in a fluid flow. Standard PIV lasers are extremely costly and have low frequencies that severely limit its capability in high speed, time-resolved imaging. The development of a multiple diode laser system consisting of continuous lasers allows for flexible high-speed imaging with a wider range of test parameters. The developed laser system was fabricated with off-the-shelf parts for approximately 500. A series of experimental tests were conducted to compare the laser apparatus to a standard Nd:YAG double-pulsed PIV laser. Steady and unsteady flows were processed to compare the two systems and validate the accuracy of the multiple laser design. PIV results indicate good correlation between the two laser systems and verifies the construction of a precise laser instrument. The key technical obstacle to this approach was laser calibration and positioning which will be discussed. HDTRA1-14-1-0070.

Laser beam distribution system for the HiLASE Center

NASA Astrophysics Data System (ADS)

Macúchová, Karolina; Heřmánek, Jan; Kaufman, Jan; Muresan, Mihai-George; Růžička, Jan; Řeháková, Martina; Divoký, Martin; Švandrlík, Luděk.; Mocek, Tomáś

2017-12-01

We report recent progress in design and testing of a distribution system for high-power laser beam delivery developed within the HiLASE project of the IOP in the Czech Republic. Laser beam distribution system is a technical system allowing safe and precise distribution of different laser beams from laboratories to several experimental stations. The unique nature of HiLASE lasers requires new approach, which makes design of the distribution system a state-of-the-art challenge.

Control electronics for a multi-laser/multi-detector scanning system

NASA Technical Reports Server (NTRS)

Kennedy, W.

1980-01-01

The Mars Rover Laser Scanning system uses a precision laser pointing mechanism, a photodetector array, and the concept of triangulation to perform three dimensional scene analysis. The system is used for real time terrain sensing and vision. The Multi-Laser/Multi-Detector laser scanning system is controlled by a digital device called the ML/MD controller. A next generation laser scanning system, based on the Level 2 controller, is microprocessor based. The new controller capabilities far exceed those of the ML/MD device. The first draft circuit details and general software structure are presented.

[Processes of ventricles I-III. Review of the patient population of the Neurosurgery Clinic of the Karl Marx University 1953-1983].

PubMed

Niebeling, H G; Goldhahn, W E

1985-01-01

Within three decades 254 patients with processes of the brain ventricles I-III have been treated at the Leipzig Neurosurgical Clinic. The article subdivides the patients in general and according to the histology, localisation, lateral differences, dignity, operability as well as the postoperative lethality. The evaluation gives many clues with respect to the diagnostics and therapy of these ventricular processes. Today, the improvements obtained by computer tomography and by microsurgery are well the to fore.

'How I do it': TEM for tumors of the rectum.

PubMed

Collinson, Rowan J; McC Mortensen, Neil J

2009-02-01

Transanal endoscopic microsurgery (TEM) has an established role in the management of benign rectal tumors. It also has an expanding role in the management of malignant tumors, which is more demanding for the clinician. It requires accurate histological and radiological assessment and draws on an expert understanding of the nature of local recurrence, metastasis, and the place of adjuvant therapies. A multidisciplinary approach is recommended. This paper discusses our institutional approach to TEM for benign and malignant tumors and covers some of the current management controversies.

Alternatives to thumb replantation in three cases of traumatic amputation of the thumb.

PubMed

Matey, P; Peart, F C

1999-01-01

Three cases of complete amputation of the thumb are reported in which the amputated distal parts were not suitable for replantation. In all cases there were either complete or incomplete amputations of other digits. Two different techniques were used for thumb reconstruction: 1) pollicization of a partially amputated digit with transposition microsurgery in case 1; and 2) replantation of a less important amputated digit to the thumb stump for cases 2 and 3. These microsurgical efforts successfully restored thumb function in all three patients.

[Composite digital allotransplants: surgical technique and different applications].

PubMed

Casoli, V; Rousvoal, A; Zirak, C; Bakhach, J; Guimberteau, J-C

2007-10-01

Microsurgery and human allotransplantation progress as well as the improvement of immunosuppressive drugs actually allow the development of the composite tissue allotransplantation. One of the latest challenges in plastic surgery is to restore the anatomic and functional structures using similar tissues. Composite tissue allotransplantation will probably reach this goal. Our work is to find new surgical techniques for the reconstruction of the osteotendinous apparatus of the long digits. In this paper, we will demonstrate the surgical technique to harvest the allotransplant and its modulation in the reconstruction of various digital defects.

Human Eye Phantom for Developing Computer and Robot-Assisted Epiretinal Membrane Peeling*

PubMed Central

Gupta, Amrita; Gonenc, Berk; Balicki, Marcin; Olds, Kevin; Handa, James; Gehlbach, Peter; Taylor, Russell H.; Iordachita, Iulian

2014-01-01

A number of technologies are being developed to facilitate key intraoperative actions in vitreoretinal microsurgery. There is a need for cost-effective, reusable benchtop eye phantoms to enable frequent evaluation of these developments. In this study, we describe an artificial eye phantom for developing intraocular imaging and force-sensing tools. We test four candidate materials for simulating epiretinal membranes using a handheld tremor-canceling micromanipulator with force-sensing micro-forceps tip and demonstrate peeling forces comparable to those encountered in clinical practice. PMID:25571573

Severe Crush Injury to the Forearm and Hand: The Role of Microsurgery.

PubMed

Del Piñal, Francisco; Urrutia, Esteban; Klich, Maciej

2017-04-01

The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand. Copyright © 2016 Elsevier Inc. All rights reserved.

Prerequisites of realization of total breast reconstruction concept in Tomsk region

NASA Astrophysics Data System (ADS)

Dudnikov, A.; Smirnov, N.; Belozertseva, A.; Baitinger, A.; Kudyakov, L.

2015-11-01

The recent research represents the attempt of economical evaluation of the Total Breast Reconstruction concept (TBR), which was formulated in «Scientific and Research Institute of Microsurgery», in 2014. This concept includes anatomical and functional breast reconstruction, afferential reinnervation, sensitivity recovery and the creation of a new erogenous zone in the reconstructed breast. The created clinical-economical model allows for the evaluation of the efficacy and benefits of using the TBR concept. The benefits of using TBR concept for Tomsk Region also were evaluated.

Investigations of a Dual Seeded 1178 nm Raman Laser System

DTIC Science & Technology

2016-01-14

20 W. Because of the linewidth broadening, a co- pumped second Stokes Raman laser system is not useful for the sodium guidestar laser application... pumped second Stokes Raman laser system is not useful for the sodium guidestar laser application which requires narrow linewidth. Keywords: Raman...optical efficiency of 52% when pumped with a linearly polarized 1120 nm fiber laser10,11. Because of the all-polarization maintaining configuration, a

Ground-Based and Space-Based Laser Beam Power Applications

NASA Technical Reports Server (NTRS)

Bozek, John M.

1995-01-01

A space power system based on laser beam power is sized to reduce mass, increase operational capabilities, and reduce complexity. The advantages of laser systems over solar-based systems are compared as a function of application. Power produced from the conversion of a laser beam that has been generated on the Earth's surface and beamed into cislunar space resulted in decreased round-trip time for Earth satellite electric propulsion tugs and a substantial landed mass savings for a lunar surface mission. The mass of a space-based laser system (generator in space and receiver near user) that beams down to an extraterrestrial airplane, orbiting spacecraft, surface outpost, or rover is calculated and compared to a solar system. In general, the advantage of low mass for these space-based laser systems is limited to high solar eclipse time missions at distances inside Jupiter. The power system mass is less in a continuously moving Mars rover or surface outpost using space-based laser technology than in a comparable solar-based power system, but only during dust storm conditions. Even at large distances for the Sun, the user-site portion of a space-based laser power system (e.g., the laser receiver component) is substantially less massive than a solar-based system with requisite on-board electrochemical energy storage.

From Dye Laser Factory to Portable Semiconductor Laser: Four Generations of Sodium Guide Star Lasers for Adaptive Optics in Astronomy and Space Situational Awareness

NASA Astrophysics Data System (ADS)

d'Orgeville, C.; Fetzer, G.

This presentation recalls the history of sodium guide star laser systems used in astronomy and space situational awareness adaptive optics, analysing the impact that sodium laser technology evolution has had on routine telescope operations. While it would not be practical to describe every single sodium guide star laser system developed to date, it is possible to characterize their evolution in broad technology terms. The first generation of sodium lasers used dye laser technology to create the first sodium laser guide stars in Hawaii, California, and Spain in the late 1980's and 1990's. These experimental systems were turned into the first laser guide star facilities to equip medium-to-large diameter adaptive optics telescopes, opening a new era of LGS AO-enabled diffraction-limited imaging from the ground. Although they produced exciting scientific results, these laser guide star facilities were large, power-hungry and messy. In the USA, a second-generation of sodium lasers was developed in the 2000's that used cleaner, yet still large and complex, solid-state laser technology. These are the systems in routine operation at the 8-10m class astronomical telescopes and 4m-class satellite imaging facilities today. Meanwhile in Europe, a third generation of sodium lasers was being developed using inherently compact and efficient fiber laser technology, and resulting in the only commercially available sodium guide star laser system to date. Fiber-based sodium lasers will be deployed at two astronomical telescopes and at least one space debris tracking station this year. Although highly promising, these systems remain significantly expensive and they have yet to demonstrate high performance in the field. We are proposing to develop a fourth generation of sodium lasers: based on semiconductor technology, these lasers could provide the final solution to the problem of sodium laser guide star adaptive optics for all astronomy and space situational awareness applications.

