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PubMedDate not supplied

[Augmentation of VDS (ventral derotation spondylodesis) using double rod instrumentation: surgical method and early results].

INTRODUCTION AND AIM OF THE STUDY: The advantages of the VDS according to Zielke with excellent three dimensional correction and shorter fusion levels in comparison to posterior instrumentation techniques are well known. A disadvantage is the postoperatively necessary long immobilisation in a body cast due to lack of primary stability. Aim of the presented double-rod-VDS is to optimize the system by augmentation and allow a postoperative plaster cast- and brace-free treatment. METHOD AND MATERIAL: Following thoracolumbar phrenotomy and ligation of the segmental vessels Kaneda-clamps are inserted. First VDS-screws are implanted into the posterior holes of these clamps. Using a M-4 compression rod, correction is obtained by centripetal compressive forces to the nuts. Next VDS-screws for the M-5 treated rod are inserted into the anterior holes of the Kaneda clamps. The rod is implanted in a slightly compressive manner and augments the system. Within a prospective study 12 patients with idiopathic and neuromuscular scoliosis underwent this surgical procedure. Three patients with thoracolumbar scoliosis have been followed for 12 months postoperatively and are presented as case reports. All patients were treated brace-free postoperatively, only using a semi-elastic vest for 4 months. RESULTS: Remarkable intra- and postoperative complications have not been noted. Curve correction ranged from 75 to 86%. Implant related complications and loss of correction have not been noted so far. The sagittal plane was within physiological limits postoperatively. Scanning stereography demonstrated excellent three dimensional correction. CONCLUSION: The results of the Double-rod-VDS allow the statement, that the advantages of the VDS according to Zielke are optimized by augmentation of the system with the possibility of plaster cast and brace-free postoperative treatment. Larger operation numbers and a longer follow-up period are needed for further assessment.

Adolescent↗
PubMed1992

[Universal hip fixator "Zespol". Construction of the fixator, principles of function, instrumentation, surgical technique, indications and results of treatment].

The construction and principles of function of hip fixator based on Zespol method, with compression of the fragments provided by elastic deformation of a plate is presented. Original instrumentation, operative technique and indications for this type of osteosynthesis is described. Results analysis revealed that out of 64 patients 10 died within 6 month from surgery, all of them older than 80 years of age. In 46 from remaining 56 patients a union of fractured bone was found. There were 82.2% of good results in patients with femoral neck fracture and 87.5% in the group with trochanteric fractures. Few complications produces hope for Zespol hip fixator to become valuable device for treatment both trochanteric and femoral neck fractures.

Adult↗
PubMed1998

Minimally invasive cardiac surgery in the adult: surgical instruments, equipment, and techniques.

To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.

Adult↗
PubMed2000

[A new cardiovascular surgical instrument: cannula stabilizer].

A new instrument has been developed to safely keep the venous cannula out of the operative field during open heart surgery. This instrument is designed for holding the venous cannula in a curved state at a desired angle. It consists of four semicircular claws mounted on a bar. The size of the claws is tailored so that they comfortably accommodate the standard-size two-stage venous cannula. The bar is flexible enough to be bent manually to form the required curvature, and at the same time it is strong enough to resist the self-uncoiling force of the cannula. When in use, the bar is bent to form the desired curvature and then it is placed on the required portion of the venous cannula. The angle of its curvature and its location on the cannula can be adjusted easily as required during the course of the operative procedure. With this instrument the venous cannula can be easily held in a curved state without disturbing venous return so that the cannula does not come into the way of the surgeon's hands.

Cardiovascular Surgical Procedures↗
PubMed1994

Ultrasound guided endoscopic neurosurgery--new surgical instrument and technique.

