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At least 451 records · Page 25Linked to original sources
PubMed2004

Total laparoscopically and robotically assisted aortic aneurysm surgery: a critical evaluation.

BACKGROUND: Laparoscopically assisted aortic aneurysm resection requiring a minilaparotomy can be performed as a routine procedure. It was the purpose of our study to evaluate whether a total laparoscopic operation can be offered to aneurysm patients as a minimally invasive alternative. We also wanted to test whether a master-slave robot could facilitate the total laparoscopic procedure. METHODS: A prospective, consecutive number of 50 patients was evaluated. A transperitoneal left retrocolic access was used to expose the aorta. If possible, a tube graft repair was performed. The aortic anastomosis was sutured totally laparoscopically, with the surgeon standing on the right side of the operating table. In 10 consecutive patients, the anastomosis was sutured with the help of the Zeus robot. RESULTS: After excluding 3 cases that required suprarenal cross-clamping, 47 patients were operated using a total laparoscopic approach. A totally laparoscopic operation could be performed successfully in 39 patients with aneurysms. In 8 patients (17%), conversion to a laparoscopic hand-assisted operation with a 7-cm minilaparotomy was required. The robot was used to perform the aortic anastomosis in 10 patients. In 8 patients, a tube graft repair could successfully be performed totally laparoscopically. In the remaining patients, a bifurcated graft was implanted laparoscopically. The mean operating time was 227 minutes in the laparoscopy group and was 242 minutes in those patients in whom the anastomosis was sutured with the help of the Zeus Robot. Mean cross-clamping time, +/- SD, was 81.4 + 31 minutes. None of the patients died perioperatively. Major complications occurred in three patients (6.3%). The overall morbidity was 14.8%, including one patient who required temporary hemodialysis postoperatively. The time to suture the aortic anastomosis was significantly shorter in the robotic-assistance group (40.8 +/- 4 minutes), yet total operating time was longer in this group because of the technical complexity of the robotic device. Patients with a total laparoscopic procedure asked for significantly fewer analgesics and could regain full mobility earlier compared with those patients for whom a minilaparotomy after conversion to the laparoscopic hand-assist procedure was required. CONCLUSIONS: Total laparoscopic aneurysm resection can be offered to the majority of patients in our institution. The robot still requires further refinements to reduce operating times and the aortic cross-clamping period. We now have the technique and the instrumentation to offer laparoscopic aneurysm surgery as a minimally invasive alternative for patients whose conditions are unsuitable for endovascular aneurysm repair.

Anastomosis, Surgical↗
PubMedDate not supplied

[The specific features of surgery of herniated intervertebral disks].

In 200 patients with posterolateral and foraminal hernias, the sizes of intervertebral foramens were studied by anatomic methods and on the operating table. There was evidence for the effectiveness of controlled decompression of neurovascular formations with the optimum foremen-root ratio of 1.5-1.8:8.1. Outcomes of different procedures of the operation were comparatively analyzed. Controlled decompression exhibited its advantage in reducing poor outcomes to 1.6%.

Adult↗
PubMed1990

[Miniaturized extracorporeal circulation for infants].

By using the smallest commercially available oxygenator and our own modification of an apparatus for extracorporeal circulation we achieved minimal filling. By placing the apparatus close to the operating table the set can be miniaturized and the length of the tubes can be maximally reduced, while a satisfactory overview is ensured. The authors compared a group of 10 children operated by using this miniature apparatus with a control group of 20 children where the standard set up was used. The filling of the apparatus incl. added solutions was significantly smaller in the group with the mini-apparatus--on average 420 ml, as compared with the control group (671 ml). Despite the substantially larger amount of transfused blood in the control group with the greater volume (500 ml/patient), the resulting packed cell volume was the same in both groups. The other common postoperative parameters did not differ significantly in the two groups. The minimal filling of the apparatus for extracorporeal circulation in the described set up makes possible in the majority of children and infants with an elevated packed cell volume perfusion without the use of donor blood which is consistent with contemporary trends.