High-power direct-diode laser successes

NASA Astrophysics Data System (ADS)

Haake, John M.; Zediker, Mark S.

2004-06-01

Direct diode laser will become much more prevalent in the solar system of manufacturing due to their high efficiency, small portable size, unique beam profiles, and low ownership costs. There has been many novel applications described for high power direct diode laser [HPDDL] systems but few have been implemented in extreme production environments due to diode and diode system reliability. We discuss several novel applications in which the HPDDL have been implemented and proven reliable and cost-effective in production environments. These applications are laser hardening/surface modification, laser wire feed welding and laser paint stripping. Each of these applications uniquely tests the direct diode laser systems capabilities and confirms their reliability in production environments. A comparison of the advantages direct diode laser versus traditional industrial lasers such as CO2 and Nd:YAG and non-laser technologies such a RF induction, and MIG welders for each of these production applications is presented.

Heterodyne laser instantaneous frequency measurement system

DOEpatents

Wyeth, Richard W.; Johnson, Michael A.; Globig, Michael A.

1989-01-01

A heterodyne laser instantaneous frequency measurement system is disclosed. The system utilizes heterodyning of a pulsed laser beam with a continuous wave laser beam to form a beat signal. The beat signal is processed by a controller or computer which determines both the average frequency of the laser pulse and any changes or chirp of th frequency during the pulse.

Laser system development for gravitational-wave interferometry in space

NASA Astrophysics Data System (ADS)

Numata, Kenji; Yu, Anthony W.; Camp, Jordan B.; Krainak, Michael A.

2018-02-01

A highly stable and robust laser system is a key component of the space-based Laser Interferometer Space Antenna (LISA) mission, which is designed to detect gravitational waves from various astronomical sources. The baseline architecture for the LISA laser consists of a low-power, low-noise Nd:YAG non-planar ring oscillator (NPRO) followed by a diode-pumped Yb-fiber amplifier with 2 W output. We are developing such laser system at the NASA Goddard Space Flight Center (GSFC), as well as investigating other laser options. In this paper, we will describe our progress to date and plans to demonstrate a technology readiness level (TRL) 6 LISA laser system.

Comparisons of selected laser beam power missions to conventionally powered missions

NASA Technical Reports Server (NTRS)

Bozek, John M.; Oleson, Steven R.; Landis, Geoffrey A.; Stavnes, Mark W.

1993-01-01

Earth-based laser sites beaming laser power to space assets have shown benefits over competing power system concepts for specific missions. Missions analyzed in this report that show benefits of laser beam power are low Earth orbit (LEO) to geosynchronous Earth orbit (GEO) transfer, LEO to low lunar orbit (LLO) cargo missions, and lunar-base power. Both laser- and solar-powered orbit-transfer vehicles (OTV's) make a 'tug' concept viable, which substantially reduces cumulative initial mass to LEO in comparison to chemical propulsion concepts. Lunar cargo missions utilizing laser electric propulsion from Earth-orbit to LLO show substantial mass saving to LEO over chemical propulsion systems. Lunar-base power system options were compared on a landed-mass basis. Photovoltaics with regenerative fuel cells, reactor-based systems, and laser-based systems were sized to meet a generic lunar-base power profile. A laser-based system begins to show landed mass benefits over reactor-based systems when proposed production facilities on the Moon require power levels greater than approximately 300 kWe. Benefit/cost ratios of laser power systems for an OTV, both to GEO and LLO, and for a lunar base were calculated to be greater than 1.

Performance calculation and simulation system of high energy laser weapon

NASA Astrophysics Data System (ADS)

Wang, Pei; Liu, Min; Su, Yu; Zhang, Ke

2014-12-01

High energy laser weapons are ready for some of today's most challenging military applications. Based on the analysis of the main tactical/technical index and combating process of high energy laser weapon, a performance calculation and simulation system of high energy laser weapon was established. Firstly, the index decomposition and workflow of high energy laser weapon was proposed. The entire system was composed of six parts, including classical target, platform of laser weapon, detect sensor, tracking and pointing control, laser atmosphere propagation and damage assessment module. Then, the index calculation modules were designed. Finally, anti-missile interception simulation was performed. The system can provide reference and basis for the analysis and evaluation of high energy laser weapon efficiency.

Comparative hazard evaluation of near-infrared diode lasers.

PubMed

Marshall, W J

1994-05-01

Hazard evaluation methods from various laser protection standards differ when applied to extended-source, near-infrared lasers. By way of example, various hazard analyses are applied to laser training systems, which incorporate diode lasers, specifically those that assist in training military or law enforcement personnel in the proper use of weapons by simulating actual firing by the substitution of a beam of near-infrared energy for bullets. A correct hazard evaluation of these lasers is necessary since simulators are designed to be directed toward personnel during normal use. The differences among laser standards are most apparent when determining the hazard class of a laser. Hazard classification is based on a comparison of the potential exposures with the maximum permissible exposures in the 1986 and 1993 versions of the American National Standard for the Safe Use of Lasers, Z136.1, and the accessible emission limits of the federal laser product performance standard. Necessary safety design features of a particular system depend on the hazard class. The ANSI Z136.1-1993 standard provides a simpler and more accurate hazard assessment of low-power, near-infrared, diode laser systems than the 1986 ANSI standard. Although a specific system is evaluated, the techniques described can be readily applied to other near-infrared lasers or laser training systems.

Optically-Based Diagnostics for Gas-Phase Laser Development

DTIC Science & Technology

2010-08-01

Laser (COIL), Electric Oxygen Iodine Laser (EOIL), Diode-Pumped Alkali Laser (DPAL), and Exciplex Alkali Laser (XPAL). The papers at this Symposium... exciplex -assisted absorption and laser-induced fluorescence, and multi-photon excitation of infrared atomic alkali transitions.11,12 In this paper... EXCIPLEX LASER SYSTEMS Proper review and discussion of the DPAL and XPAL laser systems can be found elsewhere,11,12 and in the paper by Carroll and

Phasing surface emitting diode laser outputs into a coherent laser beam

DOEpatents

Holzrichter, John F [Berkeley, CA

2006-10-10

A system for generating a powerful laser beam includes a first laser element and at least one additional laser element having a rear laser mirror, an output mirror that is 100% reflective at normal incidence and <5% reflective at an input beam angle, and laser material between the rear laser mirror and the output mirror. The system includes an injector, a reference laser beam source, an amplifier and phase conjugater, and a combiner.

Formation of propagation invariant laser beams with anamorphic optical systems

NASA Astrophysics Data System (ADS)

Soskind, Y. G.

2015-03-01

Propagation invariant structured laser beams play an important role in several photonics applications. A majority of propagation invariant beams are usually produced in the form of laser modes emanating from stable laser cavities. This work shows that anamorphic optical systems can be effectively employed to transform input propagation invariant laser beams and produce a variety of alternative propagation invariant structured laser beam distributions with different shapes and phase structures. This work also presents several types of anamorphic lens systems suitable for transforming the input laser modes into a variety of structured propagation invariant beams. The transformations are applied to different laser mode types, including Hermite-Gaussian, Laguerre-Gaussian, and Ince-Gaussian field distributions. The influence of the relative azimuthal orientation between the input laser modes and the anamorphic optical systems on the resulting transformed propagation invariant beams is presented as well.

Lasant Materials for Blackbody-Pumped Lasers

NASA Technical Reports Server (NTRS)

Deyoung, R. J. (Editor); Chen, K. Y. (Editor)

1985-01-01

Blackbody-pumped solar lasers are proposed to convert sunlight into laser power to provide future space power and propulsion needs. There are two classes of blackbody-pumped lasers. The direct cavity-pumped system in which the lasant molecule is vibrationally excited by the absorption of blackbody radiation and laser, all within the blackbody cavity. The other system is the transfer blackbody-pumped laser in which an absorbing molecule is first excited within the blackbody cavity, then transferred into a laser cavity when an appropriate lasant molecule is mixed. Collisional transfer of vibrational excitation from the absorbing to the lasing molecule results in laser emission. A workshop was held at NASA Langley Research Center to investigate new lasant materials for both of these blackbody systems. Emphasis was placed on the physics of molecular systems which would be appropriate for blackbody-pumped lasers.

Laser Pyro System Standardization and Man Rating

NASA Technical Reports Server (NTRS)

Brown, Christopher W.

2004-01-01

This viewgraph presentation reviews an X-38 laser pyro system standardization system designed for a new manned rated program. The plans to approve this laser initiation system and preliminary ideas for this system are also provided.

Four generations of sodium guide star lasers for adaptive optics in astronomy and space situational awareness

NASA Astrophysics Data System (ADS)

d'Orgeville, Céline; Fetzer, Gregory J.

