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At least 505 records · Page 28Linked to original sources
PubMed1987

[New operative technic for resecting cardiac cancers with dissection of the lower mediastinal lymph nodes through transabdominal phrenotomy using an improved hook suspender and an autosuture surgical stapling instrument].

To obtain a sufficient operative field at the operation for cardiac cancer, especially with esophageal infiltration, thoracotomy or sternotomy has been added to laparotomy. These procedures are not easy and cause great stress in patients. Through our new technique, left sided thoracotomy and sternotomy can be eliminated in favor of transabdominal phrenotomy, which is able to be performed much easier to obtain a good operative field. In order to perform the phrenotomy, the diaphragm has to be stretched using our modified hook suspender, by which the costal arch is lifted strongly upward and cranially. With these procedures, about a 5cm long esophagus is able to be resected with lymph node dissection in the lower mediastinum without difficulty. No marked influence of the hook suspender as well as the phrenotomy has been recognized on respiratory and circulatory systems. The anastomosis between the esophagus and jejunum or residual stomach seems to be very difficult, because the site of the anastomosis is located quite deep in the mediastinum. This problem, however, can be completely resolved by means of a surgical stapling autosuture instrument.

Cardia↗
PubMed1999

BrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases.

OBJECTIVE: The BrainLab VectorVision neuronavigation system was used in 131 cases of different brain pathological conditions. The neuronavigation system was used without problems in 125 cases. These cases included 114 microsurgical operations, 4 endoscopic procedures, 4 frameless stereotactic biopsies, and 3 catheter placements. METHODS: The BrainLab VectorVision neuronavigation system is an intraoperative, image-guided, frameless, localization system. The system consists of a computer workstation for registration of images and physical spaces, an intraoperative localization device, and a computer image display. The system provides real-time responses regarding the locations of surgical instruments. VectorVision is based on passive reflections of infrared flashes. Universal adapters with reflective markers for surgical instruments, endoscopes, and the operating microscope are used. RESULTS: In six cases, the system could not be used because of system failure or mishandling. In 125 neurosurgical cases, the neuronavigation system was useful, with a target-localizing accuracy of 4+/-1.4 mm (mean+/-standard deviation). For small cerebral lesions, we never performed an exploration with negative results. CONCLUSION: The BrainLab neuronavigation system has been shown to be very helpful and user-friendly for routine neurosurgical interventions. Its advantage lies in its mobility, based on wireless reflective adapters for surgical instruments, endoscopes, and the operating microscope.

Biopsy↗
PubMed2005

Lumbar spinal stenosis: indications for arthrodesis and spinal instrumentation.

Surgical indications for simple decompression in patients with lumbar spinal stenosis are well established. Following these guidelines, surgeons can expect good and excellent outcomes in 75% to 90% of patients. Despite the publication of many studies pertaining to the addition of arthrodesis and instrumentation, the indications for adding these procedures to a decompression are much less clear. Preoperative and intraoperative factors must be carefully considered when contemplating the addition of arthrodesis in the setting of spinal stenosis. In patients with preoperative degenerative spondylolisthesis, scoliosis, or kyphosis, and those in whom stenosis develops at a previously decompressed segment, serious consideration should be givenfor inclusion of an arthrodesis. Fusion should also be considered for those patients with stenosis adjacent to a previously fused lumbar segment. Excision of a significant portion of the facet joints or radical excision of the intervertebral disk during the course of the decompression predispose the patient to postoperative instability. The addition of an arthrodesis will likely benefit these patients. Relative indications for the use of spinal instrumentation in the setting of spinal stenosis include correction of deformity, recurrent spinal stenosis with instability, degenerative spondylolisthesis, adjacent segment stenosis with instability, and multiple level fusions.

Arthrodesis↗
PubMed1996

Force feedback for virtual reality based minimally invasive surgery simulator.