Extracorporeal Circulation↗
PubMed2001

Serum levels of interleukin 6 and stress related substances indicate mental stress condition in patients with rheumatoid arthritis.

OBJECTIVE: To evaluate the influence of mental stress on the neuroendocrine-immune system in patients with rheumatoid arthritis (RA). METHODS: Twenty-two patients with RA and 8 patients with osteoarthritis (OA) who underwent total knee or hip arthroplasties under general anesthesia were enrolled in the study. The blood levels of interleukin 6 (IL-6) and other substances related to stress were measured just before administering anesthesia on the day of the operation when the patients lay on the operating table and roughly 30 min later when the patients were under general anesthesia without mental stress. These values were compared with those at the same time on the day before the operation, which were considered the control levels. RESULTS: In patients with RA, the levels of IL-6, cortisol, and epinephrine in the peripheral blood were significantly increased under mental stress, before anesthesia (p < 0.01). However, under general anesthesia, the IL-6, cortisol, and epinephrine were significantly decreased, compared with the levels before anesthesia (p < 0.01). Such changes were not apparent in patients with OA. The levels of other substances in the peripheral blood known to be related to stress, such as corticotropin-releasing factor, dopamine, and norepinephrine, showed no changes in patients with RA or OA. CONCLUSION: In patients with RA, excessive mental stress should be eliminated to modify the interaction between the stress-immune system and stress-endocrine system as a method to better control disease activity.

Aged↗
PubMedDate not supplied

Effect of general anesthesia on the abnormal immune response in patients with rheumatoid arthritis.

OBJECTIVE: To evaluate the influence of mental stress on the neuroendocrine-immune system in patients with rheumatoid arthritis (RA). METHODS: Twenty-four patients with RA and 10 patients with osteoarthritis (OA) who underwent total knee or hip arthroplasty under general anesthesia were enrolled in this study. The blood levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1Ra), tumor necrosis factor-alpha (TNF-alpha), soluble TNF receptors (TNF-Rs) and other substances related to stress were measured just before administering anesthesia on the day of the operation when the patients lay on the operating table and roughly 30 min later when the patients were under general anesthesia without mental stress. These values were compared with those at the same time on the day before the operation, which were considered as controls. RESULTS: In patients with RA under general anesthesia, the levels of IL-6, TNF-alpha, and TNF-R1 and TNF-R2 in the peripheral blood were significantly decreased compared with the levels before anesthesia (p < 0.01). Before anesthesia the levels of IL-1Ra in the peripheral blood were significantly higher, and the level of IL-1Ra was enhanced after the administration of general anesthesia, when compared with the level on the day before the operation (p < 0.01). Such changes were not apparent in patients with OA. CONCLUSION: In patients with RA, excessive mental stress should be eliminated to modify the interaction between the stress-immune system and stress-endocrine system as a method to better control disease activity.

Aged↗
PubMed1996

Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience.

A retrospective review of 115 patients treated surgically for displaced supracondylar humeral fractures was conducted. All patients had a minimum of 2 years' follow-up (range 2 to 7 years). According to a modified Gartland (19) classification system, 18.3% were type II (21/115), 77.4% were type III (89/115), and 4.3% (5/115) type IV supracondylar fractures. Twelve percent (14/115) of patients presented with neurapraxias, with the radial nerve being the most commonly affected. Sixty percent (69/115) of patients were treated with a crossed K-wire configuration, while another 30% (35/115) received two lateral pins as their internal fixation. The remaining 10% (11/115) of patients were treated with a variety of "other" pin configurations, including four lateral pins, three lateral pins, one lateral and one medial pin constructs. Eighty patients were treated in the lateral position with the C-arm horizontal, while 35 were treated supine using the C-arm base as the operating table. There were 23 complications noted, with 5 children with cubitus varus, 4 children with cubitus valgus, 3 pin-tract infections requiring antibiotic therapy, 3 failed closed reductions in the operating room that required formal open reduction and internal fixation, and 2 patients experiencing pin breakage. For a subgroup of 77 patients, satisfactory clinical and radiographic data were available for the purpose of evaluating these patients with Flynn's supracondylar rating scale as well as Baumann's angle (15). Eighty-three percent had good or excellent results, 14- had fair results, and 3% had poor results. At completion of bony healing 9 children fell outside the normal range for Baumann's angle established by Williamson et al. (45). Five children were noted to have cubitus varus (Baumann's angles ranging from 83 degrees to 90 degrees) and 4 children had significant cubitus valgus (Baumann's angles ranging from 60 degrees to 63 degrees).