2016-07-01

This paper recalls the history of sodium guide star laser systems used in astronomy and space situational awareness adaptive optics, analyzing the impact that sodium laser technology evolution has had on routine telescope operations. While it would not be practical to describe every single sodium guide star laser system developed to date, it is possible to characterize their evolution in broad technology terms. The first generation of sodium lasers used dye laser technology to create the first sodium laser guide stars in Hawaii, California, and Spain in the late 1980s and 1990s. These experimental systems were turned into the first laser guide star facilities to equip mediumto- large diameter adaptive optics telescopes, opening a new era of Laser Guide Star Adaptive Optics (LGS AO)-enabled diffraction-limited imaging from the ground. Although they produced exciting scientific results, these laser guide star facilities were large, power-hungry and messy. In the USA, a second-generation of sodium lasers was developed in the 2000s that used cleaner, yet still large and complex, solid-state laser technology. These are the systems in routine operation at the 8 to 10m-class astronomical telescopes and 4m-class satellite imaging facilities today. Meanwhile in Europe, a third generation of sodium lasers was being developed using inherently compact and efficient fiber laser technology, and resulting in the only commercially available sodium guide star laser system to date. Fiber-based sodium lasers are being or will soon be deployed at three astronomical telescopes and two space surveillance stations. These highly promising systems are still relatively large to install on telescopes and they remain significantly expensive to procure and maintain. We are thus proposing to develop a fourth generation of sodium lasers: based on semiconductor technology, these lasers could provide a definitive solution to the problem of sodium LGS AO laser sources for all astronomy and space situational awareness applications.

Exhaust Plume Measurements of 15-Pound BATES (Ballistic Test and Evaluation System) Motors.

DTIC Science & Technology

1985-06-01

laser transmissometer measurements as a plume... System 7 3 AFRPL Laser Transmission/Scattering Measurement System During Motor Firing 8 4 Laser Scattering Detector Schematic 9 5 Laser Scattering... measurement goals. The instrumentation includes a multi -wavelength, single line-of-sight IR-E/A system , a UV emission spectrometer, an exhaust

Perspectives of using the 223-nm wavelength of the KrCl excimer laser for refractive surgery and for the treatment of some eye diseases

NASA Astrophysics Data System (ADS)

Bagayev, Sergei N.; Chernikh, Valery V.; Razhev, Alexander M.; Zhupikov, Andrey A.

2000-06-01

The new surgical UV ophthalmic laser system Medilex based on the KrCl (223 nm) excimer laser for refractive surgery was created. The comparative analysis of using the UV ophthalmic laser systems Medilex based on the ArF (193 nm) and the KrCl (223 nm) excimer lasers for the correction of refractive errors was performed. The system with the radiation wavelength of 223 nanometer of the KrCl excimer laser for refractive surgery was shown to have several medical and technical advantages over the system with the traditionally used radiation wavelength of 193 nanometer of the ArF excimer laser. In addition the use of the wavelength of 223 nanometer extends functional features of the system, allowing to make not only standard for this type systems surgical and therapeutic procedures but also to treat such ocular diseases as the glaucoma and herpetic keratities. For the UV ophthalmic laser systems Medilex three variations of the beam delivery system including special rotating masks and different beam homogenize systems were developed. All created beam delivery systems are able to make the correction of myopia, hyperopia, astigmatism and myopic or hyperopic astigmatism and may be used for therapeutic procedures. The results of the initial treatments of refractive error corrections using the UV ophthalmic laser systems Medilex for both photorefractive keratectomy (PRK) and LASIK procedures are presented.

Geometric calibration of a coordinate measuring machine using a laser tracking system

NASA Astrophysics Data System (ADS)

Umetsu, Kenta; Furutnani, Ryosyu; Osawa, Sonko; Takatsuji, Toshiyuki; Kurosawa, Tomizo

2005-12-01

This paper proposes a calibration method for a coordinate measuring machine (CMM) using a laser tracking system. The laser tracking system can measure three-dimensional coordinates based on the principle of trilateration with high accuracy and is easy to set up. The accuracy of length measurement of a single laser tracking interferometer (laser tracker) is about 0.3 µm over a length of 600 mm. In this study, we first measured 3D coordinates using the laser tracking system. Secondly, 21 geometric errors, namely, parametric errors of the CMM, were estimated by the comparison of the coordinates obtained by the laser tracking system and those obtained by the CMM. As a result, the estimated parametric errors agreed with those estimated by a ball plate measurement, which demonstrates the validity of the proposed calibration system.

State of the art of CO laser angioplasty system

NASA Astrophysics Data System (ADS)

Arai, Tsunenori; Mizuno, Kyoichi; Miyamoto, Akira; Sakurada, Masami; Kikuchi, Makoto; Kurita, Akira; Nakamura, Haruo; Takaoka, Hidetsugu; Utsumi, Atsushi; Takeuchi, Kiyoshi

1994-07-01

A unique percutaneous transluminal coronary angioplasty system new IR therapy laser with IR glass fiber delivery under novel angioscope guidance was described. Carbon monoxide (CO) laser emission of 5 mm in wavelength was employed as therapy laser to achieve precise ablation of atheromatous plaque with a flexible As-S IR glass fiber for laser delivery. We developed the first medical CO laser as well as As-S IR glass fiber cable. We also developed 5.5 Fr. thin angioscope catheter with complete directional manipulatability at its tip. The system control unit could manage to prevent failure irradiations and fiber damages. This novel angioplasty system was evaluated by a stenosis model of mongrel dogs. We demonstrated the usefulness of our system to overcome current issues on laser angioplasty using multifiber catheter with over-the-guidewire system.

Laser-induced damage threshold of camera sensors and micro-optoelectromechanical systems

NASA Astrophysics Data System (ADS)

Schwarz, Bastian; Ritt, Gunnar; Koerber, Michael; Eberle, Bernd

2017-03-01

The continuous development of laser systems toward more compact and efficient devices constitutes an increasing threat to electro-optical imaging sensors, such as complementary metal-oxide-semiconductors (CMOS) and charge-coupled devices. These types of electronic sensors are used in day-to-day life but also in military or civil security applications. In camera systems dedicated to specific tasks, micro-optoelectromechanical systems, such as a digital micromirror device (DMD), are part of the optical setup. In such systems, the DMD can be located at an intermediate focal plane of the optics and it is also susceptible to laser damage. The goal of our work is to enhance the knowledge of damaging effects on such devices exposed to laser light. The experimental setup for the investigation of laser-induced damage is described in detail. As laser sources, both pulsed lasers and continuous-wave (CW)-lasers are used. The laser-induced damage threshold is determined by the single-shot method by increasing the pulse energy from pulse to pulse or in the case of CW-lasers, by increasing the laser power. Furthermore, we investigate the morphology of laser-induced damage patterns and the dependence of the number of destructive device elements on the laser pulse energy or laser power. In addition to the destruction of single pixels, we observe aftereffects, such as persistent dead columns or rows of pixels in the sensor image.

Laser cutting system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dougherty, Thomas J

A workpiece cutting apparatus includes a laser source, a first suction system, and a first finger configured to guide a workpiece as it moves past the laser source. The first finger includes a first end provided adjacent a point where a laser from the laser source cuts the workpiece, and the first end of the first finger includes an aperture in fluid communication with the first suction system.

Ultra-fast laser system

DOEpatents

Dantus, Marcos; Lozovoy, Vadim V

2014-01-21

A laser system is provided which selectively excites Raman active vibrations in molecules. In another aspect of the present invention, the system includes a laser, pulse shaper and detection device. A further aspect of the present invention employs a femtosecond laser and binary pulse shaping (BPS). Still another aspect of the present invention uses a laser beam pulse, a pulse shaper and remote sensing.

Two Wavelength Ti:sapphire Laser for Ozone DIAL Measurements from Aircraft

NASA Technical Reports Server (NTRS)

Situ, Wen; DeYoung, Russel J.

1998-01-01

Laser remote sensing of ozone from aircraft has proven to be a valuable technique for understanding the distribution and dynamics of ozone in the atmosphere. Presently the differential absorption lidar (DIAL) technique, using dual ND:YAG lasers that are doubled to pump dye lasers which in turn are doubled into the UV for the "on" and "off' line lasers, is used on either the NASA DC-8 or P-3 aircraft. Typically, the laser output for each line is 40-mJ and this is split into two beams, one looking up and the other downward, each beam having about 20-mJ. The residual ND:YAG (1.06 micron) and dye laser energies are also transmitted to obtain information on the atmospheric aerosols. While this system has operated well, there are several system characteristics that make the system less than ideal for aircraft operations. The system, which uses separate "on" and "off" line lasers, is quite large and massive requiring valuable aircraft volume and weight. The dye slowly degrades with time requiring replacement. The laser complexity requires a number of technical people to maintain the system performance. There is also the future interest in deploying an ozone DIAL system in an Unpiloted Atmospheric Vehicle (UAV) which would require a total payload mass of less than 150 kg and power requirement of less than 1500 W. A laser technology has emerged that could potentially provide significant enhancements over the present ozone DIAL system. The flashlamp pumped Ti:sapphire laser system is an emerging technology that could reduce the mass and volume over the present system and also provide a system with fewer conversion steps, reducing system complexity. This paper will discuss preliminary results from a flashlamp-pumped Ti:sapphire laser constructed as a radiation source for a UV DIAL system to measure ozone.

Variable emissivity laser thermal control system

DOEpatents

Milner, J.R.

1994-10-25

A laser thermal control system for a metal vapor laser maintains the wall temperature of the laser at a desired level by changing the effective emissivity of the water cooling jacket. This capability increases the overall efficiency of the laser. 8 figs.