For minimal invasive endoscopic neurosurgery, a mini-caliber endoscope equipped with a useful working channel and its guidance system is basically essential. We developed the device for ultrasound guided endoscopic neurosurgery. A minicaliber fiberscope with an outer diameter of 3.4 mm equipped with 2.5 mm of working channel for forceps, suction, and coagulation probe was developed. A 5 MHz phase arrayed 12 mm ultrasound probe was used as guidance system. A fixation device for the mini-caliber fiberscope and ultrasound probe was also constructed. The surgical procedure is very simple, and can be performed through a 2 cm burr hole. Real-time and a directly visualized image might provide more safety and reliability during brain surgery.

Brain Diseases↗
PubMed2002

Learning to use minimal access surgical instruments and 2-dimensional remote visual feedback: how difficult is the task for novices?

Performing minimal access surgery requires the use of 2-dimensional information to produce 3-dimensional movements, as well as precise motor control for manipulating laparoscopic tools. The added visuomotor demands of this task make it more demanding and complex than traditional open surgery. The purpose of this study was to determine the relative task difficulty of performing laparoscopic tool movements with normal vision or 'laparoscopic vision' provided by a remote 2-D monitor. A second purpose of this study was to evaluate whether movement performance changes are induced by practice with normal vision (NV) and laparoscopic vision (LV). The study was also designed to determine whether order of visual condition (NV or LV) practice impacts the rate of performance acquisition when transferred to the opposing visual condition. Eleven individuals participated in this study. All subjects performed a bean grasping and a suturing task in two visual conditions: normal vision and laparoscopic vision. Results revealed that laparoscopic tools themselves do not appear to be problematic in performing minimal access surgery. Furthermore, performance ability in normal vision does not positively transfer to performance when switched to a laparoscopic vision condition. The 2-dimensional video does appear to be problematic for skill acquisition, as performance levels decreased as complexity of the task increased.

Canada↗
PubMed1971

Ergonomic evaluation of a redesigned surgical instrument.

Some problems have been encountered with the current design of the bayonet forceps, one of the more frequently used instruments of the neurosurgeon. By studying its function and operational use, a new design was conceived to make the instrument more amenable to the surgeon's hand, ie ergonomically suitable. This was tested in the laboratory and the operating room, and was found superior to the old one in comfort, stability-in-use, and ease of operation. This method of ergonomic redesign and evaluation can be used for other similar problems.

Journal Article↗
PubMed1992

Surgical instrument design for the accurate cutting of bone for implant fixation.

Oscillating saws and rotary drills are the most common instruments used in orthopaedic surgery for the cutting of bone and the drilling of holes through the cortex in preparing surfaces for implants to be placed on the bone ends. To obtain precision of placement of the surfaces and holes, various techniques have been developed to guide the instruments, such as holes, slots and flat surfaces. For sawing surfaces in total knee replacement a survey was conducted to assess the accuracy of cutting the distal end of the femur and the proximal end of the tibia with both slotted and surface guides used in some of the currently available prostheses instrument sets.

Clinical Competence↗
PubMed1997

Robotic surgical instruments for dexterity enhancement in thoracoscopic coronary artery bypass graft.

OBJECTIVES: Endoscopically sutured vascular anastomoses are complex, time consuming, and require great dexterity. We decided to evaluate performance enhancement using a robotic device to create sutured coronary artery bypass anastomoses with endoscopic techniques in a plastic model. METHODS: Seven coronary artery bypass anastomoses were endoscopically created in a plastic model using a robotic enhancement technology (Computer Motion, Goleta, CA). Anastomoses were created with a single running suture (7-0 monofilament). Our endpoints were operative time, intraoperative incidents, stability and dexterity of the robotic system, surgeon's fatigue, and anastomotic patency. RESULTS: Operative time was 46+/-12 min (mean+/-SD). There were no intraoperative incidents. Patency was confirmed in all anastomoses. The system's stability and dexterity were high. Surgeon's fatigue was mild. CONCLUSION: The use of robotic enhancement technology leads to an efficient performance of sutured coronary artery bypass anastomoses in a plastic model. The robotic device enhances dexterity, precision, and reduces surgeon's fatigue while preserving the quality of hand suturing.

Clinical Competence↗