Bone Nails↗
PubMed1998

Knowledge and fears of anaesthesia and surgery. The Jamaican perspective.

This study was undertaken to assess patients' knowledge and perceptions, fears and concerns regarding perioperative management. 300 patients were interviewed consecutively and a questionnaire was completed for each patient. 25% admitted to having anxiety about their upcoming operation. The prevalence of preoperative fear was significantly higher in younger patients (age < 40 years, p < 0.05) and in more educated patients (secondary and tertiary levels, p < 0.001). The commonest fears were those of a morbid nature (e.g. death on the operating table). 34% of the patients did not realize that anaesthetists were qualified doctors, and only 10% recognized the central role played by anaesthetists in the monitoring of vital signs throughout an operation. There is continuing need for public education on the role of the anaesthetists in health care, and anaesthetists must ensure that preoperative concerns of their patients are adequately addressed.

Adolescent↗
PubMed1978

[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)].

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.

Clot Retraction↗
PubMed1994

Instruments and equipment used in operative laparoscopy.

Successful operative laparoscopy is dependent on the proper use and knowledge of a variety of appropriate surgical equipment. This chapter describes cameras, light sources, videos, video positioning, operating tables, anaesthesia, insufflators, laparoscopes, trocars, irrigators, forceps, scissors, electrosurgical instruments, lasers, suturing, staples and uterine manipulators. Knowledge of the best choice and proper use of instruments has a more important role in performing operative laparoscopy than laparotomy.

Electrosurgery↗
PubMed2001

Intraoperative computed tomography with the mobile CT Tomoscan M during surgical treatment of orbital fractures.

Up to now it has only been possible to monitor the alignment of orbital floor fractures postoperatively with a computed tomography (CT) examination with coronal sectioning. If this showed an incorrect positioning, renewed surgery and anaesthetics were often required. The purpose of this study was the implementation and definition of the spectrum of indications for intraoperative CT examinations while keeping patient radiation exposure to a minimum. Thirty-two orbital fracture cases were examined pre- and intraoperatively using the mobile computer tomograph Tomoscan M in coronal sectioning. In this patient collective, 12 cases showed an isolated orbital floor fracture and twenty cases an orbital floor fracture associated with a zygomatic fracture. The technical prerequisite for these examinations was the construction of a suitable radiolucent operating table which permitted coronal sections to be made with the CT-Gantry tilted. The authors aimed to reduce radiation exposure by optimizing the technical setting parameters and closely defining the scan region for the operator. In three of 32 cases there were no surgical indications following clinical and preoperative CT examination. In three of the 20 cases with associated zygomatic fracture a closed reduction with a reduction hook was carried out, and no revision was necessary after the intraoperative CT examination. In 26 cases an open reduction was carried out. Of these open reduced fractures, four had to be revised after intraoperative CT monitoring; one of the isolated orbital floor fractures and three of those associated with a zygomatic fracture. Intraoperative CT monitoring of orbital floor fractures is considered a useful surgical aid. Its advantages are immediate monitoring of the surgical reduction, the presence of the surgeon during scanning enabling him to determine directly the relevant sections to scan, and the resulting radiation exposure.

Adult↗
PubMed1987

Submitral left ventricular aneurysms. Correction by a new transatrial approach.