Surface modification of tooth root canal after application of an X-ray opaque waveguide

NASA Astrophysics Data System (ADS)

Dostálová, T.; Jelínková, H.; Šulc, J.; Němec, M.; Koranda, P.; Bartoňová, M.; Radina, P.; Miyagi, M.; Shi, Y.-W.; Matsuura, Y.

The interest in endodontic use of dental laser systems has been increasing. With the development of thin and flexible delivery systems for various wavelengths, laser applications in endodontics may become even more desirable. The aim of this study is to check the X-ray opacity of a hollow waveguide and to observe the results after laser root canal treatment. The root canal systems of 10 molars were treated endodontically by laser. For the laser radiation source, an Er:YAG laser system generating a wavelength of 2940 nm and an Alexandrite laser system generating a wavelength of 375 nm were used. The hollow waveguide used was checked under X-ray . A root canal surface treated by laser radiation was analyzed by a scanning electron microscope (SEM). The special hollow glass waveguide used was visible in the root canal system under X-ray imaging. Surface modification of the root canal after laser treatment was not found. After conventional treatment the root canal was enlarged. The surface was covered with a smear layer. After application of both laser systems, the smear layer was removed. The resulting canal surface was found to be clean and smooth. Under SEM observation open dentinal tubules were visible. No cracks were present, nor were surface modifications observed.

Method and system for powering and cooling semiconductor lasers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Telford, Steven J; Ladran, Anthony S

A semiconductor laser system includes a diode laser tile. The diode laser tile includes a mounting fixture having a first side and a second side opposing the first side and an array of semiconductor laser pumps coupled to the first side of the mounting fixture. The semiconductor laser system also includes an electrical pulse generator thermally coupled to the diode bar and a cooling member thermally coupled to the diode bar and the electrical pulse generator.

Electric motor for laser-mechanical drilling

DOEpatents

Grubb, Daryl L.; Faircloth, Brian O.; Zediker, Mark S.

2015-07-07

A high power laser drilling system utilizing an electric motor laser bottom hole assembly. A high power laser beam travels within the electric motor for advancing a borehole. High power laser drilling system includes a down hole electrical motor having a hollow rotor for conveying a high power laser beam through the electrical motor.

Laser source for dimensional metrology: investigation of an iodine stabilized system based on narrow linewidth 633 nm DBR diode

NASA Astrophysics Data System (ADS)

Rerucha, Simon; Yacoot, Andrew; Pham, Tuan M.; Cizek, Martin; Hucl, Vaclav; Lazar, Josef; Cip, Ondrej

2017-04-01

We demonstrated that an iodine stabilized distributed Bragg reflector (DBR) diode based laser system lasing at a wavelength in close proximity to λ =633 nm could be used as an alternative laser source to the helium-neon lasers in both scientific and industrial metrology. This yields additional advantages besides the optical frequency stability and coherence: inherent traceability, wider optical frequency tuning range, higher output power and high frequency modulation capability. We experimentally investigated the characteristics of the laser source in two major steps: first using a wavelength meter referenced to a frequency comb controlled with a hydrogen maser and then on an interferometric optical bench testbed where we compared the performance of the laser system with that of a traditional frequency stabilized He-Ne laser. The results indicate that DBR diode laser system provides a good laser source for applications in dimensional (nano)metrology, especially in conjunction with novel interferometric detection methods exploiting high frequency modulation or multiaxis measurement systems.

Tunable solid state lasers for remote sensing; Proceedings of the Conference, Stanford University, CA, October 1-3, 1984

NASA Technical Reports Server (NTRS)

Byer, R. L. (Editor); Trebino, R. (Editor); Gustafson, E. K. (Editor)

1985-01-01

Papers are presented on solid-state lasers for remote sensing, diode-pumped Nd:YAG lasers, and tunable solid-state-laser systems. Topics discussed include titanium-sapphire tunable laser systems, the performance of slab geometry, and the development of slab lasers. Consideration is given to garnet host solid-state lasers, the growth of lasers and nonlinear materials, and nonlinear frequency conversion and tunable sources.

Free-space QKD system hacking by wavelength control using an external laser.

PubMed

Lee, Min Soo; Woo, Min Ki; Jung, Jisung; Kim, Yong-Su; Han, Sang-Wook; Moon, Sung

2017-05-15

We develop a way to hack free-space quantum key distribution (QKD) systems by changing the wavelength of the quantum signal laser using an external laser. Most free-space QKD systems use four distinct lasers for each polarization, thereby making the characteristics of each laser indistinguishable. We also discover a side-channel that can distinguish the lasers by using an external laser. Our hacking scheme identifies the lasers by automatically applying the external laser to each signal laser at different intensities and detecting the wavelength variation according to the amount of incident external laser power. We conduct a proof-of-principle experiment to verify the proposed hacking structure and confirm that the wavelength varies by several gigahertzes to several nanometers, depending on the intensity of the external laser. The risk of hacking is successfully proven through the experimental results. Methods for prevention are also suggested.

Development of the micro-scanning optical system of yellow laser applied to the ophthalmologic area

NASA Astrophysics Data System (ADS)

Ortega, Tiago A.; Mota, Alessandro D.; Costal, Glauco Z.; Fontes, Yuri C.; Rossi, Giuliano; Yasuoka, Fatima M. M.; Stefani, Mario A.; de Castro N., Jarbas C.

2012-10-01

In this work, the development of a laser scanning system for ophthalmology with micrometric positioning precision is presented. It is a semi-automatic scanning system for retina photocoagulation and laser trabeculoplasty. The equipment is a solid state laser fully integrated to the slit lamp. An optical system is responsible for producing different laser spot sizes on the image plane and a pair of galvanometer mirrors generates the scanning patterns.

High power laser workover and completion tools and systems

DOEpatents

Zediker, Mark S; Rinzler, Charles C; Faircloth, Brian O; Koblick, Yeshaya; Moxley, Joel F

2014-10-28

Workover and completion systems, devices and methods for utilizing 10 kW or more laser energy transmitted deep into the earth with the suppression of associated nonlinear phenomena. Systems and devices for the laser workover and completion of a borehole in the earth. These systems and devices can deliver high power laser energy down a deep borehole, while maintaining the high power to perform laser workover and completion operations in such boreholes deep within the earth.

Optical radiation hazards of laser welding processes. Part II: CO2 laser.

PubMed

Rockwell, R J; Moss, C E

1989-08-01

There has been an extensive growth within the last five years in the use of high-powered lasers in various metalworking processes. The two types of lasers used most frequently for laser welding/cutting processes are the Neodymium-yttrium-aluminum-garnet (Nd:YAG) and the carbon dioxide (CO2) systems. When such lasers are operated in an open beam configuration, they are designated as a Class IV laser system. Class IV lasers are high-powered lasers that may present an eye and skin hazard under most common exposure conditions, either directly or when the beam has been diffusely scattered. Significant control measures are required for unenclosed (open beam), Class IV laser systems since workers may be exposed to scattered or reflected beams during the operation, maintenance, and service of these lasers. In addition to ocular and/or skin exposure hazards, such lasers also may present a multitude of nonlaser beam occupational concerns. Radiant energy measurements are reported for both the scattered laser radiation and the plasma-related plume radiations released during typical high-powered CO2 laser-target interactions. In addition, the application of the nominal hazard zone (NHZ) and other control measures also are discussed with special emphasis on Class IV industrial CO2 laser systems.

Development of Fiber-Based Laser Systems for LISA

NASA Technical Reports Server (NTRS)

Numata, Kenji; Camp, Jordan

2010-01-01

We present efforts on fiber-based laser systems for the LISA mission at the NASA Goddard Space Flight Center. A fiber-based system has the advantage of higher robustness against external disturbances and easier implementation of redundancies. For a master oscillator, we are developing a ring fiber laser and evaluating two commercial products, a DBR linear fiber laser and a planar-waveguide external cavity diode laser. They all have comparable performance to a traditional NPRO at LISA band. We are also performing reliability tests of a 2-W Yb fiber amplifier and radiation tests of fiber laser/amplifier components. We describe our progress to date and discuss the path to a working LISA laser system design.

Biomedical effects of low-power laser controlled by electroacupuncture

NASA Astrophysics Data System (ADS)

Kalenchits, Nadezhda I.; Nicolaenko, Andrej A.; Shpilevoj, Boris N.

1997-12-01

The methods and technical facilities of testing the biomedical effects caused by the influence of low-power laser radiation in the process of laser therapy are presented. Described studies have been conducted by means of the complex of fireware facilities consisting of the system of electroacupuncture diagnostics (EA) and a system of laser therapy on the basis of multichannel laser and magneto-laser devices. The task of laser therapy was concluded in undertaking acupuncture anaesthetization, achievement of antioedemic and dispersional actions, raising tone of musculus and nervous system, normalization of immunity factors under the control of system EA. The 82 percent to 95 percent agreement of the result of an electroacupuncture diagnostics with clinical diagnoses were achieved.