This paper presents ongoing research towards an endoscopic surgery simulation system. Our specific application of interest is laparoscopic surgery. The goal is to conceive an endoscopic surgical training tool which allows to realistically simulate the interactions between one or several surgical instruments and the gastrointestinal organs in a virtual reality based environment. An artificial patient is being developed into which endoscopic surgical instruments can be inserted to operate upon virtual organs displayed on a video monitor. In order to achieve a faithful and precise simulation, not only a realistic graphical representation of the organic tissue and its behavior is needed, but also the forces and moments on the surgical instruments encountered during an operation are required to be simulated. The laparoscopic surgery simulator must therefore provide force feedback through the endoscopic instruments manipulated by the surgeon. This paper details the mechanical design of the force feedback mechanisms and addresses some of the technical challenges of this project.

Computer Simulation↗
PubMed1975

A new instrument for surgical exposure of subaortic and subpulmonic stenosis.

An instrument for providing adequate visualization of the subvalvular area during repair of intracardiac defects is described. Essentially a type of modified nasal speculum, the instrument has proved helpful in performing resections in both subaortic and subpulmonic stenoses by exposing a wider surgical field.

Aortic Stenosis, Subvalvular↗
PubMedDate not supplied

Computer-assisted neurosurgery system: Wayne State University hardware and software configuration.

Computer-assisted neurosurgery uses the latest technological advancements in imaging, computers, mechanics, and electronics to improve the accuracy and reduce the invasiveness and risk of neurosurgical procedures. We describe the Wayne State University, Detroit, Michigan, computer-assisted neurosurgical system with the emphasis on software and discuss the theory guiding the development of this system and its application in real-time position tracking systems. Our system consists of the Neurological Surgery Planning System (NSPS) software which we developed at our medical center and three types of position tracking systems: the Zamorano-Dujovny (Z-D) are digitizer for frame-based procedures, an articulated arm, and an infrared-based digitizer for frameless procedures. The NSPS software is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions by preoperatively planning a surgical trajectory. Software consisting of the most advanced technologies in computer vision, computer imaging/graphics, and stereotactic numeric analysis forms the core of the system. Capabilities for correlating data from imaging studies to facilitate image reconstruction, image mapping, and three-dimensional (3D) visualization of target volumes enable the neurosurgeon to simulate surgical procedures into a preoperative protocol to be used during surgery, both to follow the preplanned trajectory and to track the position of surgical instruments in real-time on the computer monitor. The tracking systems position and orient the surgical instruments relative to the patient's head. With these devices, the display of the surgical instruments together with the virtual images create an excellent intraoperative tool.

Algorithms↗
PubMed1994

Preparation of instruments used in minimally invasive surgery in a washer-disinfector.

The safe sterilisation of surgical instruments presumes that one is dealing with small amounts of standardised residual contamination and in particular, that the cleaning process adheres to good manufacturing practices, taking into account the protection of the personnel. Only mechanical processes can be standardised and are suitable for the preparation of surgical instruments. The development process which the instruments used in minimally invasive surgery have undergone, along with improvements in the field of cleaning technology and disinfection, now means that preparation of instruments of this nature can be entrusted to an automatic washer/disinfector. New cleaning and disinfection methods allow the complete array of instruments, including fibreoptic light guides and lenses, to be cleaned and disinfected in one procedure.

Fiber Optic Technology↗
PubMed2004

Plasma cleaning of dental instruments.

The theoretical risk of prion transmission via surgical instruments is of current public and professional concern. These concerns are further heightened by reports of the strong surface affinity of the prion protein, and that the removal of organic material by conventional sterilization is often inadequate. Recent reports of contamination on sterilized endodontic files are of particular relevance given the close contact that these instruments may make with peripheral nerve tissue. In this paper, we report the effective use of a commercial gas plasma etcher in the cleaning of endodontic files. A representative sample of cleaned, sterilized, files was screened, using scanning electron microscopy and energy-dispersive X-ray analysis, to determine the level of contamination before plasma cleaning. The files were then exposed for a short-term to a low-pressure oxygen-argon plasma, before being re-examined. In all cases, the amount of organic material (in particular that which may have comprised protein) was reduced to a level below the detection limit of the instrument. This work suggests that plasma cleaning offers a safe and effective method for decontamination of dental instruments, thus reducing the risk of iatrogenic transmission of disease during dental procedures. Furthermore, whilst this study focuses on dental files, the findings indicate that the method may be readily extended to the decontamination of general surgical instruments.