Submitral left ventricular aneurysm is a widely recognized but relatively unknown entity that occurs almost exclusively in African patients and is often associated with mitral regurgitation. In the past 2 1/2 years, nine patients with submitral aneurysm were operated on by a new transatrial approach that exposes the neck of the aneurysm through an incision in the floor of the left atrium (roof of the aneurysm). There were four female and five male patients and the mean age was 28 +/- 3 years (range 23 to 35 years). All patients but one had significant mitral valve regurgitation and were in New York Heart Association Class III or IV. All operations were performed with standard cardiopulmonary bypass. At operation the neck of the aneurysm was invariably found beneath the posterior mitral valve anulus, at any site between the anterolateral and posteromedial commissures. The transverse diameter was variable, replacing up to two thirds of this portion of the annulus. In one patient the aneurysm perforated into the left atrial cavity. The neck of the aneurysm was closed directly in all patients and all mitral valves were preserved. Comprehensive valvuloplasty, including a Carpentier ring, was required in four patients. One patient died on the operating table of an uncontrolled diffuse pericardial hemorrhage. The remainder were discharged from the hospital and have good mitral valve function postoperatively. The transatrial approach to the repair of submitral left ventricular aneurysms results in a lower operative mortality and morbidity and almost invariably permits conservation of the mitral valve.

Adult↗
PubMed1976

Permanent atrial pacing. Epicardial approach - "pinch-on" electrodes.

Atrial pacing, while recognized to have therapeutic indications, has not been easily accomplished because there have been no simple and reliable electrodes available. A short parasternal mediastinotomy provides sufficient exposure for easy application of "pinch-on" electrodes to the presenting fold of the right atrium. Special attention is given to the recording of electrical indexes of the pulse generator and electrodes (voltage threshold, calculated impedance, and intrinsic amplitude of the P wave) with testing apparatus, most of which is conveniently brought to the operative table. Less than ideal results are not accepted, and immediate replacement of the electrodes into adjacent areas of the atrial myocardium is performed with ease. Five patients have tolerated the procedure without complication. These electrodes and this operative procedure have proved to have been successful over a six-month term of observation.

Aged↗
PubMed2000

Phacoemulsification in a patient with marked cervical kyphosis.

A patient with long-standing ankylosing spondylitis and chronic uveitis needed cataract extraction in his only eye. Extensive spinal deformities, including cervical kyphosis, prevented him from being positioned satisfactorily for surgery using a routine head-end or temporal position for the surgeon. The best possible position for surgery was achieved using an orthopedic operating table, which allowed the patient's head to be reclined to a position of 60 degrees to the horizontal. Successful combined phacoemulsification and trabeculectomy was then performed, although the angle of approach for the surgeon and the operating microscope was awkward.

Adult↗
PubMed2000

Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases.

BACKGROUND AND PURPOSE: Telemedicine is the use of telecommunication technology to deliver healthcare. Telementoring has been developed to allow a surgeon at a remote site to offer guidance and assistance to a less-experienced surgeon. We report on our experience during laparoscopic urologic procedures with mentoring between Rome, Italy, and Baltimore, USA. MATERIAL AND METHODS: Over a period of 3 months, two laparoscopic left spermatic vein ligations, one retroperitoneal renal biopsy, one laparoscopic nephrectomy, and one percutaneous access to the kidney were telementored. Transperitoneal laparoscopic cases were performed with the use of AESOP, a robotic for remote manipulation of the endoscopic camera. A second robot, PAKY, was used to perform radiologically guided needle orientation and insertion for percutaneous renal access. In addition to controlling the robotic devices, the system provided real-time video display for either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, and access to electrocautery for tissue cutting or hemostasis. RESULTS: All procedures were accomplished with an uneventful postoperative course. One technical failure occurred because the robotic device was not properly positioned on the operating table. The round-trip delay of image transmission was less than 1 second. CONCLUSION: International telementoring is a feasible technique that can enhance surgeon education and decrease the likelihood of complications attributable to inexperience with new operative techniques.

Baltimore↗
PubMed2002

Reduction mammaplasty with the "owl" incision and no undermining.