Laser System for Photoelectron and X-Ray Production in the PLEIADES Compton Light Source

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gibson, D J; Barty, C J; Betts, S M

2005-04-21

The PLEIADES (Picosecond Laser-Electron Interaction for the Dynamic Evaluation of Structures) facility provides tunable short x-ray pulses with energies of 30-140 keV and pulse durations of 0.3-5 ps by scattering an intense, ultrashort laser pulse off a 35-75 MeV electron beam. Synchronization of the laser and electron beam is obtained by using a photoinjector gun, and using the same laser system to generate the electrons and the scattering laser. The Ti Ti:Sapphire, chirped pulse amplification based 500 mJ, 50 fs, 810 nm scattering laser and the similar 300 {micro}J, 5 ps, 266 nm photoinjector laser systems are detailed. Additionally, anmore » optical parametric chirped pulse amplification (OPCPA) system is studied as a replacement for part of the scattering laser front end. Such a change would significantly simplify the set-up the laser system by removing the need for active switching optics, as well as increase the pre-pulse contrast ratio which will be important when part of the scattering laser is used as a pump beam in pump-probe diffraction experiments using the ultrashort tunable x-rays generated as the probe.« less

Atomic vapor laser isotope separation process

DOEpatents

Wyeth, R.W.; Paisner, J.A.; Story, T.

1990-08-21

A laser spectroscopy system is utilized in an atomic vapor laser isotope separation process. The system determines spectral components of an atomic vapor utilizing a laser heterodyne technique. 23 figs.

Robotic Laser Coating Removal System

DTIC Science & Technology

2008-07-01

Materiel Command IRR Internal Rate of Return JTP Joint Test Protocol JTR Joint Test Report LARPS Large Area Robotic Paint Stripping LASER Light...use of laser paint stripping systems is applicable to depainting activities on large off-aircraft components and weapons systems for the Air Force...The use of laser paint stripping systems is applicable to depainting activities on large off-aircraft components and weapons systems for the Air

New Laser System For Combined Monitoring And Treatment Of Neonatal Hyperbilirubinemia

NASA Astrophysics Data System (ADS)

Hamza, Mostafa; Hamza, Mohammad

1989-09-01

Laser photoradiation therapy for neonatal hyperbilirubinemia is a breakthrough in the management of neonatal jaundice. In this paper the authors present a new laser system that provides combined monitoring and therapy for neonatal hyperbilirubinemia. The new system incorporates tunable laser sources that can be operated at selected wavelengths to achieve both transcutaneous differential absorption measurements of bilirubin concentration in addition to laser photoradiation therapy. The new laser system can allow the treating physician to avoid over or under treatment of jaundiced neonates by the control of serum bilirubin from a critically high level to a reasonably safe level.

Spatio-temporal characterisation of a 100 kHz 24 W sub-3-cycle NOPCPA laser system

NASA Astrophysics Data System (ADS)

Witting, Tobias; Furch, Federico J.; Vrakking, Marc J. J.

2018-04-01

In recent years, OPCPA and NOPCPA laser systems have shown the potential to supersede Ti:sapphire plus post-compression based laser systems to drive next generation attosecond light sources via direct amplification of few-cycle pulses to high pulse energies at high repetition rates. In this paper, we present a sub 3-cycle, 100 kHz, 24 W NOPA laser system and characterise its spatio-temporal properties using the SEA-F-SPIDER technique. Our results underline the importance of spatio-temporal diagnostics for these emerging laser systems.

Material Processing with High Power CO2-Lasers

NASA Astrophysics Data System (ADS)

Bakowsky, Lothar

1986-10-01

After a period of research and development lasertechnique now is regarded as an important instrument for flexible, economic and fully automatic manufacturing. Especially cutting of flat metal sheets with high power C02-lasers and CNC controlled two or three axes handling systems is a wide spread. application. Three dimensional laser cutting, laser-welding and -heat treatment are just at the be ginning of industrial use in production lines. The main. advantages of laser technology. are - high. accuracy - high, processing velocity - law thermal distortion. - no tool abrasion. The market for laser material processing systems had 1985 a volume of 300 Mio S with growth rates between, 20 % and 30 %. The topic of this lecture are hiTrh. power CO2-lasers. Besides this systems two others are used as machining tools, Nd-YAG- and Eximer lasers. All applications of high. power CO2-lasers to industrial material processing show that high processing velocity and quality are only guaranteed in case of a stable intensity. profile on the workpiece. This is only achieved by laser systems without any power and mode fluctuations and by handling systems of high accuracy. Two applications in the automotive industry are described, below as examples for laser cutting and laser welding of special cylindrical motor parts.

Fiber coupled optical spark delivery system

DOEpatents

Yalin, Azer; Willson, Bryan; Defoort, Morgan

2008-08-12

A spark delivery system for generating a spark using a laser beam is provided, the spark delivery system including a laser light source and a laser delivery assembly. The laser delivery assembly includes a hollow fiber and a launch assembly comprising launch focusing optics to input the laser beam in the hollow fiber. In addition, the laser delivery assembly includes exit focusing optics that demagnify an exit beam of laser light from the hollow fiber, thereby increasing the intensity of the laser beam and creating a spark. In accordance with embodiments of the present invention, the assembly may be used to create a spark in a combustion engine. In accordance with other embodiments of the present invention, a method of using the spark delivery system is provided. In addition, a method of choosing an appropriate fiber for creating a spark using a laser beam is also presented.

Laser technologies in ophthalmic surgery

NASA Astrophysics Data System (ADS)

Atezhev, V. V.; Barchunov, B. V.; Vartapetov, S. K.; Zav'yalov, A. S.; Lapshin, K. E.; Movshev, V. G.; Shcherbakov, I. A.

2016-08-01

Excimer and femtosecond lasers are widely used in ophthalmology to correct refraction. Laser systems for vision correction are based on versatile technical solutions and include multiple hard- and software components. Laser characteristics, properties of laser beam delivery system, algorithms for cornea treatment, and methods of pre-surgical diagnostics determine the surgical outcome. Here we describe the scientific and technological basis for laser systems for refractive surgery developed at the Physics Instrumentation Center (PIC) at the Prokhorov General Physics Institute (GPI), Russian Academy of Sciences.

Laser Technology in Interplanetary Exploration: The Past and the Future

NASA Technical Reports Server (NTRS)

Smith, David E.

2000-01-01

Laser technology has been used in planetary exploration for many years but it has only been in the last decade that laser altimeters and ranging systems have been selected as flight instruments alongside cameras, spectrometers, magnetometers, etc. Today we have an active laser system operating at Mars and another destined for the asteroid Eros. A few years ago a laser ranging system on the Clementine mission changed much of our thinking about the moon and in a few years laser altimeters will be on their way to Mercury, and also to Europa. Along with the increased capabilities and reliability of laser systems has came the realization that precision ranging to the surface of planetary bodies from orbiting spacecraft enables more scientific problems to be addressed, including many associated with planetary rotation, librations, and tides. In addition, new Earth-based laser ranging systems working with similar systems on other planetary bodies in an asynchronous transponder mode will be able to make interplanetary ranging measurements at the few cm level and will advance our understanding of solar system dynamics and relativistic physics.

Coherent Laser Radar System Theory.

DTIC Science & Technology

1987-11-05

This program is aimed at developing a system theory for the emerging technology of multifunction coherent CO2 laser radars. It builds upon previous...work funded by U.S. Army Research Office contract DAAG29-80-K-0022. Keywords include: Laser radar theory, Radar system theory , and Laser speckle.

Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery.

PubMed

Song, Minju; Kim, Hyeon-Cheol; Lee, Woocheol; Kim, Euiseong

2011-11-01

This study examined the clinical causes of failure and the limitation of a previous endodontic treatment by an inspection of the root apex and resected root surface at 26× magnification during endodontic microsurgery. The data were collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and January 2011. All root-filled cases with symptomatic or asymptomatic apical periodontitis were enrolled in this study. All surgical procedures were performed by using an operating microscope. The surface of the apical root to be resected or the resected root surface after methylene blue staining was examined during the surgical procedure and recorded carefully with 26× magnification to determine the state of the previous endodontic treatment by using an operating microscope. Among the 557 cases with periapical surgery, 493 teeth were included in this study. With the exclusion of unknown cases, the most common possible cause of failure was perceived leakage around the canal filling material (30.4%), followed by a missing canal (19.7%), underfilling (14.2%), anatomical complexity (8.7%), overfilling (3.0%), iatrogenic problems (2.8%), apical calculus (1.8%), and cracks (1.2%). The frequency of possible failure causes differed according to the tooth position (P < .001). An appreciation of the root canal anatomy by using an operating microscope in nonsurgical endodontic treatment can make the prognosis more predictable and favorable. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches.

PubMed

Noudel, R; Gomis, P; Duntze, J; Marnet, D; Bazin, A; Roche, P H

2009-08-01

Therapeutic options for vestibular schwannomas (VS) include microsurgery, stereotactic radiosurgery and conservative management. Early treatment of intracanalicular vestibular schwannomas (IVS) may be advisable because their spontaneous course will show hearing loss in most cases. Advanced microsurgical techniques and continuous intraoperative monitoring of cranial nerves may allow hearing preservation (HP) without facial nerve damage. However, there are still controversies about the definition of hearing preservation, and the best surgical approach that should be used. In this study, we reviewed the main data from the recent literature on IVS surgery and compared hearing, facial function and complication rates after the retrosigmoid (RS) and middle fossa (MF) approaches, respectively. The results showed that the average HP rate after IVS surgery ranged from 58% (RS) to 62% (MF). HP varied widely depending on the audiometric criteria that were used for definition of serviceable hearing. There was a trend to show that the MF approach offered a better quality of postoperative hearing (not statistically significant), whereas the RS approach offered a better facial nerve preservation and fewer complications (not statistically significant). We believe that the timing of treatment in the course of the disease and selection between radiosurgical versus microsurgical procedure are key issues in the management of IVS. Preservation of hearing and good facial nerve function in surgery for VS is a reasonable goal for many patients with intracanalicular tumors and serviceable hearing. Once open surgery has been decided, selection of the approach mainly depends on individual anatomical considerations and experience of the surgeon.