Argon↗
PubMed2005

Technologic advances in Robotic Surgery.

Medical science has achieved enormous accomplishments during the past couple of decades. These advances encompass the list of techniques involving manipulations of DNA and stem cells to minimally invasive techniques. The recent advances in integration of computer sciences, biomechanics and electronic miniaturization have made it possible to make the surgical techniques less invasive and highly precise. Much progress has been made in integrating robotic technologies with surgical instrumentation, as evident by thousands of successful robot-assisted surgical procedures. Such advances will enable continued progress in surgical instrumentation and, ultimately, surgical care.

Humans↗
PubMed2004

Microtechnology applications for medical instrumentation.

The recent progresses in microtechnologies open new possibilities in terms of design, cost reductions, improve performances and, moreover, open new fields of applications in surgical instrumentation. Microtechnology techniques will lead to reconsider the design of medical instrumentation. Surgical tools should not be thought as mechanical systems but as surgical components ("surgical chips") designed with micro-technologies and including microsensors/microactuactors.

Biomedical Technology↗
PubMed1992

Effect of surgical manipulation of polytetrafluoroethylene grafts on microstructural properties and healing characteristics.

The effects on graft healing of alterations in the microstructure of polytetrafluoroethylene (PTFE) grafts induced by surgical instruments have not been fully elucidated. This study evaluates changes in the structural and physical properties of PTFE grafts resulting from the intentional application of commonly used surgical instruments and the influence of these changes on cellular ingrowth. The extent of cellular ingrowth into intact (10, 30, and 60 microns unreinforced and 30 microns reinforced [R]) and structurally compromised PTFE grafts (30 reinforced and 60 microns nonreinforced) implanted subcutaneously in Sprague-Dawley (n = 14) rats was evaluated at 7 and 21 days. The thrombogenicity of 10-, 30-, 60-, and 80-microns intact graft segments was determined gravimetrically after suspension in the internal jugular vein of dogs for 90 minutes. Cellular ingrowth consisting of fibroblasts, macrophages, and microvessels was directly related to porosity and was most extensive in 60-microns uncompromised graft segments, being 7-, 17-, and 20-fold greater than was observed in 60- and 30R-microns compromised grafts and undamaged 10-microns grafts, respectively. There was a direct relationship between porosity and thrombogenicity of intact graft segments suspended in the jugular vein. The amount of thrombus adherent to 80-microns graft segments was eightfold greater compared with 10-microns grafts. Manipulation of PTFE with surgical instruments significantly impairs healing and may be a possible etiologic factor in the poor long-term performance of these grafts.

Animals↗
PubMed1995

Computer-simulated eye surgery. A novel teaching method for residents and practitioners.

PURPOSE: To describe an eye surgery simulator that uses a computerized graphic display to allow ophthalmic surgeons of all experience levels to enhance their surgical skills. METHODS: The eye surgery simulation environment consists of a high-speed computer graphics workstation, a stereo operating system, a wrist rest, and a position tracking stylus connected to force feedback motors. The surgeon views computer-generated images of the eye and surgical instruments through the stereo operating system and controls the position and orientation of the chosen surgical instrument by moving the stylus. During the simulated instrument-tissue interactions, three feedback motors generate component force feedback along three orthogonal axes connected by thin rigid bars to the tip of the stylus. RESULTS: The current proof-of-concept system provides a method for rapid learning experiences in a living eye simulation. Procedures can be recorded for playback and analysis, as well as for examination of techniques from different viewpoints (e.g., from inside the eye). Four simulated surgical instruments are available for use (scalpel, forceps, scissors, and phacoemulsifier). CONCLUSION: Eye surgery simulation offers both beginning and experienced ophthalmic surgeons an opportunity to learn new techniques and skills and achieve a satisfactory level of proficiency before use of that procedure in the operating room. When fully developed, this system should shorten the learning curve for new surgeons (i.e., residents) and offer an opportunity for practice before doing a difficult case or development of new techniques by experienced surgeons. The goal of replacement of current standard training methods for surgeons awaits further refinement and adjustment of the model.