Reduction mammaplasty has traditionally been done using the Wise pattern of incision. Because of the box-like effect in breast shape, the lack of projection, and the long scars associated with the inverted T incision, two techniques have emerged as alternatives: the vertical reduction of Lassus/Lejour and the "round block" periareolar technique popularized by Benelli. Each of these techniques has its pros and cons. The "owl" incision combines the features of the large periareolar reduction (Benelli's) and the vertical reduction (Lassus/Lejour); the horizontal inframammary scar is either made very short or completely eliminated. Volume reduction is done through a heart-shaped parenchymal resection, leaving the nipple-areolar complex over a supero-central pedicle. Maintenance of the central parenchyma behind the nipple-areolar complex and mobilization of the vertical pillars toward the center of the breast give excellent projection and diminish the lateral fullness. Enlargement of the periareolar skin resection diminishes the length and pleating of the vertical scar; conversely, inclusion of the vertical component to the periareolar technique eliminates the pleating effect of the periareolar incision. The short horizontal excision eliminates any resultant "dog ears" in the new inframammary fold. Thus, the discrepancy in the length of scars is better distributed. There is no skin or parenchymal undermining, so drains are not needed. Excellent results are obtained immediately on the operating table, and large volumes of glandular resection and correction of severe ptosis can be accomplished without compromising vascularity of either the nipple-areolar complex or the skin flaps.Ninety-four patients in a 7-year period were operated upon using this technique. Seventy-two had bilateral reductions up to 1900 gm per breast, 12 had unilateral reduction for symmetry following breast reconstruction, and 10 were patients with severe ptosis. Complications were rare and of a minor nature. No conversion to free grafts was done, even in the larger resections. One case required minor revision under local anesthesia, one case required bilateral re-reduction, and another case required unilateral re-reduction for continued growth of breast tissue. Almost 90 percent of the patients underwent procedures as outpatients. The owl-type incision and the supero-central pedicle flap are elements of a reduction mammaplasty technique that provides excellent projection and shape with minimal visible scars. It takes advantage of the positive features of the periareolar and vertical reduction techniques and minimizes their negative features. The new design of parenchymal resection improves the vascularity of the residual flaps. Additionally, it may better preserve the sensation to the nipple-areolar complex and lactation is not compromised.

Breast↗
PubMed1999

[The overall and step-by-step duration of cesarean section].

The purpose of this study is to define the time for different steps of Caesarean section from the moment the women lays on the operating table to the last stitch on the skin. The study is prospective and include 82 elective and emergent CS. The traditional surgical technique is used without omitting any step. The mean stay of the women in the operating theater is 90 min. The preparation for the anesthesia/analgesia is 23 min (range 8-41). The proper time of the operation is 44.3 min. The laparotomy by Pannenstiel incision takes 3 min. The opening time of the uterus is 37 sec (10-190) and the closer on two layers is 17 min (10-35). The extraction of the foetus takes 53 sec (15-180). The exteriorization of the uterus doesn't affect the repair time. Leaving the visceral and parietal peritoneum unsutured can spare 5.5 min. The elective CS takes more time than the emergent one. The time from the beginning of the operation to the extraction of the foetus is longer in resection (7 min) than in first CS (5 min).

Anesthesia, Spinal↗
PubMedDate not supplied

[Possible causes of rise of the intraocular pressure after trabeculectomy and the ways of their correction].

Basing on the results of follow-up of 50 patients repeatedly operated on at the site of previous trabeculectomy, the authors recommend to stick to a certain order of surgical manipulations and stop the intervention when intraocular pressure is reduced to its normal level on the operative table. Such technique, together with the use of a viscous sponge to prevent coarse postoperative adhesions, helped achieve a stable hypotensive effect that was present for at least 2 years in the overwhelming majority of the patients operated on repeatedly.

Glaucoma↗
PubMedDate not supplied

[A new positioning board in the preparation for surgery].

The present paper describes a new aid for positioning the patient on the operating table. This aid is a hinged, radioparent board which is laid under the leg, buttocks, shoulder, or arm--folded flat--when positioning the patient. If necessary, the position of the extremities can be altered before or during the operation by varying the degree to which the flap is raised. The device is particularly suitable for surgery on the lower limbs, and has proved extremely useful in practice.

Humans↗