Trends in Accreditation Council for Graduate Medical Education Accreditation for Subspecialty Fellowship Training in Plastic Surgery.

PubMed

Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

2018-05-01

The purposes of this study were to (1) determine the proportion of plastic surgery residents pursuing subspecialty training relative to other surgical specialties, and (2) analyze trends in Accreditation Council for Graduate Medical Education accreditation of plastic surgery subspecialty fellowship programs. The American Medical Association provided data on career intentions of surgical chief residents graduating from 2014 to 2016. The percentage of residents pursuing fellowship training was compared by specialty. Trends in the proportion of accredited fellowship programs in craniofacial surgery, hand surgery, and microsurgery were analyzed. The percentage of accredited programs was compared between subspecialties with added-certification options (hand surgery) and subspecialties without added-certification options (craniofacial surgery and microsurgery). Most integrated and independent plastic surgery residents pursued fellowship training (61.8 percent versus 49.6 percent; p = 0.014). Differences existed by specialty from a high in orthopedic surgery (90.8 percent) to a low in colon and rectal surgery (3.2 percent). From 2005 to 2015, the percentage of accredited craniofacial fellowship programs increased, but was not significant (from 27.8 percent to 33.3 percent; p = 0.386). For hand surgery, the proportion of accredited programs that were plastic surgery (p = 0.755) and orthopedic surgery (p = 0.253) was stable, whereas general surgery decreased (p = 0.010). Subspecialty areas with added-certification options had more accredited fellowships than those without (100 percent versus 19.2 percent; p < 0.001). There has been slow adoption of accreditation among plastic surgery subspecialty fellowships, but added-certification options appear to be highly correlated.

The impact of new technology on surgery for colorectal cancer

PubMed Central

Makin, Gregory B; Breen, David J; Monson, John RT

2001-01-01

Advances in technology continue at a rapid pace and affect all aspects of life, including surgery. We have reviewed some of these advances and the impact they are having on the investigation and management of colorectal cancer. Modern endoscopes, with magnifying, variable stiffness and localisation capabilities are making the primary investigation of colonic cancer easier and more acceptable for patients. Imaging investigations looking at primary, metastatic and recurrent disease are shifting to digital data sets, which can be stored, reviewed remotely, potentially fused with other modalities and reconstructed as 3 dimensional (3D) images for the purposes of advanced diagnostic interpretation and computer assisted surgery. They include virtual colonoscopy, trans-rectal ultrasound, magnetic resonance imaging, positron emission tomography and radioimmunoscintigraphy. Once a colorectal carcinoma is diagnosed, the treatment options available are expanding. Colonic stents are being used to relieve large bowel obstruction, either as a palliative measure or to improve the patient’s overall condition before definitive surgery. Transanal endoscopic microsurgery and minimally invasive techniques are being used with similar outcomes and a lower mortality, morbidity and hospital stay than open trans-abdominal surgery. Transanal endoscopic microsurgery allows precise excision of both benign and early malignant lesions in the mid and upper rectum. Survival of patients with inoperable hepatic metastases following radiofrequency ablation is encouraging. Robotics and telemedicine are taking surgery well into the 21st century. Artificial neural networks are being developed to enable us to predict the outcome for individual patients. New technology has a major impact on the way we practice surgery for colorectal cancer. PMID:11819841

Sodium Fluorescein-Guided Resection under the YELLOW 560 nm Surgical Microscope Filter in Malignant Gliomas: Our First 38 Cases Experience

PubMed Central

Tian, Hailong; Huang, Dezhang; Meng, Xianbing; Guo, Wenqiang; Wang, Chaochao; Yin, Xin; Zhang, Hongying; Jiang, Bin; He, Zheng

2017-01-01

Objective Sodium fluorescein (FL) had been safely used in fluorescence-guided microsurgery for imaging various brain tumors. Under the YELLOW 560 nm surgical microscope filter, low-dose FL as a fluorescent dye helps in visualization. Our study investigated the safety and efficacy of this innovative technique in malignant glioma (MG) patients. Patients and Method 38 patients suffering from MGs confirmed by pathology underwent FL-guided resection under YELLOW 560 nm surgical microscope filter. We retrospectively analyzed the clinical characters, microsurgery procedure, extent of resection, pathology of MGs, progression-free survival (PFS), and overall survival (OS). Results Thirty-eight patients had MGs (10 WHO grade III, 28 WHO grade IV). With YELLOW 560 nm surgical microscope filter combined with neuronavigation, sodium fluorescein-guided gross total resection (GTR) was achieved in 35 (92.1%) patients and subtotal resection in 3 (7.69%). The sensitivity and specificity of FL were 94.4% and 88.6% regardless of radiographic localization. Intraoperatively, 10 biopsies (10/28 FL[+]) showed “low” or “high” fluorescence in non-contrast-enhancement region and are also confirmed by pathology. Our data showed 6-month PFS of 92.3% and median survival of 11 months. Conclusion FL-guided resection of MGs under the YELLOW 560 nm surgical microscope filter combined with neuronavigation was safe and effective, especially in non-contrast-MRI regions. It is feasible for improving the extent of resection in MGs especially during emergency cases. PMID:29124069

Gamma Knife radiosurgery for hemangioma of the cavernous sinus.

PubMed

Lee, Cheng-Chia; Sheehan, Jason P; Kano, Hideyuki; Akpinar, Berkcan; Martinez-Alvarez, Roberto; Martinez-Moreno, Nuria; Guo, Wan-Yuo; Lunsford, L Dade; Liu, Kang-Du

2017-05-01

OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare vascular tumors. A direct microsurgical approach usually results in massive hemorrhage and incomplete tumor resection. Although stereotactic radiosurgery (SRS) has emerged as a therapeutic alternative to microsurgery, outcome studies are few. Authors of the present study evaluated the role of SRS for CSH. METHODS An international multicenter study was conducted to review outcome data in 31 patients with CSH. Eleven patients had initial microsurgery before SRS, and the other 20 patients (64.5%) underwent Gamma Knife SRS as the primary management for their CSH. Median age at the time of radiosurgery was 47 years, and 77.4% of patients had cranial nerve dysfunction before SRS. Patients received a median tumor margin dose of 12.6 Gy (range 12-19 Gy) at a median isodose of 55%. RESULTS Tumor regression was confirmed by imaging in all 31 patients, and all patients had greater than 50% reduction in tumor volume at 6 months post-SRS. No patient had delayed tumor growth, new cranial neuropathy, visual function deterioration, adverse radiation effects, or hypopituitarism after SRS. Twenty-four patients had presented with cranial nerve disorders before SRS, and 6 (25%) of them had gradual improvement. Four (66.7%) of the 6 patients with orbital symptoms had symptomatic relief at the last follow-up. CONCLUSIONS Stereotactic radiosurgery was effective in reducing the volume of CSH and attaining long-term tumor control in all patients at a median of 40 months. The authors' experience suggests that SRS is a reasonable primary and adjuvant treatment modality for patients in whom a CSH is diagnosed.

[How much pressure is applied on the eye balls during craniotomy?: Measurement with FlexiForce contact surface force sensor].

PubMed

Okada, Takeshi; Ishikawa, Tatsuya; Nishimura, Hiromi; Suzuki, Akifumi

2012-12-01

Visual loss following craniotomy is a serious postoperative complication in which elevation of ocular pressure during retraction of the skin flap may cause retinal ischemia. We reported that continuous monitoring of extraocular pressure with the FlexiForce sensor may avoid excessive skin flap retraction during craniotomy and thus prevent ocular complications. Between January 2008 and December 2011, we analyzed data from 46 consecutive patients for whom continuous monitoring of extraocular pressure with FlexiForce sensor was performed. This sensor continuously displays the compressive force, allowing surgeons to check values on the monitor at any time. An alarm sounds if 50 gf is exceeded. We analyzed the temporal course of extraocular pressure and the relationship with patient characteristics. No visual complications were encountered in this patient series. Maximum compressive force during craniotomy was 35.8±27.2 gf, with increases typically seen when surgeons used hooks or drills. However, due to the alarm, no prolonged periods of high force were noted in any patient. Effective methods for reducing force were: (1) taking off hooks on the compressive side; (2) changing the direction of hook tension; and (3) placing cushions such as gauze under the side of the skin flap. Maximum compressive force during microsurgery was 21.8±18.4 gf, and correlated with the beginning force of microsurgery. Compressive force was greatly reduced compared to the force reported previously. The etiologies of visual disability are not fully understood, but this sensor may be helpful in reducing extraocular compression.

Systematic Review of Factors Influencing Surgical Performance: Practical Recommendations for Microsurgical Procedures in Neurosurgery.