Computer Simulation↗
PubMed1999

Infectivity of scrapie prions bound to a stainless steel surface.

BACKGROUND: The transmissible agent of Creutzfeldt-Jakob disease (CJD) is not readily destroyed by conventional sterilization and transmissions by surgical instruments have been reported. Decontamination studies have been carried out thus far on solutions or suspensions of the agent and may not reflect the behavior of surface-bound infectivity. MATERIALS AND METHODS: As a model for contaminated surgical instruments, thin stainless-steel wire segments were exposed to scrapie agent, washed exhaustively with or without treatment with 10% formaldehyde, and implanted into the brains of indicator mice. Infectivity was estimated from the time elapsing to terminal disease. RESULTS: Stainless steel wire (0.15 x 5 mm) exposed to scrapie-infected mouse brain homogenate and washed extensively with PBS retained the equivalent of about 10(5) LD50 units per segment. Treatment with 10% formaldehyde for 1 hr reduced this value by only about 30-fold. CONCLUSIONS: The model system we have devised confirms the anecdotal reports that steel instruments can retain CJD infectivity even after formaldehyde treatment. It lends itself to a systematic study of the conditions required to effectively inactivate CJD, bovine spongiform encephalopathy, and scrapie agent adsorbed to stainless steel surfaces such as those of surgical instruments.

Animals↗
PubMed2004

Robotic technology in surgery: past, present, and future.

It has been nearly 20 years since the first appearance of robotics in the operating room. In that time, much progress has been made in integrating robotic technologies with surgical instrumentation, as evidenced by the many thousands of successful robot-assisted cases. However, to build on past success and to fully leverage the potential of surgical robotics in the future, it is essential to maximize a shared understanding and communication among surgeons, engineers, entrepreneurs, and healthcare administrators. This article provides an introduction to medical robotic technologies, develops a possible taxonomy, reviews the evolution of a surgical robot, and discusses future prospects for innovation. Robotic surgery has demonstrated some clear benefits. It remains to be seen where these benefits will outweigh the associated costs over the long term. In the future, surgical robots should be smaller, less expensive, easier to operate, and should seamlessly integrate emerging technologies from a number of different fields. Such advances will enable continued progress in surgical instrumentation and, ultimately, surgical care.

Equipment Design↗
PubMed1999

New software applications for interchangeable instrumentation in spinal stereotaxis.

Computer image-guided surgery has been widely accepted because it allows the surgeon to track an instrument through unvisualized critical structures of a patient in real-time, thus minimizing the risk of injury. Current spinal and cranial image-guided surgery is, however, limited by the lack of surgical instruments and software applications that would allow rapid interchange of useful instruments to perform the procedures. Most image-guided systems utilize a single standard probe or a few pre-defined instruments that are not necessarily useful for performing the actual surgical procedure. Present image-guided technology for screw placement in spinal surgery utilizes the standard probe only to confirm the entry point location and view the planned trajectory of the screw. The surgeon then resumes the procedure using standard surgical instruments to drill, tap and place screws without the benefit of image guidance. Our clinical laboratory experience with spinal image-guided surgery indicates that there is potential for error between each of these procedural steps of screw placement. Despite accurately locating an entry point, any deviation in the trajectory during drilling of a pilot hole, tapping or screw placement may result in significant errors in screw placement and potential neurovascular injury. We have developed custom software applications and universal hardware adaptation devices for spinal image-guided surgery that allow the use of standard instruments for intraoperative guidance. Utilizing universal dynamic registration hardware and software, standard surgical instruments are adapted for real-time image guided surgery. An array of light emitting diodes can be attached to essentially any rigid instrument with a definable tip and then calibrated to the system for intraoperative use. Laboratory tests using a cadaveric model indicate a difference in accuracy of less than 1.0 mm between the standard probe and a dynamically registered custom instrument and an absolute mean error of less than 2.0 mm for the image-guided system which is clinically insignificant in most cases. This technology is a significant step forward as it allows the surgeon to use a full array of instruments with image guidance and will ultimately make spinal and intracranial surgery safer and more accurate.

Bone Screws↗