PubMed

Belykh, Evgenii; Onaka, Naomi R; Abramov, Irakliy T; Yağmurlu, Kaan; Byvaltsev, Vadim A; Spetzler, Robert F; Nakaj, Peter; Preul, Mark C

2018-04-01

Microneurosurgical techniques involve complex manual skills and hand-eye coordination that require substantial training. Many factors affect microneurosurgical skills. The goal of this study was to use a systematic evidence-based approach to analyze the quality of evidence for intrinsic and extrinsic factors that influence microneurosurgical performance and to make weighted practical recommendations. A literature search of factors that may affect microsurgical performance was conducted using PubMed and Embase. The criteria for inclusion were established in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) statement. Forty-eight studies were included in the analysis. Most of the studies used surgeons as participants. Most used endoscopic surgery simulators to assess skills, and only 12 studies focused on microsurgery. This review provides 18 practical recommendations based on a systematic literature analysis of the following 8 domains: 1) listening to music before and during microsurgery, 2) caffeine consumption, 3) β-blocker use, 4) physical exercise, 5) sleep deprivation, 6) alcohol consumption before performing surgery, 7) duration of the operation, and 8) the ergonomic position of the surgeon. Despite the clear value of determining the effects of various factors on surgical performance, the available body of literature is limited, and it is not possible to determine standards for each surgical field. These recommendations may be used by neurosurgical trainees and practicing neurosurgeons to improve microsurgical performance and acquisition of microsurgical skills. Randomized studies assessing the factors that influence microsurgical performance are required. Copyright © 2018 Elsevier Inc. All rights reserved.

Effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory: a prospective cohort study.

PubMed

Chung, Joonho; Seok, Jeong-Ho; Kwon, Min A; Kim, Yong Bae; Joo, Jin-Yang; Hong, Chang-Ki

2016-01-01

We prospectively evaluated the effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory. Between March 2012 and June 2013, 56 patients were recruited for this study. Fifty-one patients met the inclusion criteria and were enrolled. Inclusion criteria were as follows: (1) age ≤65 years and (2) planned microsurgery or endovascular surgery for unruptured intracranial aneurysm. Exclusion criteria were as follows: (1) preoperative intelligence quotient <80 (n = 3); (2) initial modified Rankin scale ≥1 (n = 1); (3) loss to follow-up (n = 1). An auditory controlled continuous performance test (ACCPT), word-color test (WCT) and verbal learning test (VLT) were performed before and after (6 months) preventive surgery. ACCPT (attention), WCT (executive function) and VLT (learning and memory) scores did not change significantly between the pre- and postoperative evaluations. The ACCPT, WCT, total VLT scores (verbal learning) and delayed VLT scores (memory) did not differ significantly between patients undergoing microsurgery and those undergoing endovascular surgery. However, ACCPT, WCT and delayed VLT scores decreased postoperatively in patients with leukoaraiosis on preoperative FLAIR images (OR 9.899, p = 0.041; OR 11.421, p = 0.006; OR 2.952, p = 0.024, respectively). Preventive surgery for unruptured intracranial aneurysms did not affect attention, executive function, learning or memory. However, patients with leukoaraiosis on FLAIR images might be prone to deficits in attention, executive function and memory postoperatively, whereas learning might not be affected.

Analysis of 10-Year Training Results of Medical Students Using the Microvascular Research Center Training Program.

PubMed

Onoda, Satoshi; Kimata, Yoshihiro; Sugiyama, Narushi; Tokuyama, Eijiro; Matsumoto, Kumiko; Ota, Tomoyuki; Thuzar, Moe

2016-06-01

Background In this article, we reviewed the training results of medical students using the Microvascular Research Center Training Program (MRCP), and proposed an ideal microsurgical training program for all individuals by analyzing the training results of medical students who did not have any surgical experience. Methods As of 2015, a total of 29 medical students completed the MRCP. In the most recent 12 medical students, the number of trials performed for each training stage and the number of rats needed to complete the training were recorded. Additionally, we measured the operating time upon finishing stage 5 for the recent six medical students after it became a current program. Results The average operating time upon finishing stage 5 for the recent six medical students was 120 minutes ± 11 minutes (standard deviation [SD]). The average vascular anastomosis time (for the artery and vein) was 52 minutes ± 2 minutes (SD). For the most recent 12 medical students, there was a negative correlation between the number of trials performed in the non-rat stages (stages 1-3) and the number of rats used in the rat stages (stages 4-5). Conclusion Analysis of the training results of medical students suggests that performing microsurgery first on silicon tubes and chicken wings saves animals' lives later during the training program. We believe that any person can learn the technique of microsurgery by performing 7 to 8 hours of training per day over a period of 15 days within this program setting. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Can rotational thromboelastometry predict thrombotic complications in reconstructive microsurgery?

PubMed

Kolbenschlag, Jonas; Daigeler, Adrien; Lauer, Sarah; Wittenberg, Gerhard; Fischer, Sebastian; Kapalschinski, Nicolai; Lehnhardt, Marcus; Goertz, Ole

2014-05-01

Thrombotic occlusion of the microvascular pedicle is the major reason for flap loss. Thus, identifying patients who are at risk for such events is paramount. Rotational thromboelastometry (RTE) is widely used to detect coagulopathy and hypercoagulable states. The aim of our study was to assess its diagnostic value in reconstructive microsurgery. In all 181 patients undergoing free tissue transfer at our department between February 2010 and November 2011 preoperative RTE was performed. In addition, coagulation values as well as patient's demographic data, cause and localization of defect, type of flap and surgical revisions were recorded. The majority of patients was male (59.6%) with traumatic (59.7%) defects located on the lower extremity (60.3%). ALT was the most often used flap (35.9%). Preoperatively, 36.5% of patients had a hypercoagulable RTE (higher than physiological RTE values; intrinsic (ICPT) or extrinsic (ECPT) mean clot firmness (MCF) >72mm or functional fibrinogen (ICF) MCF >25mm). A total of 28 primary thrombosis of the microvascular pedicle occurred, 11 of those in-patients with a hypercoagulable state. Total flap loss rate because ofthrombosis was 7.7% (n = 14). Both a hypercoagulable RTE assay and a functional fibrinogen to platelet ratio (FPR) of >43 (MCF value of ICF divided by the MCF value of ICPT) were significant predictors of thrombotic flap loss when performing multivariate binary logistic regression, co-factoring for age, sex, and comorbidities (p = 0.036 and 0.003, respectively). RTE seems to be able to identify patients that are prone to thrombotic complications and might be used as a screening tool. Copyright © 2013 Wiley Periodicals, Inc.

[Vascularloops in reconstructive microsurgery: A review of the literature].

PubMed

Shipkov, H; Traikova, N; Voinov, P; Boucher, F; Braye, F; Mojallal, A

2014-02-01

The success of free tissue transfer depends on the quality of vascular micro-anastomosis and recipient vessels. Adequate recipient vessels are sometimes not available near the recipient site for they can be either destroyed or of poor quality (radiotherapy, traumatism). In such cases, good quality recipient vessels are at a distance from the reconstructed site. If this distance is important flap pedicle lengthening implies - for the artery, for the vein or for both flap artery and vein. This lengthening can be carried out in two manners - by interpositional vein grafts (VG) or by a vascular loop (VL) in one or two stages. The aim of this study was to review the utilisation of VL and their type since their introduction in the clinical practice of reconstructive microsurgery. Two main types of VL are used - BV by VG and VL "in situ". Both of them can be carried out in one or two stages. Each of these techniques has its advantages and disadvantages. The overall data from the literature shows that VL are indicated in cases where both artery and vein are damaged or destroyed. There is not enough evidence concerning the VL in one or two stages but there are some tendencies in favour of the VL in one stage. The technique of VL seems to be more avantageous over the interpositional VG but with a smaller success rate compared to free-flaps with direct anastomosis to recipient vessels. Further studies are necessary to investigate these controversial questions. Copyright © 2013. Published by Elsevier SAS.

Microsurgery in 46 cases with total hand degloving injury.

PubMed

Ju, Jihui; Li, Jianning; Hou, Ruixing

2015-10-01

To summarize the characteristics of total hand degloving injury and investigate the curative effect of microsurgery. A total of 46 patients with total hand degloving injury were enrolled in this study. The injury classification and treatment methods were as follows: Type I (11 cases), treated by replantation of the gloved skin; Type II (6 cases), treated by reconstruction using thumb wrap-around flap and second toe; Type III (4 cases), treated by reconstruction using bilateral second toe with dorsal foot flap; Type IV (9 cases), treated by replantation in situ or reconstruction; Type V (16 cases), treated by replantation or abdominal flap reconstruction. Of the patients who received Type I treatment, five completely survived, whereas eight had finger necrosis. In Type II, both the reconstructed fingers and hand flaps survived. For four patients who received Type III treatment, eight reconstructed fingers survived. In Type IV, two patients with reconstructed fingers survived, whereas the six with replantation in situ had necrosis of the partial palmar or hand dorsum skin. In Type V, nine patients with reconstructed fingers survived, and five cases with abdominal skin flap reconstruction and one case with anterolateral femoral flap survived. The restoration of hand appearance and function was the best in patients who received replantation. For reconstruction cases, however, the hand function was recovered to the basic self-care level. In cases with abdominal flap reconstruction, the hand function showed poor recovery. Total hand degloving injury can be classified into different types according to the injury degree. The appropriate microsurgical treatment based on these types can produce better curative effect. Copyright © 2015. Published by Elsevier Taiwan.

Long-term Auditory Symptoms in Patients With Sporadic Vestibular Schwannoma: An International Cross-Sectional Study.

PubMed

Tveiten, Oystein Vesterli; Carlson, Matthew L; Goplen, Frederik; Vassbotn, Flemming; Link, Michael J; Lund-Johansen, Morten

2015-08-01

There are limited data on the long-term auditory symptoms in patients with sporadic small- and medium-sized vestibular schwannoma (VS). The initial treatment strategy for VS is controversial. To characterize auditory symptoms in a large cohort of patients with VS. Patients with ≤3 cm VS who underwent primary microsurgery, gamma knife surgery, or observation between 1998 and 2008 at 2 independent hospitals were identified. Clinical data were extracted from existing VS databases. At a mean time of 7.7 years after initial treatment, patients were surveyed via mail with the use of the Hearing Handicap Inventory for Adults (HHIA) and the Tinnitus Handicap Inventory. The response rate was 79%; a total of 539 respondents were analyzed. Overall, the hearing prognosis was poor, because more than 75% of all patients had nonserviceable hearing at the last clinical follow-up. Good baseline hearing proved to be a strong predictor for maintained serviceable hearing. Treatment modality was independently associated with both audiometric outcome and HHIA results. Active treatment with microsurgery or gamma knife surgery did not appear to be protective, because patients who were observed had the greatest probability of durable hearing. Patients in the surgical series had the greatest hearing loss. Tinnitus Handicap Inventory results were less predictable. The only predictors of tinnitus handicap were age and HHIA score. The overall prognosis for hearing in sporadic VS is poor regardless of treatment strategy. Treatment modality was an independent predictor of hearing status; observation was associated with the highest rate of hearing preservation. .

Microsurgery Versus Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Matched Cohort Study.

PubMed

Chen, Ching-Jen; Ding, Dale; Wang, Tony R; Buell, Thomas J; Ilyas, Adeel; Ironside, Natasha; Lee, Cheng-Chia; Kalani, M Yashar; Park, Min S; Liu, Kenneth C; Sheehan, Jason P

2018-05-12

Microsurgery (MS) and stereotactic radiosurgery (SRS) remain the preferred interventions for the curative treatment of brain arteriovenous malformations (AVM), but their relative efficacy remains incompletely defined. To compare the outcomes of MS to SRS for AVMs through a retrospective, matched cohort study. We evaluated institutional databases of AVM patients who underwent MS and SRS. MS-treated patients were matched, in a 1:1 ratio based on patient and AVM characteristics, to SRS-treated patients. Statistical analyses were performed to compare outcomes data between the 2 cohorts. The primary outcome was defined as AVM obliteration without a new permanent neurological deficit. The matched MS and SRS cohorts were each comprised of 59 patients. Both radiological (85 vs 11 mo; P < .001) and clinical (92 vs 12 mo; P < .001) follow-up were significantly longer for the SRS cohort. The primary outcome was achieved in 69% of each cohort. The MS cohort had a significantly higher obliteration rate (98% vs 72%; P = .001), but also had a significantly higher rate of new permanent deficit (31% vs 10%; P = .011). The posttreatment hemorrhage rate was significantly higher for the SRS cohort (10% for SRS vs 0% for MS; P = .027). In subgroup analyses of ruptured and unruptured AVMs, no significant differences between the primary outcomes were observed. For patients with comparable AVMs, MS and SRS afford similar rates of deficit-free obliteration. Nidal obliteration is more frequently achieved with MS, but this intervention also incurs a greater risk of new permanent neurological deficit.

Incidence, treatment and outcome of rectal stenosis following transanal endoscopic microsurgery.

PubMed

Barker, J A; Hill, J

2011-09-01

As an alternative to more radical abdominal surgery, transanal endoscopic microsurgery (TEM) offers a minimally invasive solution for the excision of certain rectal polyps and early-stage rectal tumours. The patient benefits of TEM as compared to radical abdominal surgery are clear; nevertheless, some drawback is possible. The aim of our study was to determine the risk factors, treatment and outcomes of rectal stenosis following TEM. We analysed a series of 354 consecutive patients who underwent TEM for benign or malignant rectal tumours between 1997 and 2009. We recorded the maximum histological diameter of the lesion, and whether the lesion was circumferential. Rectal stenosis was defined as a rectal narrowing not allowing passage of a 12 mm sigmoidoscope. Histological results with a measured specimen diameter were available in 304 of the 354 cases. There were 11 stenoses in total (3.6%), 7 stenoses due to 9 circumferential lesions (78%) and 4 due to lesions with a maximum diameter ≥ 5 cm (3.2%). Two patients presented as emergencies, and the other 9 patients reported symptoms of increased stool frequency at follow-up. Three of the stenoses were associated with recurrent disease. All stenoses were treated by a combination of endoscopic/radiological balloon dilatation or surgically with Hegar's dilators. A median of two procedures were required to treat stenoses until resolution of symptoms. Rectal stenosis following TEM excision is rare. It is predictable in patients with circumferential lesions but is rare in patients with non-circumferential lesions with a maximum diameter ≥ 5 cm. It is effectively treated with surgical or balloon dilatation. Most patients require repeated treatments.

Laser-induced damage threshold of camera sensors and micro-opto-electro-mechanical systems

NASA Astrophysics Data System (ADS)

Schwarz, Bastian; Ritt, Gunnar; Körber, Michael; Eberle, Bernd

2016-10-01

The continuous development of laser systems towards more compact and efficient devices constitutes an increasing threat to electro-optical imaging sensors such as complementary metal-oxide-semiconductors (CMOS) and charge-coupled devices (CCD). These types of electronic sensors are used in day-to-day life but also in military or civil security applications. In camera systems dedicated to specific tasks, also micro-opto-electro-mechanical systems (MOEMS) like a digital micromirror device (DMD) are part of the optical setup. In such systems, the DMD can be located at an intermediate focal plane of the optics and it is also susceptible to laser damage. The goal of our work is to enhance the knowledge of damaging effects on such devices exposed to laser light. The experimental setup for the investigation of laser-induced damage is described in detail. As laser sources both pulsed lasers and continuous-wave (CW) lasers are used. The laser-induced damage threshold (LIDT) is determined by the single-shot method by increasing the pulse energy from pulse to pulse or in the case of CW-lasers, by increasing the laser power. Furthermore, we investigate the morphology of laser-induced damage patterns and the dependence of the number of destructed device elements on the laser pulse energy or laser power. In addition to the destruction of single pixels, we observe aftereffects like persisting dead columns or rows of pixels in the sensor image.

Laser material processing system

DOEpatents

Dantus, Marcos

2015-04-28

A laser material processing system and method are provided. A further aspect of the present invention employs a laser for micromachining. In another aspect of the present invention, the system uses a hollow waveguide. In another aspect of the present invention, a laser beam pulse is given broad bandwidth for workpiece modification.

Intravital multiphoton fluorescence imaging and optical manipulation of spinal cord in mice, using a compact fiber laser system.

PubMed

Oshima, Yusuke; Horiuch, Hideki; Honkura, Naoki; Hikita, Atsuhiko; Ogata, Tadanori; Miura, Hiromasa; Imamura, Takeshi

2014-09-01

Near-infrared ultrafast lasers are widely used for multiphoton excited fluorescence microscopy in living animals. Ti:Sapphire lasers are typically used for multiphoton excitation, but their emission wavelength is restricted below 1,000 nm. The aim of this study is to evaluate the performance of a compact Ytterbium-(Yb-) fiber laser at 1,045 nm for multiphoton excited fluorescence microscopy in spinal cord injury. In this study, we employed a custom-designed microscopy system with a compact Yb-fiber laser and evaluated the performance of this system in in vivo imaging of brain cortex and spinal cord in YFP-H transgenic mice. For in vivo imaging of brain cortex, sharp images of basal dendrites, and pyramidal cells expressing EYFP were successfully captured using the Yb-fiber laser in our microscopy system. We also performed in vivo imaging of axon fibers of spinal cord in the transgenic mice. The obtained images were almost as sharp as those obtained using a conventional ultrafast laser system. In addition, laser ablation and multi-color imaging could be performed simultaneously using the Yb-fiber laser. The high-peak pulse Yb-fiber laser is potentially useful for multimodal bioimaging methods based on a multiphoton excited fluorescence microscopy system that incorporates laser ablation techniques. Our results suggest that microscopy systems of this type could be utilized in studies of neuroscience and clinical use in diagnostics and therapeutic tool for spinal cord injury in the future. © 2014 Wiley Periodicals, Inc.

Modematic: a fast laser beam analyzing system for high power CO2-laser beams

NASA Astrophysics Data System (ADS)

Olsen, Flemming O.; Ulrich, Dan

2003-03-01

The performance of an industrial laser is very much depending upon the characteristics of the laser beam. The ISO standards 11146 and 11154 describing test methods for laser beam parameters have been approved. To implement these methods in industry is difficult and especially for the infrared laser sources, such as the CO2-laser, the availabl analyzing systems are slow, difficult to apply and having limited reliability due to the nature of the detection methods. In an EUREKA-project the goal was defined to develop a laser beam analyzing system dedicated to high power CO2-lasers, which could fulfill the demands for an entire analyzing system, automating the time consuming pre-alignment and beam conditioning work required before a beam mode analyses, automating the analyzing sequences and data analysis required to determine the laser beam caustics and last but not least to deliver reliable close to real time data to the operator. The results of this project work will be described in this paper. The research project has led to the development of the Modematic laser beam analyzer, which is ready for the market.